Evaluating the computer-assisted HIV/AIDs education intervention implemented in school’s in Uganda

Abstract

Over 29 years into the epidemic, fighting HIV (Human Immunodeficiency Virus), the virus that causes AIDS (Acquired, Immune, Deficiency, Syndrome) continues to be a global concern. School-based computer-assisted HIV/AIDS interventions can provide innovative ways of preventing HIV among young people from diverse backgrounds in Africa. However, questions of technological, social and organisational readiness cannot be overlooked. This is because of: (1) being health interventions implemented in educational centres; (2) limited technological facilities and skills; (3) the prevailing norms that associate young people’s sex education with sex experimentation. Despite these concerns, there are significantly few studies evaluating school based computer-assisted HIV/AIDS interventions in developing countries. In addition, the commonly used health promotion theories have limited application in HIV prevention. These theories tend to lack sufficient attention to contextual mediators that influence implementation and impacts of HIV interventions. This research addresses some of these gaps by evaluating the implementation and the impacts of a computer-assisted HIV/AIDS intervention, known as the World Starts with Me (WSWM), which is implemented in schools in Uganda. To overcome some of the criticisms voiced above, this research employed mixed quantitative and qualitative methods to conduct three investigations. Investigation 1 is a quantitative controlled before-after intervention study that assessed the level of significance of the impacts of the WSWM intervention on in-school young people. Investigation 2 is a qualitative cross-case analysis study that explored in-depth why the WSWM intervention implementation was completed in one school but abandoned in another. Investigation 3 is a qualitative study that assessed in-depth the impacts and the computer-mediated benefits of the WSWM intervention on out-of-school young people. Overall, this research involved 584 quantitative questionnaires answered by 292 participants, 53 interviewees and 2 focus group discussions comprising of 50 participants. Findings indicate that: (1) the intervention significantly improved the in-school young people’s HIV/AIDS knowledge, attitudes self-efficacy, sex abstinence and fidelity, but had no significant impact on condom use. (2) Implementation factors include technological facilities, perceived usefulness, confidence and skills, cultural-religious compatibility, management support, match with routine workflow, and institutional climate, all of which were more favourable in the school that completed the intervention than in the school that abandoned it. (3) The intervention had positive impacts on the out-of-school young people’s sexual behaviours, HIV/AIDS knowledge and perception of vulnerability, attitudes and self-efficacy. (4) Contextual mediators such as familial mediators, relationship characteristics, peer influence, gender-biased social norms, economic constraints and religious beliefs influence young people’s uptake of HIV preventive measures. (5) Computer-mediated benefits of the intervention include privacy and confidentiality of the otherwise sensitive information, unlimited geographical accessibility, source of the otherwise denied sexuality and HIV/AIDS information, and interactivity and social support.