Acceptability of an economic support component to reduce early pregnancy and school dropout in Zambia: a qualitative case study

ABSTRACT

Background: Cash Transfer (CT) schemes have become popular poverty reducing measures in many low and middle-income countries. Research indicates that when provided to girls in resource poor settings, cash transfers can increase education and postpone marriage and pregnancy. However, a few studies indicate that they can also have negative effects which can affect their acceptability, such as generating intra-community tensions.

Objective: Conceptually informed by Rogers’ diffusion of innovation theory, this paper explores factors affecting the acceptability of economic support in a randomized controlled trial in rural Monze and Pemba Districts of Southern Province in Zambia.

Methods: Qualitative data were collected through five focus group discussions and six in-depth, semi-structured interviews and analysed using thematic analysis. This study was done in the combined arm of a trial where girls received both economic support and participated in youth clubs offering sexuality and life-skills education.

Results: In the study communities, acceptability was encouraging by the belief that economic support provided benefits beyond beneficiaries and that it improved access to education, and reduced teen pregnancies, marriages and school drop-out. However, provision of economic support only to selected girls and their parents and fear among some that the support was linked to satanic practices negatively affected acceptability. These fears were mitigated through community sensitisations.

Conclusion: The study demonstrated that relative advantage, observability, simplicity and compatibility were key factors in influencing acceptability of the economic support. However, to enhance acceptability of cash transfer schemes aimed at addressing early marriage and pregnancy, it is important to explore socio-cultural factors that create suspicions and negative perceptions and to provide schemes that are perceived as relatively better than available similar schemes, understood, compatible and viable beyond the immediate beneficiary.

KEYWORDS:

• Acceptability
• Cash transfer
• adolescent health
• Zambia

Responsible Editor Maria Emmelin, Umeå University, Sweden

Responsible Editor Maria Emmelin, Umeå University, Sweden

Acknowledgments

This study was sponsored by CISMAC and the GLOBVAC programme. Additional funding was provided by the Swedish Research Council Research. The authors greatly appreciate the support that was provided by the RISE study team in developing this study project, in particular, Astrid Blystad, Karen Marie Moland and Ecloss Munsaka.

Data availability statement

The datasets for this study are available from the corresponding author on reasonable request.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

Ethical clearance to conduct this study was sought and granted by the UNZABREC (REF. NO. 066-06-17). Informed and written consent was obtained from all participants upon the agreement that confidentiality would be ensured.

Paper context

Diffusion theory proposes a set of ideas that can be used to understand the acceptability of innovations. However, some of these concepts are not relevant in some SCT support acceptance settings. By identifying the parameters of Rogers’ perceived attributes in SCT support acceptability processes, finding from this study can help understand factors that lead to the failure of SCT schemes and why these factors occur. The study can also help in successful dissemination and implementation of community-based implementation systems.

Additional information

Funding

This study is funded by the University of Bergen and the Norwegian Research Council through its Centre for Excellence scheme to the Centre for Intervention Science in Maternal and Child Health (CISMAC, project reference number 223269) and the GLOBVAC programme (project number 248121). Additional funding was provided by the Swedish Research Council Research Link project grant number 2016-05830. The funders had no influence on the design of the study or the collection, analysis and interpretation of the data or writing of the paper.

Notes on contributors

Emmanuel Banda

EB and JMZ contributed to the conception and design of the study. EB developed the system, conducted the interview, collected, coded, analysed and interpreted the data, and drafted the manuscript. IG, JMZ, JS and IFS contributed to the drafting, commented and critically revised the manuscript. All authors read and approved the final manuscript.