Young women’s health behaviours in context: a qualitative longitudinal study in the Bukhali trial

The Bukhali trial is being implemented with young women (18-28 years) in Soweto, South Africa. A qualitative longitudinal study was conducted to explore Bukhali trial participants’ perceptions of health and their health behaviours over time and in the context of their life circumstances. This article reports an interpretation of interview data from a sub-sample of 11 of 35 participants who participated in four interviews conducted over 12 months. A longitudinal case analysis approach was applied, and four themes were developed: life circumstances, perceptions of health, health behaviours and changes, and experiences of the trial. Participants experienced largely challenging life circumstances characterised by instability and lack of security in terms of employment and education. Their health and health behaviour trajectories also lacked stability and were fragile within the Soweto context. Data were also interpreted through the lens of a concept previously explored in Soweto and introduced in the final interview: ukuphumelela (‘flourishing’). This concept provided a useful framework for understanding the dominance of external or structural (versus internal or personal) factors and social dynamics influencing the health behaviour and life trajectories of participants, particularly in terms of success in the face of difficulty. Participants’ experiences of the trial highlighted the critical role of support provided by and trust established with trial staff. This longitudinal qualitative approach provides unique perspectives about the Bukhali trial over time, the importance of contextualising health behaviour change, and the variable instability impacting the participants, outcomes and implementation of Bukhali in Soweto, a vulnerable setting.