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Table 1 Thematic Analysis of Articles Included Following Full Text Screening

From: A systematic review of sexual and reproductive health interventions for young people in humanitarian and lower-and-middle-income country settings

Author/Year Country/Setting Population Psychosocial Components SRH components Study Design Delivery Information Key Findings
Humanitarian Crisis Settings (Defined by WHO) and Refugee Populations
 Cowan et al. 2010 [25] Zimbabwe Girls and boys ages 18–22 Cognitive Youth: HIV prevention, sexual risk behavior, gender equity; Community: adult support of youth SRH, safe spaces Cluster RCT: 2 arm School-based youth groups (4 years, 24 sessions in year 4);
Parent + community stakeholder program (22 sessions);
Nurse training program in clinics
Intervention: sig increase in STI knowledge, & pregnancy prevention; no effects on HIV knowledge, sexual behavior, clinic attendance or HIV rates; increase in condom negotiation self-efficacy for females only at 4 yrs
 Stark et al. 2018 [26] Ethiopia (refugees) Girls and boys ages 13–19 none Creating safe spaces, economic empowerment Quasi-Experimental Community-based groups;
10 90 min weekly sessions;
10 caregiver discussion groups
No sig intervention effects on SRH outcomes
 USAID 2017 [27] Ethiopia Girls and boys ages 10–24 none YFS: Family planning service delivery for youth; contraception education & provision Quasi-Experimental: 2 arm Counseling & provision of contraception at clinics; Family planning outreach activities Rates of new acceptors of contraception higher at intervention sites post-intervention, but no statistical differences; uptake of implants increased at interventions sites; no difference for IUDs
 Ezeanolue et al. 2016 [28] Nigeria Male partners, avg. age = 38 none Pregnancy education, ANC care education, HIV transmission, HIV integrated services Cluster RCT: 2 arm Church-based/family-based;
1 session: pregnancy and health education via a “game show”
Male partners in intervention group showed higher rates of HIV testing compared with controls at post-intervention (post-delivery)
 Ishola et al. 2015 [29] Nigeria HIV+ pregnant women Mindfulness, Cognitive, Goal Setting HIV post-test counseling Solomon 4-group PMTCT Center groups;
1 ACT session + weekly text messages for 3-months
Intervention: sig improvements in psychological flexibility at post-intervention
 Okonofua et al. 2003 [30] Nigeria Girls and boys ages 14–20
(n = 1896)
none Reproductive health education, STI prevention & referrals; clubs & campaigns in school, public lectures RCT: 2 arm School-based RH clubs;
Peer-educator training, peer delivered counseling (individual or group-based), peer outreach;
Health provider training in STI treatment (30 h of lectures)
Intervention: sig higher STI knowledge, awareness of partner’s STIs, & STI treatment-seeking; sig reduced STI prevalence at post-intervention
 Mercy Corps 2015 [31] Niger Girls ages 10–18
(n = 829)
Support networking
(Safe spaces: SS)
RH education, risk of early pregnancy (Livelihood Training) Post test with a control Community-based groups;
87–91 h of direct intervention (SS over 9 months, SS+ Livelihood Training over 19 months)
Sig reductions in attitudes on contraceptive use & age to have a baby in both groups at post-intervention; SS only had sig higher RH knowledge
 Bass et al. 2013 [32] Dem Rep
Congo (DRC)
Women avg. age = 36.9; 33.8 Cognitive none Mixed Method Community-based groups;
1 individual session + 11,120 min group sessions
Intervention: sig improved anxiety, PTSD symptoms, depression
 OCallaghan et al. 2013 [33] Dem Rep
Congo
Girls ages 12–17 (war affected) Relaxation, problem solving, coping skills, emotion regulation, cognitive, psychoeducation none RCT: 2 arm 15,120 min sessions 3 days per week Intervention: sig reduced PTSS symptoms, distress, anxiety, depression at post-intervention
 Panter-Brick et al. 2018 [34] Jordan
(Syrian Refugees)
Girls and boys ages 12–18 Support networking, communication skills, relaxation, psychoeducation, resilience building Gender equity, creating safe spaces RCT: 2-arm Community youth center groups;
2 sessions per week for 8 weeks;
Structured group activities
Intervention: sig improved MH, insecurity & distress at post-intervention; sustained effects for distress at 1-yr follow-up
 Langhe-Nielson et al. 2011 [35] Palestine
(Gaza)
Refugees
Girls and boys ages 12–17 Narrative none Quasi Experimental School-based groups in camps;
2 15 min writing sessions on traumatic memories for 3 days
No significant effects of intervention
 Barron et al. 2016 [36] Palestine Girls and Boys ages 11–15 Coping skills, relaxation psychoeducation, exposure none RCT: 2 arm School-based groups;
5 sessions: Teaching Recovery Techniques (TRT)
Intervention: sig reduced PTSD symptoms at post-intervention
 Punamaki et al. 2014 [37] Palestine
(Gaza)
Girls and boys ages 10–13 Coping skills, relaxation psychoeducation, exposure none RCT School-based groups after school;
2 sessions per week for 6 weeks: Teaching Recovery Techniques (TRT)
No sig differences in emotion regulation (ER) at post-intervention, ER intensity mediated intervention effects on MH outcomes
 Qouta et al. 2012 [38] Palestine
(Gaza)
Girls and boys ages 10–13 Coping skills, psychoeducation, creative expression none Cluster RCT: 2-arm School-based groups;
2 sessions per week for 4 weeks;
1 psychologist per group
Intervention: sig reduced clinical PTSS in boys only compared with controls at post-intervention
 Diab et al. 2014 [39] Palestine Girls and boys ages 10–13 Relaxation, emotion regulation, problem solving, psychoeducation none Quasi Experimental School-based groups (TRT);
Delivered by trained counselors; Structured group activities;
Homework to practice relaxation
No sig effects of intervention on MH outcomes at post-intervention
 Kalantari et al. 2010 [40] Iran
(Afghani refugees)
Girls and boys ages 12–18 Narrative none Pre-post School-based groups;
2 15 min sessions per day on trauma memories for 3 days
Intervention: sig decrease in traumatic grief at post-intervention (small sample size; n ~ 30)
 Mon et al. 2017 [41] Myanmar
(HIV+ parent)
Girls and boys ages 10–16 Mindfulness, relaxation, RH education: (puberty, HIV/STIs contraception, pregnancy) RCT: 2- arm Community center groups;
3 monthly sessions conducted by 3 trained instructors;
Homework to practice meditation
Intervention: sig higher RH knowledge at 3 mos but not 6 mos; sig higher emotion regulation & interpersonal effectiveness
 Mon et al. 2016 [42] Myanmar (HIV+ parent) Girls and boys ages 10–16 Mindfulness, relaxation, RH education Cluster RCT: 2- arm Community center groups;
3 monthly sessions;
Homework to practice meditation
Intervention: sig lower conduct and emotional problems at 6 mos follow-up
 Newmann et al. 2016 [43] Kenya HIV+ men and women ages 18–45 none Family planning talks, provision of condoms & effective contraception RCT: 2 arm Family planning integrated into HIV services Intervention site: sig higher gender equity attitudes in men only, sig more effective contraception use in women only at 1 yr follow-up
 Bryant et al. 2017 [44] Kenya Women, avg. age = 35 Behavioral activation, problem solving, relaxation, support networking none RCT: 2 arm Home-based individual sessions;
5 weekly 90 min sessions (Problem Management: PM+)
Intervention: sig greater reductions in distress; reductions in functional impairment; no differences in gender based violence at 6 mos follow-up
 Dawson et al. 2016 [45] Kenya Women, avg. age = 33 affected by GBV Behavioral activation, problem solving, relaxation, support networking none Pilot
RCT: 2 arm
Home-based individual sessions;
5 weekly 90 min sessions (PM+)
Intervention: sig reductions in PTSD symptoms at post-intervention; no sig differences in distress or functional impairment
 Baiocchi et al. 2017 [46] Kenya Girls and boys ages 10–16 Girls Education: assertiveness training, problem solving, emotion regulation Boys education: gender equality (Gender equity), sexual assault prevention (GBV), Cluster RCT:
Matched pairs
School-based groups (boys and girls separate);
6 weekly 120 min sessions + 1 booster session at 3-mos;
Structured group activities
Intervention: sig increase in self-efficacy (perceived ability to cope with stress) and decrease in “estimated” rate of sexual assault at post-intervention
 Puffer et al. 2016 [47] Kenya Girls and boys ages 10–16 Modeling, problem solving, goal setting, coping skills, communication skills HIV education & prevention, economic empowerment Cluster RCT: 2 arm Family-based/church-based;
9120 min sessions;
Parent groups, youth groups (boys and girls separated), & church leader discussion groups
Intervention: sig improved family communication at 1 & 3 mos, higher self-efficacy for safe sex at 1 mo; no effects on beliefs about sexual risk; marginal effects for HIV knowledge
 Cohen et al. 2017 [48] Kenya HIV+ Women ages 18–45 none Integration of HIV & FP services; family planning counseling Cluster RCT: 2 arm Family counseling provided at HIV clinics Sig increase in use of effective contraception, decrease in pregnancy rates at 1 & 2 yrs.
 Turan et al. 2015 [49] Kenya HIV+ mothers and infants none Integration of PMTCT and HIV care with antenatal care services Cluster RCT: 2 arm “Week-long” health care provider training on HIV, PMTCT and ANC care & service promotion Intervention: sig higher HIV care enrollment at 1 yr, more likely to initiate & use ART during pregnancy
 Adam et al. 2013 [50] Kenya 1st & 2nd yr University Students none HIV prevention: condom use, monogamy, abstinence RCT: 2 arm University-based/peer-delivered;
Peer educator training;
32 h over 4 weeks
No sig differences between groups at post-intervention
 Grossman et al. 2011 [51] Kenya HIV+ women ages 18–45 none Family planning services integrated into HIV clinics Cluster RCT: 2 arm Trained peer educators delivered family planning education in groups (sessions not described) Intervention: sig higher odds of using effective contraception at 1 yr, no sig difference in condom use
Lower Income Country Settings
 Penfold et al. 2014 [52] Tanzania Women ages 13–49 and infants none Antenatal care education Cluster RCT: 2 arm Home-based individual sessions;
3 sessions pre-birth + 1 post-birth;
Delivered by trained volunteers
Sig higher reports of delaying first birth, exclusive breastfeeding, and cord cutting hygiene post-delivery
 Magoma et al. 2013 [53] Tanzania Pregnant women avg. age = 25 none Birth planning education integrated into ANC services Cluster RCT: 2 arm Clinic-based sessions;
ANC providers received 2 days of didactic training
Intervention: effects moderated by SES; women more likely to deliver in health unit but not statistically significant for all women
 Ross et al. 2007 [54] Tanzania Girls and boys avg. age = 15.7 none Increase provision of youth friendly SRH services, sexual health education, condom promotion/provision Community RCT: 2 arm School-based groups;
12 40-min sessions over 1 year;
Teacher led & peer-assisted;
Community-wide activities (e.g., condom promotion by youth)
Intervention: sig impact on SRH knowledge, HIV/STI knowledge, sexual behavior attitudes at 3 yrs.; no sig effects on HIV or STI prevalence
 Jordans et al. 2010 [55] Nepal Girls and boys ages 11–14 Creative expression, exposure, narrative, psychoeducation, resilience building none Cluster RCT: 2 arm School-based groups;
15 60 min sessions over 5 weeks;
Structured groups activities
Intervention: moderate reductions in psychological problems for boys, increased prosocial behavior for girls at post-intervention
 Ssewamala et al. 2010 [56] Uganda
(Aids Orphaned)
Girls and boys avg. age = 13.7 none Economic empowerment Quasi RCT School-based groups;
12 sessions on financial planning; monthly peer mentorship meetings for 10 months
Intervention: sig improved sexual risk taking attitudes for boys at post-intervention; girls showed increased approval of sexual risk-taking
 Bolton et al. 2007 [57] Uganda Girls and boys ages14–17 Interpersonal therapy; creative expression none RCT: 2 arm Groups held in displaced person camps;
16 weekly 90–120 min sessions
Intervention: girls only showed sig improvements in depression at post-intervention; no effect on anxiety
 Devries et al. 2017 [58] Uganda Girls and boys ages 11–14 Goal setting, psychoeducation- staff Sexual/emotional violence education; power in relationships Cluster RCT: 2 arm School-based group sessions;
Good Schools Toolkit: activities for students and staff
Intervention: sig reduced levels of violence (including sexual) at 3 mos follow-up
 Atwood et al. 2012 [59] Liberia 6th grade girls and boys
(n = 812)
  HIV prevention, condom use attitudes, perceived sexual risk, sexual refusal self-efficacy; condom negotiation self-efficacy Match Group RCT: 2 arm School-based groups;
1 male & 1 female health educator delivered education in health class weekly over 8 weeks
Intervention: sig improved attitudes about condoms, increased condom use at 9 mos; no effect on age first sex or multiple sex partners
 Hossain et al. 2013 [60] Cote
d’lvoire
Men avg. age = 32 none Gender-based violence, healthy relationships Pilot RCT: 2 arm Community program + men’s discussion group;
16 sessions over 4 months
Intervention: sig lower reports of GBV, improved attitudes about GBV at 1 yr follow-up
 Gupta et al. 2013 [61] Cote
d’lvoire
Women avg. age = 37 Communication skills Gender norms & attitudes, economic empowerment, GBV RCT
2 arm
Community-based groups for women and their male partners;
8 1.5–2.5 h sessions over 16 weeks;
Delivered by 1 male & 1 female facilitator
Intervention: acceptance of wife beating reduced at 3 mos, no sig differences in reported IPV or attitudes about sex refusal
Middle Income Settings
 Villaruel et al. 2010 [62] Mexico Girls avg. age = 17.6
(n = 829)
none Sexual risk reduction, pregnancy education, contraception, parent-adolescent sex talks RCT: 2 arm School-based groups;
6 h of sessions total;
Structured group activities;
Parent groups
Intervention: sig more likely to be older & use a condom at first sex at 48 mos; no effect on consistent condom use
 Kaljee et al. 2005 [63] Vietnam Boys and girls ages 15–20
(n = 480)
  HIV/AIDS Knowledge, effective contraception, intentions to use condoms, sexual decision making skills RCT School-based groups;
10 weekly 2 h sessions;
1 facilitator per group (same gender groups);
Parent groups
Intervention: sig greater HIV/AIDS knowledge; condom use self-efficacy and condom negotiation self-efficacy; perceived efficacy of condoms; intentions to use condoms at post-intervention and 6 mos
 Leventhal et al. 2016 [64] India Girls, avg. age = 13 Emotion regulation, assertiveness training, communication skills, problem solving, resilience building Gender equity, gender based violence; RH heath education (health curriculum) RCT: 3- arm School-based groups;
1 session weekly for 21–23 weeks;
2 trained facilitators per group;
Structured group activities
Psychosocial curriculum + health curriculum group had sig higher gender equality attitudes and RH health knowledge than controls at post-intervention
 Leventhal et al. 2015 [65] India Middle school girls Resilience building, emotion regulation, assertiveness training problem solving, goal setting, communication skills none Stratified Block RCT: 4 groups School-based groups;
23 60 min weekly sessions;
Structured group activities
Intervention: sig higher emotional resilience, self-efficacy (belief that one can cope with adversity and perform difficult tasks), well-being at post-intervention; no effect for depression
 Raj et al. 2016 [66] India Couples; husbands ages 18–30   Gender equity, family planning counseling, contraception education, sexual-risk behaviors Cluster RCT: 2 arm Clinic-based or home sessions;
2 individual sessions delivered by male health providers to men &
1 couples session over 3 months
Intervention: women sig more likely to communicate about contraception & use effective contraception at 9 mos, less likely to report IPV at 18 mos; men sig less likely to report acceptance of IPV at 9 & 18 mos; no effect on pregnancy rates
 Jewkes et al. 2008 [67] South
Africa
Girls and boys ages 15–26 Communication skills; coping skills HIV prevention, STIs pregnancy prevention, sexual risk taking, condom use, GBV Cluster RCT: 2 arm Community-based groups;
13 3 h sessions (girls and boys separated), 3 peer group meetings, 1 community meeting
Intervention: reduced reported GBV in boys but not significant at p < .05; no sig effects for girls at 2 yrs.; no sig effects on HIV prevalence
 Taylor et al. 2014 [68] South
Africa
Girls and boys avg. age = 14
(n = 816)
none Pregnancy prevention, gender norms, education on puberty, decision-making, healthy relationships RCT: 2 arm School-based groups;
12 weekly sessions;
Structured group activities
Intervention: sig healthier attitudes, intentions for abstinence, plans to communicate with partner about pregnancy, higher reported condom use at 8 mos follow-up
 Matthews et al. 2016 [69] South
Africa
Girls and boys avg. age = 13 Assertiveness training, communication skills HIV prevention, IPV prevention, gender equity, GBV, sexual decision-making, healthy relationships Cluster RCT: 2 arm School-based groups after school;
21 60–90 min education sessions; School IPV prevention program;
School-based youth friendly health service
No sig differences in sexual risk behavior at 12 mos; intervention sig less likely to report experiencing sexual violence; higher HIV knowledge & condom knowledge
 Jones et al. 2013 [70] South
Africa
Pregnant women avg. age = 28 Communication skills, problem-solving, assertiveness training HIV/STI prevention, contraceptive use, PMTCT service usage RCT: 2 arm Clinic-based/Couples-based;
4 weekly 90–120 min couples sessions
Intervention: sig decreased partner violence, increased HIV knowledge, condom use, use of sexual negotiation skills at post-intervention
 Mott MacDonald Team 2017 [71] Zambia Girls ages 10–14; 15–19 Resilience building Vouchers for SRH services, economic empowerment, health education RCT: 2 arm Weekly meetings over 2 years No sig evidence for effects on SRH outcomes at 2 yrs
 Vance et al. 2013 [72] Ghana &
Zambia
Women postpartum avg. age = 24 none Family planning messages integrated with immunization services, family planning referrals, LAM education Cluster RCT: 2 arm Clinic-based individual sessions;
4 sessions, 30 s each; Vaccinators trained via manual to provide LAM education, family planning messages & referrals
No sig differences between groups and very few women knew LAM criteria at post-intervention
 Rockiki et al. 2017 [73] Ghana Girls ages 14–24 none Pregnancy prevention, reproductive anatomy, STI prevention and education, effective contraception education Cluster
RCT: 3-arm
1 text message per week for 12 weeks (unidirectional = RH information; interactive = quiz + feedback and encouragement) Interactive: sig higher RH knowledge than unidirectional & control at 3-mos; no sig differences at 15-mos
 Aninanya et al. 2015 [74] Ghana Girls and boys ages 10–19 none SRH education, sexual attitudes and behaviors; promoting youth SRH, ANC, prenatal, and HIV/STI service usage Cluster RCT School-based youth groups;
Peer outreach activities;
Youth friendly health services provider training (1 session);
Community mobilization meetings (50+ sessions);
Delivered by government workers
Intervention: sig higher odds of STI, ANC, and prenatal service usage at 3 yrs.; no sig differences in HIV or SRH service usage
 Carlson et al. 2013 [75] Mongolia Female sex workers, avg. age = 25 Motivation
enhancement
HIV risk reduction, gender-based violence Cluster RCT: 3 arm Groups held at NGO building;
4 weekly 90 min sessions;
2 wrap-up sessions for MI group
Intervention: sig reductions in violence from paying sex partners in MI alone, MI+ risk reduction, and also controls at 6 mos follow-up
 Khan et al. 2017 [76] Pakistan Pregnant women ages 18–30 Psychoeducation, relaxation, support networking none Pilot RCT: 2 arm Home-based/family-based;
1 20 min session + 1 60 min session
No sig differences between groups at post-intervention
 Bhutta et al. 2011 [77] Pakistan   none Antenatal care promotion Cluster RCT: 2 arm Community-based groups; quarterly sessions delivered by lay workers No sig differences between groups
Middle East Non-humanitarian Crisis Settings
 Bastani et al. 2006 [78] Iran Pregnant women ages 18–30 Relaxation, psychoeducation none RCT: 2 arm Clinic-based groups;
7 weekly 90 min sessions;
Delivered by trained nurses
Intervention: sig lower anxiety & stress post-delivery, sig reductions in low birth weight and C-sections
 Berger et al. 2014 [79] Israel Girls and boys ages 11–13 Emotional regulation, relaxation none Quasi RCT: 2 arm 16 90 min weekly sessions Intervention: sig reductions in PTSD symptoms, anxiety, somatic symptoms at post-intervention
  1. Note. *Pregnancy prevention was coded as SRH education. **Sig is used as an abbreviation for “significant” and “significantly”. Studies reporting significant effects on at least one SRH outcome are highlighted in grey