University of the West Indies Open Campus Methods of Social Research Student - Candice Lela- Rolingson

Problem Statement

The effects of the film Positive and Pregnant on youth between 14-17 years old; attending secondary school in east (Valencia Secondary School Trinidad and Tobago.

hotos all rights reserved! "alencia Secondary School# $here forty students vie$ed the film ositive and regnant.

Candice Lela- Rolingson

hotos! "alencia Secondary School# $here forty students vie$ed the film ositive and regnant.

Candice Lela- Rolingson

&

Table of Contents
'a(le of Contents.............................................................................................................................) *c+no$ledgments ..........................................................................................................................., Chapter %..........................................................................................................................................Introduction .....................................................................................................................................*cronyms ......................................................................................................................................... Scope .............................................................................................................................................../ Conte0tual Report..........................................................................................................................%1 Chapter &........................................................................................................................................%& Literature Revie$ ..........................................................................................................................%& Chapter )........................................................................................................................................)2 Methodology .................................................................................................................................)2 Chapter , .......................................................................................................................................)3 4indings .........................................................................................................................................)3 5iscussion .....................................................................................................................................-2 'hemes ..........................................................................................................................................-. ........................................................................................................................................................-3 Chapter -........................................................................................................................................2% Conclusion.....................................................................................................................................2% In comparison to the Lit revie$.....................................................................................................2% 'he Study of -6o$ successful is the incorporation of popular culture in 6I" prevention in 'rinidad and 'o(ago7 85r. *ndrea 'hompson &1%19. :Many participants had previously seen or heard 6I" messages $hich used popular culture. 'hese previous messages $ere deemed to (e successful and had changed +no$ledge and attitudes and $ere $idely availa(le especially on local television. 'he use of popular culture has the potential to reduce the pro(lem of ne$ 6I" infection rates in ';'.< 8=uffield Centre for International 6ealth and 5evelopment Leeds Institute of 6ealth Sciences 4aculty of Medicine and 6ealth. 'itle of Research ro>ect! 6o$ successful is the incorporation of popular culture in 6I" prevention in 'rinidad and 'o(ago7 85r. *ndrea 'hompson &1%19 ......................................................................................................2% Changes in ?ehavior .....................................................................................................................2) Recommendations .........................................................................................................................2, *ppendi0........................................................................................................................................2@uestionnaires............................................................................................................................2Candice Lela- Rolingson )

articipant Info Sheet.................................................................................................................2Letter to the rincipal.................................................................................................................2Letter from UWI........................................................................................................................2-

Acknowledgments
I $ould li+e to than+ Mr. Winston ?aldeosingh for his patience and support throughout the research process. 'han+s to Mr. Aevin Cummings# 'eacher and 5ean of 5iscipline for his ongoing support and for facilitating the mediation process $ith Mrs. Michelle Carter- the rincipal of "alencia Secondary School. 'han+s all the students $ho partoo+ in the e0ercise and the li(rary staff $ho assisted in managing the facilities during# the data collection process. IBd finally li+e to than+ my family for their indeli(le support.

Candice Lela- Rolingson

Chapter 1

Introduction
'he o(>ective of this study is to glean empirical evidence on cause# effect and the influence of (ehavior change using the film ositive and regnant. 'his study is relevant and timely since# the current rate of 6I" infection among ne$ (orn children glo(ally is very high# as $ell there is a need to increase a$areness among youth# of the millennium goal of eradicating of mother to child transmission of 6I"C*I5S 8DM'C'9 (y the year &1%-.

E OSI'I"D ; RDF=*='B is a t$enty four minute video 5ocudrama# $hich $ill assist in the revention of Mother to Child 'ransmission 8 M'C'9 of 6I" C *I5S. It also (rings a$areness to its vie$ers on the treatment process for 6I" positive e0pectant mothers.

Candice Lela- Rolingson

'he all local cast features (urgeoning and e0perienced actors. Geanine Lee Aim as Lead actress# 5uane 5ario )5 5i0on# =aomi *(iola# auline Mar+# Lylah ersad and 6I" positive Lorna 6enry as herself. 'he D0ecutive roducer for the piece is Dm(assy of the United States of *merica and residents Dmergency lan 4or

*I5S Relief 8 D 4*R9. 'he 5ocudrama $as produced (y Candice Lela H Rolingson and 4ilm 5irector (y Stacy Lela $ith the patronage of 'he Wal+er Lela 4oundation. 'he screenplay $as $ritten (y =yron Rolingson# video production $as done (y 4ORCD4D5 roductions.

'he Wal+er Lela 4oundation for WomenBs Dmpo$erment is a =on- rofit OrganiIation $ith a mission to empo$er $omen# girls and children (y providing support services# case management# (asic s+ills education# and resource coordination# to improve and enhance the Juality of life for $omen# girls and children in 'rinidad and 'o(ago and overseas. 'he o(>ective of the organiIation is
Candice Lela- Rolingson 2

to empo$er $omen and children in deprived situations due to poverty# homelessness# teenage pregnancy# mental illness# incarceration# (y providing reha(ilitation# education# employment opportunities# health advice# se0ual (ehavior a$areness and outreach programs and other support services.

lease visit $$$.positiveandpregnant.$ee(ly.com facts a(out regnant and 6istory of the film and more information.

ositive and

Acronyms
*I5S! *cJuired Immune 5eficiency Syndrome *=C *ntenatal Clinic *R'! *nti Retroviral 'herapy
Candice Lela- Rolingson .

C*RDC! Cari((ean Dpidemiology Centre D ! D0posure- rone rocedure

DM'C'! Dradication of Mother to child transmission of 6I"C*I5S 6I"! 6uman Immunodeficiency "irus MC6! Maternal and Child 6ealth MIS! Management Information System MO6! Ministry of 6ealth MSM! Men $ho have Se0 $ith Men *6O! an *merican 6ealth Organisation I'C! rovider Initiated 'esting and Counselling M'C' revention of Mother to Child 'ransmission L6I"! eople Living With 6I" M'C'! revention of Mother to Child 'ransmission 8of 6I"9 "C'! "oluntary Counselling and 'esting. W6O! World 6ealth Organisation *?C! *(stinence# ?eing faithful# Condoms C?M ! Cari((ean ?roadcast Media artnership for 6I"C*I5S =*CC! =ational *I5S Coordinating Committee S*! u(lic Service *nnouncement SI! opulation Services International
Candice Lela- Rolingson 3

; - ositive and regnant ';'! 'rinidad and 'o(ago U''! University of 'rinidad and 'o(ago

Scope
Problem Statement

'he effects of the film ositive and regnant on youth (et$een %,-%. years oldK attending secondary school in east 8"alencia Secondary School9 'rinidad and 'o(ago.
Candice Lela- Rolingson /

Hypothesis - Variables

6 % - Loo+ing at the film ositive ; regnant positively affects 6I" a$areness. =ull - Loo+ing at the film ositive ; regnant does not affect 6I" a$areness.

Defining Changes in Behavior

It is the hypothesis of the researcher that film can be used as a medium to educate youths, by means of advocating for the awareness of the Prevention of Mother to Child transmission of HIV, by way of intervention; looking at the film can cause immediate changes in response to stigma and discrimination, the film causes positive changes in attitude and behavior in the short term, by educating youths about HIV !esting", the importance of family planning and prophylactics; which will ultimately cause a lasting effect on behavior # !he film will assist young persons in making better decisions in the short term future about se$ual behavior#

Contextual Report
Definition of Prevention of Mother to Child Transmission of HIV (PMTCT)

'he transmission of 6I" from an 6I"-positive mother to her child during pregnancy# la(our# delivery or (reastfeeding is called mother-to-child transmission. In the a(sence of any interventions transmission rates range from %--,-L M 'his
Candice Lela- Rolingson %1

rate can (e reduced to levels (elo$ -L $ith effective interventions. 'he glo(al community has committed itself to accelerate progress for the prevention of mother-to-child 6I" transmission 8 M'C'9 through an initiative $ith the goal to eliminate ne$ paediatric 6I" infections (y &1%- and improve maternal# ne$(orn and child survival and health in the conte0t of 6I".

Conte$t 'he first cases of *cJuired Immune 5eficiency Syndrome 8*I5S9# all males# $ere reported in %/3). Over the years the spread of the 6uman Immunodeficiency "irus 86I"9# the aetiologic agent# has (een such that *I5S is one of the leading causes of mor(idity and mortality in the young adult population in the Cari((ean.

'he increasing prevalence of the virus among $omen of child(earing age# and the reality of (a(ies (eing (orn infected $ith 6I" are a cause of concern to the Ministry of 6ealth. ConseJuently# the aggressive introduction of primary prevention strategies aimed at preventing $omen from (eing infected (y 6I" are of paramount importance. Other complementary strategies include the counselling of 6I" positive $omen so that they can ma+e informed choices a(out their future se0ual and reproductive life.

Candice Lela- Rolingson

%%

'he

revention of Mother to Child 'ransmission 8 M'C'9

rogramme $as

initiated in 'rinidad and 'o(ago in %///# (ased on evidence# $hich sho$ed that transmission of 6I" from an infected mother to her child could (e reduced (y (et$een -%L-23L# $ith the introduction of anti- retroviral therapy during pregnancy. *dded to this $as the afforda(ility of *N'. It $as also sho$n that avoidance of (reastfeeding resulted in a further reduction in the transmission of 6I" from mother to child (y %1-&1L.

Over the last five years 'rinidad and 'o(ago has seen a decrease in the num(er of (a(ies (orn to 6I" positive $omen each year. 'he 6I" positive mothers and the e0posed (a(ies are follo$ed (y the M'C' programme and $ith the assistance of the M'C' coordinators the status of the infants is reported to the Ministry of 6ealth 8'rinidad and 'o(ago - Ministry of 6ealth M'C' olicy &1%19

Chapter 2

iterature Re!iew
PMTCT Policy Trinidad and Tobago

Candice Lela- Rolingson

%&

'he first cases of 6I"C*I5S $ere reported in 'rinidad and 'o(ago in %/3). In %/3-# the first cases in $omen and children $ere recorded. 'he ma>ority of 6I" infected females fall $ithin the age group &--&/# $hile some apprecia(le proportion are in the %--%/ age group. Of concern are the increasing prevalence of the virus among $omen of child(earing age# and the reality of (a(ies (orn infected $ith 6I". revious sero-prevalence surveys conducted among pregnant $omen in ';' indicate that there is a high prevalence of 6I" among pregnant $omen and a conseJuent greater ris+ of transmission to infants intra and postpartum. 'he results of a small sero- prevalence survey of ).- $omen at one antenatal clinic 8March5ecem(er %///9# sho$ed a ).-L sero-prevalence. Similarly# a cord (lood survey in 'o(ago demonstrated &..L sero-prevalence. Fiven this high prevalence of 6I" among pregnant $omen# there is a greater li+elihood of transmission from mother to child in the event of no *R" intervention. 'he aediatric *C'F1.2 study pu(lished in the =e$ Dngland

Gournal of Medicine %//,K ))%!%%.)- %%31 sho$ed that Nidovudine Monotherapy could reduce the transmission of 6I" to infants (orn to 6I" infected mothers (y 2..-L i.e. from &-.-L to 3.)L. It is $ith this in mind that the Ministry of 6ealth revention of Mother 'o Child 'ransmission 8 M'C'9 programme $as initiated in %///. 'hrough the =ational Strategic lan and the 6ealth Sector
Candice Lela- Rolingson

lan the
%)

Ministry of 6ealth is committed to addressing the prevention of the spread of 6I". 'he olicy see+s to harmonise and standardise efforts aimed at minimising the spread of the virus to the un(orn infant 8Ministry of 6ealth M'C' olicy &1%19

Global Initiatives

*n estimated ,)1 111 children $ere ne$ly infected $ith 6I" in &113# over /1L of them through mother-to-child transmission 8M'C'9. Without treatment# a(out half of these infected children $ill die (efore their second (irthday. Without intervention# the ris+ of M'C' ranges from &1L to ,-L. With specific interventions in non-(reastfeeding populations# the ris+ of M'C' can (e reduced to less than &L# and to -L or less in (reastfeeding populations. 'o prevent the transmission of 6I" from mother to (a(y# the World 6ealth Organisation 8W6O9 promotes a comprehensive approach# $hich includes the follo$ing four components! rimary prevention of 6I" infection among $omen of child(earing ageK reventing unintended pregnancies among $omen living $ith 6I"K reventing 6I" transmission from a $oman living $ith 6I" to her infantK and roviding appropriate treatment# care and support to mothers living $ith 6I" and their children and families.

Candice Lela- Rolingson

%,

*s the lead United =ations 8U=9 agency in the health sector and the only U= agency $ith the technical and programmatic mandate to address all four components of the comprehensive approach to prevention of mother-to-child transmission 8 M'C'9 of 6I"# W6O is in a uniJue position to help support glo(al M'C' efforts.

In many developed countries# paediatric 6I" has (een virtually eliminated. 'he ne$ly revised &11/ W6O recommendations for 6I" treatment# M'C' and infant feeding provide an important ne$ opportunity to implement highly effective interventions glo(ally# and particularly in resource-limited settings# and promote the health of mother and child. 'his M'C' strategic vision &1%1H&1%- defines W6OBs commitment to help

countries achieve agreed international goals on M'C'# increase access to Juality M'C' services and integrate these services $ith maternal# ne$(orn and child health and se0ual and reproductive health programmes. 'he o(>ectives of the strategic vision illustrate W6OBs ongoing commitment to the M'C'-related

goals of the United =ations Feneral *ssem(ly Special Session 8U=F*SS9 and to strength- en support for 5evelopment Foals. M'C' $ithin the conte0t of the Millennium

Candice Lela- Rolingson

%-

Results from country programmes# cohort studies and mathematical modelling illustrate that significant and su(stantial reduction in ne$ paediatric infections can (e achieved as a result of high coverage $ith effective interventions for prevention of mother-to-child transmission of 6I" 8 M'C'9. 4ollo$ing the success of a high-level# multilateral# heads-of-agency meeting in Gune &1%1# $hich endorsed the goal of elimination of mother-to-child trans- mission of 6I" 8M'C'9# there is strong glo(al commitment to the general concept and overall goal of M'C' elimination. 6o$ever# there has (een less clarity on the definition and terminology# the most appropriate targets# ho$ to translate glo(al targets to regional and national targets# the most appropriate indicators and the (est methods for monitoring progress to$ards elimination. *s a result# the World 6ealth Organisation 8W6O9# United =ations ChildrenBs 4und 8U=ICD49# Goint United =ations rogramme on 6I"C*I5S 8U=*I5S9 and United =ations opulation

4und 8U=4 *9 co-convened a technical consultation on the :Dlimination of mother-to-child transmission of 6I"<# on /H%% =ovem(er &1%1 in Feneva# S$itIerland to discuss these issues# develop technical guidance on the elimination of M'C'# and outline a draft frame$or+ for goals and monitoring 8including indicators# (aselines# target-setting# monitoring and reporting9# and for an operational frame- $or+ and action plan to support the elimination of M'C' at the glo(al# regional and country levels.
Candice Lela- Rolingson %2

'he (old# aspirational goal of eliminating ne$ paediatric 6I" infections (y &1%$as endorsed and positioned $ithin the (roader vision of improved 6I"-free survival# maternal and child health 8MC69# and se0ual and reproductive health 8SR69. It $as agreed that the elimination agenda should (e lin+ed to the glo(al commitment to achieving the &1%- Millennium 5evelopment Foals 8M5Fs9# as the success of Recent data indicate that reaching these goals demands a rene$ed commitment# and a comprehensive and sustained approach to scaling up Juality and effective M'C' services# especially in high-(urden countries. 'o this end# W6O $ill focus on the follo$ing seven strategic directions! %. commitment! Strengthen commitment and leadership for achieving full coverage of M'C' services. &. technical guidance! rovide technical guidance to optimise 6I" prevention# care and treatment services for $omen and children. ). Integration! romote and support integration of 6I" prevention# care and

treatment services $ith maternal# ne$(orn and child health and reproductive health programmes. ,. eJuita(le access! Dnsure relia(le and eJuita(le access for all $omen# including the most vulnera(le.

Candice Lela- Rolingson

%.

-. 6ealth systems! romote and support health systems interventions to improve the delivery of 6I" prevention# care and treatment services for $omen and children. 2. Measurement! 'rac+ programme performance and impact on M'C' rates and on maternal and child health outcomes. .. Colla(oration! Strengthen glo(al# regional and country partnerships for providing 6I" prevention# care and treatment for $omen# infants and young children# and advocate for increased resources.

W6OBs glo(al# regional and country support efforts in the ne0t fe$ years $ill focus on responding to the needs of the ten countries $ith the highest num(er of pregnant $omen $ith 6I". It is in these countries# $here .-L of the need for M'C' is found# that W6O can have the greatest impact on paediatric infections averted and lives saved. In addition# W6O $ill also intensify its support to accelerate regional approaches to eliminate paediatric 6I"# particularly in lo$prevalence and concentrated epidemic settings.

Implementation Approach

4ocus on %1 highest-(urden countries!

Candice Lela- Rolingson

%3

In &113# an estimated %., million pregnant $omen in lo$- and middle-income countries $ere living $ith 6I"# of $hom /1L $ere from >ust &1 countriesK all (ut one 8India9 are in su(- Saharan *frica 8see figure (elo$ and *ppendi0 *9. It is in these countries that W6O can have the greatest impact on infections averted and lives saved# especially the %1 countries $ith the highest num(er of pregnant $omen $ith 6I"# $here .-L of the need for M'C' services is found. In these %1 countries alone# successful scale-up of effective interventions to achieve M'C' rates of less than -L $ould prevent more than &-1 111 infant infections annually. More effective# integrated M'C' interventions at the regional and country levels in these high- (urden countries $ill help advance the glo(al M'C' effort to$ards elimination of

paediatric 6I"# and ma+e significant progress to$ards the M5Fs. While W6O $ill continue to provide support to all regions and all high-(urden countries as needed# W6OBs glo(al efforts in the ne0t fe$ years $ill focus on responding to the needs of the %1 countries $ith the highest num(er of pregnant $omen $ith 6I" and coordinating support for related initiatives focusing on these countries . W6OBs approach to implementation $ill follo$ the strategic directions and activities outlined in this M'C' strategic vision. Within this vision# several +ey approaches $ill (e highlighted# including active support for! the national programme# including management# updating of guidelines# target-setting# and
Candice Lela- Rolingson %/

annual revie$s and monitoringK the >oint U= programme frame$or+K and e0panded and strategic partnerships $ith international and (ilateral funding and implementing agencies. 8W6O M'C' Strategic "ision &1%1-&1%-9

'he elimination of M'C' is directly lin+ed to the health of the mother and the child. *dditional lin+ages are needed $ith maternal health# 6I" counselling and testing# (roader 6I" treatment and prevention programmes# and $ith other initiatives using the same MC6 platform 8e.g. elimination of congenital syphilis9. 'he elimination goal needs to (e supported (y a strong# focused glo(al campaign. *t the same time# synergies $ith related MC6 and SR6 initiatives need to (e strengthened and M'C' elimination needs to (e supported (y these (roader initiatives as $ell. Success in achieving elimination $ill reJuire a comprehensive and multifaceted approach# including for decreasing the num(er of 6I"-infected pregnant $omen 8primary prevention and family planning9# (ringing M'C'

services to all $omen and children in need# providing the most efficacious interventions feasi(le# strengthening health systems and $or+ing $ith

communities. Community and civil society participation and support are integral to the success of elimination clear (aselines# annual targets and an agreed frame$or+ to monitor and measure progress need to (e developed to support one programme and one monitoring mechanism $ith targets for &1%-. W6O and U=ICD4#
Candice Lela- Rolingson &1

$or+ing $ith other United =ations 8U=9 and Interagency 'as+ 'eam 8I*''9 partners# $ill $or+ together to produce a glo(al guide on setting targets and indicators for elimination# and $ill develop an action frame$or+ to pro- mote the elimination initiative and strengthen lin+ages to other# related initiatives and glo(al strategies. 'he I*'' and partners $ill $or+ to develop and further support. Regional frame$or+s for elimination and partners $ill $or+ at country level to

support national 8country-level9 targets for scale-up and elimination.

'he consultation recognised that elimination of ne$ paediatric infections (y &1%is an aspirational goal# and the proposed numerical targets are intended to focus the glo(al community on significantly reducing glo(al M'C' and ne$ paediatric infections to a much lo$er level pu(lic health pro(lem. Regional differences# type of epidemic# disease (urden# level of current country programmes# capacity and strength of health systems 8especially the MC6 infrastructure and the 6I" programme9 all need to (e considered in adapting these targets at the regional and country levels. 8'OW*R5S 'he elimination Of mO'heR-'O-chil5 'ransmission Of 6I" Report of a W6O technical consultation /-%% =ovem(er &1%1 Feneva# S$itIerland9

Global Monitoring and Evaluation Candice Lela- Rolingson &%

'he glo(al community has committed itself to eliminating mother-to-child transmission of 6I" (y &1%-. 'he strategy for reaching this am(itious goal is laid out in the Flo(al lan to$ards the Dlimination of =e$ 6I" Infections among Children (y &1%- and Aeeping 'heir Mothers *live# adopted in &1%%. 'he initiative is referred to as :DM'C'<ODliminating Mother-to-Child 'ransmission. 'he Flo(al lan covers all lo$- and medium-income countries. It focuses#

ho$ever# on && priority countries $ith high estimated num(ers of pregnant $omen living $ith 6I"! *ngola# ?ots$ana# ?urundi# Cameroon# Chad# Cote dBIvoire# 5emocratic Repu(lic of the Congo# Dthiopia# Fhana# India# Aenya# Lesotho# Mala$i# MoIam(iJue# =ami(ia# =igeria# South *frica# S$aIiland# Uganda# United Repu(lic of 'anIania# Nam(ia and Nim(a($e. 'he DM'C' initiative places ne$ emphasis on improving health outcomes for mothers and children. 'his is a shift from the previous emphasis on e0panding the coverage of services for preventing mother-to-child transmission 8 M'C'9. 'he ne$ emphasis on outcomes reJuires a corresponding shift in the focus of monitoring and evaluation 8M;D9 of efforts for prevention of mother-to-child transmission of 6I" 8 M'C'9. 'his document outlines a common frame$or+ for trac+ing progress to$ards DM'C' as $e move to$ards &1%-# including e0planation of the targets outlined in the Flo(al lan# essential M;D activities at the country level and plans for
Candice Lela- Rolingson &&

reporting. It is intended for policy-ma+ers# programme managers# M;D officers# and staff of technical agencies and international partners involved in supporting DM'C'.

Targets and indicators

Clear targets for &1%- and a clear frame$or+ for monitoring and measuring progress are necessary to support one M;D system for the initiative# integrated into the national M;D system. 'he DM'C' initiative has %1 targetsO& overall targets# & child health targets# and 2 targets related to the four prongs of M'C'. 'he t$o overall glo(al targets are! %. Reduce the num(er of ne$ 6I" infections among children (y /1L (y &1%&. Reduce the num(er of 6I"-associated deaths to $omen during pregnancy# child(irth or puerperium (y -1L (y &1%-. Aey M;D activities at the country level. 'he Flo(al lan for DM'C' calls on countries to :improve outcomes assessment# data Juality and impact assessment<. Routine monitoring and ongoing evaluation is a priority for DM'C' and is one point in the %1-point action plan outlined in the Flo(al lan as concrete steps for country-level implementation. Monitoring and evaluation related to DM'C' can (e planned# revie$ed and strengthened in the follo$ing five areas!
Candice Lela- Rolingson &)

%. Setting targets and (aselines &. Revie$ing routine M;D systems# and improving and validating data Juality ). Measuring M'C' programme impact and validating the elimination of motherto-child transmission ,. Operational research -. rogramme revie$ and evaluation.

Reporting progress

Flo(al progress to$ards the elimination of ne$ 6I" infections among children and +eeping their mothers alive $ill (e reported annually through the U=. In addition# progress $ill (e monitored through the policy and programme milestones set out in the Flo(al lan. 4or the && priority countries# ongoing process

monitoring $ill (e conducted# including indication of $hether any technical assistance reJuests have (een fulfilled.

Technical assistance and the IATT

'hrough the Interagency 'as+ 'eam on Infection in

revention and 'reatment of 6I"

regnant Women# Mothers and Children 8I*''9# development

partners $ill collectively support governments to revie$ M;D plans# assess M;D systems and needs# esta(lish (aseline data# set national targets# and support

Candice Lela- Rolingson

&,

monitoring systems and impact assessments that are ro(ust and capa(le of trac+ing progress to$ards DM'C'. 'his descri(es the monitoring and evaluation 8M;D9 frame$or+ for the Flo(al lan. It revie$s the targets# indicators# and (aselines for this initiative. *lso# it summarises the M;D activities that are important to gauge progress to$ards the elimination of mother-to-child transmission 8DM'C'9. 'hese activities include setting (aselines and targetsK revie$ing routine M;D systemsK validating and improving data JualityK and measuring M'C' programme impact. D0isting

country M;D systems and activities can (e revie$ed and strengthened as programmes scale up for DM'C'. 'his document also descri(es reporting processes to trac+ progress to$ards DM'C' and milestones set out in the Flo(al mechanisms. lan as $ell as coordination

'he I*'' $or+s in coordination $ith the Flo(al Steering Froup 8FSF9 for the Flo(al lan and its support team. 'he M;D Wor+ing Froup is availa(le to assist countries $ith the M;D components of their DM'C'.

Candice Lela- Rolingson

&-

M&E guides for the elimination of mother-to-child transmission of HIV;

P 'his document# Flo(al monitoring frame$or+ and strategy for the elimination of ne$ child 6I" infections (y &1%-# outlines the glo(al targets for DM'C' and recommended related indicators for reporting progress to$ards the targets of the Flo(al lan. 'his document can (e used (y policy-ma+ers and other sta+eholders $ho $ant a Juic+ overvie$ of monitoring of the DM'C' initiative. P Monitoring and evaluating the prevention of mother-to-child transmission of 6I"! a guide for national programmes is a detailed guide listing descriptions of harmoniIed indicators recommended for national M'C' programme monitoring# $ith details and e0amples of national and su(-national monitoring# data use# considerations $hen setting up registers and aggregating reporting forms# and recommendations for revising or implementing a functional M'C' M;D system. 'his document can (e used (y M'C' and M;D officers $ho reJuire details of the indicators and operational issues related to M'C' M;D systems. P Fuidance on measuring the impact of national summarises several +ey approaches to measuring M'C' programmes (riefly M'C' impact. 4or some

approaches there are specific generic protocols that can (e adapted at the country level. 'he short guide can (e useful to all sta+eholders $ho need a Juic+ overvie$ of the different $ays that M'C' impact can (e assessed# including their (udget reJuirements.
Candice Lela- Rolingson &2

'hese

documents

can

(e

found

online

at!

http!CC$$$.$ho.intChivCpu(CmeCenCinde0.html 8FLO?*L MO=I'ORI=F 4R*MDWORA *=5 S'R*'DFQ for the Flo(al lan to$ards the elimination of ne$ 6I" infections among children (y &1%- and +eeping their mothers alive 8DM'C'9 *pril &1%&9

Monitoring and Evaluation in Trinidad and Tobago

'he =ational M'C' Coordinator should ensure adeJuate and comprehensive data collection in accordance $ith the agreed national core indicators for M'C'K R 5ata collection and analysis should (e done in accordance $ith the M'C' Monitoring and Dvaluation lanK R 5ata on the core indicators should (e collected at the district and regional levels and cumulatively analysed at the national level. 'his data $ill (e collected using the same mechanism and personnel in charge of collecting all health data. M'C' data $ill (e fully integrated into the MinistryBs 6ealth Information Management System. R 'his analysis $ill allo$ for a comprehensive overvie$ of data from the M'C' programme for policyCprogramme development and (udgetary allocations.

Candice Lela- Rolingson

&.

Communication theories and approaches in use in PMTCT programmes

* num(er of different communication theories or approaches have (een used in the conte0t of M'C' across su(-Saharan *frica# as outlined in the ne0t sections. Communication for development and the *C*5* process! ?ased on pilot programmes in ?ots$ana and R$anda# U=ICD4 encourages use of the communication-for-development-planning M'C' communication approach# around $hich advocacy# involves social

developing

strategies

mo(ilisation and programme communication. Multisectoral teams use the *C*5* 8assessment# communication analysis# design and action9 process to develop integrated M'C' communication strategies for advocacy# social mo(ilisation and programme communication. Communication for development in the South *frican conte0t! In &11& the Fovernment of South *frica# in colla(oration $ith the Centres for 5isease Control and revention 8C5C9 in the United States# tested the

communication-for-development approach# (ased on the *C*5* planning process# and concluded that this $as the (est option for South *frica. 'he approach is colla(orative and meant to ensure community participation in the development of conte0t-specific strategies for each province. 'raining $as su(seJuently provided to multisectoral teams. 'he M'C' communication strategy aims to!
Candice Lela- Rolingson &3

P Increase access to condoms in non-traditional sitesK P 5ecrease stigma in communities in order to increase support and careK P Increase access to "C' in non-traditional sitesK P Increase e0clusive infant-feeding choices through family counselling aimed at esta(lishing ne$ community normsK P Dncourage up-ta+e of *=C servicesK P Mo(ilise sta+eholders such as traditional healers to in- crease support for M'C' and "C' services through community dialogue. In developing this revie$ attempts to locate follo$-up documentation of this programme 8or evaluations of its outcomes9 proved unsuccessful. 'his highlights the importance of ongoing monitoring and evaluation during the development of future M'C' communication strategies. 'his $ill ensure that lessons learned are documented and can feed (ac+ into and contri(ute to$ards the development of appropriate communication strategies. 4or e0ample# it $ould (e useful to +no$ $hat the outcomes of the &11) colla(oration (et$een the government and the C5C $ere and $hat lessons $ere learned during the process. ?ehaviour change communication 8?CC9! D 4*R has (een actively involved in designing and implementing (ehaviour change communication 8?CC9 M'C' strategies in various countries# including South *frica.-3 ?CC strategies using information# education and communication
Candice Lela- Rolingson &/

aim at promoting comprehensive 6I"-prevention messages and delivering these messages to specific audiences $ith the aim of changing health-related (ehaviour. Information# education and communication 8IDC9! * num(er of programmes ma+e use of locally developed in- formation# education and communication 8IDC9 materials to raise a$areness in the $ider community a(out M'C' and availa(le services. Community-oriented approach to (ehaviour change! Community-oriented (ehaviour recognises that (ehaviour change occurs in a conte0t of social change. 8Information -3 D 4*R &11,. -/ D 4*R &11,# 21 Shetty# Marag$anda#

Strani0-Chi(anda# Chandisare$a# Chipara et al.# &113 2% ereI# Mu+ote+$a# Miller# Orne-Flieman# Flensha$# Chitsi+e et al.# &11, 2& IM*U ; C5C SUgandaT# &11)9

New Media as a catalyst for social change

*ccording to a study onK :6o$ successful is the incorporation of popular culture in 6I" prevention in 'rinidad and 'o(ago7U (y *ndrea 'hompson =uffield Centre for International 6ealth and 5evelopment# Leeds Institute of 6ealth Sciences 4aculty of Medicine and 6ealth# Leeds University.

Candice Lela- Rolingson

)1

'he 6I" rate in 'rinidad and 'o(ago 8';'9 is higher than the Cari((ean average# at %.-L for adults aged %--,/. 6I" is predominantly spread via heterose0ual se0# $hile rates of infection (y in>ection drug users and men $ho have se0 $ith men are lo$. 'herefore prevention efforts are predominantly aimed at the high ris+ group of heterose0ual adults and teens. 'he =ational *I5S Coordinating Committee 8=*CC9 of 'rinidad and 'o(ago recently closed# leaving no governmental (ody in the country dedicated to 6I"C*I5S. 'his has provo+ed concern in some non-governmental organisations 8=FOs9. Rates of 6I"C*I5S in ';' may (e associated $ith se0ual (ehaviours and education. Some reports claim there are high levels of se0ual promiscuity# especially amongst men in 'rinidad and 'o(ago# and that parents do a poor >o( of giving se0 education advice to their daughters. 'here have (een e0amples of school-(ased interventions $hich use popular culture to teach 6I" prevention# (oth in the Cari((ean and across the $orld. * study from =e$ Qor+ (y ?outin-4oster et al 8&1%19 used a method of teaching youths to analyse the lyrics of hip hop and rap music to understand the messages portrayed $ithin the music# and ho$ this might influence 6I" ris+ (ehaviour. 'his method of e0ploring the messages presented $ithin popular music $as deemed to (e successful.

Candice Lela- Rolingson

)%

opular culture represented as music# dance and theatre is highly integrated into the lives of people living in the Dnglish-spea+ing Cari((ean. 'herefore many organisations# (oth governmental and non-governmental# such as 5ance , Life# 'he Cari((ean ?roadcast Media artnership 8C?M 9 and the ?*RC*M# have

used this popularity to integrate messages of 6I" prevention into various forms of popular culture. It can (e proposed that messages of 6I" prevention aimed at high-ris+ groups# may (e considera(ly more accepted $hen coming from a media source $hich is en>oyed and respected. 6o$ever evaluation of the effectiveness of such an approach has (een largely neglected. While there are many e0amples of popular culture (eing used for 6I" prevention in the Cari((ean# there has (een very little pu(lished evaluation of the success or impact of this approach. 'his study $ill focus on 'rinidad and 'o(ago 8';'9# a country $here there has (een a lot of time and resources invested into popular culture (ased methods of 6I"C*I5S a$areness.

It is not +no$n if such messages alter opinions# +no$ledge and attitudes relating to 6I"C*I5S# and therefore $hether it is li+ely to have any impact on (ehaviour and lead to reduction in ne$ infections. It is also not +no$n $hether this approach is more or less successful than using more traditional# forms of 6I" education $hich
Candice Lela- Rolingson )&

do not incorporate popular culture. 'his research therefore aims to assess the success of 6I" prevention messages $hich have incorporated aspects of popular culture. 'his $ill (e achieved (y sho$ing e0amples of messages $hich use music and drama to participants $ithin the population of students and staff at a university (ased in 'rinidad# and gathering their opinions.

*im ; O(>ectives- 'his study aims to assess the impact of 6I" prevention messages $hich use popular culture in 'rinidad and 'o(ago 8';'9# to ascertain ho$ successfully messages may alter +no$ledge and attitudes to$ards 6I"C*I5S. 'his $ill include gathering opinions on e0amples of popular culture 6I" messages# and assessing if the clips change +no$ledge and attitudes regarding 6I"C*I5S prevention. It $ill also assess $hether this approach should (e used more in ';'# and its success in comparison to more traditional 6I" prevention messages.

Method-4ocus groups and semi-structured intervie$s $ere conducted $ith %. students and staff at the University of 'rinidad and 'o(ago. articipants $ere

sho$n three video clips of 6I" prevention messages $hich incorporated popular culture and as+ed their opinions on the clips and the approach of using popular culture in general.
Candice Lela- Rolingson ))

4indings-Ano$ledge and attitudes $ere not changed (y the clips as participants already felt they $ere informed a(out 6I"C*I5S. 'he clips $ere deemed to successfully portray the message of 6I" prevention. It $as thought that this approach should (e used more in ';'# and that music $as the (est form of popular culture to use. articipants did not feel their +no$ledge or attitudes had changed after $atching the video clips# although some felt their previous +no$ledge and attitudes $ere reinforced. 'his $as due to participants already feeling they $ere informed a(out 6I" prevention.

'he clips used successfully portrayed the message of 6I" prevention. Music is the (est form of popular culture to use for giving 6I" prevention messages as music# especially EsocaB# is $idely popular and listened to (y many in 'rinidad and 'o(ago. Qoung people $ere the target of most 6I" prevention messages $hich are the age group at the greatest ris+. 6o$ever this may lead to a lac+ of similar messages aimed at older people $ho may also (e at ris+. Many participants had previously seen or heard 6I" messages $hich used popular culture. 'hese previous messages $ere deemed to (e successful and had changed +no$ledge and attitudes and $ere $idely availa(le especially on local television.
Candice Lela- Rolingson ),

 opular culture 6I" prevention messages should (e sho$n more# especially in schools. 'here is reason to have messages played more around carnival# (ut they must also (e circulated at all other times of the year. opular culture is a more successful $ay of teaching 6I" prevention than more traditional approaches $hich may (e deemed less interesting. ?y using popular culture people are more engaged and $ill listen more to the messages.

opular culture should continue to (e used as tool for 6I" education in ';'# and its utilisation should (e e0panded# especially in the form of music. opular culture messages should (e used in school-(ased teaching# and messages should (e created to target all age groups. 'he use of popular culture has the potential to reduce the pro(lem of ne$ 6I" infection rates in ';'. 8=uffield Centre for International 6ealth and 5evelopment Leeds Institute of 6ealth Sciences 4aculty of Medicine and 6ealth. 'itle of Research ro>ect! 6o$ successful is the incorporation of

popular culture in 6I" prevention in 'rinidad and 'o(ago7 85r. *ndrea 'hompson &1%19

Candice Lela- Rolingson

)-

Chapter "

#ethodology
Research design $ill (e a Juantitative methodology# using Juestionnaires in close ended format. *s the aim of the research is to understand the effect of the film ositive and regnant on youth# their a$areness to 6I"C*I5SC M'C' and general

Candice Lela- Rolingson

)2

attitudes# this design $as the most appropriate method. * Juantitative study $ould not provide this data.

Aim and Objective

'his study aims to e0plore the effects of the film ositive and regnant on youth (et$een %,-%. years old attending secondary school in east 'rinidad and 'o(ago. 'his study $ould assess ho$ successfully the filmBs messages may alter +no$ledge and attitudes to$ards 6I"C*I5S.

Participants

?aseline data $ill (e o(tained via random sampling of students# the sample frame is &11 students $ithin the specific age group and sample siIe is ,1 pupilsK &1 girls and &1 (oys selected randomly from forms & to - respectively.

Theoretical Justification

'he (aseline data $as collected via Juestionnaires K S*T pre testing- baseline $ith close ended structured Juestions# su(seJuently# S?T an intervention screening of the &, minute docudrama follo$ed (y intervention data - post testing using close ended Juestions# (y using this method triangulation $as limited.

Candice Lela- Rolingson

).

Ethics

Strictest anonymity and confidentiality has (een regarded. ermission $as granted (y the principal of "alencia Secondary School to conduct S*?T

Analysis

'he results are compared to determine if a change occurred# 8See appendi09 for the Juestionnaire sample. Fraphs and charts are reflective of the (aseline data there(y illustrative on the master sheet. 4indings $ill (e compared and contrasted for the purpose of this study.

Chapter $ %indings
'he findings are documented (y graphs# (ar charts and histograms $hich reflect the (aseline data and intervention data decisively. 'he information $ill (e further

Candice Lela- Rolingson

)3

analyIed to dra$ conclusions that are reflective of the hypothesis# in a discussion $hich follo$s. %ach &uestion was placed on a master sheet, then a graph was formed that would assist in &uantifying the data, which are as follows;
!%'! ( %9 6ave you ever seen any educational commercial on '" or the internet a(out 6I"7 Qes -)* =o- +

&9 Where did you acJuire or learn the information you +no$ a(out 6I" M7 *9 '" - (, ?9 Internet -) C9 4riends -59 arents .( D9 all of the a(ove-(/id 01! 20'3%4 .5

Candice Lela- Rolingson

)/

)9 5o you thin+ you or your friends may (e at ris+ of getting 6I"C*I5S7 Qes --5 =o -(5

,9 5o you +no$ a lot a(out 6I"7 =o 859 Qes 869 not sure 7((8 a little 8(*9

Candice Lela- Rolingson

,1

-9 *re you allo$ed access to 4ace(oo+7 Qes 8)*8 =o 7-8 Occasionally 7-8

29 5o you +no$ someone $ho is 6I" positive7 Qes 7(-8 =o 7-68 Candice Lela- Rolingson ,%

.9 6ave you ever discriminated against someone $ith 6I"C*I5S7 Qes 7,8 =o 7))8

39 Would you date someone $ho you +no$ is 6I" V7 Qes 8 (9 =o 8 )99 Candice Lela- Rolingson ,&

/9 6ave you ever heard of the revention of mother to child transmission of 6I"7 Qes 8-:9 =o 8-:9

%19 Would you encourage your friends and family to get tested for 6I"7 Candice Lela- Rolingson ,)

Qes 8)6 9 =o 8 -9

%%9 5o you thin+ 6I" testing should (e mandatory in our country7 Qes 8),9 =o 8)9

%&9 5id you +no$ that MO'6DR to C6IL5 transmission of 6I" can (e reduced andC or eradicated (y /1L glo(ally $ith access to 6I" treatment7 Qes 8(5 9 =o 8-5 9 Candice Lela- Rolingson ,,

%)9 5o you +no$ 6I" medication is availa(le free of charge in ';'7 Qes 8-+9 =o 8(* 9

Mastersheet P1'! !%'!

Candice Lela- Rolingson

,-

%9 5o you thin+ the film effectively educated you a(out 'he revention of Mother to Child 'ransmission of 6I"7 ;es 7)98 0o 7( 8

&9 Were the facts ho$ to prevent mother to child transmission of 6I" treatment clear to you7 ;es 7)-8 0o 7)8 0ot 4eally 7)8 /I/ 01! 20'3%4 .-

)9 5o you (elieve you $ill ma+e (etter decisions in future after seeing this film7 ;es 7),8 0o 7 )8 Candice Lela- Rolingson ,2

,9 5o you thin+ the film has made you more sensitive to people living $ith 6I"C*I5S7 ;es 7)+8 0o 7 *8

-9 Would you date someone $ho you +no$ is 6I" V7 ;es 7)8 0o 7 ):8 /on"t <now 7, 8 Candice Lela- Rolingson ,.

29 5o you feel your future se0ual (ehaviour $ill (e influenced positively after seeing the film7 ;es 7)-8 0o 7*8 /I/ 01! 20'3%4 .-

.9 5o you (elieve that MO'6DR to C6IL5 transmission of 6I" can (e reduced or eradicated glo(ally $ith access to 6I" treatment7 Candice Lela- Rolingson ,3

;es 7)-8 0o 768

39 Would you encourage your friends and family to get tested for 6I"7 ;es 7+:8 0o 7:8

/9 5o you thin+ 6I" testing should (e mandatory in our country7 ;es 7)*8 0o 7 +8 Candice Lela- Rolingson ,/

A) B) C) D)

%19 Which Character can you personally identify $ith in the film7 *licia - * Marvin - : 'he ?est 4riend . -5 'he Mother . * W/I/ 01! 20'3%4 = )

%%9 5o you thin+ you or your friends may at ris+ of getting 6I"C*I5S7 ;es 7 -+8 0o 7 (*8 /I/ 01! 20'3%4. (

Candice Lela- Rolingson

-1

%&9 6o$ $ould you share the information that you learned from the film7 A) Dmail H ) B) 'e0t- + C) 4ace(oo+ H ): D) Write a letter H )

%)9 What $as your favourite scene of the film7 Candice Lela- Rolingson -%

A) B) C) D) E)

*licia as+s Marvin to ta+e an 6I" test. .. (( *licia crying a(out her pro(lem. #. + *licia gets advice from her (est friend. - 9 *licia tells her Mom she is 6I" V .9 *licia gets good ne$s from the =urse Counselor .,

A) B) C) D) E)

%,9 WhatXs $as your least favourite part of the film7 *licia as+s Marvin to ta+e an 6I" test - ) *licia crying a(out her pro(lem - (6 *licia gets advice from her (est friend. . *licia tells her Mom she is 6I" V - (, *licia gets good ne$s from the =urse Counselor - :

%-9 6ave you learnt ne$ information a(out 6I" and prevention of Mother to child transmission of 6I"7 Candice Lela- Rolingson -&

;es 7),8 0o 7)8

%29 *fter seeing the film# did you +no$ 6I" medication is availa(le free of charge in ';'7 ;es 7):8 0o 7(:8

%.9 Would you encourage an 6I" V friend or relative to ta+e medication and see+ further treatment7 ;es 7)68 0o 7-8 Candice Lela- Rolingson -)

%39 6o$ $ould you most effectively communicate that info you >ust learned a(out 6I" revention to your peers7 *9 4ace(oo+ --* ?9 Dmail -C9 "ideo -) 59 Qouth group meeting -6 49 Church Meeting-(

%/9 5oes the film cause you re-e0amine your o$n (ehavior and help you to ma+e more informed decisions for the future7 ;es 7)+8 0o 7*8 Candice Lela- Rolingson -,

&19 5o you thin+ there should (e more 6I" Info on '" andCor Internet7 ;es 7+:8 0o 7:8

Candice Lela- Rolingson

--

&iscussion
In this discussion the relationship (et$een the o(>ective of- The effects of the film Positive and Pregnant on youth between 14-17 years old; attending secondary school in east (Valencia Secondary School Trinidad and Tobago- and varia(lesK 6 % - Loo+ing at the film ositive ; regnant positively affects 6I" a$areness. =ull - Loo+ing at the film ositive ; regnant does not affect 6I" a$areness. 'hese $ill (e compared# contrasted and analyIed to the findings.

4or this purpose the analysis is segmented into themes# and then supported (y arguments. 'he comparison to the literature revie$ also supports these arguments.

Candice Lela- Rolingson

-2

Themes
Theme 1> In comparison of @uestion Y3 'est %# recorded the follo$ing varia(les! %L noted Qes in the and =o //L -=o in the ost 'est @uestionnaire# ho$ever# in re 'est @Y%) a change in cognitive perception noting Qes 8)9 5onBt Ano$ 8.9 and =o 8)19

Theme !! Comparing @Y%- ost 'est to @Y/ on 'est %! * change is nota(le.

Candice Lela- Rolingson -.

Theme "# @Y) 'est % in comparison to ost 'est @Y%%! sho$ed no significant change# the test su(>ects do not (elieve that they are at ris+ of contracting 6I" even after loo+ing at the film.

Theme 4# 'he statistiscs a(ove 'est @Y%1 sho$ed that /-L of the test su(>ects $ould encourage their friends and family for 6I" and in ost 'est @Y3 the same Juestion resulted in %11L result .

Candice Lela- Rolingson

-3

Theme $! 'est @Y. reveals 3)L has never discriminated against someone $ho is living $ith 6I" and ost 'est @Y, 3-L said they film has caused them to (ecome more sensitive to persons living $ith 6I"# a &L increase is distinguished.

Candice Lela- Rolingson

-/

%onversely& in contrasting theme " to theme 4 reveals; regardless that the test sub'ects believes& that they may not be at ris( in contracting )*V& )*V testing was still im+ortant; Post Test ,-1. showed "4 students believed that the film caused them to re-e/amine their own behavior and can influence their future decisions in this conte/t& des+ite the fact& they do not belive they aare are ris( of contracting )*V0 1ased on the findingsof basline and intervention baseline& the target audieuce dis+layed a fair (nowledge about )*V0

Candice Lela- Rolingson

21

Chapter ' Conclusion In comparison to the it re!iew

The Study of -6o$ successful is the incorporation of popular culture in 6I" prevention in 'rinidad and 'o(ago7 85r. *ndrea 'hompson &1%19. 2Many participants had previously seen or heard 6I" messages $hich used popular culture. 'hese previous messages $ere deemed to (e successful and had changed +no$ledge and attitudes and $ere $idely availa(le especially on local television. 'he use of popular culture has the potential to reduce the pro(lem of ne$ 6I" infection rates in ';'.< 8=uffield Centre for International 6ealth and 5evelopment Leeds Institute of 6ealth Sciences 4aculty of Medicine and 6ealth. 'itle of Research ro>ect! 6o$ successful is the incorporation of popular culture in 6I" prevention in 'rinidad and 'o(ago7 85r. *ndrea 'hompson &1%19 'he follo$ing graphs from the current study ofK The effects of the film Positive and Pregnant on youth between 14-17 years old; attending secondary school in east (Valencia Secondary School Trinidad and Tobago are conclusive 5r. 'hompsonBs findings.

Candice Lela- Rolingson

2%

Candice Lela- Rolingson

2&

Changes in ?ehavior
'he follo$ing changes in (ehavior $ere noted as a result of vie$ing the film ositive and regnantK

'he film ositive and regnant can (e used as a tool to educate youths#

@ooking at the film caused immediate changes in response to stigma and discrimination#

Loo+ing at the film caused positive changes in attitude and behavior in the short term#

Loo+ing at the film effectively educated youths about HIV !esting", the importance of family planning and prophylactics;

It is inconclusive that the film will ultimately cause a lasting effect on behavior#

Candice Lela- Rolingson

2)

4ecommendations

Su(seJuently to findingsK it is recommended the Juestionnaire (aseline and intervention (aseline# should (e further revie$ed and revised for triangulation purposes.

6o$ever the film can (e used as an effective tool in advocating for the a$areness of the revention of Mother to Child transmission of 6I"# in con>unction to other means intervention. 'he film can (e used as an aide in assisting young persons in ma+e (etter decisions in the short term future a(out se0ual (ehavior. 6o$ever# the limitations can (e revie$ed in a longitudinal study# to readily assess impact and outcome of the study.

'he study is conclusive in relation to 6 % - 3oo(ing at the film Positive 4 Pregnant +ositively affects )*V awareness- as there is a noted increased level of a$areness of 6.I.". C*.I.5.S. issues in terms of relevant information pertaining to the disease# in addition to affective stand-points in terms of tolerance and sensitivity to$ards persons $ith the diseaseK and an increased sense of vigilance in terms of life-choices and decisions related to se0ual (ehaviour.

Candice Lela- Rolingson

2,

Appendix
(uestionnaires )articipant Info Sheet* etter to the )rincipal etter from +,I

Candice Lela- Rolingson

2-