Goals 4 Girls study: A Participatory Dissemination Workshop

The Desmond Tutu Health Foundation (DTHF) and Grassroot Soccer hosted a virtual workshop to jointly disseminate and discuss key findings of the Goals for Girls (G4G) research study. The G4G study evaluated the impact, feasibility, and acceptability of a sport-based, integrated health-promotion intervention, called SKILLZ, seeking to improve sexual and reproductive health outcomes amongst secondary school female learners in South Africa.

Attendees of the workshop included teachers and learners involved in the study, as well as researchers, representatives from the provincial departments of education and health, and academics. The program included a presentation of key findings, comments from a Western Cape Provincial Department of Education representative, and in-depth, small group discussions of the study’s key insights and learnings.

The dissemination workshop engaged a range of stakeholders to actively interpret and discuss research findings, both presenting results to those involved in the study, and drawing on their expertise to further discuss challenges in addressing SRH outcomes for adolescent girls.

Funded by ViiV Healthcare’s Positive Action for Adolescents program, the G4G study was designed to complement the South African national, in-school “Keeping Girls in School” and Life Orientation curricula and strengthen the sexual and reproductive health content taught to girls in school. For this program, the DTHF partnered with Grassroot Soccer, who provided an adapted version of its SKILLZ Girl curriculum, training model for near-peer mentor Coaches, and shared expertise on working with adolescents.

The delivery mechanism for this intervention was a crucial factor, with two options considered and tested:

1. In-school, classroom-based, teacher- or peer-facilitated sessions that focused purely on sexual and reproductive health; and
2. After-school, sport-based, coach-facilitated sessions that included in-depth discussions of gender and power relations.

What We Learned

During the workshop, the presentations of the study looked at how impact was measured, how attendance among learners was encouraged, and how the SKILLZ program impacted risk behaviours, STI rates, HIV, and pregnancy. Socio-behavioral findings were also discussed, including attitudes towards gender norms, perceptions of sexual agency, and bodily integrity.

At baseline, the prevalence of STIs was high and increased during the study in both the control and intervention arms. However, the study revealed that participants who attended seven or more sessions and graduated from the program showed moderately lower levels of STIs and improved self-reported measures of positive gender norms than those in the control arm.

The SKILLZ intervention was found to be highly acceptable amongst the learners and schools during focus group discussions, in-depth interventions, and post-intervention surveys. However, uptake and attendance at the program varied widely across schools, which was found to be largely attributable to differences in school-specific socio-ecological settings.

The study also found an unplanned impact of the intervention: the impact for the Coaches themselves, who facilitated SKILLZ sessions with learners. Qualitative data revealed a number of insights about Coaches’ personal motivations and experience, including the seriousness with which they took their roles, their investment in their relationships with the girls, and their consequent personal and professional development.

The dissemination workshop included an opportunity for all attendees to interpret and discuss the study’s findings in smaller breakout groups, specifically interrogating areas of ambiguity and unanswered questions. Breakout groups were mixed and included government representatives, teachers, and learners, to ensure that a range of perspectives were present in each discussion.

These group discussions led to a number of salient takeaways and recommendations for future interventions:

• Participants agreed that pregnancy was a significant problem facing young learners in South Africa, especially if they faced socio-economic pressures. An emphasis was placed on the need for more thorough support for future learners — both in terms of nurses within schools and trustworthy youth-friendly health services. Sport-based programs were highlighted as an effective way of engaging learners in this space.
• Regarding the high levels of STIs found in the study, workshop attendees emphasized the need for providing health services in schools, including parents and partners in the discussion, and creating similar programs for boys and young men. Peer-supported work — for example, led by younger facilitators — was highlighted as a kind of “opposite” to peer pressure and an effective way to deliver sexual and reproductive health information to young people. A point of debate was how STI results could best be delivered in schools and whether condoms should be made accessible, reflecting the need for further engagement on these issues.
• Discussions revealed that the topic of female empowerment was considered complex. It was pointed out that while we can teach girls these concepts in the program, they might not be as empowered at home and in their relationships. As such, planning programs that account for the socio-ecological context at hand is crucial — a young women’s environment, relationships, and communities need to all be considered. Interventions beyond the individual level — engaging parents, boys, and partners — were highlighted as crucial to success in this space.
• Safety was identified as a significant barrier to attendance at after-school programs, while conversely the provision of food was highlighted as an important facilitator. Rewards for good attendance were also suggested, as well as the possibility of incorporating such programming into school/Life Orientation classes.
• There was broad agreement that challenges exist with both in-school and after-school program delivery models, and that the success of programming was different for each school. In terms of after-school programming, safety and transport were identified as major barriers, while buy-in from teachers and school administrators was said to be crucial for in-school implementation.
• There was strong consensus around the importance of integrating health and education perspectives into the program. Schools were identified as critical places for young people to receive health information, including sexual health content. Health services specifically stood out for learners as one of the program’s biggest benefits. Providing a safe space for health education and services was seen positively as a means of allowing young people to learn about and practice how to use these services as they transition into managing their own health care as adults.