Impact of the DREAMS Partnership on social support and general self-efficacy among adolescent girls and young women: causal analysis of population-based cohorts in Kenya and South Africa

Abstract

IntroductionThe Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) Partnership aimed to influence psychosocial processes that promote empowerment among adolescent girls and young women (AGYW), and reduce HIV incidence. We estimated the impact of DREAMS on aspects of AGYW’s collective and individual agency (specifically, social support and self-efficacy), in three settings where DREAMS was implemented from 2016 until at least end 2018.MethodsResearch cohorts of ~1500 AGYW aged 13–22 were randomly selected from demographic platforms in Kenya (Nairobi; Gem) and South Africa (uMkhanyakude) and followed up from 2017 to 2019. Social support was based on questions about female networks and access to safe places to meet with peers; general self-efficacy was measured using a scale previously validated in other settings. We conducted multivariable logistic regression, and estimated the causal effect of invitation to DREAMS on each outcome in 2018 and 2019 by comparing counter-factual scenarios in which all, vs no, AGYW were DREAMS invitees.ResultsIn Nairobi, Gem and uMkhanyakude, respectively, 74%, 57% and 53% were invited to DREAMS by 2018. Social support was higher among DREAMS invitees versus non-invitees (eg, adjusted OR 2.0 (95% CI 1.6 to 2.6), Gem, 2018). In 2018, DREAMS increased social support in all settings and age groups, for example, from 28% if none were DREAMS invitees to 43% if all were invitees (+15% (95% CI 10% to 20%)) in Gem. Effects were strongest in Kenya, but weakened in 2019, particularly among older AGYW. In uMkhanyakude, DREAMS invitees had greater self-efficacy compared with non-invitees in 2018 (+9% (95% CI 3% to 13%), 2018) but less so in 2019. In Kenyan settings, there was weak evidence for impact on self-efficacy among younger AGYW in Gem (+6% (95% CI 0% to 13%)) and older AGYW in Nairobi (+9% (95% CI −3% to +20%)) in 2019.ConclusionsDREAMS impacted on social support and, less consistently, on self-efficacy. Weakening effects over time may reflect changes in access to safe spaces and social networks as AGYW age and change circumstances, and withdrawal of DREAMS from uMkhanyakude in 2018, highlighting the importance of programme sustainability and improving programming for older participants.

Social support and very young adolescent girl’s knowledge on sexual relationships: A comparative qualitative study of Girl Only Clubs’ participants and non-participants in rural Malawi

“…Similar findings have been reported in other studies where the DREAMS interventions have been implemented. For example, our findings reflect those of studies among foreign migrant AGYW aged 14-19 in South Africa and among the AGYW aged 13-22 in Kenya [50,51]. These findings suggest the need for alternative sources of information for VYAs.…”

“…The asset-building framework posits that adolescent girls need a combination of social, health, cognitive, and economic assets to make a safe and healthy transition from childhood to adulthood [50,64,65]. Social asset building intervention have been found to increase agency in VYAs thereby reducing their vulnerability to HIV [50,64,65]. Our findings have SRH programming implications for VYAs who are not yet sexually active.…”

“…Moreover, social asset-building could include empowering parents and other adults on how to talk about SH issues with VYAs. The asset-building framework posits that adolescent girls need a combination of social, health, cognitive, and economic assets to make a safe and healthy transition from childhood to adulthood [50,64,65]. Social asset building intervention have been found to increase agency in VYAs thereby reducing their vulnerability to HIV [50,64,65].…”

Cross-sectional associations between mental health indicators and social vulnerability, with physical activity, sedentary behaviour and sleep in urban African young women

“…Self-efficacy is considered a key determinant of behaviour change, and social support is a recognised behaviour change technique [ 41 ]. While the importance of self-efficacy and social support have been highlighted in the context of sexual behaviours and HIV in young South Africans [ 42 – 45 ], they have not been explored in relation to physical activity, sedentary behaviour, and sleep in the context of young women’s mental health in South Africa.…”

Sexual health knowledge acquisition processes among very young adolescent girls in rural Malawi: Implications for sexual and reproductive health programs

“…Our findings have also highlighted the need for SRH programmers to create safe and supportive spaces within communities where VYA can easily access SRH information. The GOCs in Malawi are an example of such programs that involve social asset building and safe spaces, especially for VYAs, and have been demonstrated to indirectly reduce risk for HIV because they increase agency and empowerment among AGYW (54,55).…”