1. Kelly Hallman, Kasthuri Govender, Eva Roca, Cecilia Calderon,
Emmanuel Mbatha, Mike Rogan, and Hannah Taboada
Population Council, Isihlangu HDA, University of KwaZulu-Natal
Using mixed methods to study the relationship between
reproductive health and poverty: Lessons from the field
A methods workshop, PovPov Research Network
November 4-5, 2010, London
Building economic, health
and social capabilities
among adolescents
threatened by HIV and AIDS
The Siyakha Nentsha
(“Building with Young People”)
program in KwaZulu-Natal

2. Mixed methods at each stage
• Planning
• Program design
• Program implementation
• Measurement of outcomes

3. Strategic planning -
Mixed methods to learn
 Which adolescents vulnerable
- Identify highest concentrations of vulnerable by gender, age &
geography (quant w mapping)
 Whether at-risk adolescents reached by “youth”
initiatives (IDIs w programmes)
 What components missing from existing programs
(IDIs w programmes)
 How to reach/target a programme

4. Survey and quantitative analysis
Structural factors associated with
adolescent HIV risk behaviors
• Residing in relative poverty
• Fewer social connections
• Non-cohesive community
• Orphanhood
Source: Hallman 2004, 2005, 2007, 2008, 2010; Hallman & Roca 2007

5. *of those currently ages 20-24
(2005 Ethiopia DHS)
Source: “The Adolescent Experience In-Depth:
Using Data to Identify and Reach the Most
Vulnerable Young People: Ethiopia 2005.” New
York: Population Council, 2009.
http://www.popcouncil.org/publications/serialsbriefs/
AdolExpInDepth.asp
Highest rates
(48%) in the
Amhara region
Girls married by age 15: Ethiopia*

6. Pilot programme
– Via state-funded not-for-profit child welfare
organization
– Consultations with traditional leaders
– FGDs with grandparents, parents, young men,
young women
– Local education expert and social workers
developed the curriculum
– Longitudinal survey

7. Extensive engagement
with stakeholders
• Traditional leaders
• Department of education
• Schools
• Guardians

8. Intervention purpose
Improve functional capabilities and well-being of
adolescents at high risk for:
HIV and STIs teenage pregnancy early unplanned parenthood
school dropout loss of one or both parents
lack of knowledge of further employment and training opportunities

9. Intervention content
• Knowledge and skills for pregnancy and HIV prevention
and AIDS mitigation; accessing preventive, treatment and
care services
• Skills for:
– managing personal and familial resources
– Accessing social benefits, education and training opportunities
– planning and aspiring for the future
– building savings/assets over time
• Building and strengthening social networks and support

10. Intervention delivery - 1
• Incorporated into school day
• Least selective sample in this context
• Saturation of geographic area
• Timing of “life orientation” as examinable
• Females and males
• Responding to local needs
• Male attitudes, behaviors and future prospects
• National accreditation of
– Curriculum
– Implementing organization as training providers

11. Sound programming methodology
• Maximum use of existing infrastructure
– Tap & build local human and physical capacity
• Make consistent with local reality
– Facilitator pay rate same as government auxiliary
social worker
– Local residence: no absences; know local realities
– National accreditation of program
→ cache and door opener for graduates
– Curriculum geared to local opportunity structures
• Designed with an eye toward scale-up
– DOE decision-making from Day 1

12. Randomized
intervention
HIV education,
social support
+ financial
literacy
HIV
education
and social
support Delayed
intervention

13. Research Methods
• Longitudinal survey w
participants
• Household-based interview
– Data quality
– Tracking (household GIS)
• FGDs to assess experience with intervention:
participants (by gender & grade) & guardians
• IDIs with program facilitators
• School quality assessments

14. Implementation challenges
• Working within existing local program
– School or NGO
• Mandates, priorities
• Ownership (programme; facilities; personnel)
• Time and resource constraints
• Managing local expectations of what programme
will deliver
• Explaining why programme is randomised
• Rationale for control schools

15. Advantages of mixed methods
• Ongoing partnership between researchers and
programme implementers
– Allows for iterative, dynamic process
• “Course correction” during intervention
• Improved research instruments
• Ability to select qualitative study participants
purposefully from survey, based on designated
characteristics

16. Advantages of mixed methods
Triangulation
• Sheds light on “confusing” results; reveals
complexities
• Research is more policy relevant and responsive
• New research issues emerge

17. Way forward
• Assessing differential impact of
two experimental arms
• DOE eager to scale programme
out
• Need to follow participants to
assess longer-term impact of
intervention

18. Selected resources
• Hallman, K. 2010, in press. “Social exclusion: The gendering of adolescent HIV
risks in KwaZulu-Natal, South Africa,” in J. Klot and V. Nguyen eds., The Fourth
Wave: An Assault on Women - Gender, Culture and HIV in the 21st Century.
Social Science Research Council and UNESCO.
• Hallman, K. 2008.“Researching the determinants of vulnerability to HIV amongst
adolescents,” IDS Bulletin, 39(5), November 2008.
• Bruce, J. and Hallman, K. 2008. “Reaching the girls left behind,” Gender &
Development, 16(2): 227-245.
• Hallman, K and Roca, E. 2007. “Reducing the social exclusion of girls,”
www.popcouncil.org/pdfs/TABriefs/PGY_Brief27_SocialExclusion.pdf
• Hallman, K. 2007. “Nonconsensual sex, school enrollment and educational
outcomes in South Africa,” Africa Insight (special issue on Youth in Africa), 37(3):
454-472.
• Hallman, K. 2005. “Gendered socioeconomic conditions and HIV risk behaviours
among young people in South Africa,” African Journal of AIDS Research 4(1):
37–50. Abstract: http://www.popcouncil.org/projects/abstracts/AJAR_4_1.html

19. Thank you!
Our funders: ESRC/Hewlett Joint Scheme
& DFID via the ABBA RPC
photos by Ms.
Eva Roca