Assessing Change in the Knowledge, Attitudes and Practices of Youth in Two Districts of Imereti, Georgia, Regarding Healthy Lifestyles and Reproductive Health

This 83-page report details the implementation and impact of a 5-year project designed to improve reproductive health (RH) outcomes in selected districts of the Imereti, Kakheti, Tbilisi and Guria Regions of Georgia. This area is characterised by a health care philosophy that has historically favoured curative rather than preventative approaches to family planning, relying on abortion as birth control due to isolation from the development of modern, safe, and effective contraception elsewhere in the world. A lack of public information and discussion on RH has exacerbated silences that the initiative described here has sought to shift.

Specifically, launched in the autumn of 2003, the Healthy Women in Georgia (HWG) project is an effort to enhance the knowledge, attitudes, and practices of young adults (especially those 15-17 years of age) regarding healthy lifestyles and RH; it is being implemented by John Snow Inc. Research & Training Institute (JSI) along with Save the Children (SC) and 6 local non-governmental organisations (NGOs): Orthos, Curatio International Foundation, CLARITAS, Caucasus Social Marketing Association, HERA, and McCann Erickson. Author Larry Dershem here outlines the project - describing its purpose and motivation, detailing its strategies and activities, and highlighting evaluation data that indicate its impact. He focuses on the mid-term results of a population-based study which examined RH and related youth lifestyle issues in an effort to assess the behaviour change and communication change (BCC) component of HWG.

Dershem describes HWG's BCC activities; in short, they include: a) Conducting healthy lifestyles sessions, or HLS, (held after school), b) holding health awareness activities (e.g., sport competitions, health quizzes, art exhibitions, and newspaper wall displays), c) broadcasting radio programmes and spots, d) conducting peer education training and outreach, e) holding theatre performances (featuring either professional actors or peer educators), f) providing a telephone hotline service, and g) distribution of printed materials such as booklets, posters, calendars, and peer educator guidelines.

Three surveys and 3 case studies were carried out to assess the impact of these activities. The first survey, the baseline survey (BLS), was a youth population survey conducted in November 2004. The second youth population survey, originally intended to be at project end, became the mid-point survey (MPS) because of a project extension; it took place in May 2006. The third survey, the Healthy Lifestyle Session Survey (HLSS), used a systematic sampling procedure and was carried out among HLS participants.

Following this detail of survey design, Dershem shares data from the BLS and MPS which illuminate some of the challenges associated with smoking, alcohol use, abortion, and other issues in this region - and the impact that HWG has had. Results of the BLS and MPS are then compared, with findings detailed. In short, the most significant outcome the HLS had on the youth who attended, compared to youth in the general population at the MPS, was increasing their knowledge on almost all healthy lifestyle and RH issues. For example, there was a significant increase in the percentage of youth who could identify one or more negative consequences of having an abortion; 50% in BLS increasing to 70% at the MPS. Based on qualitative data gleaned from case studies, the author cites other impacts; for instance, "barriers have been lowered and taboos overcome about discussing their concerns or problems related to puberty, sexual relations and reproductive health". He claims that both boys and girls are not only openly discussing these issue among themselves, but with their friends - and increasingly with adults.

A series of recommendations are shared. For instance, evaluators learned that listening to the radio is common among the vast majority of youth surveyed and is a cheap and effective means of communication, although television and magazines were also mentioned as primary sources of RH information. In addition, friends have increasingly become a main source of RH information regardless of gender, age, or location; therefore, the outreach strategy of well-informed and accepted peer educators appears to hold promise. Although there was a substantial increase in the knowledge among youth of negative consequences of smoking, those youth who knew many more negative consequences of smoking were as likely to smoke as youth who knew few. The author suggests integrating some positive messages about not smoking (e.g., having more spendable cash for other things) into the healthy lifestyle sessions. Also, use of the hotline service was found to be very low; the author suggests that a study be undertaken to understand whether barriers such as access (e.g., poor connection or busy lines) or stigma (e.g., fear of voice being recognised) are factors.