A Quasi-Experimental Study to Assess the Impact of Four Adolescent Sexual Health Interventions in Sub-Saharan Africa

Volume 28, Number 2, June 2002 The literature on the evaluation of adolescent sexual health interventions is growing in both developed1 and developing countries.2 However, because few evaluations have shown an impact on behaviors, rigorous assessments of interventions that target adolescents are still needed. This study assesses the performance of four adolescent sexual health interventions implemented in Sub-Saharan Africa under the five-year Social Marketing Adolescent Sexual Health project, financially supported by the U.S. Agency for International Development’s Africa Bureau. It is unique in that it uses a quasi-experimental design, covers programs in multiple countries—Cameroon, Botswana, South Africa and Guinea—and presents findings within the parameters of a well-articulated analytic framework, the Health Belief Model. The Health Belief Model is one of the most widely used approaches to understanding individual health behaviors; studies in Sub-Saharan Africa indicate that it is good at explaining intentions and behavior there.3 It is used for this study because its components broadly reflect the goals of social marketing efforts (i.e., to raise risk awareness, reduce barriers to safer sex and increase perceived benefits of prevention), and it allows the examination of a range of variables that are common to several widely used conceptual models. The model is based on a cognitive approach that uses a cost-benefit perspective to understand preventive health behavior. It assumes that individual behavior change depends upon perceived severity of risk, perceived susceptibility to risk, perceived benefits of preventive action, perceived barriers to preventive action and perceived ability to take preventive action (self-efficacy).4