Influencing the Sexual and Reproductive Health of Urban Youth Through Social and Behavior Change Communication: A Literature Review

This 105-page report discusses the findings of a literature review and programme scan to reflect on urban adolescent and youth sexual and reproductive health (AYSRH) interventions in Africa, Asia, and Latin America. The review was conducted by the Health Communication Capacity Collaborative (HC3) to highlight promising programme practices, share lessons learned, and offer insights into behavioural determinants and potential strategies for reaching young people in order to strengthen social and behaviour change communication (SBCC). According to the report, SBCC can contribute to young people's abilities to make healthy decisions and adopt healthy patterns of decision-making and behaviour, yet interventions should consider the multiple spheres and levels in which young people live and address these in both SBCC and complementary components of an intervention.

The first section of the report discusses behavioural determinants, noting that, while urban areas may have more infrastructure and services than rural areas, "being geographically surrounded by such resources does not guarantee access to them, particularly for poor and marginalized young people." For example, while urban youth may have more knowledge about risks associated with sexual behaviour and be closer to potential services, they may also have: more opportunities to engage in these riskier behaviours; less parental and community support; and more negative influence by peer groups. The report provides an analysis of key behavioural determinants, based on various levels: individual, family, and peer networks; community; and societal and structural.

The second section focuses on the experiences of 29 interventions specifically designed to reach urban youth, with the goal of highlighting promising practices and identifying gaps. According to the report, most of the interventions reviewed are being implemented in school and community settings, and most have little segmentation in their intended audience. The programmes use a variety of approaches, including scripted sessions, peer education, use of positive role-models, a curriculum providing decision-making skills, and a holistic approach addressing the broader factors that affect the sexual health of urban adolescents, such as poverty or excessive alcohol consumption. There are also a number of media projects using radio, television, print, and social media.

Based on the programmatic review, the report outlines outcomes related to knowledge, attitudes, communication, behavioural intent, and behaviour change. Of the 27 interventions which were able to provide evaluation results, all demonstrated increased knowledge across a broad range of issues, while interventions with informal discussion and exchanges were more likely to influence attitude change.

Based on the review, the report offers a number of recommendations. The following are just a few examples from the report:

• Evidence suggests that behaviour change is more likely to occur in an enabling environment where protective factors are promoted and barriers removed. SBCC programmers should consider dedicating time to informal discussions and exchange, working with service providers to improve youth-friendly services and engaging parents and leaders to change the dominant norms and support positive attitudes around youth sexual health.
• Programmes should involve young people from the design stage to implementation to ensure that their needs are addressed adequately.
• Youth are not a homogenous group, and there is very little audience segmentation within interventions. "Efforts should be made to include frequently forgotten groups and their particular needs, such as youth out of school, married youth, youth with children, youth with disabilities and, where culturally (and legally) appropriate, youth who identify themselves as lesbian, gay, bisexual or transgender (LGBT)."
• Young people are influenced by their family and community. Parents, community leaders, influential people, and admired community members should be engaged to promote positive norms. Likewise, multi-component interventions that use a range of channels and activities can influence behaviours at different levels, for example, combining SBCC activities with community-based activities and working with service providers.
• Message development is key to any SBCC activity. The authors recommend ensuring clear and accurate information, increasing risk and danger awareness messages, and creating a positive image of condoms.
• The delivery of messages is also noted as important, with recommendations to use TV, the internet, and social media for reaching youth, as well as making communication fun and appealing and using role models and celebrities in campaigns.

Click here to download the Executive summary in English.

Click here to download the Executive Summary in French.