Measuring behaviour change for preventing HIV transmission in schools using cricket games through a randomised-controlled trial in Cameroon

Article type
Authors
Chia ON1, Pentesco-Gilbert D2, Okwen PM3, Buba S4
1International Relations Institute of Cameroon, Yaounde
2Wiley
3Effective Basic Services, Africa
4Universite de Yaounde 2, Soa
Abstract
Background: Cameroon is one of the countries with the highest HIV/AIDS rates in sub-Saharan Africa, with a prevalence of 4.3% and reaching 8.8% in certain regions. HIV-awareness rates have improved in recent years.

Objectives: To measure changes in knowledge, intention and behaviour for HIV prevention in school kids in Cameroon using a cricket intervention.

Methods: We conducted a cluster randomised controlled trial of 13 schools in the city of Bamenda in Cameroon for change in knowledge and intention on sexually related HIV prevention. The 3-arm study consisted of Group 1 where a cricket ambassador was attached to a school to further strengthen skills in cricket and HIV/AIDS prevention messages in addition to the school's sports teacher; Group 2 with the school sports teacher coaching only; and, Group 3 a control group with the standard national approach to HIV prevention. Data were collected at baseline, 1 month, 3 months and 6 months’ post intervention.

Results: A total of 909 students participated in the study. Analysis suggests cricket games increased knowledge by 36.1% when cricket games with ambassadors was used; by 38.2% when teachers only were used; and, by 2.9% when the standard national approach was used. There was no difference in intention. The ambassador schools' arm reached the most students (444 students) as compared to the cricket only and control arms (250 and 209 students respectively).

Conclusion: Based on behaviour-change technics (BCT) taxonomy by Abraham and Michie, this intervention utilised 3 BCTs – prompt intention formation, teach to use prompts and cues, and prompt practice. However, measuring behaviour change around issues of sexuality poses atypical challenges because young people are timid about disclosing sexual behaviours. In our context, while the boys may claim sexual activity when, in fact, there has been no sexual activity, the girls may claim sexual inactivity when, in fact, there has been sexual activity. It is therefore important to conduct more unobtrusive observational studies and develop creative approaches in measuring behaviour change in sexuality.