RATIONALE : Interventions that promote sexual health communication between adolescents and their parents or
other primary caregivers are an important tool for reducing female adolescents’ behavioral risk. Understanding
the mechanisms by which interventions effectively foster communication can inform future programs.
OBJECTIVE : An initial evaluation of Let's Talk, a structured, family-centered HIV prevention intervention for
vulnerable adolescents in South Africa, found an increase in caregiver-adolescent sexual communication. This
analysis expands upon initial findings to explore the role of parental knowledge, the quality of the parentadolescent
relationship, and the mental health of both parties on caregiver-adolescent sexual health communication.
METHOD : Using mixed methods data collected in 2015 and 2016, structural equation modeling of differenced preand
postintervention survey data from 64 female Let's Talk participants ages 13–17 and their caregivers was used
to explore the pathway to increased frequency of caregiver-adolescent sexual health communication. Focus
group discussions (FGDs) were held with intervention participants (n = 25) and facilitators (n = 6).
RESULTS : The path analysis indicates that caregivers' mental health indirectly affected caregiver-adolescent relationship
quality, and adolescents' mental health exerted a direct effect. Relationship quality, in turn, directly
affected the level of parental sexual communication reported by the adolescent. FGDs suggested that cultural
norms inhibit frank discussions between caregivers and adolescents about sexual health, but that thoughtfully
designed interventions such as Let's Talk can mitigate this barrier. Qualitative findings also echoed quantitative
findings about the role of caregiver-adolescent relationship quality and mental health on communication frequency
and highlighted the importance of enhancing participants' technical knowledge and particularly their
skills related to expression, listening, and anger management to help enable sensitive conversations.
CONCLUSIONS : Findings overall suggest that a holistic intervention approach emphasizing caregiver-adolescent
relationship development and designed to support the mental health of both parties may hold significant promise
for enhancing sexual health communication.