by Christina Laurenzi and Mark Tomlinson
Op-Ed first published in the Daily Maverick
A sports programme in Cape Town targeted 1,200 young men at risk for substance abuse, HIV and violent behaviour, with 800 of them participating in a soccer league and 400 not receiving any intervention. But when the data was analysed, the study found almost no differences in outcomes between those who participated and those who did not.
Participating in sport is highly attractive and is known to promote social cohesion and personal identity. Take soccer, for example. There are an estimated 3.5 billion soccer fans globally. In South Africa, soccer is linked to a strong sense of national identity for many people. During the 2010 Fifa World Cup, this sense of identity was harnessed across a number of community projects, aimed, for example, at urban renewal and youth development.
More broadly, community-based programmes that use sport to improve health and social outcomes — sometimes referred to as “sport-for-development” programmes — have attracted a wide audience in recent years. These programmes focus on tackling deep-seated challenges, such as interpersonal violence or HIV risk behaviours in innovative and appealing ways. Furthermore, they have been shown to help empower individuals and communities and create opportunities for structured activities.
In South Africa in particular, given our country’s high rates of gender-based violence and murder, we urgently need effective solutions to reduce interpersonal violence and associated risks. Following this year’s International Day of Sport for Development and Peace, which was observed on 6 April, we ask: are sport-for-development programmes a viable solution to this challenge?
The Institute for Life Course Health Research at Stellenbosch University, with partners from the University of California, Los Angeles, has been working for a number of years exploring the use of soccer to reduce risky behaviour among high-risk unemployed men living in poverty. In 2015 we conducted a small pilot study in Khayelitsha that showed promising results.
Encouraged by this success, we then implemented and evaluated a 12-month behavioural intervention called Eyethu Soccer League (Eyethu means “ours” in isiXhosa), with young men aged 18-29 who were neither in employment nor in education or training at the time of enrolment. We used the gold standard method for evaluating programmes such as this — a randomised controlled trial. Eyethu targeted young men at risk for substance abuse, HIV and violent behaviour. We recruited 1,200 men, of whom 800 participated in the Eyethu League, with 400 not receiving any intervention (control group).
Soccer was the mode of instruction and engagement — Eyethu was both a competitive soccer league and a platform for team members to take part in group discussions and confront norms around conflict resolution, sexual risk and substance use. Group sessions, led by trained coaches who also lived in Khayelitsha, focused on goal-setting, problem-solving and peer support to reduce conflict. As a model, Eyethu relied on both therapeutic techniques and feedback from community-based consultations, to ensure it was both grounded in the best scientific evidence and acceptable to the participants.
In our evaluation of Eyethu, we sought to understand if, and to what degree, participating in Eyethu reduced risks related to violent behaviour, HIV, and the use of substances such as alcohol, dagga, tik and Mandrax. The study was conducted from 2016 to 2020 in Khayelitsha and Mfuleni, outside Cape Town, and was implemented by highly trained staff (some of whom had worked on the pilot study) who received extensive supervision and monitoring. In the light of this, and given our earlier promising results, we were hopeful of success.
Disappointingly, when we analysed our data, we found almost no differences in outcomes between those men who participated in Eyethu and those who did not. We have recently submitted a manuscript for publication where we show that men who were part of the soccer programme showed only a very small reduction in Mandrax use, with no reported changes in the perpetration of violence, HIV testing, risky sexual behaviours, or mental health.
… integrating services that address community development with public safety initiatives may be a more effective way to tackle root causes of conflict and substance use.
What might these disappointing results mean for using sport as a way of intervening with high-risk groups? Some caution is, of course, required, as this is simply one study, and there are many others (particularly those focusing on children) that have shown more promising results. One of the lessons is that there is no “magic bullet” to solving problems of community safety or motivating individuals to change their behaviour. Social interventions need to respond to individual and environmental circumstances to maximise their effect. While we all want “success stories”, disappointing outcomes can often reveal the most about how to improve programmes.
We believe that our results call attention to broader structural issues that may have made it difficult for Eyethu to achieve its objectives as a programme. For example, one potential lesson from the Eyethu experience is the “stickiness” of social norms, which can lead to something that intervention specialists call “washout”. Even in cases where individuals in intervention programmes achieve significant gains or learn new skills, without enabling environments or structures to continue to support the practice of these skills, it can be challenging to maintain these positive effects.
It is well known, for example, that norms within a peer group (for example around binge drinking) make it exceedingly difficult for an individual within that group to simply change their own drinking patterns without also changing their peer group. Sometimes this phenomenon is a result of an intervention that is too narrowly focused; often, however, it is impossible to manage or mitigate additional factors that may shape negative outcomes.
Even well-implemented and funded intervention programmes run into these challenges. Furthermore, geography, community and context are all important pieces of this puzzle. Programmes may thrive in specific neighbourhoods while failing to take hold with individuals even just a few kilometres away. Promisingly, there may be additional structural actions that can help protect some of the positive impacts of these programmes.
For example, integrating services that address community development with public safety initiatives may be a more effective way to tackle root causes of conflict and substance use.
Our findings reinforce the need to consider how to disrupt patterns of risk from a young age. Individual and environmental factors can build over time, a concept that is known as “cumulative risk”. Children who experience multiple, ongoing risks to their well-being and safety over many years — for example, witnessing or experiencing violence at home — may find it harder to learn and adapt to stressful situations. Foundational early childhood-focused interventions are seen as a means to promote nurturing care, enabling children to achieve better health outcomes later in life.
Of course, while interventions can and should be crafted to reach people across all ages and stages of their lives, investments in child-focused programming may yield the greatest benefits: as prevention rather than treatment. Importantly, though, for effects to be maximised, these early interventions should be supplemented with additional programming and opportunities for skills-building as children develop, given what we know about the effects of cumulative risk and living in adversity.
Despite the appeal of sports-based programmes, our experience with Eyethu shows that these kinds of intervention programmes may require a stronger focus on factors that may disrupt potential gains. The long-term challenges that South Africa is facing may require more sustained and comprehensive approaches to reducing violence and promoting healthy behaviours.