Review Article

Nothing as Practical as a Good Theory? The Theoretical Basis of HIV Prevention Interventions for Young People in Sub-Saharan Africa: A Systematic Review

Table 1

Characteristics of studies included in systematic review of use of behavioural theory in HIV prevention interventions in youth in sub-Saharan Africa.

Author, year CountryYear of interventionStudy designSample size at baseline (males/females)Main intervention activities (duration)Intervention setting (urban/rural)Theory or theories usedRole of theory in the studyExplanation provided about why theory used?

Central Africa

Van Rossem and Meekers [31]Cameroon1996-1997Repeat C/S, quasiexperimental1606 (753/757)Behaviour change communication and promotion through peers and in media, condom distribution, youth-friendly services (13 months)Community (urban)Health Belief ModelDevelopment of intervention and questionnaire/evaluationNo

Speizer et al. [32]Cameroon1997-1998Repeat C/S, quasiexperimental802 (400/402)Through discussion groups, one-on-one meetings, and health and sport association gatherings, peer educators informed their peers and referred them to services. Promotional materials were distributed in schools and community (18 months)School + Community (urban)NR, focus on knowledgeNANA

Meekers et al. [33]Cameroon2000-2001Repeat C/S, pre post-controlling for exposure1956 (1056/900)Media and interpersonal communication campaign. Peer education, magazine, radio drama, radio call-in show, media campaign, condom promotion (12 months)Community (urban)Health Belief Model, Social Learning Theory, Theory of Reasoned ActionDevelopment of intervention and questionnaire/evaluationNo

Eastern Africa

Klepp et al. [34, 35]Tanzania1990Cohort, randomized schools1063 (502/561)Teachers provided information, students created posters and performed songs, poetry, drama and role-play, small-group discussions among students. Interviews and panel discussions with parents and community members (2-3 months)Primary school (urban + rural)Social Learning Theory and Theory of Reasoned ActionDevelopment of intervention and questionnaire/evaluationNo

Shuey et al. [36]Uganda1994–1996Repeat C/S, quasiexperimental800 (398/402)Strengthen existing school health curriculum, meeting with parents and community leaders, formation of school health clubs with peer education, question boxes (2 years)Primary school (urban + rural)Social Cognitive TheoryNRNo

Kinsman et al. [37]Uganda1997-1998Cohort, quasiexperimental2077 (920/1157)Extracurricular classes by trained teachers (1 year)Primary and secondary schools (rural)Behaviour Changes for Interventions ModelDevelopment of intervention and questionnaire/evaluationNo

Erulkar et al. [38]Kenya1998–2000Repeat C/S, quasiexperimental1544 (792/752)Adult counsellor in community educating youth, referral to youth-friendly services and encouraging parent-child communication (3 years)Community (urban + rural)NR, focus on values, knowledge, gender, and empowermentNANA

Ross et al. [39], Doyle et al. [40]Tanzania1998–2002Repeat C/S, randomized communitiesRoss: 9219 (5103/4116)
Doyle: 13814 (7300/6514)
Participatory, teacher-led, peer-assisted, in-school program, youth-friendly health services, condom promotion and distribution, and youth health days and video shows in community (3 years)School + Community (rural)Social Learning TheoryDevelopment of interventionNo

Maticka-Tyndale et al. [41]Kenya2002-2003Repeat C/S, randomized schools7392 (3636/3764)Peer education on level of teachers and students, question boxes, school health clubs, information corners and assemblies, drama, music and literary performances (18 months)Primary school (urban + rural)Social Learning Theory and Scripting TheoryDevelopment of interventionYes

Rijsdijk et al. [42]Uganda2008Cohort, randomized schools1986 (1096/889)low-tech, computer-based, interactive comprehensive sex education programme, teacher-led (6 months)Secondary school (urban + rural)Theory of Planned Behavior and Health Belief ModelDevelopment of interventionNo

Southern Africa

Kuhn et al. [43]South Africa1990Repeat C/S, quasiexperimental567 (not reported)Intense, high-profile focus on AIDS in the school by teachers (2 weeks)Secondary school (urban)NR, focus on knowledge and attitudesNANA

Harvey et al. [44]South Africa1993-1994Cohort, randomized schools1080 (447/633)“School open day” with drama, song, dance, poetry, and posters prepared and presented by students (3 days)Secondary school (urban + rural)Applied behaviour change frameworkDevelopment of questionnaire/evaluationNo

Meekers [45]South Africa1994–1997Repeat C/S, quasiexperimental226 (0/226)Mass media campaign, peer education and condom promotion and distribution (35 months)Community (urban)Health Belief ModelDevelopment of questionnaire/evaluationNo

Fitzgerald et al.; Stanton et al. [46, 47]Namibia1996Cohort, randomized participants515 (236/279)Curriculum taught by a teacher and out-of-school youth (7 weeks)Secondary school (urban + rural)Social Cognitive Theory/Protective Motivational TheoryDevelopment of intervention and questionnaire/evaluationNo

Kim et al. [48]Zimbabwe1997-1998Repeat C/S, quasiexperimental1426 (713/713)Mass media campaign, community drama groups, peer educators, youth-friendly health services (6 months)School + Community (urban)Steps to Behaviour Change FrameworkDevelopment of interventionNo

James et al. [49]South Africa1998Cohort, randomized schools1168 (542/616)Reading of a comic book (1 hour)Secondary school (urban + rural)Theory of Health Promotion and Social LearningDevelopment of interventionNo

Visser [50]South Africa1998–2000Repeat C/S, pre post-controlling for exposure873 (410/463)Trained teachers and professionals provide life skills and HIV/AIDS education. Parents included in action committee (1 year)Secondary school (urban)Health Belief ModelDevelopment of interventionNo

Underwood et al. [51]Zambia1999-2000Repeat C/S, quasiexperimental921 (378/543)Participatory developed mass media campaign (7 months)Community (urban + rural)Stage Theory of Behaviour ChangeDevelopment of interventionNo

Magnani et al. [52]South Africa1999–2001Cohort, pre post-controlling for exposure3052 (1375/1677)Life skills curriculum taught by teachers (2 years)Secondary school (urban)Social Learning TheoryDevelopment of interventionNo

Agha [53]Zambia2000Cohort, randomized schools481 (268/213)Peer educators using discussion and drama skits (1 hour 45 min)Secondary school (urban)NR, focus on knowledge, normative beliefs, and risk perceptionNANA

James et al. [54]South Africa2001Cohort, randomized schools936 (456/466)Life skills intervention taught by trained teachers (20 weeks)Secondary school (urban + rural)Social Cognitive Theory and Theory of Planned BehaviourDevelopment of questionnaire/evaluationNo

Plautz et al. [55]Madagascar2001-2002Cohort, pre post-controlling for exposure1785 (1000/785)Youth-friendly services, mass media, and interpersonal communication by peer educators (23 months)Community (urban + rural)Social Learning Theory, Health Belief Model, and Theory of Reasoned ActionDevelopment of intervention and questionnaire/evaluationNo

Karnell et al. [56]South Africa2002Cohort, randomized schools661 (324/337)Peer educators using recorded monologues of fictional characters, teacher support (8 weeks)Secondary school (urban)Social Learning Theory, Social Inoculation, Cognitive Behaviour TheoryDevelopment of intervention and questionnaire/evaluationYes

Visser [57]South Africa2002-2003Repeat C/S, quasiexperimental1918 (858/1060)Peer education (18 months)Secondary schools (urban)Systems TheoryDevelopment of interventionNo

Jewkes et al. [58, 59]South Africa2003-2004Cohort, randomized communities2776 (1360/1416)Participatory learning approaches taught by facilitators, peer group meeting, community meeting (6–8 weeks)Community (rural)Participatory Learning Approach and Adult Education TheoryDevelopment of interventionNo

Tibbits et al. [60]South Africa2004-2005Cohort, randomized schools4040 (2020/2020)Comprehensive, risk-reduction life skills curriculum for adolescents, teacher-led (24 months)Secondary school, urbanSelective optimization with compensation, Self-Determination Theory, and Social Cognitive TheoryDevelopment of interventionYes

Mason-Jones et al. [61]South Africa2007-2008Cohort, quasiexperimental3934 (1661/2211)Government-led peer education project, in class standard curriculum, conversations outside class, referral (18 months)Secondary school (urban + rural)NR, knowledge and psychosocial characteristicsNANA

Baird et al. [62]Malawi2008-2009Cohort, randomized schools3796 (0/3796)Monthly cash transfer programme to reduce the risk of STI infection (24 months)School + community (urban + rural)NR, focus on structural factor (poverty and education) and knowledgeNANA

Burnett et al. [63]SwazilandNRCohort, randomized youth204 (101/103)Teacher-led life-skills HIV prevention education program, curriculum, interactive techniques, role playing, and group discussions (13 weeks)Secondary school (urban)Self-efficacy theory and Protection Motivation TheoryDevelopment of interventionNo

Western Africa

Brieger et al. [64]Nigeria and Ghana1994–1997Repeat C/S, quasiexperimental1784 (not reported)Peer educators, promotion of community-level networks, referral to services (30 months)School + Community (urban)NR, focus on knowledge and attitudesNANA

Fawole et al. [65]Nigeria1996Cohort, pre post-controlling for exposure450 (204/246)Education sessions by community physicians with help of teachers (1 month)Secondary school (urban)NR, focus on knowledge and attitudesNANA

Okonofua et al. [66]Nigeria1997-1998Repeat C/S, randomized schools1896 (877/1008)Establishment of reproductive health club in school, health awareness campaigns by professionals, distribution of print material, peer education, youth-friendly services (11 months)Secondary school (urban)NR, focus on knowledge and barriersNANA

Van Rossem and Meekers [67]Guinea1997-1998Cohort, quasiexperimental2016 (925/1091)Peer educators (discussion and theatre), condom promotion, billboards, youth-friendly services and contraception distribution (8 months)Community (urban)Health Belief ModelDevelopment of questionnaire/evaluationNo

Atwood et al. [68]Liberia2007-2008Cohort, randomized schools812 (455/357)Curriculum-based program by health educators (8 weeks)Primary school (urban)Social Cognitive Theory and Theory of Reasoned ActionDevelopment of interventionNo

C/S: Repeated cross-sectional design.
NR: No theory is explicitly reported, dominant constructs used in the intervention.
NA: Not applicable.