Balancing Quality, Intensity and Scalability: Results of a Multi-level Sexual and Reproductive Health Intervention for Very Young Adolescents in Kinshasa

Jennifer Gayles; Melanie Yahner; Kathryn M Barker; Caroline Moreau; Mengmeng Li; Leah Koenig; Eric Mafuta; Pierrot Mbela; Rebecka Lundgren

doi:10.1016/j.jadohealth.2023.02.001

Balancing Quality, Intensity and Scalability: Results of a Multi-level Sexual and Reproductive Health Intervention for Very Young Adolescents in Kinshasa

J Adolesc Health. 2023 Jul;73(1S):S33-S42. doi: 10.1016/j.jadohealth.2023.02.001.

Authors

Jennifer Gayles¹, Melanie Yahner², Kathryn M Barker³, Caroline Moreau⁴, Mengmeng Li⁵, Leah Koenig⁵, Eric Mafuta⁶, Pierrot Mbela⁷, Rebecka Lundgren³

Affiliations

¹ Department of Global Health, Save the Children Federation, Washington, D.C.. Electronic address: jgayles@savechildren.org.
² Department of Global Health, Save the Children Federation, Washington, D.C.
³ Center for Gender Equity and Health, University of California San Diego, San Diego, California.
⁴ Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Soins et Santé Primaire, CESP Centre for Research in Epidemiology and Population Health, Villejuif, France.
⁵ Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
⁶ Department of Health Systems Management and Policy, School of Public Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
⁷ Save the Children International, Democratic Republic of the Congo Country Office, Kinshasa, Democratic Republic of the Congo.

PMID: 37330819
DOI: 10.1016/j.jadohealth.2023.02.001

Abstract

Purpose: In addition to the rapid physical and cognitive transformations very young adolescents (VYAs) experience between ages 10-14, gender and social norms internalized during this period have long-term implications as adolescents become sexually active. This age presents critical opportunities for early intervention to promote gender-equitable attitudes and norms for improved adolescent health.

Methods: In Kinshasa, DRC, Growing Up GREAT! implemented a scalable approach to engage in- and out-of-school VYAs, caregivers, schools, and communities. A quasi-experimental study evaluated the outcomes of sexual and reproductive health (SRH) knowledge, assets and agency, and gender-equitable attitudes and behaviors among VYA participants. Ongoing monitoring and qualitative studies provided insights into implementation challenges and contextual factors.

Results: Results show significant improvement in SRH knowledge and assets such as caregiver connectedness, communication, and body satisfaction among the intervention group. The intervention was also associated with significant improvements in gender-equitable attitudes related to adolescents' household responsibilities and decreased teasing and bullying. Intervention effects on awareness of SRH services, body satisfaction, chore-sharing, and bullying were stronger for out-of-school and younger VYAs, suggesting the intervention's potential to increase positive outcomes among vulnerable adolescents. The intervention did not shift key gender norm perceptions assessed. Implementation research suggests design decisions made to increase the intervention's scalability necessitated reductions in training and program dosing that may have affected results.

Discussion: Results affirm the potential of early intervention to increase SRH knowledge, assets and gender-equitable behaviors. They also highlight the need for more evidence on effective program approaches and segmentation for shifting VYA and SRH norms.

Keywords: Adolescents; Gender; Gender transformative; Sexual and reproductive health; Social norms.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Democratic Republic of the Congo
Humans
Reproductive Health / education
Reproductive Health Services*
Sexual Behavior / psychology
Sexual Health* / education