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Cyber-Senga: Ugandan youth preferences for content in an Internet-delivered comprehensive sexuality education program
1. AIDS Impact
Gabarone, Botswana
Thursday, September 24, 2009
Cyber-Senga: Ugandan youth preferences
for content in an Internet-delivered
comprehensive sexuality education
program
Sheana Bull, Dennis Nabembezi,
Ruth Birungi, Julius Kiwanuka
Michele Ybarra
* Thank you for your interest in this presentation. Please note that analyses included herein are
preliminary. More recent, finalized analyses can be found in: Bull, S., Nabembezi, D., Birungi, R.,
Kiwanuka, J., & Ybarra, M. (2010). Cyber-Senga: Ugandan youth preferences for content in an internet-
delivered comprehensive sexuality education programme. East African Journal of Public Health, 7(1),
58-63.
2. Presentation Objectives
• To offer background information on the
CyberSenga research project
• To discuss the methods utilized to develop and
pilot test design elements for the CyberSenga
Program
• To present initial and revised design elements of
the Internet-based program for Ugandan youth
• To consider the applicability of the method for
other technology based program development
and adaptation for health promotion in Africa
3. Background information on
CyberSenga
• Sub-Saharan Africa remains the worlds’ region
most heavily affected by HIV, accounting for
67% of all young people living with HIV and for
75% of AIDS deaths
• Among 15–24-year-olds in Uganda who were
testing for the first time, HIV prevalence was 3%
among young men and 10% among young
women in 2002
• Uganda’s HIV prevalence rates are currently
estimated to be between 6-7% ; in Mbarara, 6%
4.
5. Background information on
CyberSenga
• HIV prevention programs have led the
technology health field.
• Technology can provide a private and
confidential environment, which is particularly
important in places where stigma could limit
service access.
• Technology has the potential to be highly cost
effective
• There is evidence that the Internet and
computers may be a feasible and attractive
approach for developing country and other
resource-limited settings
6. Background information on
CyberSenga
• CyberSenga is a research project that aims to
develop and test an Internet program for
adolescents in Uganda
– “Senga” is the Luganda term for Auntie, who is the
father’s sister and is expected to offer guidance to
family as they mature
• Our goal today is to describe
– Experiences Ugandan youth have had with sexuality
education;
– Reactions to and acceptability of the concept of an
Internet based HIV prevention program;
– Preferences for content and structure of such a
program.
7. Methods
• Participants were recruited from one of five
secondary schools partnering with us on the
project
• We used a qualitative approach, conducting
three focus groups with five secondary school
students in each group. (5 female, 10 male)
• Participants were peer-nominated popular
opinion leaders in their respective school class.
• Focus groups were conducted in the
CyberSenga project office in Mbarara, Uganda.
8. Methods
• Groups were facilitated by research assistants
trained in focus group methodology; each group
had an observer to take notes
• Facilitator and observer debriefed after each
group; their notes of the debriefings are the field
notes
• Groups lasted between 75 and 90 minutes
• Groups were conducted primarily in English
although some Ruyenkole was used to clarify or
offer detail as needed
9. Analysis
• Data were tape recorded and transcribed.
For one group, there was a severe
thunderstorm and it was difficult to hear
the voices on the tape; for this group
analysis relied primarily on observer notes
and the field notes
• The data set included transcripts, observer
notes and field notes
10. Analysis
• All data were coded using three iterative
processes:
– Open coding
– Axial coding
– Summary coding
• All coding was completed by one analyst
• All procedures have been reviewed and
approved by IRB’s at MUST and
Chesapeake
11. Results
• Experiences with sexuality education
– Participants received sexuality education at home,
from family members, and at school, from teachers.
– Sexuality education at home was done by their
mothers, although some indicated that an older sister
or brother or aunt or uncle had talked to them about
sex and sexuality.
– Content of sexuality education was focused on HIV—
with less emphasis on pregnancy prevention,
prevention of other sexually transmitted diseases, and
how to cultivate healthy sexual relationships.
12. Results
• Experiences with sexuality education
– Youth need basic facts on sex and sexual
health
– Youth have received considerable information
about abstinence
– Youth are confused about how to reconcile
messages about abstinence with messages
that discuss sex and condoms
13. Results
• Experiences with sexuality education
– Participants have misperceptions that most
condoms have holes or are poorly
manufactured, which is why they should not
be relied upon
– Participants did agree that they need
information on condoms
– Participants need information on self esteem
and emphasizing future aspirations
14. Results
• Reactions to and acceptability of the
concept of a CyberSenga program
– universal understanding of the Senga, and
appreciation for the attention to the cultural
norm of accessing the Senga for sexual
health information
– High acceptability of the program delivery via
computer because of confidentiality and
privacy
15. Results
• Reactions to and acceptability of the
concept of a CyberSenga program
– While youth recognize the Senga, they
expressed distrust of “real life” Sengas and
consider this an interesting alternative
– Many youth are very familiar with computers
and access the Internet cafes
16. Participants felt
Senga shouldn’t have
Winnowing basket
Participants felt Eunice should
Be more grown up and feminine;
Eunice and Moses should be more
Clearly a couple
Participants agreed that the background suggested
A poor family without the means to achieve the education
Needed to be a Senga
17. Eunice appears more mature and
Feminine; The Senga is no longer
With a basket; the background is
More appropriate for where you would
Encounter a Senga
Moses and Eunice appear
To be closer and more likely
A couple
18. Conclusions
• Youth in Uganda have a need for
comprehensive sexuality education
• The information they receive about
sexuality tends to emphasize abstinence
and HIV to the exclusion of other topics
• They get inconsistent education
• Youth use and are familiar with computers
and the Internet
19. Conclusions
• The Senga is a well known figure, and
integrating her into a program is compelling for
youth
• Youth have specific suggestions for making the
program credible and appealing
• The process of engaging youth in focus groups
is an important step in the development of a
culturally appropriate technology based sexuality
education program for Ugandan youth
This work is supported by a grant from the National Institute of Mental Health
R01-MH080662
Notes de l'éditeur
We would like to thank the entire study team from Internet Solutions for Kids, Mbarara University of Science and Technology, University of Colorado, and Harvard University, who contributed to the planning and implementation of the study
WE lack the specific evidence to support this in Sub Saharan Africa as of yet.
NOTE: NEED PIC OF CYBERSENGA OFFICE OR OF FGD PARTICIPANTS
NOTE: NEED PIC OF CYBERSENGA OFFICE OR OF FGD PARTICIPANTS
They used to tell us that if you get HIV, you will die and if you get pregnant your education will stop from there . As another example: AIDS kills and [people] should abstain from sex and use condoms. Exception to #2: they tell us about the way we should handle ourselves, and they tell us about growing because that sexual feeling can come when you are around.
Abstinence is good. If you abstain from sex there is no chance of getting those sexual diseases, pregnancy. Abstinence is good. You are telling people to abstain, now you bring in condoms, if they are abstaining then why bring in the condoms? don’t you if you put on something about condoms, you are encouraging people to get involved in sexual immorality?...we know condoms are not 100% perfect and then you bring them in; me I think it would be, kind of- kind of contradicting?
Abstinence is good. If you abstain from sex there is no chance of getting those sexual diseases, pregnancy. Abstinence is good. You are telling people to abstain, now you bring in condoms, if they are abstaining then why bring in the condoms? don’t you if you put on something about condoms, you are encouraging people to get involved in sexual immorality?...we know condoms are not 100% perfect and then you bring them in; me I think it would be, kind of- kind of contradicting? . I think condoms can work for people who are already [having sex],