Feb 28, 2013


The Young Citizens Program engages youth to become health promoters in communities affected by HIV/AIDS, with the goals of increasing their own self-efficacy and the community’s collective self-efficacy. The 28-week program organizes sessions into five modules that use discussion and dramatization to teach participants how to communicate with and educate community members about HIV/AIDS. Young Citizens participants develop and publicly perform skits about the impact of HIV/AIDS inside the body and within the community. A randomized controlled trial in Tanzania found that youth who participated in the program increased their deliberate and communicative self-efficacy and their emotional control, compared with youth in the control group. It found no difference between youth in the two groups on measures of academic self-efficacy or resistance to peer pressure.


Target population:  Youth in communities dealing with HIV/AIDS

Young Citizens uses a health promotion framework to promote community discussion on HIV/AIDS by teaching youth to be effective health agents in their neighborhoods. Young Citizens participants attend 29 sessions, typically once a week, that last two to three hours, either after school or on weekends. The sessions are facilitated by trained young adults and are delivered using a detailed script. Sessions are organized into five modules that require increasing levels of participation and decision making from the participants.

The first module focuses on group formation and includes activities to build trust and teach participants to consider other people’s perspectives. The second module is built around understanding the community with discussion themes such as child rights and citizenship. The third module is about health and the community, during which youth act out the immune system’s response to an HIV infection, and develop their own skits about the transmission, testing, treatment, and community stigma around HIV/AIDS. The fourth module focuses on making assessments and taking action in the community. During that module, participants create and administer a mini-survey of the community in order to select the topics for their public performances that would have the biggest impact. During the final module the youth practice and perform their skits for the community and invite discussion from the audience.


Carlson, M., Brennan, R. T., Earls, F. (2012) Enhancing Self-efficacy and collective efficacy through public engagement around HIV/AIDS competence:  A multilevel, cluster Randomized-control Trial. Social Science & Medicine, doi: 10.1016/j.socscimed.2012.04.035

Evaluated population:  This evaluation included 724 youth, aged 9 to 14, and their caregivers across 30 neighborhoods in Tanzania.

Approach:  This evaluation used a cluster randomized control trial design. First, 30 neighborhoods were matched into pairs based on demographic characteristics. Next, 24 youth and their caregivers were randomly selected for participation within each neighborhood. Finally, one neighborhood (and its youth) within each pair was randomly assigned to the treatment group, the other to the control group.

The youth in the treatment group participated in the five modules across 29 sessions and performed their skits at well-populated areas such as bus stops and markets. Community sessions were held during Module 5.

The primary outcomes of interest in this evaluation were youth and community self-efficacy. Youths and their caregivers were evaluated before random assignment and within four months of the end of the intervention on a range of measures of health and self-efficacy. Several kinds of self-efficacy were measured:  deliberate (for example “I have learned how to express my opinion to adults”), communicative (for example, “I have learned how to talk with adults about what troubles me”), and academic (for example, “I have learned how hard work helps me in math”).

Groups of adult residents of the 30 neighborhoods were surveyed before randomization, and two months after treatment ended, on measures of HIV/AIDs knowledge and attitudes, child collective efficacy (for example, “adolescents in the neighborhood can teach adults some scientific facts about HIV/AIDS”), neighborhood collective self-efficacy (for example, “in this community, neighbors will take action to get food or medicine for sick neighbors”), and other demographic characteristics. Hierarchical Linear Modeling techniques were used to account for the cluster correlations between participants. There were no differences between treatment and control neighborhoods at baseline.

Results:  Post-treatment, the youth in the treatment group had higher deliberate self-efficacy (medium effect size:  0.27), communicative self-efficacy (medium effect size:  0.3), and emotional control scores (small effect size:  0.17) than youth in the control group. There was no difference between the two groups in academic efficacy or peer resistance at post-treatment.

At the follow up, child collective efficacy was greater in the treatment neighborhoods than in the control neighborhoods (large effect size:  1.36). There was no difference in collective efficacy between neighborhoods post-treatment or neighborhood problems.



Carlson, M., Brennan, R. T., Earls, F. (2012) Enhancing Self-efficacy and collective efficacy through public engagement around HIV/AIDS competence:  A multilevel, cluster Randomized-control Trial. Social Science & Medicine, doi: 10.1016/j.socscimed.2012.04.035

Contact Information

Dr. Felton Earls
Department of Global Health and Social Medicine
2 Arrow St., Suite 400
Cambridge, MA 02138
Phone: 617-495-5568

KEYWORDS:  Children, adolescents, males and females, community-based, community or media campaign, skills training, Self-sufficiency – Other, Civic Engagement – Other, Social/Emotional Health – Self-esteem/Self-Concept.

Program information last updated on 2/28/13