Leventhal Katherine Sachs, DeMaria Lisa M, Gillham Jane E, Andrew Gracy, Peabody John, Leventhal Steve M
CorStone, 250 Camino Alto, Suite 100A, Mill Valley, CA, USA.
QURE Healthcare, 1000 Fourth St., Suite 300, San Rafael, CA, USA.
Soc Sci Med. 2016 Jul;161:37-46. doi: 10.1016/j.socscimed.2016.05.004. Epub 2016 May 4.
Despite a recent proliferation of interventions to improve health, education, and livelihoods for girls in low and middle income countries, psychosocial wellbeing has been neglected. This oversight is particularly problematic as attending to psychosocial development may be important not only for psychosocial but also physical wellbeing. This study examines the physical health effects of Girls First, a combined psychosocial (Girls First Resilience Curriculum [RC]) and adolescent physical health (Girls First Health Curriculum [HC]) intervention (RC + HC) versus its individual components (i.e., RC, HC) and a control group. We expected Girls First to improve physical health versus HC and controls.
Over 3000 girls in 76 government middle schools in rural Bihar, India participated. Interventions were delivered through in-school peer-support groups, facilitated by pairs of local women. Girls were assessed before and after program participation on two primary outcomes (health knowledge and gender equality attitudes) and nine secondary outcomes (clean water behaviors, hand washing, menstrual hygiene, health communication, ability to get to a doctor when needed, substance use, nutrition, safety, vitality and functioning). Analyses included Difference-in-Difference Ordinary Least-Squares Regressions and F-tests for equality among conditions.
Girls First significantly improved both primary and eight secondary outcomes (all except nutrition) versus controls. Additionally, Girls First demonstrated significantly greater effects, improving both primary and six secondary outcomes (clean water behaviors, hand washing, health communication, ability to get to a doctor, nutrition, safety) versus HC.
This study is among the first to assess the impact of a combined psychosocial and adolescent health program on physical health. We found that combining these curricula amplified effects achieved by either curriculum alone. These findings suggest that psychosocial wellbeing should receive much broader attention, not only from those interested in improving psychosocial outcomes but also from those interested in improving physical health outcomes.
尽管最近在低收入和中等收入国家出现了大量旨在改善女童健康、教育和生计的干预措施，但心理社会福祉却一直被忽视。这种忽视尤其成问题，因为关注心理社会发展不仅对心理社会福祉，而且对身体健康可能都很重要。本研究考察了“女童优先”项目（一种结合了心理社会干预（女童优先复原力课程[RC]）和青少年身体健康干预（女童优先健康课程[HC]）的干预措施（RC + HC））与其各个组成部分（即RC、HC）以及一个对照组相比对身体健康的影响。我们预计“女童优先”项目相对于HC和对照组能改善身体健康状况。
印度比哈尔邦农村地区76所政府中学的3000多名女童参与了研究。干预措施通过校内同伴支持小组实施，由当地女性两人一组进行协助。在项目参与前后，对女童在两个主要结果（健康知识和性别平等态度）以及九个次要结果（清洁水行为、洗手、经期卫生、健康沟通、必要时看医生的能力、物质使用、营养、安全、活力和功能）方面进行了评估。分析包括差分普通最小二乘法回归和条件间平等性的F检验。
与对照组相比，“女童优先”项目在主要结果和八个次要结果（营养除外）方面均有显著改善。此外，与HC相比，“女童优先”项目显示出显著更大的效果，在主要结果和六个次要结果（清洁水行为、洗手、健康沟通、看医生的能力、营养、安全）方面均有改善。
本研究是首批评估心理社会与青少年健康综合项目对身体健康影响的研究之一。我们发现，将这些课程结合起来能放大单独一门课程所取得的效果。这些发现表明，心理社会福祉不仅应得到那些关注改善心理社会结果的人的更广泛关注，也应得到那些关注改善身体健康结果的人的更广泛关注。
