Motivational intervention for young males in

Bangladesh and Kenya – the research angle

Anke van der Kwaak, Pam Baatsen, Paul Kiage,

Mohamad Bellal Hossain

Background Young male in Kenya and Bangladesh:

• Early sexual debut, concurrent sexual partnerships, unsafe sexual

behaviour leading to amongst others STIs

• Absent in sexual health and reproductive services through:

• Perceived stigma by

the young males

themselves

• Moralizing and

patronizing attitudes

of health providers; and

or

• Top down risk approach

Amsterdam, The Netherlands www.kit.nl

Background MI+ approach

• Motivational Interviewing (MI) used to address a variety of

health-related issues, but limited application in the SRHR

domain, especially among young men.

• MI + approach inspired by evidence that sexual risk

reduction interventions are (more) effective if behavioural

individual level interventions are combined with

group–level peer-led interventions addressing issues of

intimacy, relationships, coping skills, interpersonal skills,

relapse prevention, sexual negotiation and communication

skills.

MI+ Programme

Client-centred programme which aims to:

1) substantially change the way in which health

professionals and peer educators engage with young

MSM in Bangladesh and young male in Kenya; and

introduce a genuinely new dimension to the

provider-client and peer educator/peer

interaction, and

2) elicit and strengthen clients’ motivation for

change

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MI+ programme • Builds on interventions in place: mix of

health service, outreach work and

community level activities

• Intervention sites enhanced with the MI+ approach; control sites

continue work as usual

• Master trainers, health care providers, (teachers) and peer

educators receive three trainings by the GGD Amsterdam team; &

mentoring and coaching in between

• All trainees implement MI+ approach as much as possible in their

daily work

• Master trainers

responsibility increases over

time

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Organizations involved

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Overall lead agency: KIT

Lead on motivationnal intervention: GGD

Amsterdam

Lead on programme implementation: Bandhu

Bangladesh

Lead on programme implementation: AMREF

Kenya

Lead on operational research: KIT

National researcher in Bangladesh

National researcher in Kenya

Advisory group: consortium members and key experts

Consortium Management Committtee consisting of KIT

GGD; Bandhu; and AMREF

MI+ targets Bangladesh (Dhaka and

Chittagong) Kenya (Siaya and Bondo)

MI+ intervention sites and control sites

Service providers MI+ (Drs, counsellors, paramedics) Teachers

6 for MI+ sites and 6 for control 32 for MI+ and 32 for control 16 MI+ and 16 for control

Peer Educators MI+

20 for MI+ and 20 for control 36 for MI+ and 36 for control

Target Group – overall

500 per site: 1,000 in total for MI + having access and be able to use SRHR services (HIV testing, STI management and counselling) against 1,000 for control

7,500 having access and be able to use SRHR services (HIV testing, STI management and counselling) against 7,500 for control

Sexual behaviour 500 with safer sexual practices in MI+ (against 500 in control)

2,000 with safer sexual practices in MI+ against 2,000

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MI+ training in Bangladesh

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Research

Operational research is an intrinsic component, and is focused

on:

• Measuring the effectiveness of MI+ approach for young

MSM/males in Bangladesh and Kenya

• Main research questions:

MI+ effective strategy to improve the SRHR of

young MSM/males in both settings?

Are those who have never used services now taking

them up and are those using them getting better

quality services addressing their needs?

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Research Methodology

• Mixed method comparison with quasi-experimental design:

Before and after study for a double difference comparison

between intervention and control sites

• Before and after study consists of :

Desk review with secondary data,

Survey tool, FGDs and IDIs with clients,

providers and key informants,

self-reporting, systematic observation

• Qualitative trajectory

• In last year of project; write shops to

document operational research results,

as well as other experiences gained.

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Activities Kenya Bangladesh

Before study Sept – Oct 2013 Dec – Jan 2014

First MI training Nov 2013 Feb 2014

Second MI+ training March 2014 May 2014

Trajectory May 2014 July 2014

Third MI+ Training July 2014 September 2014

After study December 2014 February 2015

Dissemination results 2015 2015

MI+ Trainings control sites 2015 2015

Time line

What we see till now!

Bangladesh

- Scope is doable; one MSM organisation and homogenous

target group but challenges reaching 15 – 18 yrs olds

- Young MSM are facing many challenges related to sexual

feelings, masturbation, dating and STIs

- MSM confronted with stigma and MI+ seen as an useful

approach to address this

- Lot of interest in the approach – desire to move away from

doing business as usual

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What we see till now!

Kenya

- Young males not part of the development discourse

- Poverty, access to education, sexual life, and growing up give

many challenges, including sexual violence

- Access to health services is a problem. Delay in a context of

STI and HIV problematic

- Judgmental attitudes of providers

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Trajectory

- In Kenya, one round: in-depth interviews and FGD with

nurses, teachers, counsellors, peer educators and young

men

- MI Part of the supervisions of the so called DASCO’s

- Trainees train other colleagues and peers

- MI+ individual and group sessions complex

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Learning from trajectory: All professionals:

- MI has changed their lives on account of more than one way

- Nurses able to identify problems young males and more of

them coming to services

- Self esteem increased of all groups, they feel they have

something to offer

- Being less judgmental helps them understand the real

problems better

- Most do not only apply it on males but also a lot on females

(young girls exposed to violence or unintended pregnancies

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Challenges

- Time (training, concepts, internalization)

- Educational background a denominator of success

- Contextualization of concepts and MI approach

- Need for training material that combines sexual and

reproductive health and rights and MI

- MI+: groups not worked out sufficiently

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Conclusions so far…

Trajectory indicates

- attitude change of different professional groups; MI enables

them to do their work better

- More young men coming to facility but this needs strengthening

in time to make it long lasting

- Not easy to measure behavourial change and access of young

males and MSM in the present design

- Unexpected spin offs need to be documented

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Acknowledgements

• GGD Amsterdam: Titia Heijman, Angelita

Casanovas, Kees de Jong, Thijs Biemans

• Bandhu: Shale Ahmed

• AMREF: Peter Ofware, Walter Odede

• DGIS Ministry of Foreign Affairs: SRH

Fund, Marcel de Kort

• KIT: Karen ‘t Hooft, Liezel Wolmarans

Amsterdam, The Netherlands www.kit.nl

Amsterdam, The Netherlands www.kit.nl