Study Name, Country, Study author | Target Group | Type of Intervention & Duration | Implementation Issues | Study design | Outcomes * | Quality Assessment | |
---|---|---|---|---|---|---|---|
Life Skills education programme[35] India Srikala & Kumar, 2010 | Youth (14–16 years) in secondary schools | Lifeskills education intervention. Skills taught include critical thinking, decision making, problem solving, communication, and coping skills Implemented once a week, (1 hr) over 12 to 20 sessions during one academic year Sessions taught by class teacher | Programme content and materials based on needs assessment with students, parents, NGOs and policy makers Teachers trained over 3 days | Quasi-Experimental - random selection of schools with matched control design: N = 1028 adolescents Control received standard civic education classes | Significant improvement in: - self-esteem, - perceived self-efficacy - pro-social behavior - perceived adequate coping Participants had significant: - better adjustment with teachers - better adjustment in school - improved classroom behaviour No change in adjustment with parents and peers | Moderate | |
School based physical fitness programme[36]Santiago, Chile Bonhauser et al., 2005 | Secondary school students age 15 years in low socioeconomic area in Chile | School based physical fitness Four units made up of three sessions each week (90 min each) for ten weeks for each unit Sessions taught by regular teachers | Teachers and students designed intervention | Quasi-experimental design N = 198 students from high school Students in control group received 90 minute exercise class once a wee | Significant improvement in adolescents’: - anxiety scores - self-esteem scores No significant changes in depression scores Significant increases in physical fitness: - oxygen capacity - speed and jump performance scores | Moderate | |
Involvement of the Board of Directors was viewed as essential in order to incorporate intervention into curriculum activities. | |||||||
Cape Town, South Africa Smith et al., 2008; Caldwell et al., 2010 | Secondary school students grades 8–9 (mean of 14 years) in low income township in Cape Town | School based leisure, life skills and sexuality education intervention 12 lessons provided in grade 8 followed by 6 booster sessions in grade 9 Programme delivered by class teacher. | Cultural adaptation of the TimeWise programme [39] and Botvin’s Lifeskills programme [40] Schools with greatest involvement in teacher training and implementation reported more positive outcomes on intrinsic student motivation. | Quasi-experimental N = 2193 adolescents mean age 14 years Life Orientation curriculum taught in control schools | Significant - increase in intrinsic motivation - decrease in introjected motivation and amotivation Increase in perception of condom availability in intervention group Control group had ‘steeper increase’ in recent and heavy use of alcohol and cigarette use. Programme effects on alcohol, cigarette use greater for girls. | Moderate | |
Resiliency Programme[41] South Africa de Villiers & van den Berg, 2012 | Children age 11–12 in Grade 6 in middle-class suburbs of South Africa | Resiliency intervention provided 15 sessions on promoting emotional regulation, stress management, interpersonal skills and problem solving. Each session lasted 90 minutes and delivered over three weeks | Parents and teachers were not involved with the programme | Solomon Four Group Design N = 161 children age 11–12 years from four schools Waitlist control Three month follow up | Significant improvement in - interpersonal strength - emotional regulation - self appraisal - emotional reactivity Improved self appraisal scores maintained at three months follow up. No significant improvement in - family involvement - intrapersonal strength - school functioning - affective strength - sense of mastery - sense of relatedness - family appraisal - general social support. | Weak | |
Resourceful Adolescent Program – (RAP-A) Depression Prevention Programme[42] Mauritius Rivet-Duval et al., 2011 | Secondary school students age 12–16 years in Mauritius | Universal depression prevention programme includes cognitive behavioural and interpersonal approaches 11 one hour weekly sessions with 8–12 participants per group. Teachers implemented sessions | RAP-A is an Australian evidenced based intervention [43]. Details of cultural adaptations not reported Teachers attended two day training workshop involving 16 hours of training, received ongoing support and half day booster training session 6 months post initial training | RCT N = 160 students from two single sex secondary schools age 12–16 years Waitlist control Six months follow-up | Significant improvement in - depressive symptoms - hopelessness - self esteem - coping skills. Improvements in self esteem and coping skills maintained at 6 months follow up. Improvements in depression symptoms and hopelessness not maintained at 6 months follow up. | Strong | |
Make a Difference (MAD) about Art: Community-Based Art Therapy Intervention[44] Nekkies township, South Africa Mueller et al., 2011 | Children affected by HIV and AIDS age 8–18 in deprived community in South Africa | Community based psychosocial intervention which consisted of art education activities designed to build a sense of self-worth, self-concept, empowerment and emotional control Children attended sessions for six months. Programme implemented in school by trained ‘Youth Ambassadors’ (youth workers) | Sessions were led by team of trained and supervised ‘youth ambassadors’ Being violent towards others and witnessing violence in the home were key predictors of self-efficacy | Quasi-experimental N = 297 youth age 8–18 years from one school | Significant programme effect on self-efficacy scores No programme effect on: - depression scores - emotional and behavioural scores - self esteem scores | Moderate | |
Peer-support group intervention for AIDS orphans[45] Uganda Kumakech et al., 2009 | Children age 10–15 years reported to have lost one or both parents due to AIDS | Peer-support intervention aims to encourage participants to reflect, challenge and face difficult experiences and to develop coping skills Two peer support exercises held per week in classroom for 10 weeks. Teachers trained to deliver intervention | Peer-group support exercises were originally intended for adults [46] and were modified for children | Cluster-randomized control trial N = 326 children age 10–15 from 20 schools | Significant reduction in: - anxiety scores - depression scores - anger scores No significant reduction effect on self-concepts | Strong | |
Classroom based psychosocial intervention (CBI)[47] Nepal Jordans et al., 2010 | Children affected by armed conflict age 11 – 14 years | School based psychosocial intervention aims to reduce distress and increase resilience and empowerment through enhancing coping, pro-social behaviour 15 sessions delivered over course of 5 weeks. Delivered by para-professionals. | Intervention was developed by Centre for Trauma Psychology in Boston Interventionists from targeted communities were selected and trained over 15 days Counsellor provided regular supervision | Cluster randomised controlled trial N = 325 students age 11–14 years from 8 schools Waitlist control | No significant effect on social emotional wellbeing Significant gender effects including: - reductions in general psychological difficulties and aggression for boys - increased pro-social behaviour for girls Significant increase in sense of hope for older children | Strong | |
Classroom-Based psychosocial Intervention (CBI)[48] Palestine Khamis et al., 2004 | Children and adolescents affected by armed conflict aged 6–11 and 13–16 years | School based psychosocial intervention aims to reduce distress and increase resilience and empowerment (same as intervention above) Programme implemented by trained CBI counselors | Recommendations: - provide booster training to CBI interventionists - organize monthly group meetings among intervention coordinators to assure fidelity of the interventionists and to address ongoing technical issues that arise | RCT N = 664: - 406 children age 6–11 years - 258 adolescents, age 13–16 years] Waitlist control | Intervention group had significantly: - better attributional style - reduced level of self-blame - higher perceived credibility - increased inter-personal trust - improved communication skills - reduced hyperactivity - emotional symptoms - conduct problems - peer problems Hyperactivity levels decreased significantly in adolescent control group. CBI had more positive effect on adolescent girls than boys. No significant gains observed among adolescent boys age 12–16 years | Strong | |
Psychosocial Structured Activities (PSSA) intervention[49] Uganda Ager et al., 2011 | Displaced children aged 7 – 12 years in primary schools in Uganda | PSSA intervention, school-based multi-phased approach designed to enhance resilience, coping skills, self esteem and future planning through structured activities- play therapy, art, drama 15 × 60 min sessions delivered over course of five weeks. Implemented by trained school teachers | PSSA intervention builds upon work of CBI intervention implemented in Palestine [50]. Intervention implemented previously in US and Indonesia PSSA encourages parental involvement through periodic meetings. | Quasi experimental N = 403 primary school students (mean age 10.23 years) from 12 schools (8 intervention) in Uganda 12 month follow up | Significant improvement in participants’ wellbeing, as measured by parents and children (but not teacher). Evidence from parent and teacher report of girls making greater progress than boys Evidence of older children making greater progress than younger children. | Moderate | |
Teaching Recovery Techniques (TRT) intervention for war affected children[50] Gaza, Palestine Quota et al., 2012 | War affected children age 10–13 years in Palestine | TRT intervention aims at creating safety and feelings of mastery, and incorporates trauma-related psychoeducation, CBT methods, coping skills training 16 sessions implemented over 4 weeks after school (two weekly 2 hour sessions) Programme implemented by psychologists | Evidence based intervention [51–53] Programme implemented by psychologists as an extra curricular activity on school premises. Families involved through homework activities | RCT N = 722 children age 10–13 years from four schools assigned to intervention and control group Six months follow up Control received normal school-provided support. | Intervention significantly reduced proportion of clinically significant Post-Traumatic Stress syndrome at post-intervention. No programme effect for girls. | Strong | |
Girls significantly benefited from intervention (in symptoms and proportion of clinically significant PTSS) if they showed low peritraumatic dissociation. | |||||||
Classroom-based group intervention for children exposed to war[54] Lebanon Karam et al., 2008 | War affected children age 6–18 years in Lebanon | Intervention consisted of cognitive behavioural strategies and stress inoculation training 12 × 90 min sessions implemented over 12 consecutive school days | Intervention delivered by teachers Teachers received one day training and supervised every 2–3 sessions Study used only diagnostic assessment measures | Quasi experimental N = 209 students (mean age 11.7 years) from six schools Matched control group did not receive structured activities | No significant effect of the intervention of rates of major depressive disorder, separation anxiety disorder and post-traumatic stress disorder. Rates of disorders peaked one month post-war and decreased over one year. Post-war major depressive disorder, separation anxiety disorder and post-traumatic stress disorder were associated with pre-war SAD and PTSD scores, family violence parameters, financial problems and witnessing war events. | Strong | |
Writing for Recover (WfR) intervention[55] Gaza Lange-Nielsen et al., 2012 | Adolescents age 12–17 from refugee camp in Gaza | Manual based short term writing intervention involves adolescents undertaking unstructured and structured writing detailing their traumatic memories and insights from what they have experienced Six short writing sessions over 3 consecutive days (2x15 min session each day). | Programme implemented by teachers who have received 1 day training 88.4% of participants reported participation as a positive experience at T3 and 94.3% at T4. Lack of adherence to manual reported | RCT N = 139 adolescents age 12–17 years from six schools Waitlist control Four-five month follow up | Significant decline in PTSD symptoms in both intervention and control group. Significant increase in intervention groups’ depression symptoms from T1-T2. Significant decline in depression symptoms from T3-T4. No significant change in intervention groups’ anxiety scores from T1 – T2 or T3 to T4. | Strong | |
Child-focused intervention for children living in conflict areas[56] Palestine (Gaze and West Bank) Loughry et al., 2006 | Children and adolescents (age 6–17 years) and their parents living in areas of conflict | Interventions aims to provide structured activities that support the resilience of children in conflict Intervention implemented over one year and focused on participation in recreational, cultural and other non-formal activities. Included parental involvement | Children’s activities included after-school recreation activities in community setting (e.g. summer camps) Activities for children’s parents included information classes and opportunities to join with children in structured activities | Quasi experimental N = 400 children and adolescents Control group did not receive structured activities | Significant reduction in intervention groups’ - total problem scores - externalizing problem scorers - internalizing problem scores Intervention had some effect in improving parental support in West Bank children only. | Strong | |
Community-Based Interventions | |||||||
Study Name, Country, Study author | Target Group | Type of Intervention & Duration | Implementation Issues | Study design | Outcomes* | Effect Sizes | Quality Assessment |
Population based intervention to promote youth health[57] Goa, India Balaji et al., (2011) | Youth age 16-24 | Community based intervention designed to promote youth health Intervention implemented over 12 months and consists of 3 main components: (i) Peer Education (ii) Teacher Training (iii) Health information Intervention implemented by intervention team which consisted of social worker, two psychologist and three peer educators | Community actively involved in programme planning Difficulties noted in the integration of peer education within existing school structures Community peer education was feasible and acceptable in rural community but not the urban community | Exploratory controlled evaluation N = 1803 students from two urban and rural communities Control communities were wait listed. 18 months follow up | Significant: - decrease in probable depression score (rural & urban) - greater knowledge and attitudes about emotional health (rural) - lower levels of suicidal behaviour (urban) Peer leaders reported increase in skills: - self-confidence - leadership ability - stress managements - conflict resolution - anger management and Improved student-teacher relationship post-intervention Significant: - increase in attitudes about reproductive and sexual health (rural & urban) - decrease in perpetration of physical violence (rural & urban) and substance abuse (urban) - Rural sample reported significant: - fewer menstrual complaints - higher levels of help- seeking for reproductive and sexual health problems by women Urban sample reported significant lower levels of - sexual abuse - RSH complaints - menstrual complaints | Not reported | Strong |
Familias Fuertas[58] Honduras Vasquez et al., 2010 | Parents and their 10–14 year old adolescents | Evidence based family skills building training programme. Focused on promoting consistent discipline, parental monitoring and positive communication patterns 7 activity based sessions Local nurses trained as FF facilitators | Programme is based on the evidence based “Strengthening Families” programme in US | Quasi-experimental design N = 41 parent-adolescent pairs Control received informational brochures 12 months follow-up | Significant improvement in intervention groups’: - positive parenting behaviours - positive perceptions among parents about their family relationships - parental self esteem Non significant reduction in adolescent or family member drug alcohol or tobacco use. | Not reported | Moderate |
Ishraq Programme[59] Egypt Brady et al., 2007 | Out of school adolescent girls age 13-15 | Multidimensional community based programme aimed at improving girls’ life skills, functional literacy, recreational opportunities, health knowledge and attitudes and mobility and civic participation. Girls meet four times a week for 30 months in in groups of around 25 girls Programme implemented by ‘Promoters’ – young local women (age 17–25) trained in their role. | Important part of the programme was work carried out with brothers and other male relatives in helping them to think and act in a more gender equitable manner | Quasi-experimental N = 587 adolescent girls from four villages in Upper Egypt | Significant improvement in social participation. Girls in the programme significantly more likely - to know about key health and rights issues - to score higher on gender role attitude index - to make and keep friends Full term participants showed greatest increase in academic skills. Strong association between desire to delay marriage and participation in Ishraq. | Not reported | Moderate |
Stepping Stones[60] South Africa Jewkes et al., 2008 | Men and women age 16-23 | HIV prevention programme aims to improve sexual and emotional health by developing strong, more equal relationships Programme delivered to single sex groups. Programme lasts 50 hours over 6–8 weeks | Workshops cover relationship skills, including assertiveness training as well as information of STIs and condoms. Facilitators were the same sex as the participants. Programme generally run on school premises after school hours | Cluster RCT N = 2776 men and women age 15–26 years Two year follow-up | Reduced (but not significant) levels of depression reported in men at 24 month follow up. No significant change in women’s depression levels in intervention group. Significant reduction in male: - physical and sexual partner violence (two year follow up) - problem drinking (one year follow up) - number of HSV-2 infections over 2 years No evidence of desired behaviour change in women. No evidence of lowered incidence of HIV. | Not reported | Strong |
The Collaborative HIV Adolescent Mental Health Programme South Africa (CHAMPSA)[61] South Africa Bell et al., 2008 | Adolescents (4th and 5th grade) and their families | HIV prevention programme aims to strengthen family relationships as well as target peer influences 10 (90 minute) sessions delivered by community caregivers over 10 weekends to families | CHAMPSA is an adaptation version of the evidence based CHAMP Family programme [62] Community members involved in programme design, delivery and research Families paid $8 for each session attended | RCT N = 478 families rearing 579 children Control received existing school based HIV prevention curriculum | Significant increase in caregivers’: - communication skills - monitoring of children - social primary networks | Caregiver data: HIV transmission knowledge ES = 0.631 Less stigma toward HIV infected people ES = 0.403 Caregiver monitoring 3 family rules ES = 0.307 Caregiver communication comfort ES 0.407 Caregiver communication frequency ES = 0.197 Social networks – primary ES = 0.265 Child data: AIDS transmission knowledge ES = 0.496 Less stigma towards HIV infected people ES = 0.698 | Strong |
South Africa’s Intervention with Microfinance for AIDS and Gender Equity: IMAGE study[63] South Africa Kim et al., 2009 | Women age 18 years and over | Community based combined gender and HIV training programme and microfinance initiative aims to address gender roles, poverty self-esteem, communication, domestic violence and HIV Delivered over 12–15 months. Phase 1 (6 months) consisted of 10 training sessions. Phase 2 encouraged wider community mobilization to engage youth and young men in the intervention | Microfinance only intervention provided women with small loans to women IMAGE ‘Sisters for Life’ gender and HIV training programme integrated gender and HIV training programme into fortnightly microfinance meetings The addition of a training component to group-based microfinance programmes may be critical for achieving broader health benefits | Cluster randomized trial Three randomly selected matched clusters (i) four villages with 2 year exposure to IMAGE combined with microfinance (ii) four villages with 2 year exposure to microfinance and (iii) control villages not targeted by any intervention. N = 860 female loan recipients enrolled | Significant improvements in empowerment among women in combined IMAGE microfinance group Micro finance only group showed no improvements in empowerment. Significant improvements in: - intimate partner violence (IPV) and HIV risk behaviour (women in combined IMAGE - microfinance group) - economic wellbeing (women in microfinance only and combined group) Micro finance only group showed no improvements in IPV and HIV risk behaviour | Not reported | Moderate |
IMAGE and microfinance study[64] South Africa Pronjk et al., 2006 | Women in rural areas in South Africa (age 14–35 years) | Community based combined gender and HIV training programme and microfinance initiative aims to address gender roles, poverty self-esteem, communication, domestic violence and HIV (same as above) | Programme consists of poverty-focused microfinance initiative and a 12–15 month participatory ‘Sisters for Life’ gender and HIV training programme | RCT N = 3339 women from 8 villages Two year follow up | Programme participants reported: - 55% fewer acts of violence by their intimate partners in previous 12 months - fewer experiences of controlling behaviour by their partners - increased economic wellbeing among intervention group Significant higher levels of social participation | Not reported | Moderate |
SUUBI - economic empowerment intervention[65–68] Uganda Ssewamala et al., (2009a, 2012, 2010, 2009b) | AIDS-orphaned children in final year of primary school | Economic intervention that involves creating asset-building opportunities and promotion of life options by providing (i) 1–2 hour workshops focused on asset building and future planning (ii) monthly mentorship programme for adolescents with peer mentors on life options (iii) Child Development Account dedicated to paying for secondary schooling, vocational training and/or family small business | Girls were likely to have higher self-esteem than boys Homeownership was significantly associated with positive changes in children’s self-esteem Children in treatment group saves, on average an equivalent of USD$6.33 a month or UDS$76 a year | RCT N = 267 children from Grade 7 in 15 primary schools Control group received usual care for orphaned children Ten month follow up | Significant - increase in self-rated self esteem at 10 months post-intervention - decrease in depression - increase in academic performance educational - aspirations and attitudes towards sexual risk taking behaviour - reduction in sexual risk taking intentions - increase in self rated physical health functioning | Not reported | Strong |