Health Promotion Journal of Australia, 2015, 26, 30–32 http://dx.doi.org/10.1071/HE14055
Health Needs and Behaviours
Love Bugs: promoting sexual health among young people in Samoa Emma Heard A,D, Leveti Auvaa B and Charlotte Pickering C A
Research and Course Development Advisor, National University of Samoa, Lepapaigalagala Campus Toomatagi, Samoa. Head of School, School for Nursing and Health Sciences, National University of Samoa, Lepapaigalagala Campus Toomatagi, Samoa. C Clinical and Community Services Advisor, Samoa Family Health Association, Savalalo, Apia, Samoa. D Corresponding author. Email: [email protected] B
Abstract Issue: This project addressed the sexual health and well being of youth in Samoa; a key at-risk group experiencing high rates of sexually transmitted infections (STIs) and alienation from sexual health services. Methods: Love Bugs included a health promotion event held at the National University of Samoa (NUS), exposing young people to sexual health information and developing personal skills and building self-efficacy around healthy relationships, communication and safer sex. A survey provided insights into participants’ knowledge and perceptions of sexual health, STIs and healthy relationships. In response to survey results, six free condom dispensers were installed at NUS. Results: Love Bugs exposed over 500 Samoan youth to positive sexual health information and provided an opportunity for personal skill development with regard to protecting sexual health and well being. Condom dispensers were developed and installed on the university campus for the ongoing access by students without concern of cost or embarrassment. Strong partnerships were built between key community and government stakeholders that encouraged collaborative action towards protecting sexual health and well being of Samoan youth. Conclusions: Love Bugs was a successful initiative which addressed sexual health and well being of young people in Samoa. A comprehensive evaluation should be undertaken. So what? Love Bugs highlighted creative and culturally-appropriate ways to address sexual health in the Pacific. Rates of STIs and unplanned pregnancies, particularly for youth, could be reduced through investment in the implementation and evaluation of such initiatives.
Key words: community-based intervention, developing countries, sexually transmitted infections. Received 11 September 2014, accepted 30 September 2014, published online 1 December 2014
Introduction
Background
The sexual health of populations in the Pacific region is a key area of concern with rates of sexually transmitted infections (STIs) exceeding 25% in some countries; young people are an important target group as rates appear highest among this group.1,2 While comprehensive STI statistics in Samoa are limited, a high prevalence is estimated; for example, one study shows 38% of women attending antenatal clinics in Apia as having one or more STIs.3 Love Bugs was a health promotion initiative implemented at the National University of Samoa (NUS) that aimed to provide young people with the necessary skills and resources to improve their sexual health and well being. This paper will describe the Love Bugs initiative in detail and offer some preliminary insights regarding the outcomes.
Reproductive health services in Samoa predominantly target married couples and offer pregnancy and contraception advice; thus, young people are often alienated from such services due to embarrassment, cost, transport and lack of confidentiality.4 Further to this, young people in Samoa report low levels of exposure to family planning messages.5 Only 36% of women aged 15–49 know of the male condom as a form of contraception and only 1% have ever used one; 15% of men (12% of married men) aged 15–49 report having ever used a condom.5 Such statistics raise concern as condoms are the only contraceptive method proven to reduce the risk of all STIs.6 There is limited research exploring the low rates of condom use in Samoa; however, it has been suggested that a lack of
Journal compilation Ó Australian Health Promotion Association 2015
CSIRO Publishing
www.publish.csiro.au/journals/hpja
Young people’s sexual health in Samoa
Health Promotion Journal of Australia
31
awareness and access to and acceptance of condoms, as well as a lack of support from religious and community leaders for safer sex education play a role.4,5 International literature shows key barriers to condom use, specifically for young people, include the cost and embarrassment of obtaining condoms.7,8 Free condom dispensers have been used around the world as an effective means of addressing these barriers.7 Research shows that dispensers in discreet, easily accessible places (including university buildings) are particularly attractive to young people.7,9 Research into condom use in the Pacific region indicates that social and cultural influences play an important role and thus, initiatives addressing sexual health and condom use should be locally designed and targeted.10 Love Bugs aimed to increase awareness of STIs, promote healthy sexual relationships, develop personal communication skills and effective condom use and provide access to sexual health resources, including condoms for students at NUS.
Methods Love Bugs included a health promotion event, a sexual health survey and the installation of free condom dispensers at NUS. In 2013, NUS had a total number of 2884 students (1582 females and 1302 males) enrolled across its eight faculties. All students live off campus, most in family homes.
Health promotion event At a Love Bugs event held at NUS, students were exposed to sexual health information via flyers, posters and a multi-media presentation. The material was developed using a strengths-based approach to health promotion focusing on positive emotion; meaning that all information was presented in a non-confrontational manner.11 The Youth Development Sector at the Samoan Government Ministry of Women, Community and Social Development (MWCSD) were consulted throughout the development of the material to ensure the material was contextually appropriate for Samoan youth. The number of flyers distributed was recorded and staff observed and reported approximate numbers of students who engaged with the posters and presentation. The event included the ‘Love Wall’, a space where participants wrote personal, positive sexual health messages. This was showcased on a large billboard in the NUS foyer for the following week, increasing student exposure (Fig. 1). Lollypops carrying the ABC message (A-abstinence, B- be faithful ((only have one partner)) and C-condoms) were distributed; and staff, including a range of health promotion practitioners from the university, Government sectors and non-government organisations, engaged participants in conversation, answered questions and offered further information; where necessary participants were referred to Samoa Family Health Association (SFHA) for further services. The playing of popular music and a live condom mascot created an open, friendly and fun environment that encouraged public participation. Condoms and contraceptive kits were freely available throughout
Fig. 1. A section of the ‘Love Wall’.
the day along with information and demonstrations on how to use them. The number of condoms, contraceptive kits and ABC lollypops distributed was recorded, as were the number of messages contributed to the ‘Love Wall’. Staff observed and reported on the number of students watching the live demonstrations and engaging with other aspects of the event.
Survey Short surveys were made available for participants to complete voluntarily. The survey consisted of multiple choice and short answer questions aimed to gauge respondents’ knowledge and perceptions of healthy relationships, STIs and safe sex measures. The survey was developed with special consideration given to the fact that sex is a taboo topic in Samoa,4 and the public nature of the event; thus, the questions were brief and impersonal.
Free condom dispensers Six free condom dispensers were installed at NUS. Dispensers were built in collaboration with Red Cross Samoa from a locally-developed method using recycled plumbing pipe. The involvement by 100 students from the schools of Arts, Education and Carpentry in the styling, promotion and installation of the dispensers enhanced student ownership of the project. These students also participated in sexual health workshops that provided information on STIs and healthy relationships, offered brief counselling and question time. Condoms were supplied by SFHA.
Results During the health promotion event, 300 flyers, 120 ABC lollypops, 200 contraceptive kits and 500 condoms were distributed. 200 students contributed to the ‘Love Wall’ and ~100 students viewed ‘how to use a condom’ demonstrations (groups of 20 students participated in 5 demonstrations throughout the day). A total of ~400 students participated in one or more aspects of the event,
32
Health Promotion Journal of Australia
E. Heard et al.
including viewing and engaging with the posters and the multimedia presentation. The survey was completed by 48 students (31 females, 15 males and 2 unidentified). Results highlighted that most respondents understood key aspects of healthy relationships including: trust (90%), respect (83%) and honesty (95%); 46% of respondents listed condoms as being important for a healthy relationship. Most respondents knew what STI stood for (67%) and that condoms were effective in reducing risk of transmission (88%). Just over half (54%) of respondents identified safe sex as important for ‘protecting your and your partner’s health’, ‘preventing unwanted pregnancies’ and ‘reducing the risk of getting an STI’. The survey was voluntary and the low response rate may reflect the ongoing perception of sex as taboo, and participants may have been uncomfortable completing the survey.4 The condom dispensers held ~100 condoms and were installed with promotional posters designed by students and information on how to use condoms. After one month, three of the dispensers had been torn down and stolen. Despite this, the remaining three were refilled approximately every eight weeks for the following year; a total of 3900 condoms were dispensed during this time. Although this report was limited by the use of staff observation in lieu of concrete numbers of participants plus the relatively small sample size of the survey, results indicate the reach of Love Bugs was significant and provides some exploratory insights into the current knowledge of sexual health and the challenges experienced by young people in Samoa.
Conclusion Preliminary results show that Love Bugs exposed 500 young people to positive sexual health messages and information (through both the health promotion event and workshops held as part of the condom dispenser development and implementation). Personal
skills and self-efficacy were enhanced through condom demonstrations and the initiation of communication with regard to sexual health. Access to condoms and sexual health information was provided through the development and implementation of free condom dispensers and locally-designed sexual health promotion materials. The extent of the impact of this project is yet to be investigated and a comprehensive impact evaluation should be undertaken in order to truly understand the outcomes and reach of the project.
References 1.
Cliffe SJ, Tabrizi S, Sullivan EA. Chlamydia in the Pacific Region, the silent epidemic. Sex Transm Dis 2008; 35(9): 801–6. doi:10.1097/OLQ.0b013e318175d885 2. World Health Organisation Regional Office for the Western Pacific. HIV and sexually transmitted infections in the Western Pacific Region: 2000–2010. Manila (Philippines): World Health Organisation Press; 2012. Available from: http://www. wpro.who.int/publications/2012/document_hiv_and_sti_2000-2010.pdf [Verified 6 June 2014]. 3. World Health Organisation Regional Office for the Western Pacific Region. Western Pacific country health profiles: 2011 revision. Manila (Philippines): World Health Organisation Press; 2011. Available from: http://www.wpro.who.int/health_ information_evidence/documents/CHIPS/en/. [Verified 6 June 2014]. 4. Lata S. Decisions and dilemmas- reproductive health needs \assessment for adolescent girls in Samoa. Pac Health Dialog 2003; 10(2): 53–61. 5. Ministry of Health. Samoa domestic health survey 2009. Apia (Samoa): Government of Samoa; 2010. 6. World Health Organisation. Position statement on condoms and HIV prevention. Geneva (Switzerland): World Health Organisation Press; 2004. Available from: http://www.unfpa.org/webdav/site/global/shared/documents/news/condom_ statement.pdf. [Verified 6 May 2014]. 7. Burtney E, Fullerton D. A review of the national and international research literature on condom promotion and distribution. Dunblane (Scotland): Insights Health and Social Research; 2009. 8. Bell J. Why embarrassment inhibits the aquisition and use of condoms: a qualitative approach to understanding risky sexual behaviour. J Adolescence 2009; 32(2): 379–91. doi:10.1016/j.adolescence.2008.01.002 9. Sixsmith J, Griffiths J, Hughes J, Wren J, Penfold S, Natusch H. Accessibility of condoms to young people in Manchester, UK. J Fam Plan Reprod H 2006; 32(4): 219–25. doi:10.1783/147118906778586534 10. McMillan K, Worth H. The impact of socio-cultural context on young people’s condom use: evidence from two Pacific Island countries. Cult Health Sex 2011; 13(3): 313–26. doi:10.1080/13691058.2010.529945 11. Hastings G, Stead M, Webb J. Fear appeals in social marketing: strategic and ethical reasons for concern. Psychol Market 2004; 21(11): 961–86. doi:10.1002/mar.20043
www.publish.csiro.au/journals/hpja
Health Needs and Behaviours
Love Bugs: promoting sexual health among young people in Samoa Emma Heard A,D, Leveti Auvaa B and Charlotte Pickering C A
Research and Course Development Advisor, National University of Samoa, Lepapaigalagala Campus Toomatagi, Samoa. Head of School, School for Nursing and Health Sciences, National University of Samoa, Lepapaigalagala Campus Toomatagi, Samoa. C Clinical and Community Services Advisor, Samoa Family Health Association, Savalalo, Apia, Samoa. D Corresponding author. Email: [email protected] B
Abstract Issue: This project addressed the sexual health and well being of youth in Samoa; a key at-risk group experiencing high rates of sexually transmitted infections (STIs) and alienation from sexual health services. Methods: Love Bugs included a health promotion event held at the National University of Samoa (NUS), exposing young people to sexual health information and developing personal skills and building self-efficacy around healthy relationships, communication and safer sex. A survey provided insights into participants’ knowledge and perceptions of sexual health, STIs and healthy relationships. In response to survey results, six free condom dispensers were installed at NUS. Results: Love Bugs exposed over 500 Samoan youth to positive sexual health information and provided an opportunity for personal skill development with regard to protecting sexual health and well being. Condom dispensers were developed and installed on the university campus for the ongoing access by students without concern of cost or embarrassment. Strong partnerships were built between key community and government stakeholders that encouraged collaborative action towards protecting sexual health and well being of Samoan youth. Conclusions: Love Bugs was a successful initiative which addressed sexual health and well being of young people in Samoa. A comprehensive evaluation should be undertaken. So what? Love Bugs highlighted creative and culturally-appropriate ways to address sexual health in the Pacific. Rates of STIs and unplanned pregnancies, particularly for youth, could be reduced through investment in the implementation and evaluation of such initiatives.
Key words: community-based intervention, developing countries, sexually transmitted infections. Received 11 September 2014, accepted 30 September 2014, published online 1 December 2014
Introduction
Background
The sexual health of populations in the Pacific region is a key area of concern with rates of sexually transmitted infections (STIs) exceeding 25% in some countries; young people are an important target group as rates appear highest among this group.1,2 While comprehensive STI statistics in Samoa are limited, a high prevalence is estimated; for example, one study shows 38% of women attending antenatal clinics in Apia as having one or more STIs.3 Love Bugs was a health promotion initiative implemented at the National University of Samoa (NUS) that aimed to provide young people with the necessary skills and resources to improve their sexual health and well being. This paper will describe the Love Bugs initiative in detail and offer some preliminary insights regarding the outcomes.
Reproductive health services in Samoa predominantly target married couples and offer pregnancy and contraception advice; thus, young people are often alienated from such services due to embarrassment, cost, transport and lack of confidentiality.4 Further to this, young people in Samoa report low levels of exposure to family planning messages.5 Only 36% of women aged 15–49 know of the male condom as a form of contraception and only 1% have ever used one; 15% of men (12% of married men) aged 15–49 report having ever used a condom.5 Such statistics raise concern as condoms are the only contraceptive method proven to reduce the risk of all STIs.6 There is limited research exploring the low rates of condom use in Samoa; however, it has been suggested that a lack of
Journal compilation Ó Australian Health Promotion Association 2015
CSIRO Publishing
www.publish.csiro.au/journals/hpja
Young people’s sexual health in Samoa
Health Promotion Journal of Australia
31
awareness and access to and acceptance of condoms, as well as a lack of support from religious and community leaders for safer sex education play a role.4,5 International literature shows key barriers to condom use, specifically for young people, include the cost and embarrassment of obtaining condoms.7,8 Free condom dispensers have been used around the world as an effective means of addressing these barriers.7 Research shows that dispensers in discreet, easily accessible places (including university buildings) are particularly attractive to young people.7,9 Research into condom use in the Pacific region indicates that social and cultural influences play an important role and thus, initiatives addressing sexual health and condom use should be locally designed and targeted.10 Love Bugs aimed to increase awareness of STIs, promote healthy sexual relationships, develop personal communication skills and effective condom use and provide access to sexual health resources, including condoms for students at NUS.
Methods Love Bugs included a health promotion event, a sexual health survey and the installation of free condom dispensers at NUS. In 2013, NUS had a total number of 2884 students (1582 females and 1302 males) enrolled across its eight faculties. All students live off campus, most in family homes.
Health promotion event At a Love Bugs event held at NUS, students were exposed to sexual health information via flyers, posters and a multi-media presentation. The material was developed using a strengths-based approach to health promotion focusing on positive emotion; meaning that all information was presented in a non-confrontational manner.11 The Youth Development Sector at the Samoan Government Ministry of Women, Community and Social Development (MWCSD) were consulted throughout the development of the material to ensure the material was contextually appropriate for Samoan youth. The number of flyers distributed was recorded and staff observed and reported approximate numbers of students who engaged with the posters and presentation. The event included the ‘Love Wall’, a space where participants wrote personal, positive sexual health messages. This was showcased on a large billboard in the NUS foyer for the following week, increasing student exposure (Fig. 1). Lollypops carrying the ABC message (A-abstinence, B- be faithful ((only have one partner)) and C-condoms) were distributed; and staff, including a range of health promotion practitioners from the university, Government sectors and non-government organisations, engaged participants in conversation, answered questions and offered further information; where necessary participants were referred to Samoa Family Health Association (SFHA) for further services. The playing of popular music and a live condom mascot created an open, friendly and fun environment that encouraged public participation. Condoms and contraceptive kits were freely available throughout
Fig. 1. A section of the ‘Love Wall’.
the day along with information and demonstrations on how to use them. The number of condoms, contraceptive kits and ABC lollypops distributed was recorded, as were the number of messages contributed to the ‘Love Wall’. Staff observed and reported on the number of students watching the live demonstrations and engaging with other aspects of the event.
Survey Short surveys were made available for participants to complete voluntarily. The survey consisted of multiple choice and short answer questions aimed to gauge respondents’ knowledge and perceptions of healthy relationships, STIs and safe sex measures. The survey was developed with special consideration given to the fact that sex is a taboo topic in Samoa,4 and the public nature of the event; thus, the questions were brief and impersonal.
Free condom dispensers Six free condom dispensers were installed at NUS. Dispensers were built in collaboration with Red Cross Samoa from a locally-developed method using recycled plumbing pipe. The involvement by 100 students from the schools of Arts, Education and Carpentry in the styling, promotion and installation of the dispensers enhanced student ownership of the project. These students also participated in sexual health workshops that provided information on STIs and healthy relationships, offered brief counselling and question time. Condoms were supplied by SFHA.
Results During the health promotion event, 300 flyers, 120 ABC lollypops, 200 contraceptive kits and 500 condoms were distributed. 200 students contributed to the ‘Love Wall’ and ~100 students viewed ‘how to use a condom’ demonstrations (groups of 20 students participated in 5 demonstrations throughout the day). A total of ~400 students participated in one or more aspects of the event,
32
Health Promotion Journal of Australia
E. Heard et al.
including viewing and engaging with the posters and the multimedia presentation. The survey was completed by 48 students (31 females, 15 males and 2 unidentified). Results highlighted that most respondents understood key aspects of healthy relationships including: trust (90%), respect (83%) and honesty (95%); 46% of respondents listed condoms as being important for a healthy relationship. Most respondents knew what STI stood for (67%) and that condoms were effective in reducing risk of transmission (88%). Just over half (54%) of respondents identified safe sex as important for ‘protecting your and your partner’s health’, ‘preventing unwanted pregnancies’ and ‘reducing the risk of getting an STI’. The survey was voluntary and the low response rate may reflect the ongoing perception of sex as taboo, and participants may have been uncomfortable completing the survey.4 The condom dispensers held ~100 condoms and were installed with promotional posters designed by students and information on how to use condoms. After one month, three of the dispensers had been torn down and stolen. Despite this, the remaining three were refilled approximately every eight weeks for the following year; a total of 3900 condoms were dispensed during this time. Although this report was limited by the use of staff observation in lieu of concrete numbers of participants plus the relatively small sample size of the survey, results indicate the reach of Love Bugs was significant and provides some exploratory insights into the current knowledge of sexual health and the challenges experienced by young people in Samoa.
Conclusion Preliminary results show that Love Bugs exposed 500 young people to positive sexual health messages and information (through both the health promotion event and workshops held as part of the condom dispenser development and implementation). Personal
skills and self-efficacy were enhanced through condom demonstrations and the initiation of communication with regard to sexual health. Access to condoms and sexual health information was provided through the development and implementation of free condom dispensers and locally-designed sexual health promotion materials. The extent of the impact of this project is yet to be investigated and a comprehensive impact evaluation should be undertaken in order to truly understand the outcomes and reach of the project.
References 1.
Cliffe SJ, Tabrizi S, Sullivan EA. Chlamydia in the Pacific Region, the silent epidemic. Sex Transm Dis 2008; 35(9): 801–6. doi:10.1097/OLQ.0b013e318175d885 2. World Health Organisation Regional Office for the Western Pacific. HIV and sexually transmitted infections in the Western Pacific Region: 2000–2010. Manila (Philippines): World Health Organisation Press; 2012. Available from: http://www. wpro.who.int/publications/2012/document_hiv_and_sti_2000-2010.pdf [Verified 6 June 2014]. 3. World Health Organisation Regional Office for the Western Pacific Region. Western Pacific country health profiles: 2011 revision. Manila (Philippines): World Health Organisation Press; 2011. Available from: http://www.wpro.who.int/health_ information_evidence/documents/CHIPS/en/. [Verified 6 June 2014]. 4. Lata S. Decisions and dilemmas- reproductive health needs \assessment for adolescent girls in Samoa. Pac Health Dialog 2003; 10(2): 53–61. 5. Ministry of Health. Samoa domestic health survey 2009. Apia (Samoa): Government of Samoa; 2010. 6. World Health Organisation. Position statement on condoms and HIV prevention. Geneva (Switzerland): World Health Organisation Press; 2004. Available from: http://www.unfpa.org/webdav/site/global/shared/documents/news/condom_ statement.pdf. [Verified 6 May 2014]. 7. Burtney E, Fullerton D. A review of the national and international research literature on condom promotion and distribution. Dunblane (Scotland): Insights Health and Social Research; 2009. 8. Bell J. Why embarrassment inhibits the aquisition and use of condoms: a qualitative approach to understanding risky sexual behaviour. J Adolescence 2009; 32(2): 379–91. doi:10.1016/j.adolescence.2008.01.002 9. Sixsmith J, Griffiths J, Hughes J, Wren J, Penfold S, Natusch H. Accessibility of condoms to young people in Manchester, UK. J Fam Plan Reprod H 2006; 32(4): 219–25. doi:10.1783/147118906778586534 10. McMillan K, Worth H. The impact of socio-cultural context on young people’s condom use: evidence from two Pacific Island countries. Cult Health Sex 2011; 13(3): 313–26. doi:10.1080/13691058.2010.529945 11. Hastings G, Stead M, Webb J. Fear appeals in social marketing: strategic and ethical reasons for concern. Psychol Market 2004; 21(11): 961–86. doi:10.1002/mar.20043
www.publish.csiro.au/journals/hpja
