Cultural consensus modelling to understand the reproductive health needs of South African adolescent girls

BACKGROUND: Cultural consensus modelling (CCM) is an approach whereby individuals define the boundaries regarding a set of knowledge or behaviours shared by a group within a culture using an ethnographic approach. OBJECTIVES: To provide an overview of CCM methods and the application of CCM to examine South African adolescent girls’ contraceptive and HIV prevention practices. METHODS: In phase 1 of a CCM approach, individuals respond to questions about their culture rather than their individual behaviours, allowing individuals to draw upon a shared cultural knowledge. Utilising these identified group beliefs, phase 2 asks individuals to rate the extent to which factors identified in phase 1 are valued. Phase 3 utilises qualitative interviews with key informants from phase 2 to gather in-depth information regarding the identified determinants of the health behaviour. Lastly, phase 4 of this approach conducts a quantitative survey to determine the extent to which cultural consensus model types are associated with differences in actual behaviours. RESULTS: CCM data analytic approaches are described. Frequencies and descriptive statistics for the free listing are conducted. For phase 2, cultural consensus analysis is conducted to examine whether one or several consensus models exist and competence scores are calculated. Standard qualitative analysis approaches are utilised for phase 3. Phase 4 employs regression to examine the association between cultural models and an outcome of interest. CONCLUSION: CCM provides a novel, culturally sensitive understanding of reproductive health practices among South African adolescent girls; CCM also has broad applicability to other adolescent health research domains.