Multi-component Community and School-based Clubs and Adolescent Wellbeing Outcomes
Open Access DepositedContext is Critical
Adolescence is a critical developmental stage, where health, education, and social disparities often widen, especially in low- and middle-income countries (LMICs). Multicomponent adolescent club interventions are widely used to improve health and wellbeing in LMICs, but evidence is mixed on their effectiveness and there is often a lack of clarity on which implementation and contextual factors shape impact, especially in remote settings such as pastoralist communities. Methods
Background
The systematic review, which included 35 manuscripts representing 26 trials, and 33 unique intervention arms, indicated positive effects of clubs on health, gender norms, and economic outcomes, with mostly null findings for violence, mental health, and education. Positive outcomes were more common in high-intensity interventions, similar across supplemental programming types (family-only, family and community, community only), and somewhat higher in formal education–connected programs and those using parallel male engagement. For the evaluation in Afar, findings suggest mean levels of key outcomes (i.e. puberty knowledge, desire to get married at age 19 or later, gendered household roles) remained low, with positive program findings often mitigating negative trends among adolescents in the control group. Qualitative data suggest the program contributed to positive changes in gendered household roles and aspirations among adolescents in these remote communities. However, given the deeply entrenched cultural norms, sustained meaningful changes will require multi-pronged efforts with families and caregivers, as well as clan and religious leaders. Discussion
I combined a (1) systematic review of multicomponent community- and school-based club interventions for adolescents aged 10–24 in LMICs, synthesizing effects across adolescent health and wellbeing outcome domains and examining context modifiers such as intervention intensity and male engagement and (2) a mixed-methods cluster randomized evaluation of multicomponent, club-based program, “Act With Her” (AWH), among 499 adolescents in the Afar region of Ethiopia. Results
Multi-component adolescent club programs can improve health and wellbeing, especially when their content aligns with intended outcomes and is delivered at sufficient intensity. Persistent null outcomes in violence, mental health, and education underscore the need for adequately powered trials, stronger structural and systems components, and expanded evidence generation in remote and underserved settings.
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