Small Group Interventions

Question 1

SMALL GROUP INTERVENTIONS

Answer 1

• change towards thinking about how people can change situations/health w/focus on small group interventions

Question 2

KEY PRINCIPLES

Answer 2

1. health beh = not really about correct knowledge; while it’s a prerequisite for health beh, it’s not sufficient
2. health beh = linked to people’s identities/behs; meaningful to individuslas (even unhealthy)
3. identities = constructed in situations NOT of people’s choosing; material/symbols/institutional contexts shape possibilities of people’s identities/behs
4. powerlessness = important aspects of poor health

Question 3

2 CRITIQUES

Answer 3

1. technological solutions oft seen as solution to poor health BUT require people’s identites to change (ie. COVID-19 vaccines; uptake in people’s identities/alienation)
2. health promotion interventions oft focus on either scaring into change (ie. smoking/alcohol) OR assume people lack knowledge/otherwise have deficit to fill

Question 4

GRAM (2020): CLASSROOM, CLUB OR COLLECTIVE?

Answer 4

• suggests 3 types of interventions to promote health = common:
  1. CLASSROOM
• focused on transfer of knowledge/skills
  2. CLUBS
• tranfer knowledge OR problem-solving
  3. COLLECTIVE
• problem-solving & group action

Question 5

THEORY OF WHY THEY WORK (I)

Answer 5

• creation of “safe social spaces” via small groups; compromise 2 facets:
  1. space = safe; aka. trust/privacy/openness = possible
  2. dialogical communication can occur (in contrast to didactic communication); -> conscientisation; comprises of 3 aspects:
  i. KNOWLEDGE
• correct/relevant knowledge introduced
  ii. DIALOGUE
• open/honest discussion w/linked/trusted peers about sensitive topics
  iii. REFLECTION
• reflect on knowledge/meaning; integrate it into current knowledge/identities

Question 6

THEORY OF WHY THEY WORK (II)

Answer 6

• participatory activities promote transfer of knowledge/dialogue/reflection -> dialogical communication
• processes led by “facilitator”

Question 7

PAULO FREIRE: KEY CONCEPTS

Answer 7

BANKING EDUCATION
PROBLEM-POSING EDUCATION
CONSCIENTISATION/CRITICAL CONSCIOUSNESS

Question 8

FREIRE: BANKING EDUCATION

Answer 8

• didactic education
• students = empty vassals to be filled w/teacher’s wisdom
• aka. knowledge = gift bestowed by the “knowledgable” upon those they consider to know nothing

Question 9

FREIRE: PROBLEM-POSING EDUCATION

Answer 9

• dialogue = heart
• people’s knowledge/ideas = important BUT no real dif between teachers/students; rather knowledge = constructed BETWEEN people

Question 10

FRIERE: CONSCIENTISATION/CRITICAL CONSCIOUSNESS

Answer 10

• via dialogue (problem-posing) people understand “real” causes of their issues & how they may come together to challenge/change them

Question 11

AUGUSTO BOAL: KEY CONCEPTS

Answer 11

FORUM THEATRE
- actors act out oppression scene
- spectators come up to try & change story once finished
REHEARSAL FOR REALITY
- aspects of illuminating how change can/may happen in safe spaces

Question 12

TRANSFERRING IDEALISM OF FREIRE -> GLOBAL HEALTH PRACTICALITIES

Answer 12

• how do we take Freire & others to implement in ways to use to improve people’s health & measure such changes?
• via peer education & SGIs focusrd on problem solving approached underpinned by Freirian ideas

Question 13

CASE STUDY: STEPPING STONES & CREATING FUTURES (BACKGROUND)

Answer 13

• young people in urban informal settlements in South Africa experience multiple overlapping challenges (ie. high IPV perpetration & experience/poor mental health/substance abuse/HIV-incidence) driven by poverty (2/3rds young people = unemployed)/gender inequitable norms supporting of men’s power over women/other violence experiences in childhood/adulthood

Question 14

CASE STUDY: STEPPING STONES & CREATING FUTURES (CONCEPT)

Answer 14

• 2 components:
  1. transforming gender norms
  2. livelihood strengthening
• 21 sessions; each 3h; primarily single sex
• men/women AREN’T in relationships
• delivered by trained peer-facilitarors
• based on assumptions of participatory methodologies

Question 15

CASE STUDY: STEPPING STONES & CREATING FUTURES (KEY CONCEPTS)

Answer 15

• leanrer centred
• participatory
• skill-building (ie. communication/livelihood)
• experience based
• role plays/discussions/games

Question 16

CASE STUDY: STEPPING STONES & CREATING FUTURES (METHODOLOGY)

Answer 16

• ongoing qualitative process & outcomes evaluation incl.
  1. in-depth interviews w/20 men & women
  2. photovoice w/10 young women on reproductive choices
  3. facilitator observations/interviews
• integrated cost-effectiveness analysis

Question 17

CASE STUDY: STEPPING STONES & CREATING FUTURES (FLOWCHART)

Answer 17

• 34 clusters (n = 1360)
• control = 17 clusters (340 women/men)
• intervention = ^
• intervention -> receive intervention
• control/intervention = 12 & 24 month follow-up

Question 18

CASE STUDY: STEPPING STONES & CREATING FUTURES (MEN’S OUTCOMES)

Answer 18

• self-reported IPV perpetration/alcohol use
• sig reduction in past year physical/sexual perpetration (p = .019)
• sig reduction in past year economic IPV perpetration (p = .035)
• marginal reduction in past year non-partner rape perpetration (p = .1)
• sig reduction in overall alcohol consumption in past year (p = .041)
• sig increase in savings (totals & past month)
• sig increase in past year work consistency (p < .001)

Question 19

CASE STUDY: STEPPING STONES & CREATING FUTURES (WOMEN’S OUTCOMES)

Answer 19

• sig increase in working in past 3 months (p = .002)
• sig increase in past year work consistency (p = .006)
• sig increase in past month earnings
• increased total amount saved

Question 20

WASHINGTON, JEWKES & GIBBS: ANALYSIS OF MEN CHANGING IN SSCF (CREATION OF SAFE SOCIAL SPACES)

Answer 20

• establishment of egalitarian relations between facilitators/pps; aka:
  1. non-judgemental; open to speak/discuss freely
  2. sharing own stories/experiences
  3. emergence of brotherhood

Question 21

WASHINGTON, JEWKES & GIBBS: ANALYSIS OF MEN CHANGING IN SSCF (KNOWLEDGE)

Answer 21

• practical skills to navigate livelihoods (ie. basic livelihood skills shared; experience of trying/receiving positive feedback)
• communiation skills (ie. “I” statements)

Question 22

WASHINGTON, JEWKES & GIBBS: ANALYSIS OF MEN CHANGING IN SSCF (DIALOGUE & REFLECTION)

Answer 22

• emotional impact/masculinity; challenged dominant ideas of non-expressive masculinities via sharing stories of shame/building trust, etc.
• deconstructing ideals & managing anger/shame; many resisted unideal work; personal failings = collective challenge shaped by wider context; encouraged to accept other work; helped reduce shame/anger about position
• shifts in relations w/women; recognised impact of power/control over others

Question 23

SSCF: WHY DIDN’T IT IMPACT WOMEN MORE?

Answer 23

• little “space” for women to assert change in relations; intervention failed to engage women’s sexual partners
• exceedingly high rates of poor mental health compounded by multiple/repeitive traumas; must be addressed before engaging in other life changes
• high poverty rates; while earnings sig increased post intervention, overall earnings = still v low; aka. change = hard

Question 24

SSCF: NOT IMPACTING MEN EQUALLY

Answer 24

• aka. limits of SGIs
• LCA of SSCF to group men into 3:
  1. most violent (29.4%)
  2. medium violence (50.2%)
  3. lowest violence (NOT peaceful; 20.5%)
• trial outcomes show impact of SSCF = on most violent (p = .014)

Question 25

SUMMARY

Answer 25

- small group interventions = key approach to intervening to improve health BUT must: 1. create safe spaces 2. provide factual knowledge 3. support pps to engage in dialogue about topic in open way 4. support pps to reflect on new knowledge & integrate it into current world views (aka. rehearsal for reality)