A Qualitative Exploration of the Salience of MTV-Shuga, an Edutainment Programme, and Adolescents' Engagement with Sexual and Reproductive Health Information in Rural KwaZulu-Natal, South Africa

"MTV Shuga may act as a valuable educational resource helping individuals and communities to challenge negative social norms and improve discussion about SRH for the benefit of young people."

Implemented throughout the world, edutainment programmes involve stories that are designed to draw the audience into the centre of a social issue and move them emotionally as a means of sparking reflection, discussion, and debate. Evaluations show that edutainment programmes such as MTV Shuga can have wide audience reach, strong viewer engagement, and positive impacts on young people's sexual and reproductive health (SRH). This paper examines the extent to which MTV Shuga has influenced young people's engagement with SRH information in rural KwaZulu-Natal, South Africa, a setting in which adolescent girls' and young women’s HIV incidence is high.

Prior to 2015, there existed few HIV prevention interventions specifically designed for adolescents and youth in rural KwaZulu-Natal. It was into this context that the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) initiative was introduced. This multi-sectoral HIV prevention programme resulted in a considerable scaling-up of the SRH services available to young people in the implementing communities. During the implementation of DREAMS between 2016 and 2018, an independent, evidence-based edutainment programme, MTV Shuga Down South Season V, was broadcast on national television with one episode a week for 12 weeks (with repeats later the same week), over 2 consecutive years. Set in the cool clubs, hangouts, and schools of Johannesburg's Braamfontein, and the township of "Zenzele", MTV Shuga Down South explored abusive relationships, toxic masculinity, sexual assault, back-alley abortions, and age-disparate transactional sexual relationships, in addition to continuing the conversation about HIV. The show's messaging was reinforced via a "360 mass media" campaign with a strong presence on radio, social media, and comic books. Previous and subsequent seasons of MTV Shuga have been set in Kenya and Nigeria, with plans to set future seasons in Egypt and India. (For more details, see Related Summaries, below.)

Through existing surveillance activities, a representative population-based prospective cohort of females aged 13-23 was established in 2017 and followed over 2 years in a rural and resource-constrained area, uMkhanyakude, a district in KwaZulu-Natal that is economically poorer than other parts of South Africa. This paper reports on a nested qualitative study that was conducted in the same population. In 2019, the researchers conducted 8 community-based screenings of a single 22-minute MTV Shuga Down South episode (any one of episodes 4-7), followed by 25 individual in-depth interviews and 13 focus group discussions with young people aged between 15 and 30.

The results section of the paper first briefly outlines participants' descriptions of their lives in their communities, including their access to SRH information. Many participants, both female and male, described having access to SRH information and services, including at local clinics, from social workers, as part of a study subject in school, and from the Africa Health Research Institute (AHRI). Some participants also described knowing how and where to access specific services such as contraception, HIV testing, and voluntary medical male circumcision (VMMC). In practice, however, few participants described feeling comfortable and confident to access SRH information or services, owing to perceived judgment and disapproval by clinic staff of them being sexually active at their age. Furthermore, few participants described being able to approach their parents or guardians for SRH information or guidance, even though several expressed a desire for this type of interaction with their parents.

The paper then examines participants' narratives concerning what they learned from MTV Shuga in relation to SRH. In general, the majority of participants had not watched MTV Shuga when it was shown on TV for reasons including discomfort with watching it in the presence of the adults in their households and not having space or time to watch it by themselves. Following the screening, which was the first time that the majority of participants had watched MTV Shuga, a number of them described valuing MTV Shuga because it was both educational - giving them an opportunity to engage with SRH information in a new way - and designed specifically for young people. By watching the experiences and consequences of the decisions that the young characters in the episode made, study participants described learning something that they could relate to in their lives.

The featured storylines appeared to be salient for participants owing to them being considered believable. This relatability was described as stemming from the fact that they were able to recognise the stories and draw parallels in their lives or the experiences of others they knew in their communities. MTV Shuga presented scenarios to young people that offered possibilities for acting on their knowledge in their own real-life situations. These included: ways of resisting peer pressure to have fun and take potentially harmful risks; strategies for rejecting harmful social norms that persuade adolescent girls and young women to engage in transactional sex as a means to meet their needs; and pathways to making their own decisions, having thought through the potential consequences of their choices for their future. In this way, MTV Shuga provided an entertaining and visual guide for young people to navigate the risk and vulnerabilities they faced in a way that engaged and resonated with them. (Quotations from participants illustrate these findings.)

The findings highlight the importance of enabling young people in rural areas to watch MTV Shuga with peers in a safe space in which discussion of the content is facilitated. There is also value in encouraging parents to watch MTV Shuga as a means of enabling discussions between children and adults in their lives about SRH matters; concrete guidance to parents about how to hold such structured conversations would be helpful.

In short, this paper provides evidence that MTV Shuga was well received by participants in a low-income setting in KwaZulu-Natal. It "appears to have had particular salience amongst adolescents, enabling them to animate important and accurate information related to their SRH owing to its educational and youth-friendly design and targeting. There is a valuable potential to make MTV-Shuga more accessible to young people in rural areas with limited access to TV and internet through safe spaces, as well as to make parents more aware of MTV Shuga."

Discussion of the pathways of effect - or how - MTV Shuga impacted on young people's behaviour as they navigate HIV prevention and SRH services is the subject of a forthcoming publication from this study.