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“But there are no snakes in the wood”: risk mapping as an outcome measure in evaluating complex interventions
  1. Robert Power1,
  2. Lisa Langhaug2,
  3. Frances Cowan2
  1. 1Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia
  2. 2Centre for Sexual Health and HIV Research, University College London, London, UK
  1. Correspondence to:
 Prof R Power
 Burnet Institute for Medical Research and Public Health, GPO Box 2284, Melbourne, Victoria 3001, Australia; robert{at}


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

Methods: 78 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 “subcategories.” Workshops continued to be held until “saturation”, whereby no new categories emerged. “Axial coding” identified the inter-relationship between categories and subcategories according to their relevance to sexual and reproductive health risk.

Results: Six “risk area” Grounded Theory categories emerged from the data: bush/rural terrain, commercial centres, homes, school environs, religious and spiritual venues, and roadsides. 17 subcategories emerged, grouped under each of the risk area categories, such as riverbeds, growth points, homesteads, classrooms, all-night prayer meetings and truck stops. Risks and the consequences of risks included sexually transmitted infections (including HIV), violence, sexual abuse, expulsion from school and 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.

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  • Published Online First 7 March 2007

  • Funding: This research was funded by the National Institutes of Mental Health. The funders had no involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

  • Competing interests: None.

  • Ethics approval for the study was obtained from the institutional review boards at University College London (Ethics Committee Alpha), the London School of Hygiene and Tropical Medicine and the University of Zimbabwe (the Medical Research Council of Zimbabwe) before the commencement of any research activities, and is renewed annually in line with the Office for Human Subjects Research Protection Guidelines.

    Contributions: RP and LL conducted the workshops from which the data were derived. All three authors participated in data analysis, design and writing of the article.