Implementation of Healthy Conversation Skills to support behaviour change in the Bukhali trial in Soweto, South Africa: A process evaluation
Bibliographic record
Abstract
Background To address the need for preconception health interventions in low- and middle-income countries, the Healthy Life Trajectories Initiative (HeLTI) was launched in Soweto, South Africa to optimise young women's physical and mental health to establish healthier trajectories for themselves and, where relevant, the next generation. As part of HeLTI trial, the Bukhali intervention utilises the Healthy Conversation Skills (HCS) approach to promote behaviour change with 18–28-year-old women. The aim of this article is to report on the process evaluation of implementing HCS, to identify implementation challenges, and make recommendations for HCS adaptations. Methods Data were collected from intervention session records (participants’ response to setting behaviour change goals, community health workers (CHWs) impression of their HCS use; n = 7418), individual in-depth interviews with participants (n = 35), focus groups (3) and debrief sessions (13) with CHWs who deliver the intervention. Results The findings indicated that the HCS approach was not implemented as originally intended. Challenges were reported regarding participants' willingness to set behaviour change goals, and prioritise health and health behaviour change, as well as participants’ exposure to trauma, influencing their ability to prioritise health behaviour change. While CHWs were able to identify strengths of the HCS approach, there were challenges with contextual adaptation, especially using HCS in a multilingual setting such as Soweto. Recommendations for contextual adaptations of the HCS approach in Soweto, South Africa include simplification of certain HCS tools, language adaptions for a multilingual setting, adapting training to fit in with time constraints of a trial, and adopting a trauma-informed perspective to health behaviour change. Conclusions This article extends our understanding of challenges to health behaviour change for young women in a low-income setting, highlighting the role of trauma, and the need for a trauma-informed perspective to understand behaviour change in this context. (PACTR201903750173871, Registered March 27, 2019).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.038 | 0.040 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".