Straight Talk Campaign In Uganda: Parent Survey

Straight Talk Campaign in Uganda: Parent Survey Karusa Kiragu1, Cathy Watson2, Medard Muhwezi3, Richard Kibombo4, Tobey Nelson5, Ann Akia-Fiedler3, and Milka Juma6

1

Horizons/PATH, Nairobi Straight Talk Foundation, Uganda 3 Formerly Straight Talk Foundation, Uganda 4 Makerere University, Uganda 5 Horizons/International Center for Women, Washington DC 6 Formerly Horizons, Nairobi 2

Acknowledgments The principle investigators for this study were Karusa Kiragu (Horizons/PATH, Nairobi), Tobey Nelson (Horizons/ICRW, Washington DC), Ann McCauley (formerly with Horizons/ICRW, Washington DC), and Milka Juma (formerly with Horizons/Population Council, Nairobi). This report was prepared by Karusa Kiragu. Data collection was supervised by Richard Kibombo, an independent statistician consultant at Makerere University. Scott Geibel (Horizons/Population Council, Nairobi) was the data analyst for the study. Alison Lee (consultant, Washington DC) copy-edited the report, and Sherry Hutchinson (Horizons/Population Council, Washington DC) oversaw the layout. The research team would like to thank Straight Talk Foundation (STF) for their exceptional support including Cathy Watson (STF Director), Anne Akia Fiedler (formerly STF Programme director), Medard Muhwezi (formerly Head, Monitoring and Evaluation Section, STF), and the entire Monitoring and Evaluation Section. Special appreciation is extended to the adolescents and parents who answered the questions in this study. The authors are grateful to the United States Agency for International Development (USAID-Uganda) and the Department for International Development (DFID) for funding this evaluation. This publication was developed and produced by the Horizons and Straight Talk Foundation research teams. This document was reviewed by members of the research team but it did not receive an external technical review. The information, findings, and recommendations expressed herein do not necessarily represent the views of Horizons/Population Council. This document is one of four background documents to the final report, “The Straight Talk Campaign in Uganda: Impact of Mass Media Initiatives,” which can be accessed at www.popcouncil.org/pdfs/horizons/UgandaStraightTalk.pdf.

This study and final report were made possible by the President’s Emergency Plan for AIDS Relief and the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Cooperative Agreement No. HRN-A-00-97-00012-00. The contents do not necessarily reflect the views of USAID or the United States Government. Published in September 2007.

This study was also supported by a grant from the UK Department for International Development. This document may be reproduced in whole or in part without permission of the Straight Talk Foundation provided full source citation is given and the reproduction is not for commercial purposes.

Table of Contents Abbreviations Abstract

1

Introduction and Background

2

Definition of exposure to STF materials Methods

2 4

Sample design

4

Ethical clearance and gatekeeper approvals

4

Study tools and administration

4

Interviewer training and data collection

4

Data processing and analysis

5

Limitations of the survey

5

Results

6

Exposure to ST materials

7

Utilization of Parent Talk

7

Utilization of Straight Talk and Young Talk newspapers

7

Utilization of Straight Talk radio

7

Parent-child communication

8

Attitudes toward gender

9

Attitudes toward teaching adolescents reproductive health education in school

11

Knowledge

12

HIV testing

13

Conclusions and Discussion

14

References

16

Abbreviations ABC AGI ASRH BCC EA GYC HIV/AIDS OVC PT PMCT ST STD STI STF UBOS UDHS UNCST USAID UHSBS VCT YT

Abstinence, Be faithful, Use condoms Alan Guttmacher Institute Adolescent sexual and reproductive health Behavior change communication Enumeration area Gulu Youth Centre Human Immunodeficiency Syndrome/Acquired Immune Deficiency Disease Orphans and vulnerable children Parent Talk Prevention of mother to child transmission (of HIV) Straight Talk Sexually transmitted diseases Sexually transmitted infection Straight Talk Foundation Uganda Bureau of Statistics Uganda Demographic and Health Survey Uganda National Council for Science and Technology United States Agency for International Development Uganda HIV/AIDS Sero-Behavioral Study Voluntary counseling and testing Young Talk

Straight Talk: Parent Survey

Abstract The purpose of this study was to assess how Ugandan parents are using Straight Talk Foundation materials designed for their adolescent children as well as for themselves. The materials comprise of a weekly multi-lingual radio program for adolescents, a monthly multilingual newsletter for older adolescents, a quarterly English language newspaper for younger adolescents, and an English language newspaper for parents. The parent newspaper, Parent Talk, was launched in June 2004 and at the time of the survey, only three issues had been published. Since 2006, STF has been broadcasting multi-lingual radio programs for parents, and has also launched multi-lingual versions of Parent Talk. However, these were not in existence during the evaluation and are therefore not addressed in this report. A total of 678 mothers and fathers with children between the ages of 10 and 19 years of age were interviewed in six districts in Uganda through a house-hold survey. In four of those districts, STF has more intensive activities and are therefore termed as high intensity districts. Data were collected in August 2005 using a face-to-face questionnaire. The results show that many parents are familiar with STF activities, and about 60 percent are exposed to the materials. Parents in high intensity districts are twice as likely to report exposure as those in low intensity districts (65 percent vs 35 percent). Fathers have more access to STF materials than mothers but being in a high-intensity district equalizes this gap. About 16 percent of parents had read Parent Talk newspaper; among these, 62 percent had taken some action as a result and nearly all would recommend it. Half the parents have ever talked to their adolescent-age children about reproductive health, but 55 percent would prefer that the child go elsewhere for this information. Three quarters feel schools should teach their children family planning and two thirds feel they should teach about condoms. Results show an association between parental communication during the respondent’s adolescence, and whether s/he had ever talked to their adolescent child now: respondents whose own parents had ever talked with them when they were teenagers were twice as likely to also talk with their own children. There is also direct correlation between residing in a high-intensity district and having talked with the child, with 40 percent of those in low-intensity districts having had such a talk compared to 56 percent of those in high-intensity districts. Parents appear to possess attitudes that may socialize their daughters into male subservience and their sons into female dominance. For example, nearly a third seemed to feel that boys should be favored in case of scarce resources, about the same proportion seem to question the intellect of girls relative to boys, about 40 percent seem to imply that wives should tolerate abuse from husbands, and about half feel that men should be the final decision makers in terms of sexual activities. In summary, the study demonstrates that parents are an important audience for STF materials and a significant proportion uses them. Those who use them seem to like them and so efforts to promote them to parents may be worth the while. The data also suggest that parents need considerable help talking with their children, and STF’s efforts to assist them would be greatly welcomed.

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Introduction and Background It is normally expected that parents should socialize their children appropriately and help them navigate the transition from adolescence to adulthood. Discussions between parents and children about sexual issues can clarify expected behavior, enable parents to communicate their values, and provide a chance to educate and inform the child. While some studies have mixed results, most research shows that parent-child communication is associated with healthier sexual decision making, delayed onset of sex, and greater likelihood of having protected sex among those who are sexually active. Parent-child communication can foster a sense of caring between parents, create a supportive environment, and strengthen the connectedness between parents and children. The Straight Talk Foundation (STF) has been working in Uganda since 1993, as a voice for adolescents. It has been implementing a wide array of audience-driven activities to communicate with adolescents, and to help them re-script their lives into healthier adults. It does this through multilingual Straight Talk (ST) radio programs, multi-lingual ST newspapers for older adolescents (those in secondary schools), and Young Talk (YT) newspapers for younger adolescents (those in primary schools). While initially focused on adolescents, STF has increased its activities for parents, teachers and other adults significant to the lives of Ugandan adolescents. Many STF products address parents directly or indirectly. They also encourage adolescents to talk with their parents. In June 2004, STF embarked on an English language newspaper Parent Talk, specifically for parents. This was followed in 2006 by prints in four other languages. In 2005, STF also started to broadcast half-hour parent-centered weekly radio programs, also called Parent Talk. Parent Talk radio now airs in six languages: Luganda, 4Rs, Lukonzo, Lugbara, Lwo and Lumasaba. In addition to promoting healthy parent-child issues, Parent Talk activities also promote parent-specific topics such as healthy living and the Basic Care package that has been shown to reduce mortality and morbidity especially among those infected with HIV. Through scripts, the radio programs address general adult issues, including parenting. Parents are also being encouraged to form Parents Clubs. STF also conducts activities in schools, focusing on training teachers to foster a youth-friendly school environment. In 2005, STF and Horizons/Population Council undertook on a cross-sectional household survey to document the impact of STF programs on adolescents. An important component of this evaluation was also to assess the extent to which parents used STF materials and what they thought of them. STF also wished to assess parental knowledge and attitudes, in order to develop responsive activities. Therefore a nested parent survey was included, and this report presents its findings.

Definition of Exposure to STF Materials The main STF materials being assessed in this study are a) Parent Talk newspaper; b) ST radio programs, and c) ST or YT newspapers. Parent Talk radio was not yet under way and is therefore not included in this report. In order to assess the dose-response association between exposure to STF materials and the study outcomes, parents have been classified into four groups: a) those not exposed to any item, b) those exposed to one item, c) those exposed to two items and d) those exposed to all three items. A second measure of exposure will be media intensity at the district level (see Box 1 below). STF has been implementing its activities at varying levels of intensity in different districts; the variations are largely limited by funding shortage. As Box 1 shows, all districts receive the English STF and the

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Straight Talk: Parent Survey

English YT1 newspaper. They also receive the weekly English STF youth radio show. In addition, four districts, Apac, Arua, Ntungamo, and Soroti receive weekly half hour radio shows in their local language. They also receive occasional local language versions of the ST newspaper. This varying response has provided a natural experiment whereby some districts have more activities than others. For the purpose of this study, districts receiving just the English newspapers and radio show are characterized as “low intensity”. Those receiving the English language papers and radio shows, AND also receiving local language newspaper and radio show, are characterized as high intensity. Thus the main difference between low and high-intensity districts is the presence of local language programming in the high intensity districts.

Box 1 Definition of district media intensity by parental exposure to STF materials

Radio

Newspapers

1

High intensity districts(Apac, Arua, Ntungamo, and Soroti)

Low intensity districts (Kamuli and Kisoro)

English Straight Talk program

English Straight Talk program

Local language Straight Talk program

None

Young Talk (English)

Young Talk (English)

Straight Talk (English)

Straight Talk (English)

Local language Straight Talk

None

YT newspaper is only published in English language.

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Methods Sample Design A more detailed explanation of the survey and its methods is found on the evaluation’s full report 2. The survey targeted 2,160 never-married adolescents ages 10 to 19 years in six districts: Apac, Arua, Ntungamo, Kamuli, Kisoro, and Soroti. These districts were selected to provide a diverse geographic distribution of ST activities. In about a third of households, a parent or guardian was targeted for interviewing, generating a sample of 736 parents. During data cleaning, 58 questionnaires were eliminated due to missing information. Thus this report is based on the remaining sample of 678 parents. Interviews were structured so as to generate a 50/50 gender balance. The parents’ interviews occurred only in households where an adolescent had been interviewed, in order to facilitate the relevance of the questions. The study was conducted in two counties in each district, for a total of 12 counties. Within each county, a sub-county, parish and eventually enumeration area was identified using random sampling procedures. The enumeration areas were based on the Uganda Bureau of Statistics (UBOS) system. The STF survey used the same list recently compiled for a household survey of adolescents conducted by ORC/Macro and Alan Guttmacher Institute (AGI) (Neema et al. 2006).

Ethical clearance and gatekeeper approvals The questionnaires and consent forms were approved by the Uganda National Council for Science and Technology (UNCST). The study protocol had also been reviewed and approved through Horizons’ ethical review procedures. In each district, the study also sought the approval of district officials, community gatekeepers, and others as appropriate. Each respondent interviewed in the study provided written informed consent prior to commencement of the interview. Parental/guardian consent was also obtained for all adolescents participating in the study, regardless of age. The questionnaires and consent forms were stored separately in order to ensure no identifying information could be linked.

Study tools and administration Parents were interviewed at their homes using face-to-face questionnaires. Each questionnaire took about 30 minutes to complete. The questionnaires were translated into six languages: Ateso, Luo, Lugbara, Lusoga, 4Rs, and Rufumbira. They were administered by interviewers fluent in the local language. The questionnaires were pre-tested and revised twice before data collection. They were also reviewed by the data entry team, in order to identify problems that could hamper data entry.

Interviewer training and data collection Interviewers were trained over a four-day period, in August 2005. Sixty enumerators and 12 supervisors, including six STF monitoring and evaluation staff, were trained. Most of the enumerators were university students or graduates who had conducted interview research before, and many had worked with UBOS. Training topics included the research objectives, interviewing skills, household listing, respondent selection, call-backs, quality control, obtaining consent, and ethics in research. The 2

The full report is available on the Straight Talk Foundation web site at http://www.straighttalk.or.ug/downloads/downloads.html.

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Straight Talk: Parent Survey

interviewer training included a field practicum, after which the questionnaire was revised, finalized, and printed. In each district, the research team comprised about ten interviewers and a supervisor. Supervisors received training covering household listing, household selection, field work management, and other aspects to enhance quality control. Because a purpose of the evaluation was capacity building, STF staff from the Monitoring and Evaluation department was involved in all aspects of data collection and fieldwork supervision. Data collection started on August 29, 2005 and ended on September 7, 2005.

Data processing and analysis Once the data were collected, the supervisor reviewed the questionnaires and identified any problems needing correction. At the end of the day, the supervisor collated the questionnaires and entered them into a data collection registry. Each batch of questionnaires identified district, county, sub-county, and parish of origin. The consent forms were also collected, labeled, and stored in separate envelopes. The items were stored in a secure and locked box or room and prepared for shipping to Kampala for data entry. Data entry at STF premises began as soon as data collection was over, using EPI-DATA software version 3.02. The questionnaires were keyed twice to minimize data entry errors. Technical support for the data entry process was provided by a Makerere University statistician with input from the Horizons data analyst. Data cleaning yielded 58 unusable questionnaires, reducing the sample to 678 parents. Data were analyzed using SPSS v. 11 and STATA v 9.0 software. Data analysis included univariate and bivariate methods.

Limitations of the survey An important limitation of this study is the representativeness of the sample at the district level. Because the survey did not purport to provide district estimates, no proportionate allocations were attempted. Therefore conclusions at the district level should be made with caution. A second limitation was social desirability bias. Even though respondents were informed that the interview was confidential and anonymous, and each respondent was interviewed in private, it is possible that some of them gave socially desirable answers. The final limitation derives from the fact that this was a cross-sectional survey. Therefore it cannot provide evidence of “causality”. Rather it provides evidence of associations between outcome and predictor variables. The reader is alerted to keep these limitations in mind.

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Results Among the 678 respondents in the sample, 336 (50 percent) were fathers and 342 (50 percent) were mothers (see Table 1). They had an average of 6.2 children, which included 6.8 among fathers and 5.5 among mothers (data not shown). Further analysis of family size documented that an average of 2.8 children were between the ages of 10 and 19 years. When asked about the relationship to the adolescent who was also interviewed, 44 percent of the respondents indicated the child was their son, 40 percent indicated the child was their daughter, and 16 percent indicated that the child was an “other relative” (grandchild, niece, nephew, brother, sister, etc.). The majority of respondents (75 percent) resided in rural areas and had lived at their current resident for over 20 years. About 80 percent had primary or less education, and only 22 percent were employed outside the home.

Table 1 Demographic characteristics of the respondents Characteristics Mean age in years % reside in urban area Mean number of years at current residence^ % employed outside home Highest level of education Never attended school Primary Secondary and over % Christian % married % living with partner if married Mean number of children Mean number of children ages 10-19 District of residence Low ST intensity district High ST intensity district Intensity of exposure to ST materials Not exposed Exposed to 1 item Exposed to 2 items Exposed to 3 items

Males (n = 336)

Females (n = 342)

All (n = 678)

46.4 24.1 24.7 28.4

39.0 26.9 16.8 16.5

42.8 25.5 20.5 22.4

19.1 51.5 29.5 84.2 95.8 97.8 6.8 3.0

39.4 47.4 13.2 82.6 76.3 87.0 5.5 2.7

29.3 49.4 21.3 83.4 86.0 93.1 6.2 2.8

35.4 64.6

34.8 65.2

35.6 64.4

34.8 21.1 29.8 14.3

44.4 27.2 21.9 6.4

39.7 24.2 25.8 10.3

^Excludes those who said “always resided here”, i.e., 31.4 percent of men, 23.9 percent of women, and 27.7 percent of all.

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Straight Talk: Parent Survey

Exposure to ST Materials As mentioned earlier, parents were classified by the level of intensity with which ST activities were being implemented. Based on this classification, about two-thirds of parents resided in districts considered “high intensity” ST districts (see Table 1). Parents were also asked if they had ever been exposed to any ST materials, specifically: a) Parent Talk newspaper, b) ST’s newspapers for adolescents (i.e., Young Talk or Straight Talk), or c) Straight Talk radio programs. Parent Talk was still relatively new, having been started the year before the survey in 2004, and only three issues had been distributed by then (one on parent-child communication, the other two on couple communication). About 16 percent had been exposed to Parent Talk, 41 percent to Straight Talk or Young Talk newspapers, and 55 percent to the Straight Talk Radio programs. These responses were further combined and classified as exposed to 0, 1, 2, or 3 ST items. Using this classification, the data show that 40 percent of the parents had never been exposed to any ST materials, while 10 percent had been exposed to all three items (see Table 1). About 65 percent of parents in high intensity districts are accessing STF materials, compared to 35 percent of their counterparts in low-intensity districts. While fathers are more likely to access STF materials in general compared to mothers (65 percent vs 56 percent), the differences narrow in high-intensity districts, and fathers are just as likely to access STF materials as mothers. Thus activities in high intensity districts seem to allow mothers to catch up with fathers.

Utilization of Parent Talk The 82 parents who had read Parent Talk were further interviewed to document their use of the magazine. About 21 percent had read Parent Talk every time or almost every time, 34 percent had read “a few times,” and 45 percent “rarely.” When asked what kind of information readers obtained, 82 percent said they learned about how to talk to their children, and about parent-child relationships. About 62 percent (52 parents) said that they took some type of action as a result of reading Parent Talk. The most common action was talk to other parents/friends (39 percent), talk with child’s friends (17 percent), recommend the magazine to someone (17 percent), or talk with spouse (13 percent). Nearly all readers (96 percent) said they would recommend Parent Talk to other parents.

Utilization of Straight Talk and Young Talk Newspapers The 41 percent (n=270) of respondents who knew of ST or YT newspapers were asked how they learned about them, and 30 percent said through the radio, 27 percent said through their children, 22 percent said from other parents, and 9 percent said from the newspapers. When asked whether they had ever recommended the newspapers to the child being interviewed, 66 percent said they had, 29 percent said they had not, and 5 percent said the adolescent already read them.

Utilization of Straight Talk Radio The 55 percent (n=367) of parents who listened to Straight Talk Radio were asked whether they had ever taken any action as a result of the exposure, and 62 percent said they had. For most (90 percent), the action comprised talking to their children.

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Parent-child Communication Parents were asked which one person they thought their children would feel most comfortable talking to “about growing up, relationships, and sexual matters.” About 39 percent felt that the child would prefer talking to the respondent himself/herself, and 12 percent thought the adolescent would prefer the other parent. Thus, about half preferred themself or the other parent to talk to the child. The rest, or nearly half the parents, believed that their children would feel most comfortable talking to other individuals about sex, and not themselves. Parents were also asked who they preferred the child talk to about these issues and 29 percent said they would prefer that the child come to them, while 16 percent preferred the child go to the other parent. Thus 45 percent of parents preferred that their child come to them or to the other parent. When asked to specify who, if not the parent, they preferred their child to go to, those who preferred this option specified aunts/uncles (10 percent), teachers (8 percent), or brothers and sisters (8 percent) to talk to the adolescent. Put together, the data suggest that the majority of parents, i.e., 55 percent, prefer that someone else, rather than themselves, assume the role of educating their children about sexuality and reproductive health.

Table 2 Parent-child communication Respondents’ characteristics

Percent ever talked to child

Among talked (n = 344) mean age at which talked

50.5 51.3

12.1 11.9

50.5 47.5 59.4

11.9 11.7 12.6

54.1 49.8

12.4 11.8

40.8* 56.4*

12.2 11.9

40.2* 58.0* 57.1* 60.0* 50.9

11.8 11.8 12.0 12.2 12.0

Sex Fathers Mothers Schooling status No schooling Primary Secondary Current residence Urban Rural District type Low intensity High intensity Intensity of exposure to ST materials Not exposed Exposed to 1 item Exposed to 2 items Exposed to 3 items All respondents

* Association between ST exposure and outcome significant at p < 0.05

Parents were also asked whether they had ever talked with the adolescent being interviewed about “issues related to sexuality,” and half (51 percent) said they had (see Table 2). This is consistent with the finding that about half the adolescents said that they had held such a discussion with their parents (see study full report). There was a correlation between residing in a high-intensity ST district and the parent having talked to the adolescent (p = 0.00). There was also an association between ST exposure

8

Straight Talk: Parent Survey

and having talked to the adolescent as well (p = 0.000). The average age at which such a conversation started was when the adolescent was 12 years old. On average, those who had talked to their children during the year had done so an average of 4.2 times (range 0–20 times), and about half of these had had a conversation in the previous week (data not shown). When asked who started the conversation, 92 percent of parents said they did, and 90 percent said they thought the discussion was very helpful. When asked what the adolescent thought about the last discussion, 69 percent of the parents said that the adolescent was “happy it had happened,” 13 percent said the adolescent was unhappy, and 18 percent could not determine. Parents who already talk to their children appeared confident and comfortable doing so: over 96 percent said they felt “very comfortable” or “comfortable,” 97 percent reported feeling confident about their ability to hold these talks, and 97 percent considered themselves well-informed and knowledgeable enough to hold these discussions. All respondents were asked whether they had ever talked to their own parents about sexual matters when they were teenagers themselves, and 42 percent had, 56 percent had not and 2 percent could not remember. There was an association between parental communication during the respondent’s adolescence, and whether s/he had ever talked to their adolescent child now: 54 percent of those who said their parents had talked to them had also talked with their child, compared to 29 percent of those who said their parents had not talked to them (p = 0.000).

Attitudes Toward Gender Parents were read a series of statements on gender, in order to document their opinions. They could agree with the statement, disagree, or say they cannot decide. The results are presented in Table 3 and show that many parents possess attitudes that may socialize their daughters into male subservience and their sons into female dominance. For example, when read the statement, “If money is scarce and the family cannot send all children to school, boys should be sent before girls,” 26 percent agreed, with no sex differences. However, respondents in high intensity ST districts had more genderequitable responses than those in low intensity districts. There was also a strong correlation between exposure to ST materials and possessing more gender equitable responses. A similar pattern was observed with other statements: for example, when read the statement, “Girls are generally not as intelligent as boys,” this time 27 percent agreed with the statement, again with no differences between mothers and fathers. The correlation between gender-equitable responses and ST exposure was also evident in this question even though it did not reach statistical significance. Respondents were also read statements assessing the extent to which they would accept domestic violence against women (see Table 3). The results show that 66 percent of respondents agreed with the statement that “women should tolerate abuse from her husband in order to keep the family together”, with mothers themselves more likely to agree so than fathers. There was no correlation between abuse tolerance and exposure to ST activities (ST materials had not addressed domestic violence among adults). When read the statement, “There are times when women deserve to be beaten,” 35 percent agreed, with mothers as likely to agree as fathers. There was no association between ST exposure and responses to this question. The data also suggest that many parents harbor attitudes that could socialize males into domination. For example, when read the statement, “When it comes to sex, it is the man who should have the final word,” 47 percent agreed, with only minor sex differences. Exposure to ST materials was associated with more egalitarian attitudes, but only at the highest level, suggesting that these opinions are deeply

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Table 3 Attitudes Respondents’ characteristics

% agree that when money is scarce and the family cannot send all children to school, boys should be sent before girls

% disagree that it is OK for boys to have sex before marriage

% agree that girls are generally not as intelligent as boys

% agree that a woman should tolerate abuse from her husband in order to keep her family together

% agree that when it comes to sex, it is the man who should have the final word

% agree that there there are times when women deserve to be beaten by their husbands

% disagree that % disagree that % agree that in % disagree that a girl who it is ok for girls Uganda, men who a school boy becomes to have sex have many women who makes a pregnant while before marriage are considered schoolgirl in school should “powerful” pregnant should be expelled be expelled from school

Summary of gender score (out of 10 possible points)

23.6 28.5

92.8 94.1

25.9 27.9

62.3* 70.4*

44.0* 49.4*

34.5 34.4

39.4 30.9

93.7 92.3

24.2* 21.1*

45.5 38.9

6.3* 5.9*

Schooling status No schooling Primary Secondary or more

33.0* 26.7* 16.7*

94.4 93.1 93.0

30.6 27.0 22.2

66.2 69.5 39.7

52.8* 50.9* 29.9*

32.3 37.0 31.5

27.4* 34.2* 46.9*

92.4 93.4 93.0

26.7* 23.3* 16.1*

33.2* 43.1* 51.7*

5.6* 6.0* 6.9*

Current residence Urban Rural

15.7 29.5

95.4 92.8

17.4* 30.2*

64.5 67.0

40.4 48.9

32.7 35.1

37.2 34.4

92.4 92.3

18.1 24.2

41.9 42.3

6.5* 6.0*

District type Low intensity High intensity

28.2* 24.8*

91.6 94.5

28.3 26.2

69.8 64.5

41.6* 49.5*

33.2 35.2

33.9 35.8

93.3 92.9

26.5* 20.6*

36.9 45.1

5.8* 6.2*

Intensity of exposure to ST materials Not exposed Exposed to 1 item Exposed to 2 items Exposed to 3 items

31.7* 25.2* 25.6* 8.6*

91.4 93.9 96.0 94.3

28.7 27.0 29.7 12.9

70.8 63.4 62.1 67.1

48.5* 51.2* 46.6* 30.0*

33.3 36.0 34.7 34.8

31.0* 30.9* 39.4* 50.0*

91.8 94.4 93.7 92.9

27.1* 18.8* 23.4* 12.9*

38.1* 38.1* 43.4* 64.3*

5.7* 6.1* 6.3* 7.2*

42.2

6.1

All respondents 26.0 93.5 26.9 66.4 46.7 34.5 35.1 93.3 22.7 *Association between ST exposure and outcome significant at p < 0.05; statistical significance could be reflecting variations in “agree”, “disagree” or “cannot decide”.

10

Straight Talk: Parent Survey

Sex Fathers Mothers

Straight Talk: Parent Survey

engrained. When read the statement, “In Uganda, men who have many women are considered powerful,” 23 percent agreed, again with only minor sex differences. These data suggest that large proportions of parents in the survey held views conducive to serious gender inequities, inequities that could leave both their sons and daughters at great risk for HIV. In order to assess gender variation in the acceptability of premarital sex, respondents were read the statement, “It is OK for boys to have sex before marriage.” Nearly all (94 percent) disagreed, suggesting strong opposition to premarital sex among adolescent males (see Table 3). Similarly, they were read the statement “It is OK for girls to have sex before marriage,” and again, nearly all (93 percent) disagreed. Respondents were also read a statement to explore attitudes toward pregnancyrelated school expulsion and whether they had different attitudes toward pregnant schoolgirls and schoolboys who made schoolgirls pregnant. The first statement was, “A girl who becomes pregnant while in school should be expelled.” About 35 percent of the parents disagreed with this statement, with sharp differences by education and exposure to ST materials. When asked the same of boys (“A schoolboy who makes a schoolgirl pregnant should be expelled”), 42 percent disagreed, also with sharp differences by education level and exposure to ST materials. Put together, the results suggest a less punitive response to school-related pregnancies. But the results also indicate parents are more willing to allow the boy to remain in school than the girl. An aggregate gender score was developed by awarding a point for each response that demonstrated gender equity. The ten questions in Table 3 were used to construct the scale and points ranged from 0 (strongly gender biased) to 10 (strongly gender equitable). The mean score was 6.1, suggesting a justabove-average level of gender-equitable attitudes. There was a strong correlation between ST exposure and the gender score: respondents in high ST intensity districts had a gender score of 6.2, compared to those in the low intensity district with a score of 5.8 (p = 0.000). There was also relationship between number of items a respondent had been exposed to and the mean score: mean score for those exposed to 0 items was 5.7, those exposed to one item was 6.1, those exposed to two items was 6.3, and those exposed to three items was 7.2 (p = 0.000).

Attitudes Toward Teaching Adolescents Reproductive Health Education in School Parents were asked whether they thought adolescents should be taught various topics in school. The overwhelming majority of parents (94%) felt that their children should be taught about HIV/AIDS, abstinence (92 percent), and being faithful (86 percent). The majority also felt that their children should be taught about family planning in school (74 percent), boy-girl relationships (72 percent), and sexuality (70 percent). About two-thirds (66 percent) felt that their children should be taught about condoms in school (see Table 4).

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Table 4 Percent who agree that young people should be taught the following topics Respondents’ characteristics Sex Fathers Mothers Schooling status No schooling Primary Secondary or more Current residence Urban Rural District type Low intensity High intensity Intensity of exposure to ST materials Not exposed Exposed to 1 item Exposed to 2 items Exposed to 3 items All respondents

Family planning

Sexuality

HIV/ AIDS

Condoms

Abstinence Being faithful

Boy-girl relationships

77.4 71.0

70.3 70.2

93.7 94.7

64.3 68.2

93.9 89.2

87.8 85.0

70.0 74.5

75.3 74.2 72.0

68.5 69.8 73.9

90.8 95.2 96.5

65.3 66.7 64.3

89.6 92.4 93.0

87.1 84.9 88.9

69.6 70.9 78.9

66.1 76.9

70.8 70.0

96.0 93.6

68.4 65.6

91.2 91.7

86.0 86.5

74.3 71.6

73.0 76.3

65.8 72.8

93.1 96.2

66.7 66.1

90.7 93.2

86.9 86.1

67.4* 75.0*

75.4 72.7 73.6 74.3 74.1

66.9 68.4 74.4 75.7 70.2

94.4 92.0 93.7 100.0 94.2

66.0 61.0 69.5 71.4 66.2

91.3 88.7 92.0 98.6 91.6

84.2 83.7 89.7 92.9 86.4

68.2 70.0 78.2 78.6 72.3

* Association between ST exposure and outcome significant at p < 0.05

Knowledge Six true/false questions were included in the questionnaire, to document the level of knowledge among parents. They comprised the following (percent correct shown in parenthesis): A person can get the AIDS virus by having sexual intercourse without a condom (81 percent). A person who looks healthy can be infected with the AIDS virus (90 percent). The AIDS virus can be passed from a pregnant mother, if she is infected with HIV, to her unborn child (75 percent). Using condoms usually prevents pregnancy (75 percent). A girl cannot get pregnant if she has sex the first time she has intercourse (59 percent). If used correctly and consistently, condoms are effective in preventing HIV transmission (69 percent). The results show that the parents were informed about some of the questions listed above but suggest gaps in others. For example, the data suggest that a quarter of parents are not aware of perinatal transmission of HIV, the same proportion is not aware that using condoms can prevent unwanted pregnancy, and about 30 percent are not aware that using condoms correctly and consistently can prevent HIV transmission. In addition, nearly 40 percent are not aware that a girl can get pregnant the first time she has sex. An aggregate knowledge score was developed by awarding a point for each correct answer, and the scale ranged from 0 (all answers incorrect) to 6 (all answers correct). The mean score was 4.2. There was a correlation between ST exposure and the knowledge score: respondents in high ST intensity districts had a mean knowledge score of 4.4, compared to those in the low intensity district with a mean score of 3.8 (p = 0.000). There was also relationship between the number of items a respondent had been exposed to and the mean score: those exposed to 0 items had a mean score of 3.7, those

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Straight Talk: Parent Survey

exposed to one item had a mean score of 4.5, those exposed to two items had a score of mean 4.5, and those exposed to three items had a mean score of 4.3 (p = 0.000).

HIV Testing Parents were asked whether they had been tested for HIV and 19 percent said they had. Those in highintensity districts were more likely than those in low-intensity districts to have been tested (23 percent versus 11 percent; p = 0.000). There was also a strong association between HIV testing and the number of materials one had been exposed to: 10 percent of those exposed to zero items had been tested, compared to 18 percent of those exposed to one item, 27 percent of those exposed to two items, and 33 percent of those exposed to three items (p = 0.000).

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Conclusions and Discussion It is often desired that parents be able to communicate with their children about sexual matters, so that they can impart parental expectations, nurture values, and strengthen the relationship between themselves and their children. However, many factors mediate the extent to which parents can converse effectively with their children including parental knowledge, communication skills, and beliefs. In Uganda, STF has been implementing activities to educate parents about adolescent sexual health, as part of a broader program to help adolescents navigate their own course from childhood to adulthood. This paper presents the extent to which parents have utilized STF materials, and the extent to which these materials are associated with selected outcomes. The results show that many parents are familiar with STF activities, and about 60 percent are exposed to the materials. This means that STF messages about parents and children are being accessed by more than half the parents in the study area. About 65 percent of parents in high intensity districts (i.e. districts receiving both English and local language programming) are accessing STF materials, compared to 35 percent of their counterparts in low-intensity districts (receiving English language programming only). While fathers are more likely to access STF materials in general compared to mothers (65 percent vs 56 percent), the differences narrow in high-intensity districts, and fathers are just as likely to access STF materials as mothers (around 65 percent each). Thus adding local language programming seems to allow mothers to catch up with fathers. Given the crucial role mothers play in the upbringing of their children, the benefit of implementing activities in a language that they can understand is clear. About 16 percent of parents had read Parent Talk newspaper and among these, 62 percent had taken some action as a result, suggesting that parents found useful information to act on. Nearly all who read Parent Talk said they would recommend this newspaper. The results also show that many parents like ST youth publications and 66 percent had already recommended it. About 55 percent of parents also listen to ST radio. Half the parents have ever talked to their children about ASRH, comparing well with the figures in companion the adolescent survey that found that half the adolescents had ever talked with their parents. However, it means that half have not, a cause for concern since all parents interviewed had an adolescent between the age of 10 to 19 residing in the household. There is a direct correlation between residing in a high-intensity district and having talked with the child: while only 40 percent of those in low-intensity districts had had such a discussion, this rises to 56 percent for parents in high-intensity districts. This suggests that STF efforts to help parents talk to their children are essential. Strengthening the ability of parents to talk to children is particularly important because most already say they are uncomfortable doing so, and 55 percent would prefer that the child go elsewhere for this information. Results show an association between parental communication during the respondent’s adolescence, and whether s/he had ever talked to their adolescent child now: respondents whose own parents had ever talked with them when they were teenagers were twice as likely to also talk with their own children. This implies that the efforts parents invest in today, will make it simpler for their children to talk with their own children in the future. In addition, those parents who communicate with their children feel that these discussions are useful, suggesting that activities to encourage parent-child communication are likely to lead to a good experience for parents. The companion report to this study also documents that adolescents whose parents had talked with them found the experience to be a positive one (Adamchak et al, 2007), indicating a win-win outcome for both parent and their children. Parents appear to possess attitudes that may socialize their daughters into male subservience and their sons into female dominance. For example, a quarter feels that boys should be favored in case of scarce resources, a similar proportion questions the intellect of girls relative to boys, two thirds say that wives should tolerate abuse from husbands, a third feel that “there are times when women deserve to be beaten by their husbands”, and about half feel that men should be the final decision makers in terms of sexual activities. These beliefs point to the need for parent-centered activities that can help mothers and fathers to

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Straight Talk: Parent Survey

deconstruct their values and examine them in the context of how they are socializing their children. Mass media activities can provide important triggers for self-reflection and discussion, but the Parents Clubs that STF is promoting can go a step further in providing an environment where parents can talk with peers. These activities can be more effective if they are strategically guided and build on behavioral theories such as Social Cognitive Theory, and social structural theories such as the Theory of Gender and Power (DiClemente et al, 2002). Many parents feel that adolescents should be taught reproductive health in schools, with three quarters feeling they should even be taught about family planning in school and two thirds be taught about condoms. Thus many parents are open to schools taking on many sensitive topics and this information may be of interest to teachers. In summary, the study demonstrates that parents are an important audience for STF materials and a significant proportion uses them. Those who use them seem to like them and so efforts to promote them to parents may be worth the while. The data also suggest that parents need considerable help talking with their children, and STF’s efforts assist them would be greatly welcomed.

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References Neema, S. et al. 2006. “Adolescent sexual and reproductive health in Uganda: Results from the 2004 Uganda national survey of adolescents,” Occasional Report no. 25. New York: Guttmacher Institute. DiClemente, RJ., Crosby, RA and Kegler (eds). 2002. Emerging theories in health promotion practice and research. San Francisco: John Wiley and Sons.

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