Plautz A, Meekers D. Evaluation of the Reach and Impact of the 100% Jeune Youth Social Marketing Program in Cameroon: Findings from Three Cross-Sectional Surveys. Reprod Health. 2007 Feb 26;4:1.
To evaluate the reach of the 100% Jeune youth social marketing program; to determine trends in reproductive health behavior and their predictors; and to estimate the effect of program exposure on these variables.
This analysis is a longitudinal, cross-sectional evaluation of data from three waves of the Cameroon Adolescent Reproductive Health Survey, implemented at 18-month intervals between 2000 and 2003.
Yaoundé and Douala, Cameroon.
Participants were drawn from a sub-sample of unmarried youth aged 15-24 years surveyed in the Cameroon Adolescent Reproductive Health Survey. Data from 1,956 youth were included in the 2000 survey; 3,237 in 2002; and 3,370 in 2003. A four-stage stratified sampling design was employed to select eligible participants. Neighborhoods were selected using probability of selection proportional to population size, and households were chosen randomly from a list of households in which at least one eligible person resided. Participants were younger in 2000 compared to 2002 and 2003. Males comprised approximately 55% of participants in all years, and participants had lower levels of education in 2002 compared to 2000 and 2003.
100% Jeune is a social marketing program for reproductive health aimed to reduce barriers to condom use and increase safe behavior among youth. It was launched in 2000 in Yaoundé and Douala by Programme de Marketing Social au Cameroon, an affiliate of Population Services International, and was supported through the Gates Foundation. Drawing on elements of the social learning theory, the theory of reasoned action, and the health belief model, the program targeted youth aged 15-24 years and used a combination of mass media and interpersonal communication methods to promote abstinence and consistent condom use as effective strategies to prevent unwanted pregnancies, sexually transmitted infections (STIs), and HIV. Mass media efforts included peer education sessions, a weekly radio call-in show, a monthly magazine, and a serial radio drama. Integrated television, radio, and billboard campaigns, as well as a network of branded youth-friendly condom outlets, supported these activities. Messages and activities were refined in 2002 on the basis of mid-project research results and an external evaluation of the peer education program.
Using pre-tested French-language questionnaires, trained peer interviewers assessed the respondents' HIV risk behavior, level of sexual activity, and condom use. This study examined the extent to which perceived severity of sexual risk, perceived susceptibility, perceived condom attribute and access, perceived social support, and self-efficacy predict condom use. Unprompted and prompted exposure to the 100% Jeune program and other reproductive health programs were also assessed. Respondents who reported having high exposure to two or more of the key campaign elements were classified as having "high" exposure, those who reported high exposure to only one campaign element as having "medium-high" exposure, and the remainder as having "low" exposure. Prompted recall (i.e. remembering) of specific elements in the 100% Jeune program was only assessed in 2002 and 2003, as the 2000 survey was conducted before the program was fully implemented.
The percentage of youth reporting having heard of at least one reproductive health program (unprompted) increased significantly from 35% in 2000 to 42% in 2002 to 50% in 2003. Unprompted recall of the 100% Jeune program increased from 1% in 2000 to 26% in 2002. Between 2002 and 2003, the level of unprompted recall remained constant. Recall to multiple, specific elements of the 100% Jeune program was significantly higher during 2003 than in 2002 (p<0.01).
The percentage of respondents who reported always using condoms with regular partners increased from 14% in 2000 to 21% in 2002 to 31% in 2003 among females and from 20% to 33% to 45% among males (p<0.01). Similarly, the percentage of respondents reporting always using condoms with casual partners increased from 29% in 2002 to 50% in 2002 to 70% in 2003 among females and from 45% to 53% to 70% among males (p<0.01). Despite efforts to promote abstinence, the program did not decrease the level of sexual activity or reduce the number of sexual partners. Likewise, there is no evidence that the 100% Jeune program or other reproductive health programs for youth in Cameroon led to increased sexual activity.
Among both male and female respondents, almost all predictors of condom use (perceived severity, perceived susceptibility, perceived condom attributes and access, self-efficacy, and social support) improved during the study period, as did the indicators of condom use. Although the levels of risky sexual activity did not decline during the study period, among males, self-reported STI symptoms within the previous year decreased from 20% in 2000 to 11% in 2003 (p<0.01).
Results of dose response analysis indicate that some of the positive changes in condom use and predictors of use can be attributed to the 100% Jeune program. Among females reporting high exposure to the program in 2003, 39% reported consistent condom use with regular partners, compared with 20% in the 2002 low-exposure reference group (p <0.01). Secular trends based on comparisons of lower exposure groups indicate improvements from 20% in 2002 to 27% in 2003. Among males in the high exposure group in 2003, 53% reported consistent condom use with regular partners, compared with 29% in the reference group (p<0.01). The secular trend indicated an improvement of 29% to 38%. For several variables, there were observed secular trends not attributable to the 100% Jeune program, indicating that factors besides the 100% Jeune program contributed to improvements in outcome variables.
The authors concluded that 100% Jeune reached a high proportion of youth throughout the intervention period and that the program contributed to substantial increases in condom use, including consistent use with regular partners among youth of both sexes.
There are no widely accepted quality-scoring tools available for evaluating this type of study. As with other studies that rely on self-reported data, the results of this study are subject to reporting errors and biases. Additionally, the quality of this study was limited in that the positive changes reported by respondents cannot be attributed specifically to the 100% Jeune program. The authors note that a measure of exposure to any reproductive health program increased little between 2000 and 2002 despite the high reach of 100% Jeune, suggesting that the program predominantly reached youth who had already been reached by other programs.
Reproductive health programs often employ theories such as the health belief model, social learning theory, and the theory of reasoned action to identify behavior-change program objectives and activities. Recent studies of African youth confirm that perceived severity, perceived susceptibility, perceived condom attribute and access, perceived social support and self-efficacy influence levels of condom use, although their relative importance varies across contexts.(1-6)
The consistent statistically significant trends identified in this study suggest a positive role for social marketing programs aimed at youth in Cameroon; however, the effects of the 100% Jeune program specifically are not clear. The authors recommend that resources should be allocated to identify and understand predictors of abstinence and partner reduction to inform future programming decisions. The differences found between the genders are notable, especially the lower condom use in females, and deserve further study and intervention.
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