'Eh! I felt I was sabotaged!': facilitators' understandings of success in a participatory HIV and IPV prevention intervention in urban South Africa

Andrew Gibbs, Samantha Willan, Nwabisa Jama-Shai, Laura Washington, Rachel Jewkes, Andrew Gibbs, Samantha Willan, Nwabisa Jama-Shai, Laura Washington, Rachel Jewkes

Abstract

Participatory approaches to behaviour change dominate HIV- and intimate partner violence prevention interventions. Research has identified multiple challenges in the delivery of these. In this article, we focus on how facilitators conceptualize successful facilitation and how these understandings may undermine dialogue and critical consciousness, through a case study of facilitators engaged in the delivery of Stepping Stones and Creating Futures and ten focus-group discussions held with facilitators. All facilitators continually emphasized the importance of discussion and active engagement by participants. However, other understandings of successful facilitation also emerged, including group management--particularly securing high levels of attendance; ensuring answers provided by participants were 'right'; being active facilitators; and achieving behaviour change. These in various ways potentially undermined dialogue and the emergence of critical thinking. We locate these different understandings of success as located in the wider context of conceptualizations of autonomy and structure; historical experiences of work and education; and the ongoing tension between the requirements of rigorous research and those of participatory interventions. We suggest a new approach to training and support for facilitators is required if participatory interventions are to be delivered at scale, as they must be.

© The Author 2015. Published by Oxford University Press.

References

    1. Campbell C,, Cornish F. Towards a ‘fourth generation’ of approaches to HIV/AIDS management: creating contexts for effective community mobilization. AIDS Care 2010; 22: 1569–79.
    1. Campbell C, Cornish F. Reimagining community health psychology: maps, journeys and new terrains. J Health Psychol 2014; 19: 3–15.
    1. Beeker C, Guenther-Grey C, Raj A. Community empowerment paradigm drift and the primary prevention of HIV/AIDS. Soc Sci Med 1998; 46: 831–42.
    1. de Wit John BF, Aggleton P,, Myers T. et al. The rapidly changing paradigm of HIV prevention: time to strengthen social and behavioural approaches. Health Educ Res 2011; 26: 381–92.
    1. Gibbs A, Jewkes R, Sikweyiya Y. et al. Reconstructing Masculinity? A qualitative evaluation of the Stepping Stones and Creating Futures intervention in urban informal settlements in South Africa. Cult Health Sex 2015; 17: 208–22.
    1. Barker G,, Ricardo C, Nascimento M. Engaging Men and Boys in Changing Gender-Based Inequity in Health: Evidence from Programme Interventions. Geneva: WHO, 2007.
    1. Campbell C, Jovchelovitch S. Health, community and development: towards a social psychology of participation. J Commun Appl Soc Psychol 2000; 10: 255–70.
    1. Freire P. Pedagogy of the Oppressed. New York: Continuum, 1973.
    1. Vaughan C. Dialogue, Critical Consciousness, and Praxis In: Hook D, Franks B, Bauer M. (eds). The Social Psychology of Communication. Basingstoke: Palgrave MacMillan, 2011, 46–66.
    1. Habermas J. The Structural Transformation of the Public Sphere: An Enquiry into a Category of Bourgeois Society. Cambridge: Polity Press, 1989.
    1. Vaughan C. “When the road is full of potholes, I wonder why they are bringing condoms?” Social spaces for understanding young Papua New Guineans' health-related knowledge and health-promoting action. AIDS Care 2010; 22: 1644–51.
    1. Walker SA, Avis. M. Common reasons why peer education fails. J Adolesc 1999; 22: 573–7.
    1. Campbell C. 2003. Letting Them Die: Why HIV Interventions Fail. Oxford: James Currey.
    1. Hatcher AM, de Wet J, Bonell CP. et al. Promoting critical consciousness and social mobilization in HIV/AIDS programmes: lessons and curricular tools from a South African intervention. Health Educ Res 2011; 26: 542–55.
    1. Campbell C, Nair Y, Maimane S. et al. “Dissemination as intervention”: building local HIV competence through the report back of research findings to a South African rural community. Antipode 2012; 44: 702–24.
    1. Campbell C, MacPhail C. Peer education, gender and the development of critical consciousness: participatory HIV prevention by South African youth. Soc Sci Med 2002; 55: 331–45.
    1. Biradavolu MR, Blankenship KM, George A. et al. Unintended consequences of community-based monitoring systems: lessons from an HIV prevention intervention for sex eorkers in South India. World Dev 2015; 67: 1–10.
    1. Morrell R, Epstein D,, Bhana R. et al. Towards Gender Equality. South African Schools during the HIV and AIDS Epidemic. Pietermaritzberg: University of Kwa-Zulu Natal Press, 2009.
    1. Aveling E-L. Mediating between international knowledge and local knowledge: the critical role of local field officers in an HIV prevention intervention. J Commun Appl Soc Psychol 2011; 21: 95–110.
    1. Cooper S, Dickinson D. Just jokes! Icebreakers, innuendo, teasing and talking: the role of humour in HIV/AIDS peer education among university students. Afr J AIDS Res 2013; 12: 229–38.
    1. Vaughan C. Participatory research with youth: idealising safe social spaces or building transformative links in difficult environments? J Health Psychol 2014; 19: 184–92.
    1. Gibbs A, Jewkes R, Mbatha N. et al. Jobs, food, taxis and journals: complexities of implementing Stepping Stones and Creating Futures in urban informal settlements in South Africa. Afr J AIDS Res 2014; 13: 161–7.
    1. Gibbs A, Campbell C, Akintola O. et al. Social contexts and building social capital for collective action: three case studies of volunteers in the context of HIV and AIDS in South Africa. J Commun Appl Soc Psychol 2015; 25: 110–22.
    1. Jewkes R,, Nduna M, Jama-Shai N. Stepping Stones South Africa: A Training Manual for Sexual and Reproductive Health Communication and Relationship Skills. Pretoria: MRC, 2010.
    1. Misselhorn A, Jama-Shai N, Mushinga M. et al. Creating Futures: supporting young people in building their livelihoods. Sex Educ 2014; 14: 543–55.
    1. Misselhorn A, Mushinga M, Jama-Shai N. et al. Creating Futures: lessons from the development of a livelihood strengthening curriculum for young people in eThekwini’s informal settlements. Sex Educ 2014; 14: 543–55.
    1. Jewkes R, Nduna M, Levin J. et al. Impact of Stepping Stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. Br Med J 2008; 337: 1–11.
    1. Jewkes R, Wood K, Duvury N. 'I woke up after I joined Stepping Stones': meanings of an HIV behavioural intervention in rural South African young people's lives. Health Educ Res 2010; 25: 1074–84.
    1. Jewkes R, Gibbs A, Jama-Shai N. et al. Stepping Stones and Creating Futures intervention: shortened interrupted time series evaluation of a behavioural and structural health promotion and violence prevention intervention for young people in informal settlements in Durban, South Africa. BMC Public Health 2014; 14: 1325.
    1. Attride-Stirling J. Thematic networks—an analytical tool for qualitative research. Qual Res 2001; 1: 385–405.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77–101.
    1. Pattman R, Chege F. ‘Dear diary I saw an angel, she looked like heaven on earth’: sex talk and sex education. Afr J AIDS Res 2003; 2: 103–12.
    1. Gibbs A, Campbell C, Nair Y. et al. Mismatches between youth aspirations and participatory HIV/AIDS programmes. Afr J AIDS Res 2010; 9: 153–63.
    1. Marks D, Murray M, Evans B. et al. (eds). Health Psychology: Theory, Research and Practice. London: Sage, 2005.
    1. Gibbs A, Willan S, Misselhorn A. et al. Combined structural interventions for gender equality and livelihood security: a critical review of the evidence from southern and eastern Africa and the implications for young people. J Int AIDS Soc 2012; 15: 17362
    1. Bourdieu P. The forms of capital In: Richardson J. (ed). Handbook of Theory and Research for the Sociology of Education,. New York: Greenwood Press, 1986, 241–58.
    1. Dewing S, Mathews C, Cloete A. et al. From research to practice: lay adherence counsellors’ fidelity to an evidence-based intervention for promoting adherence to antiretroviral treatment in the Western Cape, South Africa.”. AIDS Behav 2013; 17: 2935–45.
    1. Petersen I, Fairall L, Egbe CO. et al. Optimizing lay counsellor services for chronic care in South Africa: a qualitative systematic review. Patient Educ Counsel 2014; 95: 201–10.
    1. Wight D, Obasi AI. Unpacking the ‘black box’: the importance of process data to explain outcomes In: Stephenson J, Imrie J, Bonell CP. (eds). Effective Sexual Health Interventions: Issues in Experimental Evaluation. Oxford: Oxford Scholarship Online, 2003, 1–12.
    1. Meth P. Marginalised men's emotions: politics and place. Geoforum 2009; 40: 853–63.
    1. Cooke B, Kothari U. (eds). Participation: The New Tyranny? London: Zed Books, 2001

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