Abstract
BackgroundThere are 600 million girls in low and middle income countries (LMICs), many of whom are at great risk for poor health and education. There is thus great need for programs that can effectively improve wellbeing for these girls. Although many interventions have been developed to address these issues, most focus on health and education without integrating attention to social and emotional factors. This omission is unfortunate, as nascent evidence indicates that these factors are closely related to health and education.This paper describes the methods of a 4-arm randomized controlled trial among 3,560 adolescent girls in rural Bihar, India that tested whether adding an intervention targeting social-emotional issues (based on a “resilience framework”) to an adolescent health intervention would improve emotional, social, physical, and educational wellbeing to a greater extent than its components and a control group. Study arms were: (1) Girls First, a combination of the Girls First Resilience Curriculum (RC) and the Girls First Health Curriculum (HC); (2) Girls First Resilience Curriculum (RC) alone; (3) Girls First Health Curriculum (HC) alone; and (4) a school-as-usual control group (SC).MethodsSeventy-six schools were randomized (19 per condition) and 74 local women with a tenth grade education were trained and monitored to facilitate the program. Quantitative data were collected from 3,560 girls over 4 assessment points with very low rates of participant attrition. Qualitative assessments were conducted with a subset of 99 girls and 27 facilitators.Results and conclusionsIn this article, we discuss guiding principles that facilitated trial implementation, including integrating diverse local and non-local sources of knowledge, focusing on flexibility of planning and implementation, prioritizing systematic measurement selection, and striking a balance between scientific rigor and real-world feasibility.Trial registrationClinicaltrials.gov NCT02429661. Registered 24 April 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-1008-3) contains supplementary material, which is available to authorized users.
Highlights
Introduction and assessmentsSetting group guidelines Listening skillsCharacter strengths (I)Character strengths (II)Life stories and goalsPlanning to reach our goalsIdentifying emotionsEmotional awarenessManaging strong emotions (I) Benefit findingManaging strong emotions (II)
Interviews and focus groups were recorded, transcribed, and translated by bilingual HindiEnglish translators. This intervention trial tested a school-based intervention with potential to contribute to the evidence surrounding improving emotional, social, physical and educational wellbeing among adolescent girls in developing countries such as India
Quantitative data were collected from 3,560 girls at 4 time points with very high rates of participant retention (91–93 % of the sample was reached at each time point)
Summary
Introduction and assessmentsSetting group guidelines Listening skillsCharacter strengths (I)Character strengths (II)Life stories and goalsPlanning to reach our goalsIdentifying emotionsEmotional awarenessManaging strong emotions (I) Benefit findingManaging strong emotions (II). Many interventions have been developed to address these issues, most focus on health and education without integrating attention to social and emotional factors. This omission is unfortunate, as nascent evidence indicates that these factors are closely related to health and education. Girls and women are more likely than boys and men worldwide to face psychological problems such as depression and anxiety [5,6,7,8,9] Many have recognized these concerns, creating programs to empower adolescent girls in LMICs. Currently, many programs focus on imparting physical health-related knowledge and behaviors, encouraging girls to stay in school, or teaching girls vocational skills. While various pedagogies have been used, only nascent evidence supports these interventions, and many gaps remain in our knowledge [10,11,12]
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