Overall improvement in communicating SRH topics.

Parents reported communicating about SRH topics like general health and body hygiene, menstruation and menstruation hygiene, wet dreams, body changes and the implications of these changes. In some instances, caregivers communicated to their children about the availability of STI screening services as well as contraception for adolescents. They also reported having discussions around pregnancy and other negative consequences of engaging in risky sexual practices.

Some narratives indicated that pubertal changes were a trigger for communicating about SRH risks like unwanted pregnancy or HIV. Caregivers reported engaging their children in discussions by encouraging them to approach them in case of any concerns, especially those related to menarche. A female caregiver shared her story of change, emphasizing not just the topics discussed with her children, but also how she felt relaxed as she communicated.

“My children had not started engaging in sex, but I took time and talked to them about STDs and HIV. I asked them if they knew about AIDS and if they know that it kills. One of my children said she had cut herself and asked if that meant she was going to suffer from HIV/AIDS. I told her that it is possible to get AIDS through cuts, but the most important thing right now is to protect themselves especially now that they have already started menstruating because they can become pregnant and also suffer from HIV/AIDS. Once, we were weeding the garden, I told them that ‘do you know that this person almost died?’ They asked me the cause which I said was AIDS. I also told them that condoms can prevent one from getting pregnant. I talk to them freely because we are now used to each other. They ask me questions based on what they know from school, which was not the case in the past because I used to fear telling them about such. The more they ask me the more I use the chance to explain to them and get a lot to talk about. They can only ask you questions when they don’t fear you.” (Female caregiver)

However, SRH communication was still marred by threats as when caregivers reported the use of scare tactics to pass on SRH information. Discussions with boys revolved around warnings against engaging in sexual relationships or else facing the consequences of unwanted pregnancies like being incarcerated.

Comfort with SRH communication.

Caregivers reported being more comfortable and less anxious or embarrassed discussing SRH with their young adolescents after the intervention. More so, their children were less fearful when approaching them about SRH and sensitive issues regarding their sexuality. Having developed warmer and friendlier relationships with the young adolescents after the intervention, adolescents could approach caregivers even about the risk of sexual violence in the community, in addition to experiences of bodily changes like menarche. Adolescents could ably seek material support during menstruation like pads and knickers which had not been the case before the intervention. Caregivers recalled their prior experiences of SRH communication with their older adolescents as being uncomfortable. A parent narrated being previously embarrassed to discuss some sensitive topics such as family planning and condoms, but with the intervention, they were more comfortable. A female caregiver shares her experience prior and after the intervention;

“At the start of the training, I would feel shy and wonder how I would mention some difficult terms in front of my children. But now, all is well because we are very close to each other. This is because of the strategies we were taught to use to approach our children. Now they tell me all their problems without fear and I also guide them accordingly.” (Female caregiver)

Gender-sensitive SRH communication.

Caregivers highlighted challenging cultural norms around gender roles and cross-gender communication. Some caregivers acknowledged they could communicate to their child on SRH regardless of gender differences. This is mainly reported by the male participants. A male caregiver shared his experience of talking to his daughter about menstruation in the absence her mother and supporting her with her menstruation needs. Another acknowledged that despite being a man, the new communication skills acquired from the intervention enabled him to talk to his daughter without having to go through her mother first.

“I had learned and obtained the experience on how to communicate with my daughter without any fear of being a man. This had actually always been hard for me to do before I took part in the study. This has helped very much in preventing her from the bad conduct that was developing.” (Male caregiver 1)

“Before, I never cared so much about my child, or even never cared that she had become an adolescent. I didn’t even understand much about adolescence. But ever since the intervention started, I learned that there’s a lot a male parent contributes to the growth of a child, and when I understood this, I started paying attention to my daughters, especially this one who is ten years…Recently she got into her first period and her mother wasn’t around but she came running and told me “while I was urinating, I urinated blood”. I quickly went and bought pads for her. This all happened because I had talked to her about her menstruation just like we were taught during the intervention.” (Male caregiver 2)

A female caregiver also appreciates that she has learnt that it is also important to talk to her son about SRH specifically their pubertal changes as well as the fact that they are also at risk of SRH problems if they engage in risky sexual behaviour.

Transformation in knowledge and attitudes towards SRH.

Parents acknowledged their role as the primary SRH communicators with their young adolescents; post-intervention. They appreciated the caregivers’ significant role in helping young adolescents navigate pubertal changes. Prior to the study, they believed that sexuality education was solely provided at school, while concurrently expressing their uncertainties on the accuracy of the SRH information provided there. Caregivers now acknowledge their cardinal role in deciphering SRH information for their young adolescent children. Additionally, they appreciate the fact that they can competently talk about SRH with young adolescents of the opposite sex without having to go through their partners. Fathers appreciate being able to talk to their daughters while mothers appreciate being able to talk to their sons about their SRH matters.

The stories also indicated increased knowledge among caregivers around different aspects of young adolescent SRH. One caregiver disclosed that before the intervention, he did not pay attention to his children as they entered adolescence, holding onto the belief that they were still too young to receive SRH information. After the training, they reported being more attentive to their children’s pubertal changes. One caregiver appreciated learning from the intervention that their young adolescent is at risk of getting pregnant since she previously believed that only older adolescents were capable of getting pregnant. Learning this prompted her to talk to her child about bodily changes such as menarche at age 12 years and the possibility of getting pregnant even then.

“As a parent I never knew that a girl of 12 years can go into her menstrual periods or become pregnant. I always looked at her as a child but after attending the training, we now sit together and I tell them everything, even if one is [only] 13 years old. I tell her that “boys can impregnate you.” I go ahead to tell her about her body’s changes.” (Female caregiver)

Caregivers also expressed a more positive attitude towards communicating sensitive SRH issues such as condom use. Several caregivers also mentioned learning more about how to handle instances of sexual violence. One caregiver revealed learning about the process to undertake in case of such violence, such as the need for the adolescent to be examined by a health worker and the provision of preventive therapy for HIV. They also learned that young adolescents can be screened for STIs and that adolescents also need information on these services.

“My most interesting topic and what I learned the most is a case where a young girl who stays with the grandmother or mother or relative is sent for something but is raped along the way. We always knew that the first thing is to run to the LC1 (Local Council) and police and report the case. But we instead found out that rushing this child to the hospital would save her from many things like pregnancy [and] HIV/AIDS. I loved this so much, because we didn’t know about it as village people.” (Female caregiver aged 45 years)

Positive parenting skills.

Caregivers indicated an improved responsiveness to their children by acknowledging that their role goes beyond giving birth to the child to include nurturing them and having a positive and friendly relationship with them. Caregivers report more warmth and support towards their children after the intervention. Caregivers transformed their relationships with their children from authoritarian and neglectful parenting to more affective and hands-on parenting styles. Caregivers adopted a friendlier and composed approach to relating with their children, who in turn reciprocated that warmth of feeling. This is manifested through reports of prioritizing spending more time with their children, treating them with affection and communicating with them in a calmer manner. As mentioned above, they also began to pay greater attention to the physical needs of their children, such as sanitary pads and underwear for girls, to prevent them from obtaining these through other transactional relationships that may put them at risk.

Adolescents began to openly talk about their personal lives with their caregivers, which was not the case prior to the intervention. Due to the friendly atmosphere, adolescents no longer sought information from third parties in the community but readily approached their caregivers without fear. More so, they admitted that this friendly atmosphere had helped to erase their fear of talking about SRH with their children. Some caregivers report adopting some techniques for creating comfortable and friendly environments to be able to have conversations with their children like taking advantage of meal times in the living rooms. These improvements also carried over into relationships between caregivers and their non-biological children.

Encouraging children’s agency and negotiating good behaviour.

Caregivers described how by changing their attitudes to create a less fearful environment and allowing open and comfortable discussions on different issues including sexual and reproductive health, they can now have friendly conversations with their children, listening to their opinions and allowing them the opportunity to make decisions at the household level. Young adolescents began to participate independently in domestic activities, taking on roles and executing them with minimum supervision from the caregivers.

They report abandoning punitive approaches including corporal punishment and arguing with their children, some of which were adopted from how they themselves were parented, to take up negotiating good behaviour through open and positive communication while employing listening skills. They also reported experiences of providing social rewards to young adolescents who exhibit good behaviour. This has enabled them to monitor their children, especially their movements, establish where they spend their time, who they spend their time with, how they spend their day in a fearless environment. This has earned them a positive change in their children’s behaviour allowing them to be more open and transparent about what they do in the absence of their parent.

“I always make some popcorns at home and tell them ‘whoever comes back home early will eat the popcorn and those that will come late will find that the popcorn is finished.’ This makes them come back home early. Also, because I am close with my children, they now tell me the challenges they face. I also tell them that “you see you have matured and your breasts have developed, so if you allow a boy to touch your breasts or sleep with him, you will become pregnant, get HIV and die.” (Female caregiver)

Transformation of gendered parental roles in parent-child relationships.

Caregivers reveal a change in attitude towards parenting roles. They now understand the notion of equal parenting roles no matter the issues and the sex of the child. This is mainly reported among male caregivers. A male caregiver reports previous experience of using third party communication, i.e. Communication to his children through his wife. After the intervention, he can now directly talk to his children, especially his daughter. Additionally, they have reformed traditional gender attitudes to begin socialising male young adolescents to take on household roles traditionally meant for females.

“My boy is 12 years old and I see that he has changed positively because he now knows that boys can also peel plantains [plantain is a traditional food in Uganda-before cooking, it must be peeled and traditionally, it is role of the girl to complete this task–peeling (plantain) is not for just girls! A boy can also mop the house.” (Female caregiver)

Personal and family life.

Participants report a warmer relationship with their partners and overall improved harmony in families. Couples can communicate with each other on different matters especially those regarding their children and the household. They report being able to sit and plan together which was not the case previously, when individuals abandoned their parenting roles to their partners creating tensions within households. The training on entrepreneurship and financial literacy empowered parents with new skills on how to improve their household income and support their children.

“Before I used to say, ‘I earned the money myself and I can use it the way I want since I am the family head, without consulting my wife.’ If I got like UGX150,000, I used to buy 3kgs of meat for my family to also enjoy, not knowing that my wife maybe could have a loan somewhere and could be paid using this same money and the meat waits until next Saturday. But after the study sessions, I now engage my wife in planning for the money that I get so that in case she has something bigger than what I had to spend this money on, then we go for that first, and this study has helped me so much with doing this.”(Male caregiver)

Community support and community level changes.

Adoption of collective community child-rearing practices was a key change at the community level. Parents reported that they had spread the knowledge they acquired to other children in the community whose caregivers were not part of the intervention. Caregivers also reported making a resolution to improve community connectivity and create community support systems for parenting. Having conducted the intervention amidst the Covid-19 restrictions, participants report that the community did not have incidents of unwanted pregnancies in contrast to many other communities. This was attributed to the intervention.