Process evaluation of a school-based HIV/AIDS intervention in South Africa

This paper presents a process evaluation that assessed the fidelity and quality of implementation, as well as the acceptability and subjective evaluations of a HIV/AIDS intervention among students and teachers.

The process evaluation was conducted as part of a cluster randomized controlled trial of a theory- and evidence-based school HIV/AIDS intervention in Cape Town. The intervention was designed for grade 8 high school students and delivered by teachers over a six-month period. Twenty-six schools participated in the trial, 13 in the intervention group and 13 in the control group.

The success of implementation was varied within and across the schools, with some teachers implementing the intervention with more fidelity than others. This was influenced by a combination of individual characteristics and institutional factors. The factors that aided implementation included compliance with the current outcomes-based education approach; provision of teacher training; provision of teacher manuals with detailed information and instructions about the lessons and activities; continued monitoring and support for teachers; and student enthusiasm for the lessons. Proper implementation was hindered by large class sizes; too many activities in the intervention; teacher resistance to and inexperience in using participatory methods; teacher turnover; the low status of life orientation compared to other subjects; and a general disregard for life orientation among students.

These findings are important for improving the intervention and contextualizing the results of the outcome evaluation; and to better plan for further large scale dissemination of school-based HIV/AIDS intervention programmes.