CRS conducted this evaluation to measure the effectiveness of The Faithful House in Cameroon, Ethiopia and Uganda. The evaluation found that couples who participated in the program retained positive attitudes and behaviors that reduce HIV risk.
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Even though a large share of new HIV infections in many African countries occurs within marriages and cohabiting relationships, few prevention programs focus specifically on the couple as the unit of behavior change. Implemented through workshops uniquely centered on the couple, The Faithful House (TFH) is an HIV prevention curriculum focused on fidelity within relationships/marriages. Providing relevant strategies for strengthening the bond between couples, promoting marriage in cohabitating couples, and breaking barriers to faithfulness are three key objectives of TFH curriculum. Although short-term outcomes from TFH have been documented, the sustainability of these outcomes in populations deeply rooted in cultural and gender norms was unknown. To bridge this evidence gap, Catholic Relief Services conducted a study in Cameroon, Ethiopia, and Uganda to determine any sustained effects on couples attending TFH workshops.
The evaluation population consisted of couples from three countries: the Dioceses of Kumbo and the Archdioceses of Bamenda in Cameroon; the Central, Western, and Northern regions of Uganda; and the Addis Ababa, Oromia, and Tigray regions of Ethiopia. All participants were selected through local partner linkages, and a convenience sampling method was used among couples that volunteered to participate in the evaluation. Next, the couples were randomly distributed between intervention and control groups. The Cameroon cohort, which began in September 2010, served as the pilot study for the evaluation methodology. Uganda and Ethiopia followed with baseline survey collections in January and March 2011. All participants completed baseline and followup surveys that asked questions about attitudes, beliefs, and self-reported behaviors. Focus group discussions with couples representing each region were held prior to the baseline survey and after the follow-up surveys. Intervention group couples attended a three-day workshop based upon TFH curriculum. Statistical analysis was completed using Excel and Stata software to compare changes between the control and intervention groups in the baseline and followup surveys.
This evaluation used surveys from a total of 1,639 individuals in the three countries. On average, men were older and more educated than women. Type of marriage varied by country, with the majority of couples in religious marriages in Cameroon, traditional marriages in Ethiopia, and cohabiting in Uganda. More participants in Cameroon and Uganda were from rural areas, whereas Ethiopia drew predominantly urban participants. Statistically significant positive changes among the intervention group were observed for many factors, particularly in the area of communication; control group participants did not demonstrate these same positive changes. Intervention group couples in Uganda and Ethiopia showed a greater increase in HIV testing and a higher partner disclosure rate. Overall, participants from Uganda and Ethiopia demonstrated a greater degree of positive transformation in their attitudes about behaviors that contribute to HIV risk within couple relationships.
Conclusions and Recommendations
The changes observed in this study indicate that couples receiving TFH intervention retain positive attitudes and behaviors that reduce HIV risk among couples. Continued tracking of these couples to determine long-term impact is warranted. The intervention’s positive effect on couple communication and conflict resolution positions TFH as an important couples intervention for HIV prevention. Other recommended applications include: gender development programs, programs aiming to increase male involvement in family well-being that would benefit from this curriculum, and a format adapted for marriage preparation to reach young adult couples.
Publisher: Catholic Relief Services (2012)
Evaluation/assessment: 28 pages
Dimensions: 8.5 x 11 inches
Posted on July 3, 2013