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Delivering PACE++ curriculum in community settings: Impact of TARA intervention on gender attitudes and dietary practices among adolescent girls in Bihar, India.

ABSTRACT: Adolescence phase has high intrinsic and instrumental relevance. The Transformative Action for Rural Adolescents intervention delivered PACE++ curriculum with innovations to introduce a) health and nutrition sessions and b) delivery of the content in community settings of rural Bihar. This paper examines impact of the intervention showcasing establishment of intergenerational community connect for empowering and invigorating adolescent girls on gender attitude, empowerment and adolescent health and nutrition. The impact evaluation is based on a two-arm (intervention and comparison groups) cluster randomized controlled design with two rounds of representative cross-sectional surveys. The baseline and endline sample comprised of 2327 and 2033 adolescent girls (15-19 years), respectively. Descriptive statistical, difference-in-differences and propensity score matching methods are used to confirm the program impact. The DID and PSM analyses confirm high significance of impact on gender equity norms, diets and nutritional knowledge and understanding of employee related rights and responsibilities. School-going adolescent girls performed better than those who have discontinued formal education. The intervention showcases the importance of delivering the modified PACE curriculum in rural settings through leveraging community platforms. The findings call for greater policy attention on scaling up of similar initiatives for empowerment and social capital development of adolescent girls.

SUBMITTER: Mondal S

PROVIDER: S-EPMC10624310 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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Delivering PACE++ curriculum in community settings: Impact of TARA intervention on gender attitudes and dietary practices among adolescent girls in Bihar, India.

Mondal Sudipta S Joe William W Akhauri Santosh S Sinha Irina I Thakur Putul P Kumar Vikas V Kumar Tushar T Pradhan Narottam N Kumar Abhishek A

PloS one 20231103 11

Adolescence phase has high intrinsic and instrumental relevance. The Transformative Action for Rural Adolescents intervention delivered PACE++ curriculum with innovations to introduce a) health and nutrition sessions and b) delivery of the content in community settings of rural Bihar. This paper examines impact of the intervention showcasing establishment of intergenerational community connect for empowering and invigorating adolescent girls on gender attitude, empowerment and adolescent health ...[more]

PMID: 37922252

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Project description:IntroductionThe role of gender norms in shaping education and work opportunities, distribution of power and resources, and health and wellbeing is well recognised. However, rigorous studies in low- and middle-income countries on when and how norms change over time and what factors shape adolescents' and young adult's gender attitudes are limited. This paper explores the factors that determine adolescents' gender attitudes, as well as patterns in gender attitude shifts over time among younger and older adolescent boys and girls in India.Data and methodsData presented in this paper were drawn from a unique longitudinal study of adolescents aged 10-19 (Understanding the lives of adolescent and young adults-UDAYA study) in the states of Bihar and Uttar Pradesh in India, conducted during 2015-2016 (wave 1) and 2018-2019 (wave 2). The analysis presented in this paper drew on data from 4,428 boys and 7,607 girls who were aged 10-19 and unmarried at wave 1 and interviewed at both rounds of the survey. We used univariate and bivariate analyses to examine changes in adolescents' gender role attitudes over time and the association between explanatory variables and gender role attitudes. We also used linear fixed effects regression models to identify factors that shape adolescents' gender role attitudes.ResultsGender role attitudes became more egalitarian over time among boys and girls, except among the older cohort of boys in our study. Among both younger and older cohorts, girls/young women held more egalitarian views than boys/young men and this pattern held over time for both cohorts. Factors that influenced gender role attitudes differed for younger and older adolescents, particularly among boys. While some predictors differed for boys and girls, there were substantial similarities as well. Gender attitudes were affected by factors at the individual, family, peer, and societal levels, as well as by community engagement.ConclusionsOur findings show that it is possible to shift gender attitudes toward greater equity and, in so doing, contribute to improved health and rights.

Project description:BackgroundAdolescent girls face myriad threats to their well-being and safety as a result of gender-inequitable attitudes and norms, and these risks are often exacerbated during humanitarian emergencies. While humanitarian actors have begun to address caregivers' behaviors and gender attitudes as an approach to support and meet the needs of adolescent girls, best practices for working with caregivers to improve adolescent girls' well-being in these settings have yet to be identified.Methods and findingsThis study uses panel data from a program evaluation to analyze associations between changes in gender-equitable attitudes among caregivers and changes in schooling and violence victimization for girls ages 10 to 14 years old in the Democratic Republic of the Congo (DRC). Participants were recruited in May 2015 for baseline (May to July 2015) and endline (August to October 2016) data collection. Baseline and endline data for both caregivers and girls were available for 732 girls. The average ages of adolescents and caregivers were 12 and 40.7, respectively, and 92% of caregivers were female. The predictor of interest was the change in caregivers' gender-equitable attitudes between the 2 points in time, where attitudes were measured using 10 underlying survey questions. The primary outcomes of interest were dichotomous and included improvement in schooling participation and declines in physical, sexual, and emotional violence and feeling uncared for. Logistic regression was used to estimate the association between changes in caregivers' attitudes and 5 outcomes of interest and revealed that an increase in a caregiver's gender-equitable attitude score was associated with significantly greater odds of a girl experiencing an improvement in schooling participation (aOR = 1.08, CI [1.005, 1.154], p = 0.036) and of a girl experiencing a marginal decline in physical violence victimization (aOR = 1.07, CI [0.989, 1.158], p = 0.092). Analyses also revealed that older girls had lower odds of experiencing an improvement in schooling participation (aOR = 0.77, CI [0.686, 0.861], p < 0.001), physical violence (aOR = 0.86, CI [0.757, 0.984], p = 0.028), sexual violence (aOR = 0.86, CI [0.743, 1.003], p = 0.055), or emotional violence (aOR = 0.98, CI [0.849, 1.105], p = 0.005). Important limitations in this study include the self-reported nature of outcomes, use of single questionnaire items to construct the outcome variables, and potential self-selection bias.ConclusionsResults suggest that supporting caregivers to increase gender equitable attitudes may be associated with benefits in dual outcomes of education and safety for adolescent girls in eastern DRC. Further research is needed to better understand how to induce a shift in these attitudes in multisectoral programming.Trial registrationNCT02384642.

Project description:BackgroundGynaecological morbidities are more common than reproductive and contraceptive morbidities and constitute a substantial proportion of disease burden in women. This study aimed to examine the prevalence and factors associated with gynaecological morbidities and the treatment-seeking behaviour among adolescent girls residing in Bihar and Uttar Pradesh, India.MethodologyThe study utilized data from the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey with a sample size of 14,625 adolescents girls aged 10-19 years. We defined gynaecological morbidity in dichotomous form, created from five questions on different morbidities. Further, the treatment-seeking behaviour was assessed for reported gynaecological morbidities three months prior to the survey. Univariate and bivariate analysis was used to perform analysis to carve out the preliminary results. Additionally, the study employed the heckprobit selection model, a two-equation model, to identify the determinants of outcome variables.ResultsOverall, about one-fourth (23.6%) of the adolescent girls reported suffering from gynaecological morbidities, and only one-third of them went for treatment. Non-Scheduled Caste/Scheduled Tribe (Non-SC/ST) adolescents were significantly less likely to have gynaecological morbidities (β: -0.12; CI: -0.18, -0.06) compared to SC/ST counterparts; however, they were more likely to go for the treatment (β: 0.09; CI: 0.00, 0.19). The adolescents who had 8-9 (β: 0.17; CI: 0.05, 0.29) or ten and above years of education (β: 0.21; CI: 0.09, 0.34) had a higher likelihood of going for the treatment than adolescents with no education. Moreover, adolescents who belonged to rural areas were less likely to go for the treatment of gynaecological morbidities (β: -0.09; CI: -0.17, -0.01) than urban counterparts.ConclusionMulti-pronged interventions are the need of the hour to raise awareness about the healthcare-seeking behaviour for gynaecological morbidities, especially in rural areas. Adolescent girls shall be prioritized as they may lack the knowledge for gynaecological morbidities, and such morbidities may go unnoticed for years. Mobile clinics may be used to disseminate appropriate knowledge among adolescents and screen asymptomatic adolescents for any possible gynaecological morbidity.

Project description:BackgroundThere has been much speculation about the role of inequitable gender norms and early marriage in mental health and suicide risks in girls and young women, but no prospective study has yet investigated this relationship. Understanding these links has become particularly important in the context of the COVID-19 pandemic which has led to increased risk of child marriage in the most vulnerable girls.MethodsWe examined the association between early marriage and mental health in girls using data from Understanding the Lives of Adolescents and Young Adults (UDAYA), a longitudinal study in adolescents in Uttar Pradesh and Bihar, India. The study included girls who were unmarried at wave 1 (2015-2016) and participated at wave 2 data collection (2018-2019). Information on mental health (Patient Health Questionnaire-9 (PHQ-9)), suicidal thoughts, plans and attempts were collected at both waves. Logistic regression with survey weights was used to estimate the association between marrying between the two waves and mental health.FindingsBetween waves 1 and 2, 1825 (23%) participants (n = 7864) married. Unmarried girls with depressive symptoms (PHQ score≥9) at wave 1 had greater odds of transitioning into marriage by wave 2 than those without (adjusted-OR 1.5; 95% CI 1.1 to 2.0). The odds of wave 2 depressive symptoms were higher in newly married vs unmarried girls (adjusted-OR 2.0; 95% CI 1.6-2.5). Among newly married girls, the odds of depressive symptoms were higher for those who experienced any abuse than those who did not (adjusted-OR 1.6; 95% CI 1.2-2.2). This effect was larger for girls who had not given birth (adjusted-OR 2.2; 95% CI 1.4-3.3).InterpretationOur findings show poor mental health preceded and was a consequence of child marriage. Mental health should be considered in policies and programming aimed at reducing early marriage; equally the mental health of young brides should be a focus for community and maternal health services.FundingBill and Melinda Gates Foundation and David and Lucile Packard Foundation.

Project description:BackgroundBullying is an understudied global social problem. While school-level factors are a recognized influence on bullying victimization, the elements of a 'girl-friendly' school that may reduce the risk of bullying victimization among girls and prevent dropout is understudied in lower- and middle-income countries (LMICs). This study used baseline data from the evaluation of the Room-to-Read (RtR) Girls' Education Program (GEP) in Nepal to assess the relationship of a conceptually grounded gender-equitable school (GES) index with girls' risk of direct and relational bullying victimization, adjusted for potential confounders at the individual and school levels.MethodsThe school sample included all 24 RtR GEP schools and 25 community schools attended by girls in a comparison cohort, representing 729 grade six girls with complete outcome data. We employed multilevel negative binomial regression to assess the relationship between the GES score (higher scores indicate greater support for girls), and girls' risk of peer victimization, controlling for individual- and school-level covariates.ResultsOn average, girls reported 2.84 direct victimizations and 0.27 relational victimizations in the prior week. The first component of the GES index, a generalized measure of school-level support for girls, showed a significant negative relationship with weekly relational bullying victimization in models with all school- and individual-level covariates. In the full model, a one-point higher score on the generalized GES component accounted for a 26% lower risk of relational bullying victimization in the prior week.ConclusionSchool-level policies, practices, and pedagogy designed to support girls may reduce their exposure to relational aggression, a form of bullying that girls most often perpetrate. In LMICs, the school may be an ideal place to raise awareness about the types and effects of peer bullying and to promote prosocial bystander behavior. Further research is needed to identify factors related to other forms of bullying.

Project description:BackgroundAdolescent pregnancy is an important public health problem and a socio-economic challenge in diverse societies. As a tremendously important problem, this issue has caused major concerns, as it exposes adolescent girls to social isolation and physical and psychological harm. So, this study aimed to determine the knowledge and attitude of adolescent girls and their mothers about early pregnancy, its causes, consequences, and predictors in Tabriz-Iran in 2020-21.MethodsThis cross-sectional study was done with 540 people (270 adolescent girls and 270 mothers) in the health centers of Tabriz. Data were collected using the questionnaires of sociodemographic information, knowledge, and adolescent girls' attitudes and their mothers about early pregnancy, its causes, and consequences. Multivariate logistic regression was used to determine the predictors of adolescent girls and their mothers' attitudes toward early pregnancy.ResultsThe mean (SD: Standard Deviation) of knowledge of adolescent girls and their mothers about early pregnancy was 5.17 (3.11) and 5.57 (3.01), respectively (score range: 0 to 9). Most girls (94.1%) and mothers (87.1%) opposed pregnancy before 18. There was a statistically significant relationship between the knowledge and attitudes of girls (p < 0.001) and mothers (p < 0.001) about pregnancy at a young age. Adolescent girls and their mothers mentioned the lack of sufficient knowledge about sexual relations (57.4% of girls and 66.3% mothers agree) and the lack of knowledge about contraceptive methods (51.9% girl and 59.2% mother agree) important reasons for early pregnancy. Based on the multivariate logistic regression model and controlling for potentially confounding variables, girls whose parents were married under the age of 18 were about three times more likely to agree to early pregnancy than girls whose parents married over the age of 18 (OR = 3.10; 95% Cl: 0.90 to 10.69; p = 0.037). Also, mothers whose other children were married before 18 were almost five times more likely to agree to early pregnancy than women whose other children were not married before 18 (OR = 4.91; 95% Cl: 1.60 to 15.10; p = 0.045).ConclusionsThe current study results indicate that despite the negative attitude of adolescent girls and their mothers towards early pregnancy, they had a low level of knowledge about early pregnancy. Consequently, increasing the level of knowledge of girls and their families about the consequences of marriage and pregnancy at an early age and creating a culture to correct cultural and social misconceptions to prevent marriage and pregnancy of children can reduce the severity of this damage.

Dataset Information

Delivering PACE++ curriculum in community settings: Impact of TARA intervention on gender attitudes and dietary practices among adolescent girls in Bihar, India.

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Delivering PACE++ curriculum in community settings: Impact of TARA intervention on gender attitudes and dietary practices among adolescent girls in Bihar, India.

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