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

Background: Cultural consensus modeling (CCM) is an approach whereby individuals define the boundaries regarding a set of knowledge or behaviors shared by a group within a culture using an ethnographic approach. Objectives: This paper provides 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 behaviors, allowing individuals to draw upon a shared cultural knowledge. Utilizing these identified group beliefs, Phase 2 asks individuals to rate the extent to which factors identified in Phase 1 are valued. Phase 3 utilizes qualitative interviews with key informants from Phase 2 to gather in-depth information regarding the identified determinants of the health behavior. Last, 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 behaviors. 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 multiple consensus models exist and competence scores are calculated. Standard qualitative analysis approaches are utilized for Phase 3. Phase 4 employs regression to examine the association between cultural models and an outcome of interest. Conclusion: Using CCM provides a novel, culturally sensitive understanding of the reproductive health practices among South African adolescent girls; CCM has broad applicability to other adolescent health research domains.