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The Straight Talk Campaign in Uganda:

Impact of Mass Media Initiatives

Full Report

Susan E. Adamchak 1 , Karusa Kiragu 2 , Cathy Watson 3 , Medard Muhwezi 4 , Tobey Nelson 5 , Ann Akia-Fiedler 4 , Richard Kibombo 6 , and Milka Juma 7

4 , Richard Kibombo 6 , and Milka Juma 7 1 Independent consultant 2 Horizons/PATH, Nairobi
4 , Richard Kibombo 6 , and Milka Juma 7 1 Independent consultant 2 Horizons/PATH, Nairobi
4 , Richard Kibombo 6 , and Milka Juma 7 1 Independent consultant 2 Horizons/PATH, Nairobi

1 Independent consultant

2 Horizons/PATH, Nairobi

3 Straight Talk Foundation Uganda

4 Formerly Straight Talk Foundation Uganda

5 Horizons/International Center for Research on Women, Washington DC

6 Makerere University, Uganda

7 Formerly Horizons, Nairobi

Acknowledgments

The principle investigators for this study were Karusa Kiragu (Horizons/PATH, Nairobi), Tobey Nelson (Horizons/International Center for Research on Women (ICRW), Washington DC), Ann McCauley (formerly with Horizons/ICRW, Washington DC), and Milka Juma (formerly with Horizons/Population Council, Nairobi). Data collection was supervised by Richard Kibombo, an independent statistician consultant at Makerere University. Scott Geibel (Horizons/Population Council, Nairobi) was the data analyst for the study. Alison Lee (consultant, Washington DC) copy-edited the report, and Sherry Hutchinson (Horizons/Population Council, Washington DC) oversaw the layout.

The research team would like to thank Straight Talk Foundation (STF) for their exceptional support including Cathy Watson (STF Director), Anne Akia Fiedler (formerly STF Programme Director), Medard Muhwezi (formerly Head, Monitoring and Evaluation Section, STF), and the entire Monitoring and Evaluation Section.

Special appreciation is extended to the adolescents and parents who answered the questions in this study.

This report was developed by Susan Adamchak, an independent consultant and adolescent specialist, with Karusa Kiragu and Cathy Watson. The authors are grateful to the United States Agency for International Development (USAIDUganda) and the Department for International Development (DFID) for funding this evaluation.

This publication was written by an independent consultant and produced by Horizons and Straight Talk Foundation. This document was reviewed by members of the research team but it did not receive an external technical review. The information, findings, and recommendations expressed herein do not necessarily represent the views of Horizons/Population Council. This document is one of four background documents to the final report, The Straight Talk Campaign in Uganda: Impact of Mass Media Initiatives,which can be accessed at www.popcouncil.org/pdfs/horizons/UgandaStraightTalk.pdf.

at www.popcouncil.org/pdfs/horizons/UgandaStraightTalk.pdf. Published in September 2007. This study and final report

Published in September 2007.

This study and final report were made possible by the President’s Emergency Plan for AIDS Relief and the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Cooperative Agreement No. HRN-A-00-97-00012-00. The contents do not necessarily reflect the views of USAID or the United States Government.

This study was also supported by a grant from the UK Department for International Development.

This document may be reproduced in whole or in part without permission of the Straight Talk Foundation provided full source citation is given and the reproduction is not for commercial purposes.

Table of Contents

Abbreviations

Executive Summary

1

Introduction and Background

5

Introduction

5

Background

5

Survey Overview

8

Goals and objectives

8

Definition of exposure to STF materials

8

Survey design and implementation

9

Sociodemographic Characteristics

12

Demographic characteristics

12

Schooling

13

Media utilization and intensity of exposure

15

Sources of Information on Reproductive Health

17

Sources of information

17

Exposure to Straight Talk Foundation products

24

What adolescents learned from Straight Talk Foundation products

27

Action taken due to exposure to Straight Talk Foundation products

28

Knowledge and Attitudes

29

Reproductive health knowledge

29

Reproductive health and HIV/AIDS attitudes

30

Gender attitudes

32

Self efficacy and self confidence

35

Health Seeking Behavior and STIs

38

Use of health facility services

38

Ever experienced an STI

40

Communication with Parents and Guardians

41

Comfort and confidence in speaking to parents

41

Topics discussed with parents

42

Reasons for not discussing ASRH with parents

43

Sexual Abuse and Defilement

45

Support if abuse attempted

45

Confidence in reporting abuse

46

Reproductive Behavior and HIV Risk Exposure

47

Sexual activity among adolescents

47

Transactional exchanges

49

Future plans with partner

50

Condom use

52

Reasons for never having had sex

55

HIV testing

57

Impact of Straight Talk Activities: Findings of Multivariate Analysis

58

Odds ratio of outcomes

58

Summary

62

Conclusions

64

Sources of information

64

Use of Straight Talk Foundation materials

65

Most important among sources of information

65

Straight Talk messages

66

ASRH knowledge

66

ASRH attitudes

66

Gender attitudes

67

Self efficacy and self confidence

67

Knowledge of STIs

67

Use of health facility services

67

Support if child sexual abuse attempted

68

Sexual activity among adolescents

68

Condom use at last sex

69

Reasons for never having sex

69

HIV testing

69

References

70

Appendices

71

Sample design

71

Variable definitions

73

Ugandan adolescents in context

75

2005 Straight Talk evaluation survey, Uganda

82

Abbreviations

ABC

Abstinence, Be faithful, Use condoms

AGI

Alan Guttmacher Institute

ASRH

Adolescent sexual and reproductive health

BCC

Behavior change communication

EA

Enumeration area

GYC

Gulu Youth Centre

HIV/AIDS

Human Immunodeficiency Syndrome/Acquired Immune Deficiency Disease

OVC

Orphans and vulnerable children

PT

Parent Talk

PMCT

Prevention of mother-to-child transmission (of HIV)

ST

Straight Talk

STD

Sexually transmitted diseases

STI

Sexually transmitted infection

STF

Straight Talk Foundation

UBOS

Uganda Bureau of Statistics

UDHS

Uganda Demographic and Health Survey

UNCST

Uganda National Council for Science and Technology

USAID

United States Agency for International Development

UHSBS

Uganda HIV/AIDS Sero-Behavioral Study

VCT

Voluntary counseling and testing

YT

Young Talk

Straight Talk: Full Report

Executive Summary

This report presents the findings of an evaluation of the Straight Talk Foundation’s (STF) mass media communication programs which have been implemented in Uganda since 1993. The programs largely comprise three synergistic materials: i) Straight Talk (ST) radio programs broadcast to various districts in English and 11 other Ugandan languages, aimed at in- and out-of-school youth; ii) ST newspapers in English and six other Ugandan languages, primarily aimed at secondary school students; and iii) an English language Young Talk (YT) newspaper primarily aimed at primary school students. STF also implements a complementary array of school-based activities to engender a supportive school environment. It has invested in many community activities such as health fairs, and has worked to support youth-friendly health care services.

The evaluation described here employed several strategies including a cross-sectional household survey of never-married adolescents, the main subject of this report. Other components included a household survey of parents, an assessment of the school environment, and a cost study. 1 Results from the adolescent household survey are based on interviews with 2,040 males and females between the ages of 10 and 19 years. It was conducted in six districts: Apac, Arua, Ntungamo, Soroti, Kisoro, and Kamuli. While STF has been active in all six districts, it has been particularly active in the first four, broadcasting local language radio programs and providing cross-fertilizing local language ST newspapers. Thus STF has more intensive ―conversations‖ with its audience in those districts. On the other hand, low intensity districts mostly received radio broadcasts and newspapers in English language. The study therefore assessed the impact of STF activities by level of intensity. Using multivariate methods, the study also conducted dose response analysis, i.e., impact of incremental exposure to STF activities on specific outcomes.

Data were gathered using face-to-face interviews after obtaining informed consent from the adolescent’s parent or guardian, and from the adolescent himself or herself. The study was powered at 80 percent with a confidence of 95 percent. Analysis employed bivariate and multivariate methods. Because the target audience for most STF activities is unmarried adolescents, the study excluded ever-married young people. And because the study’s ethical guidelines could not permit interviews with minors who did not have parental or guardian consent, such adolescents, including those from child-headed households, are excluded.

Description of the Sample

Of the 2,040 adolescents surveyed, half were male, and the mean age was 14.5 years. About a quarter of the sample was residing in urban areas, higher than the average urban Ugandan population of 15 percent (MOH and ORC Macro 2006). Approximately 80 percent were either Catholic or Protestant. Roughly 62 percent were living with both parents, and those that lived with only one parent were much more likely to live with their mother rather than their father. There were not large gender differences between adolescent males and females with regards to living arrangements. About 84 percent of respondents were currently in school, with slightly more boys (86 percent) than girls (81 percent) reporting school attendance. Most (80 percent) in-school adolescents in the study were in primary schools, indicating that many adolescents were rather old for their grade.

Use of STF Materials

To assess utilization of STF products, respondents were asked whether they had read, not merely seen, ST or YT newspaper, or whether they had listened to any ST radio program. The most commonly-used STF

1 These reports are available from http://www.straight-talk.or.ug/downloads/downloads.html

1

product was the radio program, which had been listened to by 55 percent of all

product was the radio program, which had been listened to by 55 percent of all adolescents, but by 76 percent of those in the high-intensity districts (i.e. those receiving local language broadcasts). In comparison, only 13 percent of respondents from low-intensity districts had listened to ST radio, demonstrating the importance of adding local language broadcasts. The second most utilized STF product was YT newspaper, which is aimed at primary schools and had been read by 49 percent of the study respondents, including 53 percent in high intensity and 35 percent in low-intensity districts. However, among those who had completed primary school and entered secondary school, 85 percent had read YT. The third most utilized STF product was ST newspaper, which had been read by 39 percent of the study sample including 45 percent of high-intensity and 25 percent of low-intensity district respondents. Among secondary school respondents, who are the main target of ST newspaper, 90 percent had read it. Seventy percent of respondents had been exposed to at least one of the three STF products, including virtually all secondary and two thirds of primary school students, as well as 56 percent of out-of-school youth. Exposure is fundamentally linked to STF’s use of local language materials—in the high-intensity districts where vernacular products were used, 84 percent of respondents had been exposed to STF materials, compared to 42 percent in districts without local languages.

STF materials were perceived as strongly supportive of abstinence, with 60 percent of exposed adolescents reporting that this was the main message they had obtained from them. When asked what they did as a result of exposure to STF products, 57 percent of boys and 64 percent of girls reported taking some action, most commonly ―continuing to abstain.

Parent-child Communication

The survey indicates that parents are the most important, and frequently the most preferred, source of information among young people. Mothers are by far the most preferred source of information among females (45 percent), followed distantly by teachers (11 percent). Fathers are the most important source among males (22 percent), followed by mothers (14 percent). However, youth question parental communication abilities, with less than 25 percent feeling ―very confident‖ that they can answer questions about sexuality. Nonetheless, nearly half of the respondents reported speaking to their parents about sexuality, growing up, or relationships between boys and girls and among these, virtually all believed the discussions were helpful. Multivariate analysis showed that exposure to STF materials was significantly associated with ever having talked with parents among both males and females. Males and females at the highest level of ST exposure were four times as likely to have talked to their parents about ASRH. This also means that for many adolescents, STF is contributing to efforts aimed at forging a stronger relationship between parents and their children

ASRH Knowledge

Greater exposure to STF materials is significantly associated with higher ASRH knowledge, and each incremental exposure is associated with increased knowledge; this relationship holds for both males and females. Adolescents at the highest level of exposure were 2.7 times more likely to have higher knowledge than those with no exposure, controlling for covariates. The STF products seem to have been particularly effective on the topic of STIs, with ST exposure associated with awareness of STIs. However, despite years of intense media coverage and community dialogue about HIV/AIDS in Uganda, there remains room for improvement in AIDS and reproductive health knowledge among young people. Many adolescents still believe that AIDS can be cured, many believe that a girl cannot become pregnant the first time she has sex, and fewer than half understand that pregnancy can occur if a girl is standing during sex. Four in ten youth do not believe condoms are effective against STIs.

2

Straight Talk: Full Report

Attitudes toward ASRH

Exposure to STF media activities generally is associated with a more balanced perspective on ASRH attitudes. For example, both male and female adolescents exposed to all three STF items are three times more likely to hold positive values toward condoms compared to those who had not been exposed. However, even those exposed to the most STF materials maintain some concerns: for example, half of those exposed to all three items still harbor misgivings that condom use is a sign of mistrust, and nearly 70 percent report feelings that girls who carry condoms are loose.

Attitudes Toward Gender

The data suggest that considerable work remains to create a more equitable gender perspective. For example, sizeable minorities of both boys and girls think boys should be favored if family resources are scarce, nearly half of the boys and a third of the girls believe men should have the final say about having sex, half of the respondents believe that women occasionally deserve to be beaten, and nearly 60 percent believe that women should tolerate abuse in order to keep the family together. Nevertheless, ST exposure is associated with favorable gender attitudes among females, but the pattern is not as clear among males. Females exposed to all three STF products were 1.7 times more likely to have favorable gender attitudes.

Self Efficacy and Self Confidence

The majority of young people feel happy the way they are, although a third lacks confidence in their position in the household and a third feel that their friends are ―better‖ than them. In addition, about a third doubt they have a bright future, particularly among those who are out of school or live in rural districts. Adolescents, particularly girls, who were exposed to two or three ST items, are significantly more likely to report higher self confidence than those who were not exposed to any item. Multivariate analysis shows that girls exposed to all three materials are twice as likely to have favorable views about themselves compared to their unexposed counterparts, but there is no difference among boys.

Use of Health Facility Services

Questions about health service utilization was restricted to the older adolescents (i.e., ages 1519 years). About 20 percent of these had visited a health facility for contraceptives, pregnancy tests, or voluntary counseling and testing for HIV/AIDS; most used public facilities. Those in urban areas and those with high exposure to STF products were more likely than their counterparts to visit a facility, probably due to the accessibility of services in urban areas and the emphasis by STF encouraging health-seeking behavior.

Support if Child Sexual Abuse Attempted

Most young people say they have someone to tell if they were pressured to have sex. Living in high media intensity districts and exposure to more STF materials is associated with higher proportions reporting someone to tell, indicating that messages about turning to a trusted adult, in most cases identified by the adolescents as a parent, are being heard and accepted. Girls seem to feel more confident that they can tell some about abuse, and those exposed to STF products were more confident than those not exposed. Fewer young boys report having someone to tell about abuse; they are also the group least likely to express confidence in telling someone about it.

3

Sexual Activity and Condom Use About a quarter of the respondents reported that they had

Sexual Activity and Condom Use

About a quarter of the respondents reported that they had a boyfriend or girlfriend, and 12 percent of the study sample had ever had sex (15 percent of males and 9 percent of females). Multivariate analysis shows a negative association between sexual activity and STF materials among males: those exposed to all three STF items are only 39 percent as likely to be sexually active compared to their unexposed counterparts. Among females, the pattern is not clear or statistically significant, in part due to the small percentage of sexually active girls and the sometimes involuntary nature of female sexual behavior19 percent of sexually active girls said their first sexual encounter was ―forced‖. This means that STF activities have contributed positively to significant proportions of males who are now not being exposed to heterosexual transmission of HIV.

About 56 percent of the sexually active boys and 70 percent of sexually active girls have had only one partner in their lives. Indeed, 38 percent of boys who have ever had sex and 41 percent of their female counterparts had not had sex in the 12 months preceding the survey, and are thus practicing secondary virginity. Multivariate analysis shows that exposure to ST is associated with secondary virginity among males: males at the highest level of exposure are three times as likely to report practicing secondary virginity compared to their unexposed counterparts. The pattern among females is not clear. Again, the association between STF activities and secondary abstinence means that STF is helping many males avert HIV by stopping sexual activity.

Just more than a quarter of the respondents plan to marry their current partner, with higher proportions of older youth, those in secondary school, and those out of school saying this. Males exposed to all three STF items are 20 times as likely as their unexposed counterparts to consider the current relationship ―serious‖, but there is no difference among females. Thus it is possible that these youth are adopting norms of fidelity promoted through STF as well as other sources in Uganda’s comprehensive HIV/AIDS prevention campaign.

Exposure to STF products is also associated with some increase in condom use, but the relationship is not statistically significant, largely due to the small sample size limiting statistical analysis. Half of the girls and 41 percent of boys report having used condoms at their last intercourse. While two-thirds of the boys report being responsible for using condoms, more than half the girls report taking the initiative to use them.

HIV Testing

Seven percent of the full sample, and 17 percent of the sexually active participants, had been tested for HIV. Urban and older youth were more likely to have been tested. Exposure to STF products was associated with having been tested, and with knowing whether a partner had been tested. Indeed multivariate analysis shows that respondents exposed to all three STF items examined were more than three times as likely to have been tested for HIV themselves.

4

Straight Talk: Full Report

Introduction and Background

Introduction

The Straight Talk (ST) program is perhaps one of the most successful ongoing media efforts to bring information about sexual and reproductive health to youth in Africa. The Straight Talk Foundation (STF) is widely recognized for grounding its programs in what young people want; it is careful not to call its efforts ―campaigns,but rather ―conversations‖ with adolescents. Consequently its activities are popular with young people. They are innovative, widespread in reach, and have endured over time. This report presents the findings of a program evaluation carried out in 20052006 to document the effect of STF activities on young people and parents in Uganda.

Background

Straight Talk Foundation (STF) is a Ugandan health communications NGO that began work in 1997, growing out of a Unicef-funded newspaper. The newspaper was called Straight Talk, and it was launched in October 1993. It appeared as a monthly insert in the main daily newspaper, The New Vision; extra copies were sent to secondary schools nationwide.

The first issues of Straight Talk attempted to communicate to several population groups: primarily older adolescents but also younger adolescents and parents. The aim was to influence adolescents to delay sex or practice safer sex if sexually active. The strategy was to talk directly to adolescents but also to help influential adults to talk to them about safe behavior.

A critical influence on Straight Talk was a 1993 WHO survey of 35 sex education programs

worldwide (Grunseit and Kippax 1993), which had drawn three key conclusions. Programs that succeeded in increasing the age of first sex were ones which urged youth to ―postpone‖ sex. ―Delay‖ was a more effective message than ―no sex.Effective programs concentrated not just on facts about HIV transmission and reproduction but also on skills such as decision making. Sex education did not cause adolescents to start sexual activity or be more sexually active.

to start sexual activity or be more sexually active. The first issues of Straight Talk received
to start sexual activity or be more sexually active. The first issues of Straight Talk received
to start sexual activity or be more sexually active. The first issues of Straight Talk received

The first issues of Straight Talk received input from a small group of doctors and counselors who gave credibility to the content. There was virtually no resistance to Straight Talk. This was the peak of the HIV epidemic in the country, and there were few messages for adolescents at the time. Uganda was open and seeking solutions.

Straight Talk was an immediate hit with older adolescents. Bright and deliberately non-frightening, it

found a niche that no one else was serving, and where the need was acute. By the end of its first year

in 1994, it was receiving over 400 letters a month, and local versions of Straight Talk were starting up

Kenya and Tanzania.

However, the original inclusion of parents could not be maintained. Almost no adults wrote in, and combining content for parents and youth in one paper was editorially difficult. By May 1994 Straight Talk had narrowed its focus to older adolescents. It had a print run of 95,000, of which 35,000 were inserted into The New Vision, 32,000 into Ugandan-language newspapers, 15,000 posted to the 600 secondary schools then existing and 13,000 distributed through NGOs.

5

For the next three years Straight Talk operated from a desk at The New Vision,

For the next three years Straight Talk operated from a desk at The New Vision, but began doing more than just newspaper work. Following requests from head teachers, Straight Talk assembled a team and began visiting secondary schools in 1996. By 1997 Straight Talk had become an NGO, the Straight Talk Foundation. It began creating expanded systems to reach more adolescents.

With Straight Talk, a relatively ―high-literacy‖ newspaper, STF was reaching only the 400,000 or so in-school, English-speaking, older adolescents aged 1519 years. Two much larger groups were getting no information:

years. Two much larger groups were getting no information: Younger adolescents aged 10 to 14 years,

Younger adolescents aged 10 to 14 years, about 700,000 of whom were in school; and Out-of-school adolescents who could not access Straight Talk, either because they could not find a copy, read English, or read at all.

To reach the younger in-school adolescents, STF started Young Talk in March 1998. Studies showed that about 25 percent of upper primary pupils had had some sexual experience. Young Talk stressed delaying sex, child rights, life skills, and staying in school. Primary schools numbered over 9,000 in 1997, so from the start distribution was Young Talk’s key challenge.

To reach out-of-school adolescents, STF began working in radio. The English Straight Talk Radio Show started in 1999. Ugandan language radio shows were added soon after: Luo (2000); Runyakitara (2001); Ateso (2002); Lugbara and Lumsamia (2003); Lumasaba, Luganda, and Lukhonzo (2004); Lusoga and Lupsabiny (2005); and Ngakarimojong (2006).

For the literate but non-English reading adolescents, STF began to produce newspapers in Ateso, Luo, Runyankole/Rukiga, Runyoro/Rutoro (the ―Four R’s‖), Luganda, and Lugbara. These were distributed at health fairs attended by local NGOs, local youth officials, and out-of-school youth.

With all of the above activity, STF was producing somethinga radio show or newspaperfor much of the adolescent population, both in- and out-of-school and in urban and rural areas. By 2004 it was also running sensitization workshops for thousands of primary school teachers a year and overseeing over 700 Straight Talk clubs in schools.

In addition it added newspapers not strictly addressed to adolescents or sexual health: Tree Talk, Teacher Talk, and Farm Talk in 2002; Kids Time in 2003 (addressing early childhood development); and Parent Talk in 2004.

As it grew, STF continually took stock of itself. About half of STF’s staff comes from journalism and mass communications backgrounds, and the NGO is the first organization in Uganda to carry out public sex education through the media. However, STF began to think of itself less as a media and increasingly as a behavior change organization.

As the HIV environment changed, STF sought innovative ways to reach young people and help them to ―re-script‖ their lives. Initially concerned about the lack of adolescent sexual and reproductive health (ASRH) information, it soon realized that information alone was not enough. It tried to address the environment around adolescents and also tackle non-biomedical topics like love, jealously, leisure, fun, and poverty.

STF attempted to be always tasteful and socio-culturally sensitive while staying forthright about sexuality. It thought of itself as engaging in dialogue with adolescents, not executing a campaign. It took pride in allowing its readers and listeners to drive the content, and hosted dozens of high school and university volunteers. It saw itself as a voice for adolescents and by the mid 2000s was

6

Straight Talk: Full Report

broadcasting over 7,000 interviews a year with adolescents. It also saw itself as an advocate for adolescents who are often stereotyped as reckless and stubborn.

Amid this growth, there were difficult questions to face about cost-effectiveness and focus. If STF was really committed to reaching the majority, why were newspapers in English its biggest core activity? STF was also worried about girls and the out-of-school youth: why were 90 percent of letters to local language radio shows from boys? Why, if local language radio shows were for those out-of- school, were 75 percent of the letters from in-school adolescents?

In 2004–5 the ―Abstinence, Be faithful, Use condoms‖ (ABC) controversy hit Uganda, causing two years of intense soul searching. For the first time, STF had to be self-conscious about what it was writing. There were hints from the government that illustrations of reproductive organs and frank talk about condoms were no longer welcome in the school newspaper Straight Talk. How much should it change its tone, STF asked itself? How much self-censorship should it exercise? Had it been over- promoting condoms at the expense of abstinence? Or was it vice versa?

At the root of all these questions was impact. After many years of implementation without a formal evaluation, STF wanted to assess its program. Were its activities changing the lives of adolescents? If so, in what ways? Which of STF’s products were being used and how? What messages were being recalled? Which adolescents were being reached? Which were not being reached? Did this vary between boys and girls? Did it vary by whether they were in urban or rural areas? Did it vary by whether they were in or out of school? STF had also started on a program to reach parents in order to encourage supportive parent-child interaction. Therefore STF wanted to know more about parents:

what were their views about STF materials? Did they know about them? Did they use them? Would they recommend them to their adolescent children? To answer these and other important questions, a comprehensive evaluation of STF activities was undertaken in 20052006. The evaluation comprised three components: 1) a community-based survey of never-married adolescents and a sub-sample of their parents; b) a survey of teachers and youth; and c) a cost analysis.

This report presents the findings of the community-based survey of adolescents. The survey was conducted in six districts in Uganda. Companion reports of the other evaluation components are available on request. 2 The second chapter of this report presents the methods used to implement the survey. Subsequent chapters are arranged thematically and report data from the main topics, including sources of ASRH information, knowledge and attitudes concerning reproductive health, HIV, gender and self efficacy, and communication with parents. Data are also presented on experiences of sexual abuse and reproductive behavior and risk of exposure to HIV/AIDS. Using key variables identified in the descriptive analysis, multivariate analyses were performed to better assess the impact of the STF program. The final chapters offer conclusions and recommendations for the future.

2 The companion reports can be obtained from http://www.straight-talk.or.ug/downloads/downloads.html

7

Survey Overview Goals and Objectives The community-based household survey was designed to answer several questions

Survey Overview

Goals and Objectives

The community-based household survey was designed to answer several questions related to ST campaigns, namely:

What proportion of youth is reached by each ST mass media, community, and school activity? Do adolescents who are exposed to STF materials have higher knowledge and more positive attitudes toward safe behaviors than those who are not exposed to these media activities? to answer several questions related to ST campaigns, namely: Do adolescents who are exposed to STF
knowledge and more positive attitudes toward safe behaviors than those who are not exposed to these

Do adolescents who are exposed to STF materials practice more safe behaviors than those who are not exposed?

Definition of Exposure to STF Materials

The main STF materials being assessed in this study are a) ST radio programs, b) ST newspapers, and c) YT newspaper. In order to assess the dose-response association between exposure to STF materials and the study outcomes, respondents have been classified into four groups: a) those not exposed to any item, b) those exposed to one item, c) those exposed to 2 items and d) those exposed to all 3 items. This is the definition that will be used in the multivariate analysis (see below).

A second measure of exposure will be media intensity at the district level (see Box 1 below). STF has been implementing its activities at varying levels of intensity in different districts, largely due funding shortfalls. As Box 1 shows, all districts receive the English STF and the English YT 3 newspaper. They also receive the weekly English STF youth radio show. In addition, four districts, Apac, Arua, Ntungamo, and Soroti receive weekly half hour radio shows in their local language . They also receive occasional local language versions of the ST newspaper. This varying response has provided a natural experiment whereby some districts have more activities than others. For the purpose of this study, districts receiving just the English newspapers and English radio show are characterized as ―low intensity‖. These are Kamuli and Kisoro districts.Those receiving the English papers, English radio shows, a local language radio show and the local language newspaper, are characterized as high intensity.

Box 1 Definition of district media intensity by exposure to STF materials

 

High intensity districts (Apac, Arua, Ntungamo, and Soroti)

Low intensity districts (Kamuli and Kisoro)

Radio

English Straight Talk program Local language Straight Talk program Young Talk (English) Straight Talk (English) Local language Straight Talk

English Straight Talk program None

Newspapers

Young Talk (English) Straight Talk (English) None

3 YT newspaper is only published in English language.

8

Survey Design and Implementation

Sample design 4

Straight Talk: Full Report

The community-based survey targeted 2,160 never-married adolescents ages 10 to 19 years in six districts: Apac, Arua, Ntungamo, Kamuli, Kisoro, and Soroti (see map in front matter). These districts were selected to provide a diverse geographic distribution of ST activities. The sample size was powered at the 80 percent level, with 95 percent confidence. This required 342 households per district, resulting in a total of 2,052 households in the survey. Each household was expected to yield one interview of an adolescent and half of them an interview with a parent. The sample was designed to accommodate refusals and not-at-homes by listing 20 percent more households per district for use when an interview was not possible.

In each participating district, two counties were selected for data collection, and within each county, two sub-counties were selected, and from them, two parishes were chosen. Thus a total of 12 counties,

24 sub-counties, and 48 parishes were included in the survey. The Uganda Bureau of Statistics

(UBOS) has divided each parish into an enumeration area (EA) which includes a list of all households. The STF survey used the same list recently compiled for a household survey of adolescents conducted by ORC/Macro and Alan Guttmacher Institute (AGI) (Neema et al. 2006).

Selection of respondents: The household listing process had generated a list of households in which it was known that at least one of the occupants would meet the eligibility criteria for the study, which was specifically to a) have never been married, b) to be between the ages of 10 and 19 years of age and c) to normally reside in the identified dwelling. In each household, as many as two eligible adolescents would be eligible for interviewing, as long as they were not of the same gender or age grouping. A random numbers table was used to select one to be interviewed if there was more than one eligible adolescent. In each household, efforts were made to interview at least one adolescent between the age of 10 and 14 years, or 15 and 19 years, resulting in a 50/50 age group split. Alternate households were to generate male and female adolescents, in order to achieve a 50/50 gender split.

Visiting adolescents were eligible if they spent the prior night at the household and if the consenting adult was their parent or guardian. Households headed by children under the age of 18 years were excluded, due to lack of adult consent. The study also excluded married adolescents, since STF’s main evaluation interest was the never-married. Interviews were completed with 2,133 adolescents;

93 questionnaires were subsequently deleted due to missing data on key variables, resulting in a

sample of 2,040.

Interviews were conducted by same-sex interviewers; i.e. male interviewers interviewed male respondents and female interviewers interviewed female respondents. In about a third of the households, interviews of both a parent and an adolescent were conducted, matched by sex when possible.

Ethical clearance and gatekeeper approvals

The questionnaires and consent forms were approved by the Uganda National Council for Science and Technology (UNCST). The study protocol had also been reviewed and approved through Horizons’ ethical review procedures. In each district, the study also sought the approval of district officials, community gatekeepers, and others as appropriate. Each respondent interviewed in the study provided

4 A full description of the sampling procedure is included in Appendix A.

9

written informed consent prior to commencement of the interview. Parental 5 consent was obtained for

written informed consent prior to commencement of the interview. Parental 5 consent was obtained for all interviews with adolescents, in addition to the adolescent himself/herself providing informed consent. The questionnaires and consent forms were stored separately in order to ensure no identifying information could be linked.

Study sites and populations

The survey was implemented in six districts: Apac, Arua, Ntungamo, Soroti, Kamuli, and Kisoro. The first four districts were chosen because they had received more STF products, including English radio and print materials, and local language radio and print materials. Kamuli and Kisoro were chosen as districts with less exposure to STF products (i.e. no local language materials).

Study tools and administration

The community-based household survey used face-to-face questionnaires: one for adolescents and one for parents (the adolescent questionnaire is found on Appendix IV). The adolescent questionnaire included a number of sensitive questions, but in-built skip patterns moved younger respondents past sections that were not appropriate for them. Each questionnaire took about 30 to 45 minutes to complete. The questionnaires were translated into six languages: Ateso, Luo, Lugbara, Lusoga, 4Rs, and Rufumbira. They were administered by interviewers fluent in the local language. The questionnaires were pre-tested and revised twice before data collection. They were also reviewed by the data entry team, in order to identify problems that could hamper data entry.

Interviewer training

Interviewers were trained over a four-day period, in August 2005. Sixty enumerators and 12 supervisors, including six STF monitoring and evaluation staff, were trained. Most of the enumerators were university students or graduates who had conducted interview research before, and many had worked with UBOS. Training topics included the research objectives, interviewing skills, household listing, respondent selection, call-backs, quality control, obtaining consent, and ethics in research. The interviewer training included a field practicum, after which the questionnaire was revised, finalized, and printed. In each district, the research team comprised about ten interviewers and a supervisor. Supervisors received training covering household listing, household selection, field work management, and other aspects to enhance quality control. Because a purpose of the evaluation was capacity building, STF staff from the Monitoring and Evaluation department was involved in all aspects of data collection and fieldwork supervision.

Data collection

The survey plan called for interviewing 2,880 respondents in 2,160 households. This comprises 1,080 adolescents ages 10 to 14 years, 1,080 adolescents ages 15 to 19 years, and 720 parents or guardians matched to an adolescent. The interviews included in-school and out-of-school youth. Interviews were evenly distributed across all districts, resulting in about 480 interviews per district. Data collection started on August 29, 2005 and ended on September 7, 2005. Each interviewer conducted at least four interviews per day and each field team covered two villages per day with a few callbacks for the

5 ―Parents‖ in this report includes guardians.

10

Straight Talk: Full Report

following day. There were no refusals; indeed field supervisors reported receiving requests from members of the community who had found out about the study, and wished to be interviewed.

Data processing and analysis

Once the data were collected, the supervisor reviewed the questionnaires and identified any problems needing correction. At the end of the day, the supervisor collated the questionnaires and entered them into a data collection registry. Each batch of questionnaires identified district, county, sub-county, and parish of origin. The consent forms were also collected, labeled, and stored in separate envelopes. The items were stored in a secure and locked box or room and prepared for shipping to Kampala for data entry.

Data entry at STF premises began as soon as data collection was over, using EPI-DATA software version 3.02. The questionnaires were keyed twice to minimize data entry errors. Technical support for the data entry process was provided by a Makerere University statistician with input from the Horizons data analyst. Data cleaning yielded a small number of unusable and out of range questionnaires, reducing the sample to 2,040 adolescents or 95 percent of initial target. Data were analyzed using SPSS v. 11 and STATA v 9.0 software.

Data analysis included univariate, bivariate, and multivariate methods, specifically logistic regression. In logistic regression, the measure of association is the odds ratio. The odds ratio compares how much more likely (or unlikely) an outcome is present among those with the exposure variable compared to those without (Hosmer and Lemeshow, 2000). The comparison group is usually assigned an odds ratio of 1.00. Statistically significant values above 1.00 indicate a positive association between exposure and the outcome, while a statistically significant value below 1.00 is indicative of a negative association. As discussed earlier, exposure to STF activities will be categorized as a) no exposure, b) exposed to 1 item, c) exposed to two items and 3) exposed to all 3 items. The comparison category will be those who have not been exposed to any STF materials (OR 1.00).

Limitations of the survey

Because the main subject for this study was unmarried adolescents, it excluded ever-married young people. So it does not provide information on the risk profiles of married adolescents, an important and vulnerable population of its own. A second limitation is representativeness of the sample at the district level. Because the survey did not purport to provide district estimates, no proportionate allocations were attempted. Therefore conclusions at the district level should be made with caution. A third study limitation was social desirability bias. Even though respondents were informed that the interview was confidential and anonymous, and each respondent was interviewed in private, it is possible that some of them gave socially desirable answers. The fourth limitation is exclusion of certain adolescents: due to ethical concerns, the study excluded adolescents who did not have a parent or guardian to provide informed consent. The final limitation derives from the fact that this was a cross-sectional survey. Therefore it cannot provide evidence of ―causality‖. Rather it provides evidence of associations between outcome and predictor variables. The reader is alerted to keep these limitations in mind.

11

Sociodemographic Characteristics Demographic Characteristics Table 1 presents the demographic characteristics of the 2,040

Sociodemographic Characteristics

Demographic Characteristics

Table 1 presents the demographic characteristics of the 2,040 adolescents in the survey. Half the sample is male, half is female, and there is a near equal split between age groups. The mean age is 14.5 years, with boys being slightly older than girls (14.7 vs. 14.4, p = 0.02; data not shown). About one quarter of the sample resides in urban areas, and the remaining three-fourths live in rural communities. About 80 percent are either Catholic or Protestant. The data suggest that the respondents practice their religion: when asked how many times they attend religious services in a month, 75 percent said they attended three or more times, 20 percent said 12 times a month, and only 5 percent said they never or rarely attended (data not shown). When asked ―how important religion is to you,‖ 81 percent said ―very important,‖ 18 percent said ―somewhat important,‖ and only 1 percent said ―not important at all‖ (data not shown).

Table 1 also shows that slightly less than two-thirds of the youth live with both parents, and those that live with only one parent were much more likely to live with their mother rather than their father. However, nearly 85 percent of adolescents live with at least one of their parents. About one in six young persons live with other relatives; this is slightly more the case for girls than boys. 6 There are not large gender differences between adolescent males and females with regards to living arrangements.

6 Appendix 3 presents comparative data on youth from the recent Uganda HIV/AIDS Sero-Behavioral Survey (200405) and other sources to establish a context for the findings of the current report.

12

Straight Talk: Full Report

Table 1 Sociodemographic characteristics of respondents

 

Male

Female

Total

 

Number

%

Number

%

Number

%

Age

   

1014

500

49.0

510

50.0

1,010

49.5

1519

521

51.0

509

50.0

1,030

50.1

Total

1,021

100.0

1,019

100.0

2,040

100.0

Residence

   

Urban

257

25.2

249

24.4

506

24.8

Rural

764

74.8

770

75.6

1,534

75.2

Total

1,021

100.0

1,019

100.0

2,040

100.0

Religion

   

Catholic

353

34.6

333

32.8

686

33.7

Protestant

455

44.6

506

49.8

961

47.2

Muslim

97

9.5

73

7.2

170

8.3

Saved/born again

101

9.9

97

9.5

198

9.7

None, other

14

1.4

7

0.7

21

1.0

Total

1,020

100.0

1,016

100.0

2,036

100.0

Living arrangements

   

Both parents

646

63.5

618

60.8

1,264

62.1

Father only

54

5.3

48

4.7

102

5.0

Mother only

176

17.6

171

16.8

347

17.1

Grandparents

50

4.9

58

5.7

108

5.3

Aunt, uncle

54

5.3

75

7.3

129

6.3

Sister, brother

25

2.5

36

3.6

61

3.0

Other^

12

1.2

11

1.1

23

1.1

Total

1,017

100.0

1,017

100.0

2,034

100.0

^Other includes boyfriend or girlfriend, brother, sister, cousin, other relative, friend, or alone. Figures exclude missing values, which comprised 0.3 percent of respondents.

Schooling

Table 2 shows the schooling experiences of adolescents in the study. About 84 percent of respondents are currently in school, with slightly more boys (86 percent) than girls (81 percent) reporting school attendance.

13

Table 2 School attendance by various characteristics   Male Female Total Number % Number %

Table 2 School attendance by various characteristics

 

Male

Female

Total

Number

%

Number

%

Number

%

Currently in school Yes No Never attended Total Current level of education Primary Post-primary Total Type of school Mixed sex Girls only Boys only Total Type of student Day student Boarder Total Highest education hope to achieve^ Primary Secondary Vocational school University/college Cannot tell Total Level at which stopped (among those dropped out) Primary Secondary Vocational Total

     

877

86.4

823

81.2

1,700

83.8

128

12.6

151

14.9

279

13.8

10

0.1

39

3.8

49

2.4

1,015

100.0

1,013

100.0

2,028

100.0

     

682

77.9

660

81.4

1,342

79.6

193

22.1

151

18.6

344

20.4

875

100.0

811

100.0

1,686

100.0

     

850

96.9

770

93.4

1,620

95.2

0

54

6.6

54

3.2

26

3.0

0

26

1.5

876

99.9

824

100.0

1,700

99.9

     

744

87.5

697

85.7

1,441

86.7

106

12.5

116

14.3

222

13.3

850

100.0

813

100.0

1,673

100.0

     

58

6.6

84

10.2

142

8.4

279

31.9

316

38.5

595

35.1

31

3.6

29

3.5

60

3.5

390

44.6

301

36.7

691

40.8

116

13.3

91

11.1

207

12.2

874

100.0

821

100.0

1,695

100.0

     

103

83.1

133

91.7

236

87.7

18

14.5

11

7.6

29

10.7

3

2.4

1

0.7

4

1.6

124

100.0

145

100.0

269

100.0

^Among those currently in school

Roughly 2 percent of the adolescents have never attended school, with girls slightly more likely than boys to have never attended. Most (80 percent) school-going adolescents in the study are in primary schools, indicating that many adolescents are rather old for their gradeprimary school attendance in Uganda begins at the age of seven years (when the child is enrolled in standard 1), and ends at the age of 13 years (when the student graduates from standard 7). The fact that nearly 80 percent of the study group is still in primary school suggests a late start to school coupled with considerable repetition within a grade. It also has implications for exposure to STF materials: although the adolescents in the

14

Straight Talk: Full Report

study are older and would probably benefit from ST newspapers, they are likely to get YT newspapers which are distributed in primary schools.

When asked what the highest level of education they thought they would achieve, 41 percent of the in-school respondents felt they would make it to college or university (see Table 2). However, a third felt that they would just make it to secondary school. While boys had greater ambitions for themselves than girls, the differences are not large, suggesting perhaps some element of realism among the respondents. When asked how confident they were they could achieve the desired academic goal they had stated, 54 percent felt very confident they could achieve it (51 percent among males and 58 percent among females; data not shown), 30 percent somewhat confident (35 percent among males and 24 percent among females) and 5 percent not confident at all (3 percent among males and 7 percent among females).

Those who dropped out of school (n = 269) were asked at what class they dropped, and the results are presented in Table 2. Nearly 88 percent dropped at primary school, including 83 percent of the boys and 92 percent of the girls. Figure 1 shows that the main reason was financial for both males and females. However a disproportionate percentage of females also dropped out because of ―work at home,‖ illness, lack of school supplies, or lack of interest. The percentages reported by males regarding these explanations were lower. On average, males dropped out of school at the age of 15.2 years and females at the age of 13.8 years (p = 0.000).

Figure 1 Reasons for dropping out of school^

80 67 70 60 50 40 33 30 17 20 12 12 11 8 7
80
67
70
60
50
40
33
30
17
20
12
12
11
8
7
6
6
7
4
5
10
0
0
Percent

Lack of

To work at

Illness

Lack of

Not

Not a good

Got

fees

home

supplies

interested

student

pregnant

 

Reason

Males (n = 124) Females (n = 145)

Males (n = 124)

Females (n = 145)Males (n = 124)

^Among the 289 school drop-outs

Media Utilization and Intensity of Exposure

Respondents were asked how often they listen to the radio and the answers are presented in Table 3. The data show that boys and girls have sharply different radio listener-ship patterns. Girls are three times more likely than boys to report that they do not listen to the radio at all (26 percent versus 8 percent). Boys are 50 percent more likely than girls to report listening to broadcasts daily. Table 3

15

also shows that two-thirds of the sample reside in districts classified as having high media

also shows that two-thirds of the sample reside in districts classified as having high media intensity in terms of STF products, specifically Apac, Arua, Ntungamo, and Soroti districts.

Table 3 Media utilization

 

Male

Female

Total

 

Number

%

Number

%

Number

%

Radio listening per week None 12 times 36 times Daily Total District media intensity High exposure Low exposure Total Number of STF items exposed to None One Two All three Total

     

76

7.5

253

25.6

329

16.5

186

18.4

205

20.7

391

19.6

293

29.0

229

23.2

522

26.2

449

44.5

302

30.5

751

37.6

1,004

100.0

989

100.0

1,993

100.0

     

675

66.1

680

66.7

1,355

66.4

346

33.9

339

33.3

685

33.6

1,021

100.0

1,019

100.0

2,040

100.0

     

257

25.2

364

35.7

621

30.4

222

21.7

227

22.3

449

22.0

230

22.5

180

17.7

410

20.1

312

30.6

248

24.3

560

27.5

1,012

100.0

1,019

100.0

2,040

100.0

As discussed in the Methods section of this report, respondents could have been exposed to three STF items: ST radio, ST newspaper and YT newspaper. Table 3 also shows that 30 percent of respondents had been exposed to zero items, 22 percent to one item, 20 percent to two items and 28 percent to three items. In subsequent tables, data are presented in relation to intensity of exposure as well as the number of items they are exposed to. In the last section of this report, multivariate analysis will further present relationship between specific outcomes and number of STF items one is exposed to, controlling for confounding variables.

16

Straight Talk: Full Report

Sources of Information on Reproductive Health

Sources of Information

Most important source of information

The survey participants were asked ―which one person‖ they considered to be their most important source of information on body changes, sexual and reproductive health, and relationships. This was a single response question; respondents could give only one answer. It was also unprompted; respondents had to state the person, and were not offered a list to choose from. The results show that mothers are by far the most important source for girls, with nearly half reporting this (see Table 4). Mothers are distantly followed by teachers as an information source for girls. In contrast, boys report fathers, teachers, and ―no one‖ as important sources in nearly equal proportions. The importance of mothers, in particular, and fathers to a somewhat lesser degree, highlights the value of parent-child communication efforts.

Table 4 Most important source of information on body changes, ASRH, and relationships

Respondent

n

Mother

Father Teacher Friend

Aunt

Health

No

Other^

characteristics

%

%

%

%

%

worker

one

%

 

%

%

Sex Male Female School status In school Primary Secondary Out of school Age group Males 1014 Females 1014 Males 1519 Females 1519 Current residence Urban Rural District media intensity High intensity Low intensity Exposure to STF materials Not exposed Exposed to 1 item Exposed to 2 items Exposed to 3 items All respondents

1,018

13.9

20.4

18.8

9.4

1.2

4.1

18.7

13.7

1,010

47.7

5.1

14.5

7.2

4.9

1.0

11.1

8.6

1,693

30.9

13.1

18.4

7.4

2.8

2.5

14.8

9.9

1,345

32.3

13.5

16.1

6.6

2.3

2.7

17.0

10.4

346

25.1

11.0

26.6

11.3

4.3

2.3

6.4

14.8

278

28.4

13.3

8.6

11.2

4.3

2.9

14.7

16.7

500

16.2

22.2

18.4

6.6

0.4

2.4

22.4

11.4

506

50.4

5.9

12.3

5.3

4.3

1.0

12.6

8.2

518

11.6

18.7

19.1

12.2

1.9

5.8

15.1

17.9

504

45.0

4.4

16.7

9.1

5.4

1.0

9.5

9.0

416

31.0

9.9

21.4

7.5

4.3

3.4

8.9

13.7

1,583

30.4

13.8

15.4

8.5

2.7

2.4

16.5

10.4

1,352

32.0

14.4

17.6

7.4

2.6

2.3

11.9

11.7

676

28.1

9.6

14.6

10.2

3.8

3.1

20.9

9.4

615

29.3

10.1

10.4

8.1

3.6

1.8

27.5

9.5

448

34.4

13.2

14.1

7.8

2.7

2.9

13.8

11.0

408

32.8

13.0

21.1

9.1

1.0

4.2

9.1

9.7

557

27.8

15.4

22.3

8.4

4.1

2.0

6.1

15.1

2,028

30.7

12.8

16.6

9.3

3.0

2.6

14.9

10.8

^Includes sister, brother, grandparent, uncle, other relative, peer educator, Straight Talk worker, religious leader, and self.

17

Reflecting changes in traditional society where aunts were the main sources of ASRH information for

Reflecting changes in traditional society where aunts were the main sources of ASRH information for adolescent females, only 5 percent of girls report aunts as their most important source. Teachers are considered an important source by a sizeable minority of young people. Higher proportions of young people mention teachers as important as exposure to STF materials increases. Presumably this reflects the distribution of ST newspapers and magazines in schools, and the discussions that they generate in the classroom. Clearly, key adults play important roles in ASRH education of young people. Health workers are reported by no more than 6 percent of youth as important sources, likely reflecting young people’s limited interface with health facilities and staff. An important difference that emerges is the high proportion of those not exposed to STF materials or programs reporting that they have no important source of information (27.5 percent). This proportion declines appreciably as exposure to STF materials and programs increases.

Preferred source of information

Respondents were asked who they preferred as their source of information. Once again, responses were unprompted. The data show that young people reported only minor differences from the pattern observed in the prior table, with mothers the preferred source for girls, and fathers the preferred source for boys (see Table 5). Expectedly, small declines were seen in the proportion reporting ―no one.

There was also a small decline in respondents citing teachers, mostly among older males. A smaller portion of the respondents prefers teachers as their exposure to STF materials and media increases, relative to the prior table. In most cases, the most important source is also the preferred source, implying that young people are seeking information from their preferred source by choice.

18

Straight Talk: Full Report

Table 5 Preferred source of information on body changes, ASRH, and relationships

Respondent

n

Mother

Father

Teacher

Friend

Aunt

Health

No

Other^

characteristics

%

%

%

%

%

worker

one

%

 

%

%

Sex Male Female School status In school Primary Secondary Out of school

1,011

14.2

21.5

14.7

8.4

1.3

5.1

10.1

24.8

996

45.3

5.4

11.3

8.2

7.4

2.2

4.4

15.6

1,672

30.1

14.7

14.5

7.1

4.1

3.7

7.1

20.0

1,329

31.5

14.7

14.3

6.2

3.9

3.3

8.1

19.5

241

25.5

13.8

14.7

10.3

5.0

5.0

3.5

22.3

274

25.5

8.1

6.2

13.1

3.6

3.6

1.1

28.5

Age group

Males 1014

497

16.7

23.3

16.5

5.0

1.2

3.8

12.7

25.2

Females 1014

496

46.8

6.3

11.5

5.8

7.5

1.4

4.2

10.2

Males 1519

514

11.9

19.6

13.0

11.7

1.4

6.4

7.6

33.9

Females 1519

500

43.8

4.6

11.2

10.6

7.4

3.0

4.6

15.8

Residence Urban Rural District media intensity High intensity Low intensity Exposure to STF materials Not exposed Exposed to 1 item Exposed to 2 items Exposed to 3 items All respondents

409

28.4

13.9

17.8

7.1

5.6

3.2

5.9

18.1

1,571

30.0

13.6

11.4

8.7

3.8

3.9

7.6

20.6

1,349

32.1

14.2

13.3

7.5

3.0

4.0

5.5

20.4

658

24.6

12.2

12.5

10.1

7.0

3.0

10.9

19.9

605

27.1

10.7

10.7

9.3

6.1

2.1

14.5

19.3

443

34.8

13.5

13.1

7.2

3.2

4.3

5.4

18.6

402

31.8

16.4

14.4

7.7

2.5

4.0

4.5

18.4

557

26.8

14.4

14.5

8.6

4.7

4.7

2.9

23.3

2,007

29.6

13.5

13.1

8.3

4.3

3.7

7.3

20.0

^Includes sister, brother, grandparent, uncle, other relative, peer educator, Straight Talk worker, religious leader, and self.

Newspaper and magazine sources

All respondents were asked which newspapers or magazines were their most important source of adolescent reproductive health information and the data are presented in Table 6. This was an unprompted single response question. The data show that 21 percent and 24 percent of respondents considered YT or ST newspapers to be their most important sources, respectively, although 43 percent said ―none.‖ When examined by gender, boys were more likely than girls to say YT or ST newspapers are their most important source. When examined by schooling status, ST newspaper appeared to be particularly significant to secondary school students, with 66 percent mentioning it as their most important print source. When examined by urban-rural residence, respondents in urban areas were more likely to consider YT or ST newspapers to be their most important print sources.

19

Table 6 Most important newspaper or magazine source of information on body changes, ASRH, and

Table 6 Most important newspaper or magazine source of information on body changes, ASRH, and relationships

Respondent characteristics

n

Young

Straight

Others

Don‘t know

None

 

Talk

Talk

%

name

%

%

%

%

Sex Male Female School status In school Primary Secondary Out of school

Age group Males 1014 Females 1014 Males 1519 Females 1519 Residence Urban Rural District media intensity High intensity Low intensity Exposure to STF materials Not exposed Exposed to 1 item Exposed to 2 items Exposed to 3 items All respondents

1,013

23.0

26.8

7.0

8.9

34.4

1,010

19.0

20.7

3.8

4.8

51.8

1,687

23.4

24.4

5.2

7.2

39.8

1,337

24.6

13.6

4.5

8.8

48.5

347

18.2

66.0

8.4

1.4

6.9

278

10.4

22.7

7.2

4.7

55.0

494

25.1

11.9

6.3

12.8

43.9

504

17.9

10.7

2.6

6.5

62.3

519

21.0

40.8

7.7

5.2

25.2

506

20.2

30.6

4.9

3.0

41.3

409

24.9

35.0

8.7

5.3

26.1

1,571

20.0

20.9

4.6

7.2

47.3

1,342

22.1

29.6

6.1

7.1

35.1

681

18.8

12.2

4.0

6.3

58.7

614

0.0

0.0

2.6

9.3

88.1

444

18.7

4.5

8.3

11.0

57.4

408

45.3

32.4

5.6

3.9

12.7

557

28.2

58.9

5.9

2.9

4.1

2,023

21.0

23.7

5.4

6.8

43.1

For the 43 percent of the adolescents who said that noneof the newspapers were their most important source of information, this could mean that they do not have access to newspapers and if they do, they do not consider them an important source. The proportion who did not specify a newspaper declined considerably by intensity of exposure to STF materials: while 88 percent of those who were not exposed to any STF materials said that no newspaper was their most important source, this dropped to 4 percent among those exposed to all three STF materials. Thus respondents who received STF publications considered them an important source of information.

Radio sources

Adolescents were also asked what was their ―most important source of ASRH information in terms of radio programs.‖ This was also a single-response unprompted question and the results are presented in Table 7. The data show that 37 percent of adolescents specifically mention ST radio program as their most important source, with boys (43 percent) more likely to do so than girls (31 percent). Older males are by far more likely to mention ST radio compared to other age groups.

20

Straight Talk: Full Report

Table 7 Most important radio source of information on body changes, ASRH, and relationships

Respondent characteristics

n

Straight Talk

Other radio

Does not know name of show

No radio

 

radio

show

show

%

%

%

%

Sex Male Female School status In school Primary Secondary Out of school

1,016

42.6

9.0

24.0

24.4

1,014

30.7

8.3

22.4

38.7

1,692

37.6

8.7

24.1

29.6

1,342

31.6

7.5

26.8

34.1

348

60.9

13.5

13.8

11.8

277

35.0

9.4

20.6

35.0

Age group

Males 1014

496

31.3

7.3

28.2

33.3

Females 1014

506

26.9

6.5

23.9

42.7

Males 1519

520

53.5

10.6

20.0

16.0

Females 1519

506

34.4

10.0

20.9

34.6

Residence Urban Rural District media intensity High intensity Low intensity Exposure to STF materials Not exposed Exposed to 1 item Exposed to 2 items Exposed to 3 items All respondents

504

42.7

10.6

23.6

23.1

1,526

35.2

8.1

23.1

33.5

1,347

52.8

7.9

21.5

17.9

683

4.8

10.1

26.6

58.4

615

0.0

4.9

25.5

69.6

446

35.2

11.0

28.3

25.6

409

44.0

11.5

25.7

18.8

560

72.7

8.8

14.8

3.8

2,030

36.7

8.6

23.2

31.5

In addition, much larger proportions of secondary school students report ST radio as important compared with primary students or those not currently in school. This may reflect both differences in access to a radio itself, as well as free time to listen to regular programming.

Finally, the content of the radio programs may appeal more to the older adolescents, particularly boys. There is not much variation in those reporting another radio show as important, or in those not knowing the name of show, with the exception of secondary students who were more likely to recall the ―Straight Talk‖ name. Not surprisingly, identifying ST as an important radio source is strongly associated with increased exposure to STF materials and products.

About a third of adolescents said that ―no radio program‖ in particular was the most important source of ASRH, implying that these adolescents do not consider radio as their most important source of information on ASRH. Females are more likely to report this than males, as are out-of-school youth when compared to in-school. Nearly six of ten respondents in the low-intensity districts said that ―no radio show‖ was an important source, compared to only 18 percent of their counterparts in high intensity districts.

21

Most important among all sources of information Respondents were then asked to assess all three

Most important among all sources of information

Respondents were then asked to assess all three sources of information: ―Of the three sources you have mentioned above, that is person, newspaper, and radio, which one is the most important overall? Is it the person, newspaper, or radio program?‖ The results are presented in Table 8 and show that on aggregate, adolescents prefer person (39 percent), followed by radio (29 percent), then newspaper (19 percent). However, there are large differences by sex. In particular, girls of all ages favor a person far more than males (48 percent vs. 29 percent). Males cite persons, print media, and radio in nearly equal shares, ranging from just under a quarter to a third.

When examined by school status, primary students and those out of school prefer a person, followed by radio and then newspapers and magazines. However, secondary schools students prefer newspapers and magazines, followed by radio and then person. This may be a reflection of literacy constraints, with primary and out-of-school youth at lower reading levels than their secondary school counterparts. About one in eight primary students and out-of-school youth are also likely to report not knowing any important source of ASRH information.

Older males exceed all others in their appreciation of media sources, both print and radio. Among the youth living in low-intensity districts, a greater reliance on individuals, or lack of any source, is reported. For those not exposed to STF products, newspaper and magazines are not important at all, and there is a heavy reliance on personal contact. Radio appears to be very important by level of exposure and relative to other sources, possibly because of its accessibility in local languages.

Primary place to seek information about growing up

Adolescents were also asked, ―If you needed information about growing up, relationships, and sexual matters, which one place would you go to for information?‖ The data show that school is by far the most commonly cited place to obtain information, across all characteristics, mentioned by 40 percent of respondents (ranging from a third to half; see Table 9). This is followed by health facility (13 percent), respondent’s house (13 percent), and church (6 percent). Not surprisingly, the exception to this pattern is out of school respondents, among whom only 15 percent mention school, with 19 percent seeking information at a health facility or in their homes. These findings appear to endorse schools as an important and salient location for ASRH education.

22

Straight Talk: Full Report

Table 8 Most important source of information on body changes, ASRH, and relationships

Respondent characteristics

n

Person

Newspaper

Radio

Don‘t

All are

 

%

or magazine

%

know

important

 

%

%

%

Sex Male Female School status In school Primary Secondary Out of school

998

29.4

23.4

33.2

12.8

1.2

1,000

48.4

14.8

24.9

10.3

1.6

1,676

39.5

20.1

28.5

10.6

1.3

1,327

42.3

16.0

27.4

13.0

1.4

347

28.0

36.9

33.1

1.2

0.8

266

34.6

15.0

36.1

12.4

1.9

Age group

Males 1014 Females 1014 Males 1519 Females 1519 Residence Urban Rural District media intensity High intensity Low intensity Exposure to STF materials Not exposed Exposed to 1 item Exposed to 2 items Exposed to 3 items All respondents

487

32.4

19.3

28.1

18.9

1.2

504

49.4

11.5

23.2

14.5

1.4

511

26.4

27.4

38.0

7.0

1.2

496

47.4

18.1

26.6

6.0

1.8

504

39.4

25.4

28.3

6.0

1.0

1,494

38.5

17.5

29.4

13.1

1.5

1,341

34.1

21.6

37.1

5.9

1.3

657

48.7

14.0

12.5

23.1

1.7

587

53.8

1.5

11.2

32.4

1.0

446

38.3

14.6

40.1

5.6

1.3

407

36.1

27.8

32.2

2.2

1.7

558

25.6

34.9

36.6

1.3

1.6

1,998

38.9

19.1

29.0

11.6

1.4

Some differences are apparent by exposure to any ST media versus none. Generally those with higher exposure are more likely to name formal institutions such as schools or health centers as primary places to seek information, and are less likely to rank their own home or someone else’s home as important. The fact that boys are more likely than girls to name health facilities as important places to obtain information may reflect that boys have more freedom to circulate in their communities, and may be more familiar with these local resources. In contrast, a higher percentage of girls report their own homes as an important place to seek information. Higher exposure to ST media is also associated with less likelihood of youth saying they don’t know any source.

Despite ongoing efforts to engage religious communities and faith-based organizations in the provision of ASRH information, only a small proportion of respondents name churches as important places in this process (6 percent); the sole exception, though still not large, is among out-of-school youth (11 percent).

About one in five young people say they do not know where they would go to seek this type of information. Females are more likely to say so than males (24 percent vs. 19 percent). When assessed by schooling status, out-of-school youth are more likely to say ―don’t know‖ compared to their in- school counterparts (25 percent vs. 20 percent), as are rural compared to urban youth (23 percent vs. 15 percent).

23

Table 9 Primary place to seek information about growing up Respondent n School Health My

Table 9 Primary place to seek information about growing up

Respondent

n

School

Health

My

Church

Don‘t

Other^

characteristics

%

facility

house

%

know

%

 

%

%

%

Sex

Male

1,013

43.1

16.1

7.9

6.0

19.3

7.5

Female

1,012

37.5

10.7

17.4

5.0

23.9

5.5

School status In school Primary Secondary Out of school Age group Males 1014 Females 1014 Males 1519 Females 1519 Residence Urban Rural District media intensity High intensity Low intensity Exposure to STF materials Not exposed Exposed to 1 item Exposed to 2 items Exposed to 3 items

1,682

45.5

12.3

11.8

4.6

20.2

5.6

1,332

45.8

9.2

13.0

4.9

22.1

5.0