The perceived impact of a skills training workshop supported by the book, HIV & AIDS, on grandmothers' communication with pre-adolescent and adolescent grandchildren in their care about sex, sexuality and HIV and AIDS in Alexandra
Date
2016
Authors
Simmonds, Jane
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Abstract
HIV continues to be a major public health issue in South Africa with young people still a high risk.
Evidence suggests that children who have lost one or both parents are at greater risk of acquiring
HIV. South African grandmothers, and other older family members, are increasingly responsible for'
raising grandchildren in the absence of parents. Conversations about sex, sexuality and HIV and AIDS
need to be part of growing up.Sexual reproductive health (SRH) communication between parents
and their children has been shown to promote safer sexual choices.Where grandmothers, and other
older family members,are the primary caregivers,this responsibility is shifting to them.There are a
number of barriers, including cultural beliefs, selfZefficacy, age and gender that impede SRH
conversations between older caregivers and the children they care for.The overall aim of this study
was to explore the phenomenon of an group of grandmothers in Alexandra in communicating about
sex, sexuality and HIV and AIDS with the pre-adolescent and adolescent children that they care for,
before and subsequent to a skills training workshop on sex, sexuality and HIV and AIDS.
Materials and methods:
This was a qualitative evaluation study that explored the experiences of grandmothers or older
caregivers when talking to their grandchildren or children in their care about sex, sexuality and HIV
and AIDS before and after a brief intervention over seven months. This study drew on a
phenomenological approach using content analysis.
The intervention consisted of a two-hour training workshop using the book,HIV & AIDS by Marina
Appelbaum as a tool to facilitate SRH communication.Data collection occurred at three points in
time.The study used convenience sampling and ten grandmothers or older female caregivers who
were the primary caregivers of pre-adolescent and adolescent grandchildren aged 10 to 18 years
volunteered to participate in the study.Of the ten participants, six women participated in a focus
group three weeks after the skills training workshop. Five of the ten women from the baseline
interviews were interviewed a second time three to six months after the skills training workshop.
Data was collected utilising individual inZdepth interviews pre- and three to seven months post
intervention,and through a focus group discussion three weeks post intervention.Thematic analysis
was conducted and inductive codes and themes were identified from the interviews.
Results:
Grandmother and older caregiver conversations about SRH matters with pre-adolescent and
adolescent grandchildren and children in their care were hindered by a number of factors. These
included taboo and cultural issues; the personal experiences of the grandmothers with SRH
communication during their childhood; the generation gap; gender; the lack of selfZefficacy
regarding SRH content; knowledge about HIV and AIDS and how to actually speak about sex,
sexuality and HIV and AIDS. In addition, a number of other hardships in the grandmothers and older
caregivers lives were barriers to making having these SRH conversations a priority.The intervention
highlighted that grandmothers and older caregivers appreciated the need to have these
conversations with their grandchildren and children in their care and were prepared to overcome
these barriers in order to promote safer sexual behaviour for the grandchildren.The skills training
workshop helped to shift the fears about SRH communication and the participants responded very
positively to the skills training workshop expressing how much more confident they felt about
addressing SRH topics after the intervention. In addition, selfZefficacy was strengthened with
participants reporting that they had attempted SRH conversations with the children in their care
after the skills training workshop.However, the grandmothers and older women felt that further
training was required for them. In addition, they felt that skills training workshops for their
grandchildren were also needed.
Conclusions:
Overall, the findings in this study demonstrated the value and need for interventions to facilitate
SRH communication between grandmothers and older caregivers and the grandchildren and children
in their care. As grandmothers and older women are committed and involved primary caregivers of
the children in their care, and in spite of numerous barriers to SRH conversations, they are prepared
to speak to their grandchildren about this topic. In addition, they recognise the value of this
communication in keeping their grandchildren and children in their care healthy and promoting safer
sexual choices. In light of the active role played by grandmother in raising grandchildren, SRH
interventions are needed to assist the role of grandmothers in talking about sex,sexuality and HIV
and AIDS. The skills training workshop made a significant contribution to increasing SRH
communication although participants recommended that additional workshops were required for
themselves and the grandchildren and children that they care for.In addition,interventions need to
recognise the day-to-day difficulties experienced by grandmothers and older women in bringing up
third generation children.
Description
A research report submitted to the School of Public Health, University of the Witwatersrand, in
partial fulfilment of the requirements for the degree of Master of Public Health