"But there are no snakes in the wood:" risk mapping as an outcome measure in evaluating complex interventions.

Abstract

Objectives: To complement biological and social behavioural markers in evaluating our complex intervention of sexual and reproductive health amongst adolescents in rural Zimbabwe, we sought community- derived markers of effectiveness. Through a participatory workshop with adolescent boys and girls we developed an innovative "risk map research workshop" to be conducted throughout our study sites.

Methods: Seventy-eight gender-specific standardised workshops were conducted among secondary school students. Participants drew risk maps of their community. Focus group discussions explored each risk area identified on the map. Grounded Theory was used to create "categories" and "sub-categories." Workshops continued to be held until "saturation," whereby no new categories emerged. "Axial coding" identified the interrelationship between categories and sub-categories according to relevance to sexual and reproductive health risk.

Results: Six "risk area" grounded theory categories emerged from the data: bush/rural terrain; commercial centres; home; school environs; religious and spiritual venues; roadside. Seventeen sub-categories emerged, grouped under each of the risk area categories, such as: riverbeds, growth points, homestead, classroom, all night prayer meetings, truck-stops. Risks and the consequences of risks included: STIs (including HIV); violence; sexual abuse; expulsion from school; illegal abortion.

Conclusions: Risk maps provide unique data that can be used to "measure" more subtle changes that occur as a result of social behavioural interventions aimed at addressing reproductive and sexual health. Another round of risk map research workshops will be held towards the end of the study to explore changes in milieu, behaviour and experiences and will complement and triangulate the biological and other social behavioural outcome measures.