Table 1.
Characteristics of studies included in systematic review of use of behavioural theory in HIV prevention interventions in youth in sub-Saharan Africa.
| Author, year | Country | Year of intervention | Study design | Sample size at baseline (males/females) | Main intervention activities (duration) | Intervention setting (urban/rural) | Theory or theories used | Role of theory in the study | Explanation provided about why theory used? |
|---|---|---|---|---|---|---|---|---|---|
| Central Africa | |||||||||
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| |||||||||
| Van Rossem and Meekers [31] | Cameroon | 1996-1997 | Repeat C/S, quasiexperimental | 1606 (753/757) | Behaviour change communication and promotion through peers and in media, condom distribution, youth-friendly services (13 months) | Community (urban) | Health Belief Model | Development of intervention and questionnaire/evaluation | No |
|
| |||||||||
| Speizer et al. [32] | Cameroon | 1997-1998 | Repeat C/S, quasiexperimental | 802 (400/402) | Through discussion groups, one-on-one meetings, and health and sport association gatherings, peer educators informed their peers and referred them to services. Promotional materials were distributed in schools and community (18 months) | School + Community (urban) | NR, focus on knowledge | NA | NA |
|
| |||||||||
| Meekers et al. [33] | Cameroon | 2000-2001 | Repeat C/S, pre post-controlling for exposure | 1956 (1056/900) | Media and interpersonal communication campaign. Peer education, magazine, radio drama, radio call-in show, media campaign, condom promotion (12 months) | Community (urban) | Health Belief Model, Social Learning Theory, Theory of Reasoned Action | Development of intervention and questionnaire/evaluation | No |
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| Eastern Africa | |||||||||
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| Klepp et al. [34, 35] | Tanzania | 1990 | Cohort, randomized schools | 1063 (502/561) | Teachers provided information, students created posters and performed songs, poetry, drama and role-play, small-group discussions among students. Interviews and panel discussions with parents and community members (2-3 months) | Primary school (urban + rural) | Social Learning Theory and Theory of Reasoned Action | Development of intervention and questionnaire/evaluation | No |
|
| |||||||||
| Shuey et al. [36] | Uganda | 1994–1996 | Repeat C/S, quasiexperimental | 800 (398/402) | Strengthen existing school health curriculum, meeting with parents and community leaders, formation of school health clubs with peer education, question boxes (2 years) | Primary school (urban + rural) | Social Cognitive Theory | NR | No |
|
| |||||||||
| Kinsman et al. [37] | Uganda | 1997-1998 | Cohort, quasiexperimental | 2077 (920/1157) | Extracurricular classes by trained teachers (1 year) | Primary and secondary schools (rural) | Behaviour Changes for Interventions Model | Development of intervention and questionnaire/evaluation | No |
|
| |||||||||
| Erulkar et al. [38] | Kenya | 1998–2000 | Repeat C/S, quasiexperimental | 1544 (792/752) | Adult counsellor in community educating youth, referral to youth-friendly services and encouraging parent-child communication (3 years) | Community (urban + rural) | NR, focus on values, knowledge, gender, and empowerment | NA | NA |
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| |||||||||
| Ross et al. [39], Doyle et al. [40] | Tanzania | 1998–2002 | Repeat C/S, randomized communities | Ross: 9219 (5103/4116) Doyle: 13814 (7300/6514) |
Participatory, teacher-led, peer-assisted, in-school program, youth-friendly health services, condom promotion and distribution, and youth health days and video shows in community (3 years) | School + Community (rural) | Social Learning Theory | Development of intervention | No |
|
| |||||||||
| Maticka-Tyndale et al. [41] | Kenya | 2002-2003 | Repeat C/S, randomized schools | 7392 (3636/3764) | Peer education on level of teachers and students, question boxes, school health clubs, information corners and assemblies, drama, music and literary performances (18 months) | Primary school (urban + rural) | Social Learning Theory and Scripting Theory | Development of intervention | Yes |
|
| |||||||||
| Rijsdijk et al. [42] | Uganda | 2008 | Cohort, randomized schools | 1986 (1096/889) | low-tech, computer-based, interactive comprehensive sex education programme, teacher-led (6 months) | Secondary school (urban + rural) | Theory of Planned Behavior and Health Belief Model | Development of intervention | No |
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| Southern Africa | |||||||||
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| Kuhn et al. [43] | South Africa | 1990 | Repeat C/S, quasiexperimental | 567 (not reported) | Intense, high-profile focus on AIDS in the school by teachers (2 weeks) | Secondary school (urban) | NR, focus on knowledge and attitudes | NA | NA |
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| |||||||||
| Harvey et al. [44] | South Africa | 1993-1994 | Cohort, randomized schools | 1080 (447/633) | “School open day” with drama, song, dance, poetry, and posters prepared and presented by students (3 days) | Secondary school (urban + rural) | Applied behaviour change framework | Development of questionnaire/evaluation | No |
|
| |||||||||
| Meekers [45] | South Africa | 1994–1997 | Repeat C/S, quasiexperimental | 226 (0/226) | Mass media campaign, peer education and condom promotion and distribution (35 months) | Community (urban) | Health Belief Model | Development of questionnaire/evaluation | No |
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| |||||||||
| Fitzgerald et al.; Stanton et al. [46, 47] | Namibia | 1996 | Cohort, randomized participants | 515 (236/279) | Curriculum taught by a teacher and out-of-school youth (7 weeks) | Secondary school (urban + rural) | Social Cognitive Theory/Protective Motivational Theory | Development of intervention and questionnaire/evaluation | No |
|
| |||||||||
| Kim et al. [48] | Zimbabwe | 1997-1998 | Repeat C/S, quasiexperimental | 1426 (713/713) | Mass media campaign, community drama groups, peer educators, youth-friendly health services (6 months) | School + Community (urban) | Steps to Behaviour Change Framework | Development of intervention | No |
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| |||||||||
| James et al. [49] | South Africa | 1998 | Cohort, randomized schools | 1168 (542/616) | Reading of a comic book (1 hour) | Secondary school (urban + rural) | Theory of Health Promotion and Social Learning | Development of intervention | No |
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| |||||||||
| Visser [50] | South Africa | 1998–2000 | Repeat C/S, pre post-controlling for exposure | 873 (410/463) | Trained teachers and professionals provide life skills and HIV/AIDS education. Parents included in action committee (1 year) | Secondary school (urban) | Health Belief Model | Development of intervention | No |
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| |||||||||
| Underwood et al. [51] | Zambia | 1999-2000 | Repeat C/S, quasiexperimental | 921 (378/543) | Participatory developed mass media campaign (7 months) | Community (urban + rural) | Stage Theory of Behaviour Change | Development of intervention | No |
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| |||||||||
| Magnani et al. [52] | South Africa | 1999–2001 | Cohort, pre post-controlling for exposure | 3052 (1375/1677) | Life skills curriculum taught by teachers (2 years) | Secondary school (urban) | Social Learning Theory | Development of intervention | No |
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| |||||||||
| Agha [53] | Zambia | 2000 | Cohort, randomized schools | 481 (268/213) | Peer educators using discussion and drama skits (1 hour 45 min) | Secondary school (urban) | NR, focus on knowledge, normative beliefs, and risk perception | NA | NA |
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| James et al. [54] | South Africa | 2001 | Cohort, randomized schools | 936 (456/466) | Life skills intervention taught by trained teachers (20 weeks) | Secondary school (urban + rural) | Social Cognitive Theory and Theory of Planned Behaviour | Development of questionnaire/evaluation | No |
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| |||||||||
| Plautz et al. [55] | Madagascar | 2001-2002 | Cohort, pre post-controlling for exposure | 1785 (1000/785) | Youth-friendly services, mass media, and interpersonal communication by peer educators (23 months) | Community (urban + rural) | Social Learning Theory, Health Belief Model, and Theory of Reasoned Action | Development of intervention and questionnaire/evaluation | No |
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| |||||||||
| Karnell et al. [56] | South Africa | 2002 | Cohort, randomized schools | 661 (324/337) | Peer educators using recorded monologues of fictional characters, teacher support (8 weeks) | Secondary school (urban) | Social Learning Theory, Social Inoculation, Cognitive Behaviour Theory | Development of intervention and questionnaire/evaluation | Yes |
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| Visser [57] | South Africa | 2002-2003 | Repeat C/S, quasiexperimental | 1918 (858/1060) | Peer education (18 months) | Secondary schools (urban) | Systems Theory | Development of intervention | No |
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| Jewkes et al. [58, 59] | South Africa | 2003-2004 | Cohort, randomized communities | 2776 (1360/1416) | Participatory learning approaches taught by facilitators, peer group meeting, community meeting (6–8 weeks) | Community (rural) | Participatory Learning Approach and Adult Education Theory | Development of intervention | No |
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| Tibbits et al. [60] | South Africa | 2004-2005 | Cohort, randomized schools | 4040 (2020/2020) | Comprehensive, risk-reduction life skills curriculum for adolescents, teacher-led (24 months) | Secondary school, urban | Selective optimization with compensation, Self-Determination Theory, and Social Cognitive Theory | Development of intervention | Yes |
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| Mason-Jones et al. [61] | South Africa | 2007-2008 | Cohort, quasiexperimental | 3934 (1661/2211) | Government-led peer education project, in class standard curriculum, conversations outside class, referral (18 months) | Secondary school (urban + rural) | NR, knowledge and psychosocial characteristics | NA | NA |
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| |||||||||
| Baird et al. [62] | Malawi | 2008-2009 | Cohort, randomized schools | 3796 (0/3796) | Monthly cash transfer programme to reduce the risk of STI infection (24 months) | School + community (urban + rural) | NR, focus on structural factor (poverty and education) and knowledge | NA | NA |
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| Burnett et al. [63] | Swaziland | NR | Cohort, randomized youth | 204 (101/103) | Teacher-led life-skills HIV prevention education program, curriculum, interactive techniques, role playing, and group discussions (13 weeks) | Secondary school (urban) | Self-efficacy theory and Protection Motivation Theory | Development of intervention | No |
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| Western Africa | |||||||||
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| Brieger et al. [64] | Nigeria and Ghana | 1994–1997 | Repeat C/S, quasiexperimental | 1784 (not reported) | Peer educators, promotion of community-level networks, referral to services (30 months) | School + Community (urban) | NR, focus on knowledge and attitudes | NA | NA |
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| Fawole et al. [65] | Nigeria | 1996 | Cohort, pre post-controlling for exposure | 450 (204/246) | Education sessions by community physicians with help of teachers (1 month) | Secondary school (urban) | NR, focus on knowledge and attitudes | NA | NA |
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| Okonofua et al. [66] | Nigeria | 1997-1998 | Repeat C/S, randomized schools | 1896 (877/1008) | Establishment of reproductive health club in school, health awareness campaigns by professionals, distribution of print material, peer education, youth-friendly services (11 months) | Secondary school (urban) | NR, focus on knowledge and barriers | NA | NA |
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| Van Rossem and Meekers [67] | Guinea | 1997-1998 | Cohort, quasiexperimental | 2016 (925/1091) | Peer educators (discussion and theatre), condom promotion, billboards, youth-friendly services and contraception distribution (8 months) | Community (urban) | Health Belief Model | Development of questionnaire/evaluation | No |
|
| |||||||||
| Atwood et al. [68] | Liberia | 2007-2008 | Cohort, randomized schools | 812 (455/357) | Curriculum-based program by health educators (8 weeks) | Primary school (urban) | Social Cognitive Theory and Theory of Reasoned Action | Development of intervention | No |
C/S: Repeated cross-sectional design.
NR: No theory is explicitly reported, dominant constructs used in the intervention.
NA: Not applicable.