A unique co-development approach to developing interventions to reduce violence against women and girls and improve the mental health and livelihoods of both young men and women in marginalised communities in South Africa has produced encouraging initial results. 

The outcomes of pilot study of a recent project point to the benefit of a unique approach to creating interventions to support young people that challenges the power inequalities between researchers, practitioners and potential beneficiaries, using a collaborative approach to framing and solving issues together.

In the fourth instalment of the Siyaphambili Youth Webinar series held on 19 June 2024 to discuss the co-development concept and process, Dr Andrew Gibbs, Senior Lecturer (Psychology) at the University of Exeter in the UK, described how previous interventions designed to address intimate partner violence in marginalised communities in KwaZulu-Natal (KZN), South Africa had seen some successes, but had also exposed gaps.

“We wanted to see stronger outcomes, particularly for women, but also for men,” said Gibbs. “Our thinking about how to address these gaps led us down a particular road”. 

That “road” meant working much more closely with young people themselves to centralise their knowledge, and drawing on the experience of local non-governmental organisations, in this case Project Empower, as well as the academic expertise of researchers from the South African Medical Research Council (SAMRC), University College London and the University of Exeter. 

One of the early outcomes of the new thinking was the launch in KZN in 2020 of the Siyaphambili Youth Project, which ran from 2020-2024 and the subsequent process of co-developing an intervention known as “Stepping Stones and Creating Futures Plus” (SSCF+).

SSCF+ aimed to address the lack of effective intimate partner violence (IPV) prevention interventions for young men and women (18-24 years) who live in marginalised communities in both rural and urban settings, who are neither in employment or training (NEET). 

Earlier work with young NEETs had produced little impact on women's experiences of IPV in particular, and no impact on the poor mental health of young people in general. It was hoped that the co-development approach to creating interventions could make a difference.

Co-creation – A ‘decolonial’ approach

Unpacking the concept of co-creation, Professor of Social Science and Global Health at University College London Jenevieve Mannell told the webinar that co-creation in research could be viewed pragmatically as a means to create better uptake and sustainability of interventions and improve their relevance to the end user. 

More importantly, however, by giving future beneficiaries the space to collaboratively frame and solve challenges, it could help to challenge and reduce power inequalities between researchers and potential beneficiaries. As such, it could also be framed as a “decolonial” research practice, she said, one that brings the knowledge systems of marginalised peoples into conversation with more dominant narratives.

Mannell admitted that concretely addressing power relations in practice required careful reflection.  

“Through our experiences as a team we came up with a few thoughts,” she told the webinar. These included the following: 

1. Recognising that those we are working with need to also have the confidence and space to have meaningful reflections and analyse their own lived realities to contribute to the process.
2. The important role of storytelling in developing collective identity and thinking of all partners in a collaboration as “us” rather than as “us and them”.
3. Understanding concepts as jointly produced, which means recognising multiple forms of knowledge and not necessarily privileging one over the other.
4. The fact that not everything can be co-produced and there is still a role in the research process for formal evaluation that requires certain expertise that communities may not have.

Mannell said that while more interventions to address violence against women and girls need to draw on co-production, it was an approach that also required large amounts of time, resources and flexibility.

“Never underestimate the amount of time co-design takes,” she said. “Ideally, it needs to be an iterative process, where the option to change direction is real.”

Mannell appealed to funders to be more open to the need for such flexibility.

“For co-production to really work, people need to be open to discovering new ways of thinking. What Siyaphambili has taught me is that we still have so much to learn and we need to be open to working through new ideas and new ways of seeing the world.” 

Steps towards change

Describing the process of co-development that led to the creation of the SSCF+ intervention, Laura Washington, Director of Project Empower based in Durban, South Africa, said a total of 17 youth peer research assistants (YPRAs) were recruited for the project and served as representatives of their peers as well as project facilitators. These 17 young men and women were a vital part of the co-development research team and were drawn from both urban informal settlements and rural communities.

Washington confirmed that the co-development approach was “not quick”.  

“It took a number of years to get from initial ‘problem trees’ to ‘theories of change’ and then to testing the curriculum,” she said referring to the multiple steps in the intervention co-development process. The process was also hindered by South Africa’s COVID-19 lockdown conditions, a failed insurrection attempt in the province of KwaZulu-Natal in 2021 that claimed the lives of 300 people and severe flooding 2022 during which 500 people lost their lives and there was widespread damage to infrastructure. 

Washington said the process of co-identifying the factors that were most open to change in young people’s lives was the most “difficult and challenging”. 

“There was a lot of going backwards and forwards, changing direction and discussion between the different team members. Once we got that right and co-built theories of change, the rest of the process was much simpler,” she said.

Washington said a composite thematic analysis compiled by researchers, which captured the lived realities, structural exclusion and drivers of violence experienced by many of the YPRAs helped significantly to build rapport between researchers and generate confidence on the part of the YPRAs in the work of the researchers.

During the process of identifying causal relationships which ‘drove’ IPV, Washington said the researchers learnt that the YPRAs were acutely aware of the difficulties they faced in their lives. “Even to the point of being overwhelmed by them,” she said. 

“Interestingly while the YPRAs were able to describe well the structural conditions they lived with, they showed in their analysis of the roots of IPV that they had internalised an ideology of self-blame for many of personal and interpersonal struggles they raised and faced.

“Without wanting to be glib, we think there was a process of consciousness-raising for YPRAs that happened through the course of doing this problem analysis. As they began to see more deeply into the causes of the problems they faced.” 

Draft theories of change were developed for each group (urban men, urban women, rural women and rural men) which included suggested resources that could effect change in young people’s lives. These were workshopped and confirmed with the YPRAs before being developed into a 15-session curriculum – which was called Stepping Stones and Creating Futures Plus. This was then tested and piloted with young people. 

A life-changing experience

Washington’s account of the YPRA engagement was confirmed by the positive comments of two YPRAs, who were also facilitators of the SSCF+ intervention, about their experience of the project.

Of the researchers, YPRA Sindi Ngocobo said: “They understood and listened to our view. They encouraged me to do something different every day. I engaged with families, friends and with people in general. It was special for me to facilitate the SSCF+ and to share my skills and knowledge more widely.”

Another YPRA and facilitator, Jabulani Khwela, declared that being part of the team had changed him. “I can see myself now as a person who is helpful and is active in my community, participating in the creation of a manual. I learned to be good person, respectful and considerate of others. There needs to be more of these platforms whereby young people can meet and discuss their problems or challenges. I hope the SSCF+ can reach more people, even outside my community.”

Operations Manager for Project Empower, Sivuyile Khaula, describing the piloting of SSCF+ with 320 young women and men in urban informal settlements and rural communities, said the success of the SSCF+ had been evident in the attendance levels of young people. It was also evident in the positive comments from the young people about the project and its impacts on them as individuals and within their communities. Khaula also emphasised how young people liked that the intervention worked with small friendship groups.

Headed in the right direction

Describing the results of the pilot of the co-developed intervention SSCF+, which saw young people being divided equally into two groups, with half receiving the intervention immediately and half six months later, Gibbs said while it could not produce definitive outcomes, it had produced “positive changes on a range of outcomes in the right direction” which suggested that if SSCF+ were done on a larger scale, it might see positive outcomes.

He said when measuring for physical, sexual, emotional, and economic violence over a period of six months, the pilot showed a consistent pattern of women who had received SSCF+ (compared with the control group) reporting less IPV experience at follow-up. He also said there was a significant reduction in women’s experiences of controlling behaviour. 

In the area of livelihoods, Gibbs said there was a “strong pattern of change” with the “markers of earnings, savings, and food security all improving in direction we would like”. 

He said that women who had received the SSCF+ arm reported improvements in livelihoods, and many were significant. “Other measures such as working in last three months, of borrowing, or stealing – they were all moving in the correct direction [which is] a strong indication or marker that women's livelihoods after five months were stronger than those in control group.”

Additionally, on a range of mental health outcomes, Gibbs said there was a consistent pattern of improvements at follow-up. 

Turning to outcomes among men, Gibbs said there were, as with the women, a “cohesive set of changes in terms of IPV outcomes”. Perpetration of violence across all measures was reduced among those men who received the intervention immediately compared to the control, and in respect of men’s perpetration of physical IPV the findings were significant. 

As with the women, the findings around livelihood were encouraging, with many key indicators moving in the right direction. Gibbs said there were indications of earnings and savings increasing among men in the intervention compared to those in the control. 

Unfortunately, when it came to men’s mental health, Gibbs said there was “no consistent pattern” of change.

Gibbs concluded by saying that overall, the approach of the Siyaphambili Youth Project and the promise of SSCF+ were clear endorsements of a co-development approach with its emphasis on teamwork and working collaboratively.

He said the next step would be a formal evaluation of the SSCF+ to establish whether the pilot findings can be sustained over longer period and whether the SSCF+ intervention was cost-effective.