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Enhancing adolescent self-efficacy and collective efficacy through public engagement around HIV/AIDS competence: A multilevel, cluster randomized-controlled trial


  • Carlson, Mary
  • Brennan, Robert T.
  • Earls, Felton


The potential capacity of children to confront the HIV/AIDS pandemic is rarely considered. Interventions to address the impact of the pandemic on children and adolescents commonly target only their vulnerabilities. We evaluated the Young Citizens Program, an adolescent-centered health promotion curriculum designed to increase self- and collective efficacy through public education and community mobilization across a municipality in the Kilimanjaro Region of Tanzania. The theoretical framework for the program integrates aspects of human capability, communicative action, social ecology and social cognition. The design consists of a cluster randomized-controlled trial (CRCT). Fifteen pairs of matched geopolitically defined neighborhoods of roughly 2000–4000 residents were randomly allocated to treatment and control arms. Within each neighborhood cluster, 24 randomly selected adolescents, ages 9–14, deliberated on topics of social ecology, citizenship, community health and HIV/AIDS competence. Building on their acquired understanding and confidence, they dramatized the scientific basis and social context of HIV infection, testing and treatment in their communities over a 28-week period. The curriculum comprised 5 modules: Group Formation, Understanding our Community, Health and our Community, Making Assessments and Taking Action in our Community and Inter-Acting in our Community. Adolescent participants and adult residents representative of their neighborhoods were surveyed before and after the intervention; data were analyzed using multilevel modeling. In treatment neighborhoods, adolescents increased their deliberative and communicative efficacy and adults showed higher collective efficacy for children. Following the CRCT assessments, the control group received the same curriculum. In the Kilimanjaro Region, the Young Citizens Program is becoming recognized as a structural, health promotion approach through which adolescent self-efficacy and child collective efficacy are generated in the context of civil society and local government.

Suggested Citation

  • Carlson, Mary & Brennan, Robert T. & Earls, Felton, 2012. "Enhancing adolescent self-efficacy and collective efficacy through public engagement around HIV/AIDS competence: A multilevel, cluster randomized-controlled trial," Social Science & Medicine, Elsevier, vol. 75(6), pages 1078-1087.
  • Handle: RePEc:eee:socmed:v:75:y:2012:i:6:p:1078-1087
    DOI: 10.1016/j.socscimed.2012.04.035

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    References listed on IDEAS

    1. repec:aph:ajpbhl:10.2105/ajph.2004.037705_0 is not listed on IDEAS
    2. Lochner, Kimberly A. & Kawachi, Ichiro & Brennan, Robert T. & Buka, Stephen L., 2003. "Social capital and neighborhood mortality rates in Chicago," Social Science & Medicine, Elsevier, vol. 56(8), pages 1797-1805, April.
    3. Onyango-Ouma, W. & Aagaard-Hansen, J. & Jensen, B.B., 2005. "The potential of schoolchildren as health change agents in rural western Kenya," Social Science & Medicine, Elsevier, vol. 61(8), pages 1711-1722, October.
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    Cited by:

    1. Salmen, Charles R. & Hickey, Matthew D. & Fiorella, Kathryn J. & Omollo, Dan & Ouma, Gor & Zoughbie, Daniel & Salmen, Marcus R. & Magerenge, Richard & Tessler, Robert & Campbell, Harold & Geng, Elvin , 2015. "“Wan Kanyakla” (We are together): Community transformations in Kenya following a social network intervention for HIV care," Social Science & Medicine, Elsevier, vol. 147(C), pages 332-340.
    2. Mburu, Gitau & Ram, Mala & Oxenham, Danielle & Haamujompa, Choolwe & Iorpenda, Kate & Ferguson, Laura, 2014. "Responding to adolescents living with HIV in Zambia: A social–ecological approach," Children and Youth Services Review, Elsevier, vol. 45(C), pages 9-17.
    3. Guerra, Nancy & Modecki, Kathryn & Cunningham, Wendy, 2014. "Developing social-emotional skills for the labor market : the PRACTICE model," Policy Research Working Paper Series 7123, The World Bank.


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