Adaptation of a gender-transformative sexual and reproductive health intervention for adolescent boys in South Africa and Lesotho using intervention mapping

Áine Aventin, Stephan Rabie, Sarah Skeen, Mark Tomlinson, Moroesi Makhetha, Zenele Siqabatiso, Maria Lohan, Mike Clarke, Lynne Lohfeld, Allen Thurston, Jackie Stewart

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Background: Rates of adolescent HIV and unintended pregnancy in southern Africa are amongst the highest in the world. Gender-transformative interventions that address underlying gender inequalities and engage both males and females have been emphasised by the World Health Organisation, amongst others, to target prevention. However, few such gender-transformative interventions have been rigorously developed or evaluated.

Objective: To expedite potential impact and reduce development costs, we conducted a needs assessment to inform the co-design, in consultation with local stakeholders, of adapted versions of an existing gender-transformative Relationships and Sexuality Education intervention for use in South Africa and Lesotho.

Methods: Adaptation of the intervention was guided by a modified version of Intervention Mapping (IM). This process involved consultation with separate adolescent, community and expert advisory groups and a collaboratively conducted needs assessment, which drew on focus groups with adolescents (8 groups, n = 55) and adults (4 groups, n = 22) in South Africa and Lesotho, and was informed by our systematic review of the literature on the determinants of condom use among adolescents in the region.

Results: The findings clarified how the intervention should be adapted, which individual- and environmental-level determinants of condom use to target, and actions for facilitating successful adoption, evaluation and implementation in the new settings.

Conclusions: The IM approach allows for a systematic appraisal of whether components and processes of an existing intervention are appropriate for a new target population before costly evaluation studies are conducted. The findings will be of interest to those wishing to rigourously develop and evaluate gender-transformative interventions engaging men to improve health for all.
Original languageEnglish
Article number1927329
Number of pages18
JournalGlobal Health Action
Issue number1
Publication statusPublished - 09 Jun 2021

Bibliographical note

Funding Information:
This work was supported by Department for the Economy Northern Ireland under grant number [DfE_ GCRF_19/1920]. The research team would like to thank the young people and adult community members in Lesotho and South Africa who gave of their time to take part. We are also indebted to the members of the project advisory groups for continued support and advice throughout the study. We would also like to thank the team of research assistants in South Africa and Lesotho who facilitated focus group discussions and the transcribers who provided translated interview transcripts. Thanks also to our funders, the Department for the Economy Northern Ireland, without whose support this research would not have been possible. Finally, we would like to thank the anonymous reviewers who took time to offer constructive feedback on earlier drafts of this manuscript.

Publisher Copyright:
© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Copyright 2021 Elsevier B.V., All rights reserved.


  • Adaptation
  • Adolescent
  • Adolescent Boys
  • Adult
  • Africa, Southern
  • Female
  • Gender Transformative
  • HIV Infections
  • Humans
  • Intervention Mapping
  • Lesotho
  • Male
  • Pregnancy
  • Reproductive Health
  • Sexual And Reproductive Health
  • Sexual Behavior
  • South Africa


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