Findings and Lessons Learned from an Evaluation of a Community-Based Teen Pregnancy Prevention Program for Young Men

Addressing inequitable gender norms

Manhood 2.0 is a pregnancy prevention program designed to engage young men in the United States in questioning and challenging inequitable gender norms to enhance gender equality. Employing a lens of intersectionality, Manhood 2.0 strives to do the following:

• Foster critical examination of gender norms among women and men
• Strengthen equitable gender norms
• Change inequitable gender norms
• Allow young men to become aware of, question, and redefine the roles and behaviors that a given community considers appropriate for men and women
• Examine the costs of ‘manhood’ for men, women, and communities
• Actively challenge racism, homophobia, and other forms of oppression that limit men from achieving social justice
• Empower young men to challenge the existing gender norms that perpetuate violence and poor health
• Allow men to focus on being allies to women in the fight for gender justice and equality

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Evaluation of Manhood 2.0

Child Trends used an individual randomized controlled trial to evaluate the impact of Manhood 2.0 on contraceptive knowledge, attitudes toward relationships, communication, self-efficacy, gender norms, social support, and intentions about contraceptive use and sexual activity. Due to initial difficulty enrolling older teens and a reduced evaluation timeline, the study recruited 110 young men—a smaller-than-anticipated sample for the evaluation. Immediately following completion of the program, the study team conducted five focus groups with 28 young men (50%) who participated in Manhood 2.0. The study team also conducted long-term follow-up through focus groups and interviews with 14 of the young men (25%) in the spring of 2020.

Recruitment and enrollment

The evaluation study recruited young men ages 15 to 22 from LAYC’s existing participants, local high schools, and the broader Washington, DC metropolitan area. However, because of challenges enrolling older age groups, the evaluation team revised the recruitment criteria and implemented the study with young men ages 15 to 18. The study took place from November 2017 to September 2018. To participate in the study, individuals had to meet all the following criteria:

• Identify as male
• Be 15 to 22 years old (later revised to 15 to 18 years old)
• Not be actively planning a pregnancy with someone
• Have never participated in the community center’s sexual and reproductive health program
• Have received no additional sexual or reproductive health programming in the last three months
• Be able to participate in a program delivered in English only

The study had nine months of enrollment before the study period ended due to funding cuts. One hundred and ten young men were enrolled in the study across six cohorts. Depending on recruitment, each cohort had an average of eight participants who participated in Manhood 2.0 over the course of one month. Of the 110 total participants, 56 were randomly assigned to receive Manhood 2.0 and 54 were assigned to the control condition, which received a Post-High School Readiness program. All participants (100% of the intervention and control groups) completed a baseline survey on the day of randomization. We achieved a response rate of 89 percent for the immediate post-intervention survey (91% for the intervention group and 87% for the control group), which is an especially high survey response rate for a community-based intervention.

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Evaluation findings

Manhood 2.0 participants attended the program at high rates.

Across all six cohorts, 89 percent of intervention participants attended at least one Manhood 2.0 session and 61 percent of participants attended six out of the eight Manhood 2.0 sessions (75% of the sessions). This is a strong attendance rate for a community-based program for young men.

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Manhood 2.0 participants in focus groups described the key roles that Manhood 2.0 facilitators played:[1]          

• Manhood 2.0 facilitators played a key role in creating a safe space for participants to have open discussions by fostering a sense of trust and brotherhood among the group.
• Participants shared that Manhood 2.0 facilitators were relatable and therefore able to develop strong connections with the young men and engage them in the program.

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Manhood 2.0 participants in focus groups elaborated and provided context on program benefits.

This included the content (knowledge of the full range of birth control methods, sexual consent, rigid gender norms) and the social support they received:

Reproductive health knowledge, attitudes, and communication

• Participants shared that the program gave them a broader and deeper understanding of female birth control methods, condoms, dual method use, and sexual consent.
• Participants shared how gaining this knowledge had strengthened their communication skills with their partners.

Gender norms

• Participants reported that Manhood 2.0 had changed their understanding of gender norms and helped them confront stereotypes.

Social support

• Participants stated that young men have difficulty expressing their feelings and require shared, safe spaces in which they feel comfortable having open discussions with each other.
• Participants reported that Manhood 2.0 had provided them a safe space to talk about everything from gender and relationships to issues they face as young men of color, such as discrimination, stereotyping, and racism.
• Participants shared that their conversations in Manhood 2.0 had helped them realize that others held similar lived experiences and helped them form connections with one another.

For more information about young men’s experiences with Manhood 2.0, see this research brief.

Participants listed many long-term program benefits.

Based on interviews and focus groups conducted with young men 1.5 to 2 years after participating in Manhood 2.0, participants indicated that the program had:

• Manhood 2.0 taught young men the knowledge and communication skills they need to comfortably discuss birth control and condom use with partners and engage in decision making.
• Manhood 2.0 made a lasting impact on how young men define sexual consent and the importance of obtaining consent.
• Young men highlighted the pressures they face as men; and, as a result, they expressed desire for more equitable relationships.
• Young men identified racism, early fatherhood, communicating feelings, and a lack of role models are some of the biggest issues they still face and need additional support to address.
• The delivery of Manhood 2.0 continued to resonate with young men 1.5-2 years after program completion. Even though participants had not found a formal safe space like Manhood 2.0 to talk with other young men, the program enabled them to create those spaces themselves.

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Implementation and evaluation lessons learned

The team learned many lessons that will be useful for future program implementation and evaluation, especially for recruiting and retaining young men in a community-based teen pregnancy prevention program and evaluation.

Manhood 2.0 facilitators were trained intensively on the Manhood 2.0 curriculum, including practice through “teach backs.” During teach backs, new facilitators facilitated each activity and received immediate feedback on their facilitation style, along with recommendations for improvement. Facilitators also participated in weekly check-ins with Promundo staff for technical assistance, which allowed them to ask questions and increase their confidence with the curriculum content.

Young men who participated in the Manhood 2.0 study identified discrimination and racism as the biggest issues they face as young men of color. Discrimination is linked to masculinity; research suggests that young men who experience racial discrimination may feel more pressure to conform to rigid gender norms to increase their feelings of self-empowerment. Therefore, it is important to offer Black and Latino young men a space to critically reflect on how discrimination has impacted their views on masculinity. Promundo modified Manhood 2.0 to provide a space for this discussion, and facilitators approached sexual and reproductive health issues with a racial lens throughout the program.

We focused heavily on in-school recruitment for the study; specifically, we recruited at local schools that had existing relationships with our implementation partner. Recruiting at local schools in addition to our community-based center expanded our recruitment pool and allowed youth to regularly attend program sessions. Because the implementation site was local for most participants, common barriers to participation (e.g., travel time and location) were greatly reduced.

Initially, the evaluation team enrolled participants, conducted the baseline survey, and randomized participants before the start of the program. We then asked participants to return for the first session at a later date. However, it was difficult to get participants to attend an after-school community-based program with which they had yet to engage, so we added a “welcome session” and revised our enrollment process. The revised process allowed participants to complete the baseline survey, immediately be randomized, and participate in an introductory activity with their cohort to build interest in the program. This and other approaches—such as providing dinner, allowing participants to co-enroll with friends, and offering multiple randomization days—increased the percentage of participants attending at least one program session from 21 percent (at the start of the study) to 89 percent.

Providing incentives and food to participants aided in the recruitment of young men for the study; however, strong personal connections between facilitators and participants maintained participant retention. Facilitators often reached out to participants via text or phone to remind them about upcoming sessions and to check in on participants who were absent from a session. Throughout the program, facilitators articulated and reinforced expectations around accountability, which was a significant motivator for participants to attend. Facilitators were open, relatable, and assumed an attitude of wanting to learn from the youth, rather than talk at or teach them. Many facilitators shared similar backgrounds to the young men and approached conversations from a place of empathy.

Early in the study, we observed low post-intervention survey response rates among control participants, likely because there was no specified programming in place for them. Due to the study’s local implementation, groups of friends often signed up together and were randomized to separate conditions. However, because there was initially no structured program for the control group, treatment group participants would sometimes leave class to join their control group friends, thus reducing intervention group attendance rates. To address this, our team delivered a structured program—the Post-High School Readiness Program—to the control group. Although not part of the original study design, this program became a critical component to the implementation of the Manhood 2.0 study. Offering structured programming, with the same dosage for both groups, allowed friends to feel equally involved in the study experience. In addition, a viable control group program allowed us to recruit from public schools in Washington DC, which had restrictions on implementing a randomized control trial without a comparable program for control group participants. The high attendance rates for control participants also improved post-test response rates.

Our team offered the post-intervention survey to all participants, in person, immediately following the last program session. Staff followed up with participants who did not attend the final session by sending a unique survey link to participants via text and email. To account for participants who did not respond remotely, we worked with our implementation partner to follow up with youth in person at their schools (including during lunch hours) or at the community center. Meeting students in person at their respective high schools was a successful way to reach participants.

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Learn more about our curriculum

To download the publicly available and open-source Manhood 2.0 curriculum, see here. For more information on the Manhood 2.0 program and evaluation results, see here.

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Acknowledgements

This publication was made possible by Grant Number 5U01DP006129, which is a partnership between the Office of Population Affairs (OPA), the U.S. Department of Health and Human Services (HHS), the Teenage Pregnancy Prevention Research and Demonstration Program, and the Centers for Disease Control and Prevention’s (CDC) Division of Reproductive Health. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official position of the OPA, HHS, or CDC. The authors would like to thank Heather Wasik for her review of this brief.

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Footnote

[1] The study team used Dedoose, a qualitative data analysis software, to analyze interview and focus group transcripts and identify common themes.