Evaluation of the Five-Touch Model for Behaviour Change around SRHR among Adolescent Girls and Mothers

Summary:

Most SRHR programs for young girls in Pakistan are employed through the platform of the schools which deprives out-of-school girls access to credible SRHR knowledge and resources. Health workers operating in communities generally don't speak with adolescents as evidenced by the findings of the Demographic and Health Survey: 88% adolescent girls (15-19) were not exposed to any mass media SRHR messaging and 90% adolescent girls did not discuss SRHR with a health worker or at a health facility. Aahung developed a family counselling module aimed at improving communication between mothers and daughters on SRHR issues through Five-Touch sessions conducted by trained mid-level providers. For implementation, Aahung trained 79 mid-level providers (30 Community Health Workers (CHWs), 10 Community Health Supervisors (CHSs), 29 Lady Health Workers (LHWs), and 10 Lady Health Supervisors (LHSs). All 164 pairs (mothers and daughters) received exposure, over a seven-month period, through the Five-Touch sessions: 1) Youth SRHR issues, 2) Adolescence and Puberty, 3) Early-age and Child Marriages, 4) Gender and Priority, and 5) Communication. This approach was effective in raising awareness around sexual and reproductive health and education among adolescents as well as in mothers and the community.

Background/Objectives:

This study was aimed at developing and testing a module for counselling out-of-school girls through their mothers by emphasizing on the importance of effective communication in discussing SRHR issues, providing timely counselling, and building trust.

Description of Intervention and/or Methods/Design:

Aahung conducted a prospective cohort study, under the Sukh project, with a baseline and endline survey. We enrolled 164 mothers and daughters in pairs in Karachi i.e. 328 participants in total for the intervention. A baseline survey was conducted to assess pre-intervention knowledge and communication in September 2017. Endline survey was conducted in April 2018 based on the same quantitative questionnaire. The questionnaire consisted of the following thematic areas: understanding of young adolescents health issues including social, emotional, mental and physical changes during puberty, early-age marriages and consequences, and knowledge around maternal and child morbidity and mortality. Descriptive statistics were used to assess sociodemographic characteristics and chi-square test was used to compare the mean differences in construct scores.

Results/Lessons Learned:

Mean age of the girls was 16, and 58% of the respondents had not studied beyond the secondary level. Mean age of the mothers was 24 and 25% of them had not attained any formal education. 26% girls and 30% mothers had correct knowledge of physical and mental pubertal changes at baseline while 30% girls and 40% mothers had correct knowledge at endline. Similarly, 21% girls and mothers had correct knowledge of social changes at baseline while 42% mothers had correct knowledge at endline. Moreover, 82% girls felt more responsible and confident to discuss problems with mothers and felt independent enough to speak about sexual harassment and violence (from baseline at 48%). Similarly, mothers knowledge and practices improved, related to early girls marriage (Baseline 27% to 69% at Endline), and timely communication and information around SRHR of girls (Baseline 18% to 48% at Endline).

Discussion/Implications for the Field:

Based on the findings over this short duration, we believe that contextually designed and implemented community-based programmes would bring positive change in adolescents knowledge, attitude, and practices as well as their mothers. Thus, there is a need for both public and private efforts for mainstreaming such models along with life skills and basic SRHR education into syllabi, and should also be integrated into community health workers curriculum to improve their communication with adolescents as well.

Abstract submitted by:

Aisha Ijaz - Aahung
Junaid-ur-Rehman Siddiqui - Consultant to Aahung
Sana Tajuddin -  Aahung