International article
Impact of a school-based peer sexual health intervention on normative beliefs, risk perceptions, and sexual behavior of Zambian adolescents

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Abstract

Purpose

To determine whether adolescents' normative beliefs about abstinence and condoms, their personal risk perception, and safer sex practices changed after the implementation of a peer sexual health education intervention implemented in Zambian secondary schools.

Methods

The peer intervention was implemented during the first week of September 2000 in Lusaka, Zambia. A quasi-experimental, longitudinal panel design was used to evaluate its impact. Three schools were randomly assigned to the intervention condition and two to the control condition. Three rounds of data from male and female adolescents in grades 10 and 11 were collected at baseline in July 2000, at first follow-up in the second half of September 2000, and at second follow-up in early April 2001. A total of 416 respondents aged 14–23 (at baseline) were interviewed in all three survey rounds. A mixed-effects logistic regression growth curve analysis was used to calculate adjusted odds ratios to compare intervention and control groups on the outcome variables.

Results

Student self-reports showed positive changes in normative beliefs about abstinence immediately after the intervention, and these improvements were largely sustained until 6 months after the intervention. Students became more likely to approve of condom use and to intend using condoms immediately after the intervention, but these positive outcomes could not be sustained during the 6 months that followed the intervention. Normative beliefs regarding condom use took longer to develop: these were only observed at 6 months follow-up. Students reported reductions in multiple regular partnerships. There was no change in condom use.

Conclusions

A single session school-based peer sexual health intervention resulted in the development of normative beliefs about abstinence that were sustained over a 6-month period. Normative beliefs about condoms took longer to develop. More regular efforts may be required to sustain the approval of, and the intention to use, condoms. The intervention was successful in reducing multiple regular partnerships.

Section snippets

The Zambia peer sexual health intervention

The Zambia peer sexual health intervention was implemented by the Society for Family Health (SFH) to reduce risky sexual behavior and sexual transmission of HIV among adolescents. The intervention was designed after a needs assessment was conducted that included focus group interviews with adolescents [12] and a review of literature on Zambian adolescents 13, 14, 15, 16.

The intervention had a relatively narrow scope, focusing on promoting abstinence and condom use among male and female

Sample description

The sample used in the analysis contained only the 416 students who were interviewed at baseline and both follow-up assessments, 162 (39%) in the control group and 254 (61%) in the intervention condition. Table 1 shows that there were significant sociodemographic differences between students in the intervention and control groups. The control group consisted of a higher proportion of males than the intervention group, 72% vs. 46%. Students in the control group were significantly more likely

Discussion

Reviews of well-designed studies on the impact of school-based interventions (either teacher-led or peer-led) in developed countries have found several factors to be important in changing adolescent sexual behavior. Effective programs focus on a narrow range of behavioral goals, promote a particular set of social norms, provide accurate but concise information through active learning methods, address social pressures on behaviors, provide skill rehearsal opportunities, and are culturally

Acknowledgements

The authors are grateful to Nils Gade, Shannon England and Dominique Meekers for their comments on an earlier version of this report and to Rebecca Cramer for editing. This research was funded by Tulane University, USAID/Zambia, and by PSI through core support provided by the British Department for International Development (DFID).

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    Copyright © 2004 Society for Adolescent Medicine. Published by Elsevier Inc. All rights reserved.