Felton Earls, Professor of Social Medicine, recently reported the publication of a definitive article on his team’s years of work with youth living in communities impacted by the HIV/AIDS pandemic in Tanzania. The paper, “Enhancing adolescent self-efficacy and collective efficacy through public engagement around HIV/AIDS competence: A multilevel, cluster, randomized trial,” appears in Social Science and Medicine 75 (2012) 1078-1087 and online on May 24th, 2012. Mary Carlson and Robert T. Brennan are co-authors.
The authors evaluated the effectiveness of the Young Citizens Program, an adolescent-centered health promotion curriculum designed to increase self- and collective efficacy through public education and community mobilization across medium-sized municipality in the Kilimanjaro Region of Tanzania. Adolescents between the ages of 9 and14 were selected from administratively defined neighborhoods and acquired the understanding and confidence to publicly engage their communities about HIV/AIDS as they dramatized the scientific basis and social context of HIV infection, testing, and treatment over a 28-week period. Based on individual and community surveys conducted before and after the intervention, adolescents were found to have increased their deliberative and communicative self-efficacy. Adults in these same communities were found to have an enhanced belief in adolescents’ ability to encourage more open communication and to contribute to greater understanding about HIV/AIDS. Following consistently positive outcomes of this cluster randomized-controlled trial, the control group received the same curriculum.
Among the outcomes, the authors report, “Although HIV testing facilities existed in the municipality, residents appealed to the participating adolescents during their performances to bring testing services directly to the community. In response, the original and second treatment groups joined to organize community HIV testing and counseling health fairs in conjunction with district health officials.” Seventy-five percent of the adults tested at these fairs stated that the Young Citizens community engagement had prompted them and their children of all ages to be tested.
This work represents a major contribution to social science and health promotion based on its strong social and behavioral theoretical framework and rigorous scale development and multilevel analytic approach. The intervention strengthened both the personal and community capabilities to exercise control over biomedical and social dimensions of HIV/AIDS. The program design is ready for replication and expansion to other health and social conditions and in other settings. The authors conclude:
“The longer-term goal is to engender structural change in which child and adolescent participation in HIV health promotion reduces stigma and promotes testing and treatment as key elements of HIV/AIDS community competence. The benefits to adolescents are seen both in their increased sense of efficacy as well as an increase in collective efficacy in their communities in the face of a serious health challenge. The community stands to benefit from the greater inclusiveness in the health competence it attains as well as from the vanguard of a new generation of informed, engaged citizens.”