Jobs, food, taxis and journals: Complexities of implementing Stepping Stones and Creating Futures in urban informal settlements in South Africa

Abstract

This paper seeks to refocus debates on structural interventions away from 'assessing' their effectiveness towards understanding processes around how such interventions are implemented. Implementation Science is focused on understanding potential challenges of translating interventions from highly controlled conditions into 'real life' settings. Using the case study of Stepping Stones and Creating Futures a structural and behavioural intervention to reduce intimate partner violence and HIV risk behaviours amongst young women and men in urban informal settlements, we explore the challenges of implementing such an approach. We move beyond simply describing challenges of implementing, to understand how these challenges had an impact on the safe social space the intervention seeks to create as its underlying theory of change. We identify four major challenges of implementation: taxi fares, food provided during the intervention, young people's ongoing need to work and journals provided during the intervention. We suggest that, in different ways, these factors all impinged on the emergence of a safe social space. Understanding the challenges of implementing the intervention is critical for reflecting on scaling up interventions. Central to this is the need to work with participants to help them negotiate the challenges of participating in interventions.

The Stepping Stones and Creating Futures intervention to prevent intimate partner violence and HIV-risk behaviours in Durban, South Africa: study protocol for a cluster randomized control trial, and baseline characteristics

“…Pilot results from long-term qualitative and quantitative research have been published [14, 20, 41]. Analysis showed men’s mean earnings in the past month increased by 247% from R411 (~$40) to R1015 (~$102), and women’s by 278% R 174 (~$17) to R 484 (about $48) (trend test, p  < 0.0001).…”

“…Prevalence of moderate or severe depression symptomatology and suicidal thoughts among men decreased significantly ( p  < 0.0001; p  = 0.01 respectively) [14]. Qualitative data from the pilot study suggested that women and men enjoyed participation in the intervention [20, 41]. In qualitative research primarily focused on men, men reported increased livelihood opportunities and greater savings [20].…”

“…Given the limited understanding of how participatory group-based interventions are delivered in ‘real-life’ and that processes of change are often ‘black boxes’ in large trials [41, 56], this study has an integrated qualitative process evaluation. The process evaluation comprises qualitative research with participants (both male and female) and facilitators.…”

Intimate partner violence: A key correlate of women’s physical and mental health in informal settlements in Nairobi, Kenya

“…disputes, and population densities, present different barriers to violence prevention in informal settlements [8,68]. A small, but growing body of research focused on designing and testing violence prevention interventions in informal settlements in LMICs, mostly in South Africa [38,40,42,69,70], suggests that structural and behavioral interventions such as gender trainings and small-scale interventions, e.g. micro-loan programs, support groups, and joband skills-trainings, might be effective strategies to help to empower women and serve as models for larger future projects in these settlements [8].…”

Factors associated with young people's attendance at an IPV prevention intervention in informal settlements in South Africa: A prospective analysis

“…Structural factors, particularly poverty, consistently undermines intervention attendance (Ringle et al, 2015;Williams et al, 2010). Poverty can operate in multiple ways, from creating conflict between work and work seeking, and session attendance (Gibbs, Jewkes, Mbatha, Washington, & Willan, 2014;Whittaker & Cowley, 2012;Williams et al, 2010), to participants lacking money to travel to sessions (Ringle et al, 2015). It is also plausible that youth living in the greatest poverty have poorer education levels , which may make intervention groups seem less familiar, friendly settings.…”