Sexuality Education Initiative; Los Angeles, CA, USA; Constantine et al (2015)
25
- Constantine NA
- Jerman P
- Berglas NF
- Angulo-Olaiz F
- Chou CP
- Rohrbach LA
Short-term effects of a rights-based sexuality education curriculum for high-school students: a cluster-randomized trial.
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The Sexuality Education Initiative aimed to improve the sexual and reproductive health of high-school students by engaging both students and their parents in a 12-week classroom-based curriculum; students served as peer advocates and had access to sexual health services on school grounds; parents received educational workshops and tailored materials on sexual and reproductive health |
Design: cluster RCT with ten high schools in Los Angeles; data collection: 1750 students (intervention group 934; control group 816) surveyed at pre-intervention, immediately after the intervention, and at 1-year follow-up |
Significant effect: increased knowledge about sexual health and sexual health services (p<0·001); non-significant effects: increased communication with sexual partners and increased intentions to use condoms |
Significant effects: more positive attitudes about sexual relationship rights (adjusted standardised mean difference 0·42); greater self-efficacy to manage risky situations (adjusted standardised mean difference 0·37) |
The PRACHAR Project; Bihar, India; Daniel and Nanda (2012)
26
The effect of reproductive health communication interventions on age at marriage and first birth in rural Bihar, India: a retrospective study.
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PRACHAR sought to increase the age of marriage for girls, delay first birth after marriage, and ensure birth spacing by improving awareness, knowledge, and understanding of reproductive health issues among adolescents aged 15–19 years, their guardians, and influential community members; information was communicated through various channels, including educational workshops, parties, home visits, wall paintings, and pamphlets; community mobilisation activities were used to foster support for programme concepts |
Design: cluster RCT with 20 villages; data collection: randomly selected adolescents (intervention group 613; control group 612) surveyed 5 years after the intervention |
Significant effects: increased odds (aOR 4·95) of contraception use after marriage and before first birth among women (p<0·001), increased odds (aOR 3·58) of contraception use after marriage among married men (p<0·001), age at first birth for women 1·5 years higher (p<0·001); decreased odds (RR 0·61) of having had a birth at 5-year follow-up (p<0·01) |
Significant effects: decreased odds (0·56) of women being married at 5-year follow-up (p<0·001); decreased odds (0·74) of men being married at 5-year follow-up (p<0·05); increased educational attainment among women (p<0·05) and men (p<0·001); non-significant effects: increased odds that women (aOR 6·10) and men expressed to their parents the age at which they wanted to marry (aOR 5·30) |
TOSTAN; Kolda Region, Senegal; Diop et al (2004)
27
- Diop N
- Faye MM
- Moreau A
- et al.
The TOSTAN program: evaluation of a community based education program in Senegal.
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The goal of TOSTAN was to improve the health of women and encourage the abandonment of FGMC and forced child marriage through education, empowerment, and social mobilisation; programme activities required participation from stakeholders across multiple levels of society and included a four module education programme, discussions with community leaders, capacity building with local non-governmental organisations, training for local community members, and a public declaration renouncing FGMC |
Design: mixed-methods quasi-experimental trial with 40 villages and three comparison groups (individuals directly exposed, indirectly exposed, and not exposed to the programme); data collection: 2397 individuals (directly exposed 967; indirectly exposed 692; not exposed 738) surveyed pre-intervention, immediately after the intervention, and 2 years after the intervention |
Significant effects: increased use of antenatal services (p<0·001) and increased proportion of girls aged 0–10 years who had not been cut (p<0·05) in individuals who had been directly or indirectly exposed to the intervention compared with individuals who had not been exposed |
Significant effects: awareness of human rights increased by 83% for women and 51% for men (p<0·001) directly exposed to the intervention; decreased proportion of men intending to have their daughters cut (p<0·001) in all three groups after the intervention compared with baseline, the degree of change was greatest in men directly exposed to the intervention; decreased proportion of women reporting experience of violence in the past 12 months (p<0·001) in all groups after the intervention compared with baseline, the degree of change was greatest in women directly or indirectly exposed to the intervention |
Shaping the Health of Adolescents in Zimbabwe Project (SHAZ!); Chitungwiza, Zimbabwe; Dunbar et al (2014)
28
- Dunbar M
- Kang Dufour M
- Lambdin B
- Mudekunye-Mahaka I
- Nhamo D
The SHAZ! Project: results from a pilot randomized trial of a structural intervention to prevent HIV among adolescent women in Zimbabwe.
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SHAZ! was an HIV prevention programme for out-of-school girls aged 16–19 years who had lost at least one parent; the programme addressed structural barriers to prevention by providing participants with sexual and reproductive health services, life skills and home-based care training, livelihoods training, and guidance counselling or adult mentorship |
Design: RCT; data collection: 315 girls (intervention group 158; control group 157) surveyed pre-intervention and every 6 months after for 24 months |
Significant effects: lower food insecurity in intervention group (OR 0·83) vs in control group (OR 0·68, p=0·02); non-significant effects: reduced risk of transactional sex (OR 0·64, p=0·25), higher likelihood of using a condom with their current partner (OR 1·79, p=0·25), fewer unintended pregnancies (HR 0·61, p=0·061), decreased HIV incidence (HR 0·94, p=0·913) |
Significant effects: increased odds of individuals having their own income (p=0·02); non-significant effects: reduced experience of violence over time (p=0·06) |
Development Initiative Supporting Healthy Adolescents (DISHA); Bihar and Jharkhand, India; Kanesathasan et al (2008)
29
- Kanesathasan A
- Cardinal LJ
- Pearson E
- Gupta SD
- Mukherjee S
- Malhotra A
Catalyzing change: improving youth sexual and reproductive health through Disha, an integrated program in India.
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DISHA aimed to improve sexual and reproductive health outcomes for young people aged 10–24 years by addressing social and economic influences; the programme provided health information and services directly to young people and training to sexual and reproductive health service providers; a media campaign was implemented to influence community awareness |
Design: mixed-methods, quasi-experimental study with 176 villages; data collection: 4645 young people aged 14–24 years and 1601 women and men older than 30 years, surveyed pre-intervention and again 3 years later; 36 focus groups |
Significant effects: increased knowledge of how to access the pill among married young women (p<0·05); increased knowledge of condoms among young people (p<0·05); decreased number of young women who disapproved of contraceptive use among married couples (p<0·0001); increased number of young people who believed that contraceptives should be available to young married couples (p<0·05); all in the intervention groups compared with the control group |
Significant effects: increased proportion of young women (63%) and young men (72%) who knew the legal age of marriage for girls (p<0·05); increased odds that unmarried young people were able to talk with their elders about marriage timing (p<0·05); increased reported ability of young women to access sexual and reproductive health services unaccompanied (p<0·05); non-significant effects: increased ability of married girls to speak with spouse about contraception; all in the intervention groups compared with the control group |
Primary School Action for Better Health (PSABH); Nyanza Province, Kenya; Maticka-Tyndale et al (2007)
30
- Maticka-Tyndale E
- Wildish J
- Gichuru M
Quasi-experimental evaluation of a national primary school HIV intervention in Kenya.
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PSABH aimed to reduce the risk of HIV infection among school students aged 11–16 years through delaying sexual debut, decreasing sexual activity, and increasing condom use; through a train-the-trainer model, teachers who attended training on the sexuality and HIV prevention programme trained their colleagues to integrate sexuality and HIV into the existing school curriculum |
Design: mixed-methods quasi-experimental study with 80 schools; data collection: 3940 students (intervention group 1964; control group 1976) surveyed pre-intervention and 18 months after the intervention; 16 focus group discussions facilitated with 320 students from 24 schools; 48 qualitative interviews with teachers from 24 schools |
Significant effects: students three times more likely to report high levels of exposure to HIV and AIDS education (p<0·001), increased HIV and AIDS knowledge among boys who were virgins before programme implementation (p<0·05), increased condom use at last intercourse among boys (p<0·05) |
Significant effects: increased self-efficacy among girls sexually active before programme implementation, as shown by greater likelihood of reporting they could say no to sex (p<0·001) and could have a boyfriend and not have sex (p<0·001); qualitative findings: boys and girls with and without history of sexual intercourse responded differently for establishing alternative scripts related to negotiation and refusal of unwanted sex; girls describe strategies to refuse sex and avoid or leave relationships; boys showed more programme-related gains in condom self-efficacy than girls; girls who had not had sexual intercourse showed higher self-efficacy for future condom negotiation than girls who had had sex |
Program H; Rio de Janeiro, Brazil; Pulerwitz et al (2006)
31
- Pulerwitz J
- Barker G
- Segundo M
- Nascimento M
Promoting more gender-equitable norms and behaviors among young men as an HIV/AIDS prevention strategy.
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The goal of Program H was to reduce the risk of HIV and sexually transmitted infections among low-income, in-school and out-of-school boys and young men aged 14–25 years by challenging gender norms around masculinity, reflecting on the consequences of inequitable gender norms, and promoting gender-equitable behaviours; this was accomplished through gender-equitable messaging in 6-month group education for boys, a community-wide lifestyle social marketing campaign, and peer promoters |
Design: mixed-methods quasi-experimental study with two sites and three study groups (group education only, combined activities, and no activities); data collection: Gender-Equitable Men Scale surveys among 780 boys (258 group education only; 250 combined activities; 272 control group) at pre-implementation and at 6 and 12 months post-implementation; 18 in-depth qualitative interviews with participants and their female sexual partners |
Significant effects: increased condom use at last sex with a primary partner at 6-month follow-up among young men in both intervention groups and maintained at 12 months in the combined activities intervention group (p<0·05), decreased reported sexually transmitted infection symptoms in the combined activities intervention group at follow up at 6 months and maintained at 12 months (p<0·05); non-significant effects: condom use increased with casual partners in all three study groups, reported sexually transmitted infection symptoms decreased compared with the previous 3 months in the group education-only intervention group and the control group |
Significant effects: decrease in the proportion of respondents who supported inequitable gender norms maintained to 12-month follow-up at both intervention sites (p<0·05) compared with the control; non-significant effects: increased partner communication about HIV and condoms in both intervention groups compared with the control; qualitative findings: group education sessions served as safe spaces for young men to discuss issues not typically spoken about (eg, community violence, relationships, and family life) |
Strengthening Household Ability to Respond to Development Opportunities Project (SHOUHARDO); North Char, Mid Char, Haor, and Coast, Bangladesh; Smith et al (2011)
32
- Smith LC
- Kahn F
- Frankenberger TR
- Wadud A
Admissible evidence in the court of development evaluation? The impact of CARE’s SHOUHARDO Project on child stunting in Bangladesh.
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The goal of SHOUHARDO was to reduce child malnutrition, poverty, and food insecurity in the poorest households with children aged 6–24 months, by addressing the underlying structural causes of poverty; through a multipronged, rights-based, livelihoods approach, the programme implemented interconnected activities to improve health, sanitation, food insecurity, education for women and girls, women’s empowerment, income-generating activities, and access to financial resources |
Design: mixed-methods quasi-experimental study using difference-in-difference propensity score matching; data collection: surveys completed by 3200 households with children 6–24 months old pre-intervention and 3 years later by 3200 households with children 48–59 months old in the same villages as baseline and 3356 new households with children 6–24 months old; collection of secondary data from national survey |
Significant effects: increased food security (p<0·001); increased care practices for children 6–24 months, including fully immunising children before 1 year of age; vitamin A supplementation, oral rehydration therapy during diarrhoea (p<0·001 for all), and breastfeeding (p<0·05); increased care practices for mothers, including three antenatal visits, iron, folic acid, and vitamin A supplementation, food intake during pregnancy, and daytime rest (p<0·001 for all); increased access to safe water and sanitary latrine (p<0·001) in households in the SHOUHARDO project area compared with national data on rural households with young children; non-significant effects: 15·7% decrease in stunting prevalence and increase in stunting among children aged 6–18 months and 48–60 months in households in the SHOUHARDO project area compared with national data on rural households with young children |
Significant effects: the women’s empowerment activities had an independent effect on stunting (p<0·001); increase in women taking more daytime rest than usual during last pregnancy (% difference 82·2, p<0·001); synergistic effects between maternal, neonate, and child health activities on stunting were women’s empowerment activities (p<0·001), sanitation activities (p<0·05), and poverty alleviation activities (p<0·05); all in households in the SHOUHARDO project area compared with national data on rural households with young children; triangulated findings: increased equitable access to land; increased number of income-generating opportunities, savings mechanisms, and access to credit; improved life skills of men and women and higher employability of girls; increased gender equity at family and community level in households in the SHOUHARDO project area compared with national data on rural households with young children |
Somos Diferentes, Somos Iguales (SDSI); Estelí, Juigalpa, and León, Nicaragua; Solórzano et al (2008)
33
- Solórzano I
- Bank A
- Peña R
- Ellsberg M
- Pulerwitz J
Catalyzing personal and social change around gender, sexuality, and HIV: impact evaluation of Puntos de Encuentro’s communication strategy in Nicaragua.
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SDSI aimed to prevent HIV infection in young people aged 10–25 years by addressing social and cultural barriers to prevention; the programme included a national television series (Sexto Sentido), a nightly call-in radio show for young people, a media campaign, information, education, and communications materials, analytical and leadership skills training related to sexual and reproductive health and rights issues for youth leaders, and alliance building between young people and adults in various sectors |
Design: mixed-methods quasi-experimental longitudinal study in three cities; data collection: 3099 young people aged 13–24 years surveyed at pre-intervention and at 1 year and 2 years post-intervention; 45 in-depth interviews with participants and non-participants (39 with key stakeholders); ten group interviews with representatives from local organisations; 20 focus group discussions with participants and non-participants |
Significant effects: exposure to SDSI increased use of services related to HIV and intimate partner violence (OR 1·48, 95% CI 1·2–1·9); increased likelihood of consistent condom use with casual partners (OR 1·42, 95% CI 1·1–1·9) among participants with greater exposure to the intervention; increased interpersonal communication about domestic violence, HIV, homosexuality, condom use, and the rights of young people (OR 1·6, 95% CI 1·5–1·8) among participants with greater exposure to the intervention compared with those with less exposure to SDSI; non-significant effects: condom use with steady partners increased among all groups |
Significant effects: higher scores on gender-equitable attitudes associated with greater exposure (ie, watched at least 2 seasons of the television series) to SDSI (p<0·001); less stigmatising attitudes towards homosexuality and people with HIV associated with greater exposure to SDSI (p<0·001); higher perceived self-efficacy to negotiate condom use in those with greater exposure to the intervention compared with those with less exposure (p=0·033); increased partner communication about HIV prevention in those with greater exposure to the intervention compared with those with less exposure (OR 1·43, 95% CI 1·2–1·7) |
Fourth R: Skills for Youth Relationships; ON, Canada; Wolfe et al (2009)
34
- Wolfe DA
- Crooks C
- Jaffe P
- et al.
A school-based program to prevent adolescent dating violence: a cluster randomized trial.
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Fourth R was a physical dating violence reduction programme for high school students aged 14–15 years; in addition to a 21-lesson educational curriculum on healthy relationships, the programme engaged students’ parents, provided teachers with trainings on dating violence and healthy relationships, and created student-led safe-school committees |
Design: cluster RCT with ten public schools; data collection: online surveys completed by 1722 students (intervention group 968; control group 754) pre-intervention and 2·5 years after the intervention |
Significant effects: decreased likelihood that boys would perpetrate physical dating violence (aOR 0·36, p=0·05); decreased experience of physical dating violence (aOR 0·41, p=0·05); increased condom use among sexually active boys (OR 1·70; p=0·05); non-significant effects: decreased engagement in peer physical violence (eg, arguments, threats of violence, hurting another with the intention to humiliate, slapping); increased condom use among all students; decreased problem substance use |
Observational findings: improved negotiation skills and more equitable decision making within relationships |
