Mixed methods study of SKILLZ to prevent Fetal Alcohol Spectrum Disorder and HIV among adolescents in South Africa

DETAILED SUMMARY

Importance

• South Africa’s Northern Cape Province has the highest reported rate of Fetal Alcohol Spectrum Disorder (FASD) in the world, along with high rates of HIV infection and unemployment. Adolescents are especially vulnerable to developing associated destructive behaviors.

Objective

• To evaluate whether SKILLZ Together mitigates FASD and HIV through educating adolescents on unsafe sexual behaviors, alcohol consumption, and peer pressure over a 9 week period in Kimberley, Richmond, and Colesburg, Northern Cape Province, South Africa.

Study details

• Study design: Mixed methods study (convergent parallel design)
• Data collection tools: Focus group discussions with participants (n = 5), Coaches (n = 2), and community members (n = 1); one key informant interview; routine attendance data (n=991); pre/post surveys with participants (n = 977)
• Participants: Adolescents aged 10-18 years (median age of pre/post surveys = 13 years)
• Implementation setting: Kimberley, Richmond, and Colesberg, Northern Cape Province, South Africa
• Study period: Not specified

Intervention

• SKILLZ Together: A 9-session soccer-based intervention addressing risks associated with unsafe sexual behaviors, alcohol consumption, and peer pressure.

Results

• Quantitative: 98.5% of participants attended ≥ 70% of the sessions and showed improvements in their knowledge, attitudes, and communication related to FASD and HIV
• Survey: 9 out of 14 survey questions show significant positive change covering communication, knowledge on FASD and HIV, self-efficacy to support pregnant women, delay in having a baby, and men’s role to prevent FASD (p values not specified)
• Qualitative findings: Participants demonstrated understanding of risks and consequences related to drinking; described increased communication, taking action, and planning; and reported avoiding negative peers and seeking support
• Coaches value their role as mentors, both in SKILLZ and the community
• Community health workers and teachers believe SKILLZ should also directly target pregnant women and parents

Conclusions and implications

• SKILLZ Together shows signals of improving participants’ knowledge, attitudes, and communication regarding alcohol consumption, FASD, and HIV prevention, potentially promoting risk-avoiding behaviors and positioning peer educators as positive role models in affected communities
• The program received strong community appreciation and support, underscoring the importance of engaging partners throughout development and implementation and addressing broader community attitudes to challenge harmful behaviors on multiple levels