Abstract
Implementing and evaluating interventions in humanitarian settings in low- and middle-income countries presents unique challenges that are little addressed in the implementation literature. We document the process of developing, implementing, and evaluating the Amenah pilot intervention that aimed to mitigate the drivers of early marriage in a Syrian refugee community in Lebanon. Adolescent girls' vulnerability to early marriage increases following displacement due to poverty, insecurity, and school disruptions. We delineate how, as a local research team, we triangulated evidence from the international literature and formative community research to make informed decisions during the intervention's design and implementation phases. The pilot was delivered to 203 Syrian refugee schoolgirls aged 11-14 years during the 2017-2018 academic year. It consisted of 16 structured, interactive sessions with girls and a set of facilitated meetings with the girls' mothers, both of which were implemented by trained female community workers from the Syrian refugee community. Process evaluation results showed that sociodemographic factors predicted attendance among mothers, but relationships with peers in the intervention were the only significant predictor of attendance among girls. The primary outcomes of the pilot were attitudinal measures related to education and marriage. Attitudes toward education were highly positive at baseline and did not change over the course of the intervention. There were no significant changes in girls' ideal age at marriage. Among girls aged 13 and older at endline, the mean self-reported expected age at marriage increased slightly from 20.2 to 20.8 years (P<.05). Our results also suggest that girls may adjust their expected age at marriage downward as they become older and if they drop out of school. We reflect in the discussion on some of the challenges encountered and lessons learned for the benefit of researchers intending to conduct community-based interventions in displacement settings.
Highlights
The global increase in forced displacement has triggered substantial growth in public health research among refugees and internally displaced populations, motivated by the need to address poor health outcomes among these vulnerable groups
This phase encompassed 2 components: (1) review the evidence on what works to mitigate the drivers of early marriage in low- and middle-income countries (LMICs), with a focus on interventions in humanitarian settings; and (2) conduct a series of community meetings to discuss the intervention with Syrian refugees, mothers of adolescent girls and other stakeholders representing humanitarian organizations, municipalities, and schools
The use of attitudinal outcomes is common in early marriage interventions due to the limited timeframe of most program evaluations,[27] this approach makes the assumption that changed attitudes will lead to changed behaviors
Summary
School Enrollment and Marriage Rates by Age Among Syrian Refugee Girls in Bekaa, Lebanon www.ghspjournal.org practical considerations related to the ease of recruiting girls through schools compared to community venues for the initial pilot study. A formative research phase aimed to inform the conceptual approach to the intervention and tailor it to the context of Syrian refugees in Lebanon This phase encompassed 2 components: (1) review the evidence on what works to mitigate the drivers of early marriage in LMICs, with a focus on interventions in humanitarian settings; and (2) conduct a series of community meetings to discuss the intervention with Syrian refugees, mothers of adolescent girls and other stakeholders representing humanitarian organizations, municipalities, and schools. Evaluation Tools The research team developed several process and outcome evaluation instruments to monitor the intervention and capture key indicators at baseline and endline (Table 2)
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