Table 3.

Intervention adaptation plan

ORIGINAL INTERVENTION	PLANNED ADAPTATIONS
INTERVENTION GOALS
‘To reduce unintended pregnancy and promote sexual health and wellbeing’	Change goals to directly highlight aims to reduce HIV/STI rates and gender inequalities in SRH, as well as unintended pregnancy. ‘To reduce unintended early pregnancy, HIV and STI rates and gender inequalities in sexual and reproductive health’
INDIVIDUAL LEVEL DETERMINANTS TARGETED BY THE INTERVENTION
FOR ADOLESCENTS: Knowledge Skills Beliefs about consequences Self-efficacy Gender role norms Normative beliefs	Add: ‘Beliefs about barriers to condom use and contraception’
ENVIRONMENTAL LEVEL DETERMINANTS TARGETED BY THE INTERVENTION
FOR PARENTS/CAREGIVERS AND EDUCATORS: Knowledge Skills Self-efficacy	Add: ‘Beliefs about speaking to young people about SRH’
INTERVENTION INPUTS AND ACTIVITIES
FOR ADOLESCENTS: Interactive video drama (IVD) Group activities Homework activity FOR PARENTS/CAREGIVERS: Animated films Parent/Caregiver factsheet FOR EDUCATORS: Training Materials	Amendments: IVD uses local actors and is filmed in local areas. All activities and materials are contextually appropriate (e.g. mention local statistics and services) Activities increase current focus on gender inequalities, consensual sex and substance use An activity that focuses on transactional sex is added Activities are amended to mention appropriate local barriers to condom/contraception use and misconceptions about condoms and other contraceptives Lesotho materials are amended to account for the criminalisation of abortion An activity focused on the dangers of unsafe abortion is added for both countries An activity targeting LGBTQI adolescents is added Homework activity is replaced with an individual activity that helps young people to safely identify an older trusted adult that they could speak to about SRH Parent/caregiver activities are amended to address local concerns, particularly addressing cultural taboo relating to adults speaking to children about SRH and increasing knowledge that talking about SRH does not encourage sex Parent/caregiver/educator materials refer to SRH education rather than relationships and sexuality education All online activities are coupled with paper versions for those with no internet access All activities should refer to SRH rather than ‘sex’ or sexuality as this is more taboo
PERFORMANCE OBJECTIVES (INTERVENTION OUTPUTS)
FOR ADOLESCENTS: Knowledge: Know how to prevent Unintended Early Prgnancy (UEP)/HIV/STIs; discounting myths about condoms; know it is good to wait until ready to have sex; know where to access contraception/safe abortion and find sexual health information and support; know that condoms prevent UEP/HIV/STIs. Skills: communicating with peers, partners and adults (health professionals, teachers); using condoms and other methods of contraception Beliefs about consequences: Believing that when a person is ready and prepared, relationships, sex and pregnancy can be positive experiences; believing that UEP/HIV could be a challenging experience which would impact on current life and future goals and plans; believing in the need to take action in order to avoid negative consequences Self-efficacy: Communicating with peers, partners and adults (parents, educators, health professionals); obtaining condoms/contraception; negotiating condom use; using condoms/contraception correctly; in SA obtaining safe abortion. Feeling confident about being able to communicate about sex and UEP, say no to sex, and obtain and use contraception Normative beliefs: Believing that peers are not having sex; Believing that peers always use contraception when they have sex; Believing that peers should not pressure others to have sex. Gender role norms: believing that both men and women have roles and responsibilities in avoiding UEP/HIV; both men and women should carry condoms; sexual pleasure is not a human right; consensual sexual relationships; ‘real’ men respect women’s sexual decisions; planning for and expecting positive sexual experiences.	Add: Knowledge: know what is consensual and non-consensual sex; know about the possible negative consequences of transactional sex; know how to evaluate relationships; know where to seek help for unhealthy or abusive relationships. For Lesotho, remove ‘know where to access abortion’. For both countries; know about the risks of unsafe abortion and know about post-abortive care. Skills: communicate expectations with sexual partners; avoiding or leaving unhealthy relationships Beliefs about consequences: believing that unhealthy relationships will impact negatively on current life and future goals Believing that gender equal relationship can be happy and fulfilling Self-efficacy: Confidence in ability to communicate personal expectations, preferences and limits Normative beliefs: Add – Believing that peers are not having sex until they feel ready; believing that peers always use condoms when they have sex, even in monogamous/steady relationships; believing that peers should not pressure others to not use condoms, believing that sexual partners should not pressure each other not to use condoms; believing that condom use is not a sign of a distrust in relationships. Gender role norms: Add – Believing that women have the right to make decisions about sex; believing that women have the right to refuse sex; believing that women have the right to request the use of condoms and to refuse sex if condoms are not available; believing that women in transactional relationships have the right to refuse sex without condoms; believing that using condoms does not emasculate men.
BEHAVIOURAL OUTCOMES
Delayed age of sexual initiation Avoidance of unprotected/condomless sex Condom use Contraceptive use Gender equality	Add: Safe abortion/post-abortive care Healthy relationships Testing for HIV/STIs/pregnancy Asserting gender equal relationships
THEORETICAL FOUNDATIONS
Theory of Planned Behaviour Transtheoretical Model of Behaviour Change Social Cognitive Theory Social norms Theory Socio-cultural influences (gender, religion, social class) Gender-transformative theory	Consider/Add: Theories of stigma Theories of power
DELIVERY METHODS
Delivered by trained teachers Delivered in Post-primary schools	Change: Delivery by trained young adult facilitators Deliver in schools and community settings Consider/Add: Drama narration versions of films delivered via local radio