The Transformative Effect of the Let’s Talk Intervention on Parenting Styles: Experiences of Female Caregivers from Soweto, South Africa

Abstract

Gendered social protection interventions such as Let’s Talk are now appreciated as a significant component of family-based HIV prevention services. The intervention deliberately focuses on bridging the caregiver–adolescent relational and communication divides in the context of HIV prevention. This qualitative study used interviews to explore the caregivers’ parenting experiences after attending the Let’s Talk programme in Soweto, South Africa. Simple random sampling was used to select four Community-Based Organisations (CBOs). Twelve caregivers were purposively sampled from the four CBOs. Data analysis was accomplished through thematic analysis. The findings indicate that Let’s Talk had positive transformative effects on the caregivers’ parenting experiences and relational dynamics with adolescents. The improved parenting experiences were characterised by better communication, mutual respect and observed behaviour improvements by adolescents. In conclusion, caregivers’ reports of improved parenting experiences provide empirical evidence of acceptability to participants, effective implementation, and Let’s Talk’s efficacy in facilitating desired outcomes.

1. Introduction

A significant proportion of caregivers in high HIV endemic areas face multiple psychosocial challenges that compromise their parenting skills and, by extension, the protective effects against HIV infection for adolescents [1]. Some of the challenges include poverty hardships, limited social support, family discord, chronic illnesses, children misbehaving, communication taboos around sex and HIV with adolescents and HIV positive status disclosure to children [1,2,3].

In the light of these challenges, caregiver–adolescent relationships are usually sub-optimal, marked by tension and communication challenges. Caregivers have reported parenting difficulties, including truancy, substance misuse, and adolescent girls and young women engaging in risky transactional sex with older men to escape from household poverty [4,5]. Some family-focused interventions have been observed to build adaptive parenting skills of caregivers. Caregivers in such Programmes have reported reduced social marginalisation; better family functioning, more positive feelings towards children under their care; and more pro-social behaviour from children they cared for [6].

The steady growth of family-focused interventions to prevent HIV infections has been welcomed [7]. These interventions complement biomedical HIV prevention methods. The Let’s Talk Programme is adding the number to the basket of family-focused social protection interventions already in existence. This study is therefore justified as it seeks to pick out the specific elements of Let’s Talk that produce desirable outcomes for possible scale-up. The study contributes to the body of scientific and empirical evidence on the value of group-based interventions in cementing experiences of caregivers. The insights from this study may be potentially leveraged to inform other Social and Behaviour Change Communication (SBCC) family-focused interventions to prevent HIV infection among adolescent girls.

1.1. Background

The South African family system has been under considerable strain [8]. HIV and AIDS have contributed to the disintegration of family systems across southern Africa, including South Africa. Dysfunctional family structures devoid of parental figures have been fertile grounds for HIV incidence and prevalence, disproportionately affecting adolescent girls [2]. The added burden of poverty has left surviving caregivers (parents and/or guardians) disempowered to offer social protection to adolescent girls in their care [4].

Many studies have shown that most caregivers in poor settings like Soweto in South Africa contend with problematic adolescent behaviours, including risky sexual behaviours, teenage pregnancies, alcohol and substance abuse and mood swings [1,9,10]. The situation is worsened by the fact that caregivers lack appropriate parenting skills to ameliorate these behavioural challenges. In frustration, caregivers often resort to aggressive parenting approaches, including physical punishment, that often elicit worse non-compliance behaviours [6]. Weakened relationships between caregivers and adolescents (especially females) open pathways for increased HIV risk, as some of them run away from home to go and stay with boyfriends [2].

A study in Southern Africa (Malawi, Zimbabwe, Zambia, Botswana, and Lesotho) established that household poverty, caregivers’ poor mental health and stigma negatively affected parenting capabilities [11]. In the same study, adolescents experiencing household difficulties (caregiver HIV infection or AIDS illness, caregiver with a disability and poverty) engaged in increased health risks, including multiple sexual partners without protection [11]. Researchers in Indonesia found that democratic parenting styles increased adolescent self-efficacy in HIV prevention [12]. Democratic parenting styles were noted for their clear boundaries, responsiveness, clear expectations, warmth and nurturing qualities that allowed caregivers to provide behavioural supervision, general care, HIV prevention education and guidance more effectively [12].

Several interventions have been established to bring parents together with children and adolescents to facilitate improved relationships. Some of the interventions include Sinovuyo Caring Families Programmes, Kgolo Mmogo, Thula Sana, Stepping Stones and Skhkokho Supporting Success. The interventions were group-based and run in community settings by trained facilitators [7,13]. Most caregivers who attended these interventions reported positive benefits resulting from their attendance, especially improved parenting practices and better relationships with their children and adolescents [7,13]. The Let’s Talk Programme, developed and piloted in 2016, is therefore a relatively new family-focused social protection intervention. The efficacy and acceptability of the Programme in improving caregivers’ parenting competencies have not been widely explored.

1.2. Overview of the Let’s Talk Programme

The Let’s Talk Programme falls within a larger HIV prevention Programme targeting adolescent girls and young women called DREAMS. The Programme focuses on developing the capacities of adolescent girls to become determined, resilient, empowered, AIDS free, mentored and safe, hence the acronym “DREAMS” [14]. Let’s Talk is the structured curriculum used to reach out to both female caregivers and adolescent girls in their care. In Let’s Talk, caregivers refer to the person who has primary custody of the adolescent girls; this person can be the biological mother of the adolescent girls or an alternative, depending on the unique circumstances of every girl in the Programme [15].

Let’s Talk is a weekly support group for caregivers caring for adolescents between 13 and 19 years old. The whole Programme is held in three phases, and all the sessions are completed in about 17 weeks. Phase 1 is exclusively for caregivers and is designed to help caregivers confront and cope with their stress; build their resilience; improve communication skills; increase self-awareness, and equip caregivers with positive coping and adaptive behaviours [15]. Phase 2 of the Let’s Talk Programme aims to help caregivers improve their parenting skills while also helping them to understand adolescents’ behaviour. This phase entails role plays during group sessions, which allow facilitators to model desirable parenting behaviours for observation by caregivers. Caregivers also get a chance to practice the desirable behaviours during role plays and get feedback from facilitators and other caregivers. Role plays, therefore, provide valuable platforms for modelling and peer and social learning of appropriate parenting behaviours. Caregivers are then given homework exercises focusing on particular parenting skills like active listening to practice and apply with their adolescents at home [15].

In Phase 3, the emphasis is on promoting healthy behaviours for adolescents in the context of HIV and their Sexual Reproductive Health and Rights (SRHR), with caregivers playing a critical support role. In Phase 3, both caregivers and adolescents are encouraged to forge supportive social networks and to engage in dialogue with their counterparts in similar situations [15].

Table 1. Let’s Talk Session Outline.

Session	Caregiver Sessions	Adolescent Sessions
Phase 1: Caregivers Matter
1	Taking care of myself	No sessions for adolescents
2	Emotional awareness
3	Coping with sadness
4	Coping with anger
Phase 2: Adolescents Matter
1	Raising an adolescent	My strengths and goals
2	Effective communication	Effective communication
3	Helping adolescents cope with difficult emotions	Emotional awareness
4	Behaviour management with adolescents	Coping with sadness
5	No session for caregivers	Coping with anger
6–Joint	Families working together
7–Joint	Positive family relationships
Phase 3: Protecting The Future
8	Adolescent risk-taking	Sexual relationships
9	Communicating with adolescents about relationships & SRH	Communicating about sex
10	Understanding HIV	HIV and STIS: Fact and fiction
11	Preventing and responding to crises	Condom use
12–Joint	Future planning
13–Joint	Graduation and looking ahead

summarises the specific content covered in the Let’s Talk sessions:

The aim of Let’s Talk is therefore to strengthen the caregiver–adolescent relationship through a gendered social protection model to prevent HIV infection among adolescent girls in resource-limited contexts [16]. The model considers maternal HIV and AIDS statuses and resource-limited environments as fertile ground for problematic adolescents’ behaviour, heightening the adolescent girls’ exposure to HIV infection [13]. The experiences and adaptive behaviours of both female caregivers and their adolescent girls in a parenting relationship will therefore throw important light on the potential HIV infection pathways due to structural disadvantage and the effects of social protection on adolescent girls‘ risky sexual behaviours [14].

Cognitive Behavioural Therapy, Social Cognitive Theory and Social Comparison Theory give the Let’s Talk intervention a robust scientific anchorage and grounding. Let’s Talk was intentionally designed to allow participants to gain knowledge and awareness of the complex interplay between thoughts, emotions and behaviours and how the three can perpetuate each other in a vicious circle for good and bad [17]. Group dynamics and structured role plays during the sessions allowed attendees to learn from their social environment through observational learning and behaviour modelling [18], hence the centrality of Social Cognitive Theory in Let’s Talk. Members’ interactions in the group also allowed them to evaluate their parenting competencies through comparing themselves to other participants in line with Social Comparison Theory [19].

2. Materials and Methods

This study utilised a qualitative cross-sectional design to explore the parenting experiences of female caregivers who attended the Let’s Talk Programme in Soweto. The study was carried out at four Community-Based Organisations (CBOs) in Soweto, where the Let’s Talk Programme was implemented. The study population comprised female caregivers who completed all thirteen Let’s Talk Programme sessions. Simple random sampling as described by [20] was used to select the four CBOs out of the 12 that implemented the Let’s Talk Programme in Soweto. Twelve caregivers were then purposively sampled from the four CBOs. The inclusion criteria stipulated that a participant had to be a female caregiver who attended the Let’s Talk sessions and was conversant in English, able, willing, and available to participate in the study. The researchers noted that English competence was a potential confounder because of its potential association with educational attainment. Therefore, the researchers thoroughly explained to the participants the scientific nature of the study and the demands placed on their honesty in giving true accounts of their experiences in the Let’s Talk programme.

A semi-structured interview guide (with open-ended questions) was the primary data collection tool. Data collection occurred at the CBOs in the form of semi-structured interviews. Demographic data that were collected from the participants include age, educational attainment, number of Adolescent Girls (AGs) under their care, ages of the AGs and participants’ relations with the AGs.

Note-taking (memos) and audio recording were used to capture raw data during the interviews. To ensure consistency between the interviews, the interviewers did pilot testing of the questionnaire as part of interview guide development. This process refined the final interview guide that maintained a core set of questions that were asked of all participants in the same order. Probing questions were used variably depending on the interview context. The researcher also took detailed field notes on the day of the interview and recorded contextual information and reflections. Verbatim transcriptions of interviews were performed to preserve the original data, which were then available for analysis by another researcher. The researchers received robust training in qualitative studies with a strong focus on scientific rigour, researcher neutrality, reflective listening and consistency in all relevant processes.

The researcher conducted data quality checks by listening to the audio tapes before transcribing the data. De-identification of data to maximise confidentiality was performed during the transcription process. The principal researcher wrote analytic memos in preparation for data coding. Data coding was manually performed by the principal researcher after deciding on the colour codes for themes and sub-themes beforehand [21]. Safe storage of raw data (audio tapes, field notes, and transcripts) was ensured by locking the raw data in a locked cabinet after fieldwork.

Major aspects of data analysis comprised manual categorisation and coding the data into themes and sub-themes using a deductive approach. Deductive data coding into themes and sub-themes was based on the study objectives [20]. During data analysis, room was also left for codes to be developed inductively for emerging themes. Themes and sub-themes were captured in the code book in a table format [20,21]. The researcher used open, axial and selective coding. Open coding was used to generate concepts through breaking down, examining and comparing data [20] gathered from the semi-structured interviews. Through axial coding, two or more concepts generated through open coding were subsumed into a category representing the experiences of the female caregivers. A category became a core category/theme buttressing several categories through selective coding, whereupon relationships between concepts and/or categories were explored, developed, refined and validated. The researcher also used the Framework approach to thematic analysis as a way of mapping and visualising the data. In the Framework approach, an index of core and sub-themes was represented in the matrix, thus aiding data visualisation in preparation for writing up the analysis [20].

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of the University of Witwatersrand, South Africa (protocol code M170860, 4 October 2017). Practical steps were taken to avoid emotional harm to the participants. Participating caregivers were well informed of the potential negative consequences that could arise from their involvement in the study, and they were provided with an opportunity to withdraw from the study at any time

Caregivers were informed that if they needed ongoing counselling and emotional support, social workers were available for referral support and were provided with the social workers’ contact details. After every interview, participants were allowed to express any feelings, thoughts, views or ask any questions arising from or related to the interview as part of the debriefing. All participants signed a letter of informed consent, which stated that their participation in the study was voluntary and that they were fully aware that they could withdraw from the study at any time and for any reason. To aid the foregoing, the researcher fully explained the broad research topic, who was undertaking and why the research was being performed.

The researcher ensured that the identities and records of study participants were kept confidential. Interviews with participants took place in offices at the CBO sites where no other people could hear what was discussed. Code names (pseudonyms) were used to identify participants, and the participants’ list and their code names are being stored separately in a locked cabinet file. Identifying details of the participants were removed from all transcripts. The transcripts and electronic recordings have been locked away in a cabinet.

3. Results

Study results include socio-demographic characteristics of the female caregivers who attended Let’s Talk, as well as the themes and sub-themes that emerged from data analysis.

3.1. Socio-Demographic Characteristics of Participants

All female caregivers who participated in the study were assigned pseudonyms for confidentiality purposes. The age range of the participating female caregivers was 26–49 years old, while the age range of the adolescent girls they cared for was 11–19 years old. Regarding the highest level of education attained, nine caregivers had secondary education; two had tertiary qualifications, while one had primary education. Eight caregivers had only one adolescent girl in their care, while four cared for two adolescent girls. The most common relationship between female caregivers and the adolescent girls in their care was that of mother and daughter (nine), followed by the aunt and niece relationship.

Table 2. Summary of participants’ (caregivers) socio-demographic characteristics and relationships with Adolescent Girls (AGs).

Caregivers’ Pseudonyms	Ages	Education Level	Number of AGs	Ages of AGs	Relationships with AGs
Phumzile	26	Tertiary	2	14 & 17	Nieces
Mpho	29	Secondary	1	13	Daughter
Andile	33	Secondary	2	11 & 12	Daughter & niece
Lerato	34	Secondary	1	14	Daughter
Thandeka	37	Secondary	1	15	Daughter
Nthabiseng	41	Secondary	2	13 & 14	Daughters
Boipelo	41	Secondary	1	16	Daughter
Ayanda	42	Tertiary	1	14	Daughter
Fezile	43	Secondary	1	19	Daughter
Akhona	46	Secondary	1	15	Niece
Zodwa	48	Secondary	1	14	Daughter
Lebohang	49	Primary	2	12 & 19	Daughters

below summarises the socio-demographic characteristics of the twelve caregivers who participated in the study.

3.2. Parenting Challenges Experienced Before Attending the Let’s Talk Programme

Many caregivers stated that before attending the Let’s Talk programme, they experienced significant challenges in handling difficult behaviours exhibited by their adolescents. Salient challenging behaviours included stubborn tendencies, smoking, promiscuity, having unprotected sex, unplanned pregnancies and failing at school.

3.2.1. Adolescents’ Stubborn and Rebellious Behaviour

Most caregivers stated that before attending the Let’s Talk programme, they struggled with stubborn behaviour from their adolescents, wherein interactions between caregivers and adolescents tended to be turbulent and impolite. One of the caregivers, Fezile complained that her daughter was stubborn, rude and was always in fighting mode. Describing her plight with her daughter’s behaviour, Fezile said:

Before I went for the ‘let’s talk’ program, I was having a big problem with my older child, the one who is twenty. She was stubborn, rude, and when I talked with her, she always fought, banged the door and stormed outside.

Lebohang also remembered her painful experience with her daughter, who displayed rebellious tendencies:

My child used to go to school and come back home at whatever time she pleased, and she would ignore me when I spoke to her, and she was rebellious. When I ask or send her to do something for me, she refuses. She wanted to do as she willed and at her own time that suited her. She used to spend nights out with boys, and when I asked her where she had been, she would swear at me. It was painful to me, and we would end up fighting and swearing at each other.

3.2.2. Smoking

Phumzile struggled with the fact that her niece was smoking marijuana with her boyfriend. Lamenting her worries regarding her niece’s smoking habits, she was also worried that the boyfriend would eventually get her niece pregnant:

She has started smoking, which broke her mother’s heart, and she wants me to understand that she is smoking… We also used to get some complaints from the school that she was smoking weed. It is a very strict school. When I told her mother, her mother was so depressed. She would come home smelling of dagga, and we could smell it on her. I am worried this thing will make her not concentrate at school… and she has been found smoking it, so this thing is ruining her life and his because he is not even furthering his studies. We were worried that she would fall pregnant by this guy.

3.2.3. Suspicions of Adolescent Girls Sleeping Around with Boyfriends

Caregivers reported worries and suspicions about adolescent girls starting to date and sleeping around with boyfriends. For instance, Phumzile felt that it was too early for her niece to start dating a boyfriend and sleeping around:

She was always naughty, and we once caught her out at night with her boyfriend. She was preparing to sleep outside with her boyfriend. So, it was a big issue, that’s when I realised that she was now starting to date. It was hard for me to get it inside me that she is now starting to date, and her age. When I look at the age, it’s very early, and I can’t change the fact that she’s growing up as an adolescent.

3.2.4. Risky Sexual Behaviours by Adolescent Girls

Phumzile vividly narrated her challenging experience with her niece, whom she caught with morning-after pills. The niece reported that she had unprotected sex with her boyfriend:

We once had an incident that happened with Zoleka that we found morning-after pills inside her school bag. When we asked her, she told us that they were for her friend. Her friend was drinking those pills and mistakenly left that box inside her bag… I then went asking one of her friends, and I called Zoleka in front of her other friend and said to her, ‘you are now caught, so tell us the truth’ and she cried and said she was afraid to tell me… I then asked her to tell me if the box belonged to her. She said yes. She had unprotected sex and was afraid she was going to fall pregnant.

3.2.5. Teenage Pregnancies

One of the caregivers, Fezile, bemoaned the fact that her daughter became pregnant while doing Grade 12. Compounding her challenging experience was the fact that the daughter was also failing at school. This made Fezile very angry to the extent that she considered kicking her daughter out of the house. This is how Fezile relived her challenging experience:

The challenge I have is that she was pregnant. Then she was doing grade 12… And she failed, and I was very angry because she got pregnant and failed at the same time, and she was in grade 12… You see because before, I used to talk to her and tell her that if you are an adolescent child, you must use protection and do not go around with boys, but she did not want to listen to me. Then she fell pregnant. I was very angry…

3.2.6. Caregivers Experiencing Poor Communication with Adolescents

Before attending the Let’s Talk programme, most caregivers stated that communication with their adolescent children posed significant challenges. Many caregivers reported that communication with their adolescents was non-existent. Others pointed out that caregiver–adolescent communication was often characterised by bouts of anger, tension, fear, and violence. For example, Mpho acknowledged the lack of communication with her daughter:

Before, the relationship wasn’t good at all, because my daughter wasn’t free at all to talk to me about the things, I could say that she wasn’t that open. I thought it was good, that I frightened her… she feared me… She couldn’t talk to me. We were just at home, just living, quiet to each other, not playing.

3.2.7. Shouting Accompanied by Physical Punishment

Unresolved anger on the part of caregivers contributed to inharmonious communication between caregivers and adolescents for many caregivers, as described by Lerato. In this case, the situation was worsened because the daughter also had deep-seated anger, as her mother explained:

Before I was in the program, we did not connect with my daughter. When she does something wrong, I would shout at her and sometimes even start to hit her because she never used to do what I asked her to do before this program… I had anger myself, and even my children. I would act with anger because my child would not listen to me, and she also had anger.

3.3. Parenting Experiences After Attending the Let’s Talk Programme

Many caregivers reported they started observing positive changes in themselves regarding their skills and approaches to parenting after attending Let’s Talk sessions.

3.3.1. Transformational Parenting Skills

Caregivers mentioned that they started using new skills and techniques acquired from Let’s Talk, including communication, listening, anger and stress management and disciplining skills. Most caregivers also shared that they adopted new behaviours, including sitting down to talk to their children and paying more attention to adolescents under their care. Caregivers also shared that on their part, adolescents started relating better with their caregivers and displayed new positive behaviours appreciated by the caregivers, including better communication, doing household chores, quitting smoking and observing curfews.

The accounts below show that caregivers adopted parenting behaviours aligned with an authoritative parenting style, which focused on meaningful discussion of issues [22]. Reports by caregivers show that they became more responsive to their adolescents while assertively setting clear and high expectations, while remaining warm and nurturing. Also, in line with parenting models of Darling and Steinberg [23], caregivers became respectfully involved with adolescents, set limits, established goals, and encouraged independence as a precursor to adulthood transition.

3.3.2. Caregivers Improving Communication Skills

Of the skills learnt during Let’s Talk, the ability to communicate was mentioned by most caregivers who also reported the benefits attendant thereto. For instance, one of the caregivers, Ayanda, mentioned that her new communication approach elicited good listening from adolescents, and that made her very happy:

The most important skill I learnt is how to communicate… because it helps you not to get angry at the issues that arise when you are raising an adolescent. Before Let’s Talk, I would just raise my voice. I used to blow the roof, and now I just let them know calmly what it is that I don’t like… Now we talk, we talk about everything, and that makes me feel very happy.

Attending Let’s Talk allowed Thandeka to introspect and reassess her relationship with her daughter. She realised that she was generally too harsh with her current communication approach, and she resolved to learn to communicate better with her daughter:

I learnt how to communicate with her. I wasn’t aware in the beginning, but I learnt and adjusted myself when I realised that I wasn’t treating my daughter in a good way. If I see there’s a problem, I will just leave her and try to communicate with her at a better time. We must communicate. If we don’t, that’s where the problem starts.

3.3.3. Caregivers Listened to and Accommodated Their Adolescents More

Let’s Talk afforded one of the caregivers, Boipelo, to reflect on her relationship with her daughter. Boipelo was quick to notice that she did not listen to her daughter as much as she should have. She attributed her strict demeanour to the way she was brought up, characterised by the absence of negotiations between adults and adolescents. Reflecting on what she learnt from Let’s Talk, Boipelo reported that:

During the time I attended the program, I could see that I needed to accommodate her… and after [Let’s Talk] we could emotionally understand each other and I could come to her level… After I got the guidance from Let’s Talk, I grew as a person, and that is why I am saying it built me emotionally, because of what I have been through when I was growing up… I was very strict because I grew up that way. There were no negotiations about things on chores or curfew… and when we got to Let’s Talk, we learnt that our children needed freedom and rules, but to keep in mind that rules can be bent and that children do bend rules.

3.3.4. Caregivers Managing Their Anger/Temperaments Better

Most caregivers came to the programme with unresolved anger, and this impacted negatively on their parenting abilities. The Let’s Talk sessions allowed Akhona to be more aware of her anger issues:

Before Let’s Talk, I used to have a lot of anger because I’m the type of person who expects a child to be obedient. If I tell a child Don’t do that and they do it anyway… Then I would fight… But now I don’t because Let’s Talk taught me that it’s not good to fight because the child might go away for good, and you lose him or her”.

Through attending Let’s Talk sessions, Nthabiseng reported that she learnt to manage her temper by cooling down before confronting her adolescents when they misbehaved. Regulating her temper and communicating without shouting contributed to a pleasant atmosphere in their household:

I was shouting, fighting, I am not a hard person, but I was short-tempered… But after Let’s Talk, I saw that it was not a good thing. It’s not a good thing at all… now everything is smooth because they talk to me, even about things which I do that they don’t like. They are not scared of me anymore, but they respect me… now it’s very excellent.

3.3.5. Stress Management Skills Employed by Caregivers

Phumzile recalled one of the stress management techniques they learnt during the programme. She reported recommending the technique to her sister, who was struggling to handle her child’s difficult behaviour:

I told her to sit down because she used to have stress… I would tell her that sometimes you need to calm yourself down and try to massage your face by frowning, the way they demonstrated for us. When you are angry, try next time to massage your face by frowning and then think of something else that makes you happy, and then see how your day will be.

3.4. Caregivers Adopting New Positive Parenting Behaviours

Over and above the use of soft skills acquired from Let’s Talk, caregivers also reported adopting new positive behaviours that enriched their parenting experiences. New salient behaviours mentioned by caregivers included sitting down to talk to adolescents, apologising to adolescents, using alternatives to corporal punishment and cooperating more with adolescents on tasks.

3.4.1. Caregivers Sitting Down and Talking to Adolescents

For many caregivers, communicating with adolescents was a challenge. Beforehand, communication tended to be non-existent, acrimonious and tense. Lebohang is one of the caregivers who now appreciates the importance of sitting down with her daughter, resulting in decent conversations:

Before the lessons I learnt here, my daughter and I did not get along with each other. We were abusive to each other. We did not communicate well. I came here and I learnt a lot… I learnt that shouting at a child when you are angry is not the best thing to do, rather sit your child down, talk with them, and listen to each other. This helped me a lot because my child and I live very well together, and we have peace in the house.

When her child failed at school, Zodwa opted to sit down and talk to her daughter to get to the bottom of the matter. The process was helpful because her daughter managed to reflect on what caused her to fail:

For me, it was an eye-opener because I came here not knowing how to speak to my child. I was always punishing her when she did wrong… Now every time she does something wrong, I take her and we sit down to discuss what’s wrong with her… For example, the first quarter she failed dismally… I spoke to her and asked her what was wrong with her and why she failed. And then she told me the problems and said Mom, I wasn’t doing my homework, and I wasn’t submitting my projects, and I did not know it would hurt you so much, and I’m sorry you are hurting so much…

3.4.2. Caregivers Gaining the Trust of Adolescents

Several caregivers mentioned being trusted with confidential information by adolescents. For most caregivers, this was a novel experience. The example of Zodwa highlights how adolescents confided in caregivers, showing increased levels of trust. What stood out in Zodwa’s experience is the fact that she managed to have a discussion in which her daughter disclosed she was dating at fourteen:

She once came back home late from school. I sat her down and asked her if she was involved in a relationship now, and she said yes, mother… I said to her: You are shocking me by doing big things like being in a relationship… She then said Mom, you know when you are with a boy, it does not mean you want to sleep with him. I don’t know what I need from the boy, but being in love gives me something to fit in with my friends.

3.4.3. Caregivers Paying More Attention to Adolescents’ Feelings

A few caregivers reported that they started paying more attention to their adolescent children after attending Let’s Talk sessions. One of the caregivers, Mpho, realised that her child was a victim of bullying at school when she made efforts to know what was happening in her daughter’s life. Mpho shared her experience as follows:

After Let’s Talk, I could ask her about her feelings. I could ask her about how her day is and stuff like that. Yes, I think the relationship was now better than before… She would come and tell me about her problems. She used to tell me of a boy who was bullying her at school. He was beating her. He used to take her stationery, and she’d tell me about how he bullied her. She was more open… She kept on saying Mama, are you going to come, and I’d say Yes, I am going to come and eventually I went to school, and she was happy to see me… I went to school and spoke to the class teacher. The teacher took the boy and my daughter. They spoke about it and the boy apologised. That’s how I handled it.

3.4.4. Caregivers Apologising to Adolescents

Another novel behaviour adopted by caregivers to improve relationships with adolescents was apologising. This was particularly the case for Phumzile, who decided to apologise to her niece as a way of regaining her trust. As her account below shows, she was careful to apologise within well-defined limits in case her niece would want to take advantage of her in the future:

I went home and told her I was sorry for everything that I did to her, but I also told her that being sorry does not mean I am stupid. Because she is younger than I, she thinks maybe I will come and apologise all the time. I told her that I am not stupid, I am just trying to gain her trust again.

3.4.5. Caregivers Implementing Alternative Methods to Physical Punishment

Many caregivers reported ongoing use of physical punishment on their children before attending Let’s Talk. After the programme, most caregivers ditched corporal punishment for more cordial disciplining methods. For Thandeka, withholding privileges like pocket money worked to elicit the desired behaviours in her daughter as opposed to hitting. Thandeka spelt out the need to discipline her daughter instead of hitting:

Now I ask her to wash the dishes, but if she doesn’t want, I will get up and wash my dishes, but I will warn her, if she doesn’t want to do what I am asking her I am going to deduct her money, and as I will be saying that she’d get up and wash them… Yes, I learnt it from Let’s Talk, because you don’t have to hit your child, you have to discipline the child.

3.4.6. Caregivers Increasing Task Cooperation with Daughters

Before attending the Let’s Talk programme, many caregivers reported being estranged from their adolescent children, where cooperation on tasks was minimal, avoided or forced. This seemed to change after attending the programme, as most caregivers shared experiences of cooperating and sharing with their children, as Fezile remembered:

They called us, and we were doing an activity where we built something together. Then we started there to communicate well and work together to solve things. So, after that, things were going well. We connect better; we talk and do things together… now we connect and can share. We share work in the house, usually I do things for myself, but this time she helps me clean the house… I like baking, she’s always there baking with me because I’m selling cakes. She never used to help me, but now I can even ask for her help when she returns from school to do other orders, and she would gladly do so.

3.5. Observed Changes in Adolescents After Attending the Let’s Talk Programme

The combined use of soft skills learnt from Let’s Talk with new parenting behaviours resulted in caregivers observing positive behaviour changes in their adolescents. Most caregivers reported adolescents communicating better, doing household chores, reaching out to caregivers, observing curfews, and respecting caregivers.

3.5.1. Adolescents Communicating Better with Caregivers

Ayanda shared her challenging experiences with adolescents regarding communication and emotional management before Let’s Talk. Since the programme, she observed an upturn in the adolescents’ communication abilities, especially for the seventeen-year-old who substituted seeking help for showing and throwing tantrums:

The way they behave now is different from the way they behaved before Let’s Talk. We communicate better, and the one at Northwest used to be unable to express her emotions; she was the worst, with tantrums and everything. But now she is better. Before Let’s Talk, it was a disaster… We are now at a point where we can communicate… The seventeen-year-old, she used to shout, but now she confronts her problems, asks me for help if she needs it, and we address them. She will also tell me if there’s something she doesn’t like.

3.5.2. Adolescents Reaching out to Caregivers

Getting a phone call from her daughter was something rare, and like Fezile explained, her daughter would almost only call her when confronted with a problem. However, this seemed to change when Fezile was pleasantly surprised to receive a warm phone call from her daughter expressing how she missed her mother (Fezile):

She is still the same quiet person, but now… yesterday she called me, and she was happy. I asked myself why because she’s a quiet person. She said Mommy, ‘ngikukhumbulile’ (I miss you). Yes, and she said Mommy, when you come back from work, you go to Portia and embrace Portia. You don’t think about me. I’m your child… I then realised that at least she is adjusting now.

In the case of Nthabiseng, Let’s Talk broke boundaries between her and her children, whom she described as never talking to her before. Since the adolescents started talking to her, Nthabiseng reported experiencing new, satisfying relationships with her children. The new relationships were characterised by chore completion, obedience, respect and humility:

They never used to speak with me… And so now I see a difference… They talk to me now, we are always playing at home, they do their job, their chores, and they do anything that I ask them to do… Eh, now, they don’t like going out a lot, not with friends, they just go to school, come back home, do their chores, school work and stay in and watch TV… Now they are respectful of their elders and are very humble… And they involve me in whatever queries they have with other people, and they are even able to apologise now.

3.6. Meaningful Engagement on HIV and SRH Topics Between Caregivers and Adolescents

Previous sections have shown how caregivers started overcoming some of the parenting challenges they experienced before attending the Let’s Talk programme. Most of the caregivers reported how they started utilising new parenting skills acquired from the programme. The positive parenting behaviours displayed by caregivers were reciprocated by adolescents. As reported by the caregivers, skills acquired from Let’s Talk by both caregivers and adolescents helped to reframe communication and relationship dynamics in the households, resulting in more harmonious living environments.

The improved caregiver–adolescent relationships were now markedly characterised by better communication and deeper exploration of HIV and SRH topics. For the first time, most caregivers started having meaningful discussions about sex, contraceptives, HIV infection, ART, adherence to ART and disclosing HIV positive status. However, a few caregivers were still not comfortable engaging adolescents on these topics, especially discussing sex and disclosing HIV positive status. This demonstrates that changing personal and social attitudes and perceptions to SRH issues happens in gradual stages. There remains, therefore, a need to provide SRH information to adolescents when their caregivers have not yet reached a comfortable stage to discuss the topics.

Some caregivers appreciated the Let’s Talk Programme because adolescents were taught about sex and HIV earlier rather than later, thereby empowering adolescents to be assertive in their relationships. Some caregivers reportedly built on the foundation set by Let’s Talk and continued having discussions with their adolescents on sex and HIV. Ayanda (42) elaborated:

Let’s Talk has taught me how to address sexual issues because she is at that stage now, boys are starting to notice her… In my house, we now talk about anything: sex, boys, girls… If a boy wants to sleep with you and you feel that you’re not ready, then don’t be forced into doing that. Sometimes they feel embarrassed, amazed that their mom is talking about these things, but I say, if I don’t tell you these things, who will? For me, the Programme is very good because they’re teaching our kids how to be responsible and teaching them about everything, about sex, HIV and everything… Being open teaches your kids to be strong, and they can handle any situation.

Despite many caregivers reporting that they were now better able to communicate SRH issues with adolescents, a few caregivers reported that they were still uncomfortable engaging adolescents in this regard. Some caregivers feared that starting any such discussions with adolescents might trigger undesirable sexual activity. These caregivers preferred taking a reactive stance to discussing sex and sexuality with adolescents to having open discussions beforehand. While acknowledging that it was her responsibility to engage adolescents on the SRH matters, Andile (33), who looked after an eleven-year-old daughter and a twelve-year-old niece, still argued:

We have not reached that point. I haven’t talked with them yet… The reason is that I haven’t seen any actions which make me want to talk about it, and I am afraid to start. Maybe if I see something, I can start talking about it. I am afraid to start because what if they don’t know anything about it? It would seem like I am teaching them, or I am putting them in the light of knowing about sex. While I am aware that even at school they are teaching them about sex, I am not free to start… It’s my responsibility, but I think I need to see something on them so that I can be able to start. But for now, there aren’t any signs yet on them.

4. Discussion

The positive parenting experiences caregivers shared about Let’s Talk are like other family-centred Programmes. Let’s Talk had transformative effects on the caregivers interviewed, analogous to findings from interventions like Sinovuyo Families Matter programme [7], Kgolo Mmogo [13], and the Botsha Bophelo [9] programme interventions. By attending these interventions, caregivers worked on their socio-emotional challenges, resulting in better psychosocial adjustment resulting in improved interpersonal, familial and social relationships. Such improved relationships allowed caregivers to access wider social support, learn parenting skills, and increase their confidence and self-efficacy regarding raising adolescents.

Study findings have shown that many caregivers faced significant challenges in raising adolescents, including poor relationships, truancy, substance misuse, unsafe sex practices and teenage pregnancies. This impacted the caregivers’ affective and emotional states, resulting in negative parenting behaviours, like shouting and physical punishment. These findings are corroborated by other studies. The unresolved emotional challenges faced by caregivers directly and indirectly affected their parenting styles [10]. The link between physically punishing children and unresolved deep-seated anger from traumatic childhood events has been reported before [6]. Other studies also reported caregivers’ aggressive communication styles marked by shouting and threats, suggestive of unresolved chronic emotional challenges [24], suggesting that this sample of caregivers was not unique.

These findings clearly showed the efficacy and soundness of the CBT theoretical framework that elicited the socio-emotional challenges reported by the caregivers [15,25]. This is because CBT allowed heightened self-awareness through deep emotional reflection and introspection [15]. This process allowed the caregivers to divulge the socio-emotional challenges they faced, leading caregivers and facilitators to confront and change depressive cognitive distortions and behaviours. As a result, caregivers started to regulate their emotions better, leading to more objective problem-solving and coping strategies, culminating in improved parenting practices and experiences.

Due to emotional maladjustment, poor parenting, socialisation and lack of skills, caregivers in this study could not effectively mitigate adolescents’ problematic behaviours as supported by the literature [3]. Rather, the caregivers often resorted to aggressive parenting behaviours, leading to chronic antagonistic relations between caregivers and adolescents before attending the Let’s Talk programme. CBT embedded in the Let’s Talk programme interrupted these cycles of socio-emotional challenges faced by caregivers wherein negative emotions, thoughts and actions bound and reinforced each other.

The study findings show that caregivers acquired important parenting skills from the Let’s Talk programme. This finding is comparable to results from other studies [26] that showed the transferability of parenting skills like communication, listening and disciplining through similar group-based interventions. This was possible because Let’s Talk used a deductive educational approach whereby facilitators shared general parenting principles that caregivers applied in their parenting duties in the form of role plays [15]. Moreover, it used role plays whereby parents got to observe facilitators and got an opportunity to model the skills portrayed by facilitators. Consequently, as in similar interventions [2,7] caregivers improved their parenting skills, including communication and listening, as well as discipline techniques.

In line with Social Cognitive Theory (SCT)’s assertion that aspects of an individual’s knowledge and behaviours can be impacted through observations in social interactions [27]. There is evidence that the Let’s Talk programme also successfully supplanted punitive parenting habits like shouting and hitting with more civil and constructive engagements involving discussions and negotiations. This is because the programme afforded caregivers opportunities to practice and receive constructive feedback to develop parenting skills and self-efficacy [15].

As observed in other studies that used aspects of social comparison theory [16,24]. The Let’s Talk programme provided a platform for the caregivers involved to evaluate the way they were parented vis-a-vis the way they were raising their children. When caregivers learnt anticipated behaviours, routine self-affirmations embedded in the sessions helped caregivers to frame their parenting abilities more positively. Due to increased parenting knowledge, skills and competence, caregivers interviewed reported supervising and paying more attention to the socio-emotional needs of their adolescents more post the Let’s Talk programme.

Before Let’s Talk, most caregivers confessed that they were raising their children the way they were also raised because they knew no other viable option. This demonstrates the power of socialisation [15] in the way the caregivers were parenting their children and adolescents. Findings in this study are consistent with other findings from the literature [15,24] that demonstrated that when presented with feasible parenting options, caregivers are malleable to adopt and effectively use the learned skills to counteract prior negative socialisation.

Observations that interventions like Let’s Talk can successfully improve caregiver–adolescent relationships are supported by the literature [2,9]. As noted, caregivers faced numerous co-existing adolescent problematic behaviours before the Let’s Talk programme, including stubbornness, truancy and risky sexual behaviours. This coincided with the time when the caregivers lacked the parenting skills to mitigate the challenging adolescent behaviours. By equipping caregivers with parenting skills and empowering adolescents with life skills (like communication and problem solving), Let’s Talk and similar interventions [9] supplanted often tumultuous caregiver–adolescent relationships with more civil and harmonious interactions. This paved the way for more meaningful communication and engagement between caregivers and adolescents on HIV prevention, safety in sexual relationships and goal setting.

The improved caregiver–adolescent relationships, therefore, give credence to the Let’s Talk programme’s theory of change. Like similar focused interventions [28]. The Let’s Talk theory of change anticipated that caregivers faced socio-emotional challenges that impeded their parenting capabilities [15]. The programme was therefore explicitly geared to provide caregivers with socio-emotional support to improve their mental health and psycho-social adjustments while equipping them with HIV prevention knowledge and skills for themselves and adolescents under their care. As other studies in poor village settings in the Eastern Cape, South Africa and impoverished Jamaican townships [28] improving caregivers’ mental health and psycho-social adjustments tends to improve their parenting abilities and relationships with adolescents. Caregivers’ better parenting skills have improved caregiver–adolescent relationships, had positive spill-overs on adolescents’ behaviours, as other family-centred interventions have recorded [9].

5. Conclusions

The Let’s Talk intervention had a transformative effect on parenting skills and behaviour of caregivers looking after adolescent girls; the caregivers adopted positive parenting practices and experienced better adolescent behavioural outcomes. By attending the programme, most caregivers reported improved problem-solving and emotional coping skills. This is important because most caregivers reported facing multiple behavioural challenges exhibited by adolescents and lacked the skills and support to cope before attending the programme. The Let’s Talk programme, therefore, helped to expand the caregivers’ parenting and coping skill sets, which also allowed them to delve deeper into HIV prevention and SRH discussions. The role plays and modelling of the desired parenting behaviours boosted the caregivers’ confidence and self-efficacy to connect better with adolescents.

The marked improvement in the nature and quality of caregiver–adolescent relationships after attending the Let’s Talk programme can be attributed to the improved parenting skills acquired from Let’s Talk, including communication, listening, and anger and stress management skills. New caregiver–adolescent relationships were marked by increased communication by both parties, who also now reached out to each other more. There was mutual trust and respect between caregivers and adolescents post the Let’s Talk programme.

Positive parenting experiences shared by caregivers provide robust evidence of acceptability to participants, effective implementation, and efficacy in facilitating desired outcomes (e.g., behaviours, attitudes, capacity to tackle HIV prevention issues with adolescents, and quality of relationships). Let’s Talk provided key insights regarding the socio-emotional challenges that often impede optimal parenting by caregivers. The positive relationships between caregivers and adolescents can be nurtured and sustained by bringing both caregivers and adolescents together to talk about and resolve their mutual challenges. The insights from this study can therefore be leveraged to scale up the Let’s Talk programme in South Africa.

5.1. Limitations

The study only covered a small geographic area of Soweto; hence, the transferability of results beyond the study area must account for context. Due to social desirability, the caregivers might have reported more on their positive parenting experiences and downplayed the negative aspects so that they could be viewed in a socially favourable light [21]. A study of this nature could have required more rigorous controls to ensure that the reported positive effects can be attributed exclusively to the treatment and not to other extraneous factors. Purposively sampling caregivers with basic proficiency in English could have potentially biased the study findings. English language proficiency could reflect prior academic background, and this could have impacted family dynamics, including parent–adolescent connectedness and communication styles. Therefore, academic background is a potential confounder in this study. This study was conducted through semi-structured interviews with female caregivers who attended the Let’s Talk programme with female adolescents in Soweto. This means that the experiences of the female adolescents were not directly captured in this study. The study also targeted female caregivers only; therefore, male caregivers are not accounted for. Expanding interventions to male adolescents is critical, as they often perpetrate risky behaviours that disproportionately affect women. Future programs should address endemic sexism and machismo to amplify societal impact.

5.2. Recommendations

The Let’s Talk Programme needs to be up-scaled in its current format within Soweto and other resource-limited settings. Let’s Talk was designed to accommodate both male and female caregivers. In this study, only female caregivers were interviewed. Male caregivers can therefore be included in Let’s Talk.

For more robust evidence on the efficacy of Let’s Talk in improving caregivers’ parenting competence, rigorous testing using randomised controlled trials (RCTs) is strongly recommended. Moreover, it is therefore highly recommended that further research be conducted exclusively focusing on the first-hand experiences of the female adolescents to provide insightful effects the Let’s Talk Programme had on their parenting experiences.

The program should also be extended to adolescent boys, as in many cases, it is males who initiate or reinforce antisocial or high-risk behaviours. Programs of this nature must focus on reducing endemic sexism and patriarchal attitudes prevalent in our societies.