An interdisciplinary research team from the London School of Hygiene and Tropical Medicine (LSHTM), the Institute of Education (IOE), the Witwatersrand Reproductive Health Institute (WRHI), and Grassroot Soccer (GRS) are conducting a randomised controlled trial (RCT) of a sport-based health promotion intervention with biological outcomes. The trial is taking place in Cape Town and Port Elizabeth, South Africa, and is backed up by a detailed qualitative and process evaluation. The trial forms the basis for at least two PhDs, one funded by a Marshall Scholarship, and the other by a Bloomsbury Scholarship.
The trial has several novel aspects. It will be the first RCT of a sports-based health promotion intervention with biological outcomes; it will use mobile phones for data collection; and it will evaluate whether fortnightly supportive SMS text messages enhance the effectiveness of the intervention.
There is growing interest in the use of sport in interventions to change behaviour and improve health. However, there is little evidence from high-quality research to confirm the effectiveness of such interventions. Though previous studies of sport-based health programmes have generated encouraging results and been popular with participants, to date, their evaluation has not used randomised designs and outcomes have been relatively subjective, such as changes in self-reported behaviours rather than assessing objective biological outcomes.
The intervention that will be evaluated in the trial is called Generation Skillz. Developed by Grassroot Soccer, an international NGO based in Cape Town, South Africa, Generation Skillz is rooted in social learning theory. The project consists of 11 interactive sessions that teach about HIV risk behaviour and aim to spark open discussion about gender norms. Informed by formative research and extensive pilot testing, the sessions particularly focus on reducing age-disparate sex, multiple partnerships, and gender-based violence. The intervention is delivered by Grassroot Soccer “coaches”; young men and women who have been specially-trained to deliver the sessions. The sessions use football/ soccer-based metaphors to stimulate discussion and debate about HIV. The version that is being tested in the GOAL Trial will be delivered to all learners (boys and girls) within Grade 9 of public schools, when most learners are aged 14-16 years.
The trial’s primary objective is to evaluate whether the Generation Skillz programme reduces HIV and HSV-2 incidence over three years among young South Africans. Secondary objectives are to assess the effect of Generation Skillz after 12 and 36 months on HIV-related knowledge, attitudes, and self-reported sexual risk behaviours (in particular age-disparate sex, multiple partnerships, and gender-based violence). A trial-within-the-trial will also assess whether fortnightly SMS reminders for participants enhance the impact of Generation Skillz on HIV-related knowledge, attitudes, and self-reported sexual risk behaviours.
Schools have been randomised to either receive the Generation Skillz intervention in 2012 and a refresher series of sessions in 2013 (intervention group) or after the study ends (control group). During the trial, control schools will receive standard HIV education. Within the intervention group, half the schools have been further randomised for their participants to receive fortnightly supportive SMS messages.
Trial participants self-complete questionnaires directly on mobile phones using open source software (Open Data Kit). They will be able to both read and listen to the questions in English or the local language isiXhosa.
The trial runs from August 2011 until December 2015, and is funded by Comic Relief and the MAC AIDS Fund. It is run by Zak Kaufman, a PhD student at LSHTM. Zak was previously the Research and Evaluation Officer for Grassroot Soccer.
Alongside the trial, a detailed qualitative and process evaluation will examine the content, quality and acceptability of the intervention and its messages from the perspectives of learners, teachers, parents, and intervention staff. This aspect will be led by Stefanie Dringus, who until recently worked for Grassroot Soccer in Cape Town. From September 2012 she will be taking up a Bloomsbury Scholarship with LSHTM and IoE to carry out the qualitative and process evaluation.
Contributed by Prof. David Ross, Professor of Epidemiology and International Public Health, London School of Hygiene & Tropical Medicine (LSHTM); Dr. Ian Warwick, Senior Lecturer, Institute of Education; and Zak Kaufman, PhD Candidate, LSHTM
More about the project:
GOAL Trial Principal Investigators:
- Prof. David Ross – Professor of Epidemiology and International Health, London School of Hygiene & Tropical Medicine (LSHTM)
- Dr. Sinéad Delany-Moretlwe – Senior Director of Research, Reproductive Health Institute, University of the Witswatersrand (WRHI)
- Zak Kaufman, PhD Student, LSHTM, Honorary Research Fellow, WRHI
Bloomsbury Scholarship PhD student (Qualitative and Process Evaluation of Generation Skilllz):
- Stefanie Dringus, PhD Student, LSHTM
Stefanie Dringus’ PhD student supervisors:
- Prof. David Ross (London School of Hygiene & Tropical Medicine)
- Dr. Ian Warwick (Institute of Education, University of London)
- Dr. Emilie Venables (Wits Reproductive Health Institute)