Stepping Stones and Creating Futures intervention: shortened interrupted time series evaluation of a behavioural and structural health promotion and violence prevention intervention for young people in informal settlements in Durban, South Africa
Outcomes: Gender‑Based Violence, Human Immunodeficiency Virus, Sexual and Reproductive Health, Women’s Economic Empowerment
View SourceKey Social Norms Take-aways
This study highlights that integrating economic empowerment with gender-transformative interventions can effectively shift social norms among young people in informal settlements. Notably, it found that material improvements in young women’s lives—such as increased income and reduced financial dependence—enabled them to better apply knowledge from gender-transformative programming, leading to reduced experience of intimate partner violence. For men, improving livelihoods facilitated more equitable masculinities centered on provision and stability, reducing controlling behaviors and improving partner relationships.
Objectives
The study aimed to evaluate whether a combined behavioral and structural intervention—Stepping Stones and Creating Futures—could improve livelihoods and reduce gender-based violence and HIV risk among out-of-school youth living in informal settlements in Durban, South Africa.
Methods
The evaluation used a shortened interrupted time series design with 232 participants (110 men and 122 women), collecting data at two baseline points and at 28 and 58 weeks post-baseline. Self-administered surveys assessed socio-economic status, mental health, gender attitudes, relationship dynamics, violence, and sexual behavior. Random effects regression models were used to assess trends over time.
Intervention Details
The intervention comprised two sequential components. Stepping Stones is a participatory program focused on HIV prevention and strengthening relationship skills, delivered through ten gender-segregated, three-hour sessions. Creating Futures followed with eleven three-hour sessions grounded in sustainable livelihoods theory, aimed at helping participants build financial, human, and social capital. Delivered by trained facilitators from a local NGO, the intervention emphasized critical reflection, job-seeking skills, small business development, saving strategies, and gender equity.
Results
Significant livelihood improvements were observed: men’s monthly income rose by 247% and women’s by 278%. Both genders showed more equitable gender attitudes, and men significantly reduced controlling behaviors. A 38% reduction in women’s experience of physical and/or sexual intimate partner violence was reported. Mental health indicators improved notably among men, with reductions in depression and suicidal thoughts. Both men and women showed increased life satisfaction and improved relationship dynamics.
Conclusions
The combined intervention showed strong potential to positively affect social norms, economic conditions, and health outcomes in challenging environments. It underscores the importance of pairing gender-transformative programming with structural support to shift deeply entrenched norms, particularly in resource-constrained, high-risk settings like informal settlements. Further evaluation is recommended to assess long-term impact and scalability.
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