Process evaluation of an HIV stigma reduction intervention among young people in northern Uganda

Abstract

HIV stigma among youth in Uganda remains prevalent and impedes efforts to advance HIV prevention. A community-based participatory approach and arts-based population health intervention were undertaken to reduce HIV stigma among young people in northern Uganda. A mixed-method process evaluation aimed to examine successes and barriers to intervention implementation, contextual circumstances that may have influenced intervention outcomes, and acceptability and subjective evaluations among participants. The process evaluation drew data from daily lesson logs and classroom observation notes from Research Assistants (RAs), minutes from research team and school meetings, exit interviews with participants, and a focus group discussion with RAs. Data were collected during the 2023 school year (January to December 2023) in 12 schools in Omoro District, northern Uganda. Key summaries were made from data sources and organized into tables. The use of Linnan and Steckler's (Process evaluation and public health interventions: an overview. In: Process Evaluation in Public Health Interventions and Research. San Francisco, CA: Jossey-Bass Publishers, 2002, 1-13.) comprehensive framework and components of process evaluation, such as context, fidelity, reach, and dose received and delivered, guided this process evaluation. Findings highlighted that although implementation faced time constraints and contextual challenges, including monetary and material compensation, the intervention was delivered as planned and increased awareness of HIV stigma and cultural knowledge for students, teachers, Elders, and communities in Omoro District. Participants also reported that the intervention enhanced cultural understanding by integrating local traditions, proverbs, and storytelling into the educational process, leading to a reduction in HIV stigma among students. Future research should consider contextual and cultural relevancy of interventions as instrumental to an intervention's acceptability and adoption among target populations.

Keywords: HIV; Uganda; arts-based intervention; process evaluation; schools; stigma; young people.