Population Council, New York, New York.
Population Council, New York, New York.
J Adolesc Health. 2018 Jul;63(1):18-31. doi: 10.1016/j.jadohealth.2017.11.294. Epub 2018 Feb 9.
Increasing attention to adolescent girls has generated an abundance of programs and a growing body of research on adolescent girls in low- and middle-income countries. Despite this, questions remain about what implementation approaches in program design are most effective, hindering efficient resource allocation, program scale-up, and replication across settings. To address these questions, we conducted a systematic review to identify lessons learned and gaps in the evidence base. We searched four electronic databases to identify studies published between 1990 and 2014 that evaluated health, social, and/or economic development programs targeting adolescent girls in low- and middle-income countries. Seventy-seven (77) studies meeting specified criteria were identified, of which 19 presented results that allowed conclusions relevant to implementation science. Studies examining the following questions were assessed: To what extent, if any, do multicomponent interventions (as opposed to single-component interventions) improve outcomes for girls? What is the added value of involving actors in addition to the girl herself such as parents, guardians, husbands (i.e., multilevel interventions)? What is the threshold proportion of girls who need to participate in a program to bring about normative and behavior changes at the community level? Is a greater level of program exposure associated with greater programmatic benefit for girls? Can supplemental "booster" activities extend the benefits of a program after it ends? We found evidence to support associations between multicomponent (vs. single component) programs, and longer program exposure (vs. less program exposure), with more favorable outcomes for girls, although both conclusions include methodological limitations. Overall, few studies assessed boosters or program saturation, and evidence on multilevel versus single-level programs was inconclusive. Few studies assessed implementation science questions by design, exposing large gaps in the evidence base. We call for future research to explicitly test such implementation science questions to inform more effective use of resources and to improve outcomes for girls.
越来越多的人关注少女群体，这使得针对中低收入国家少女的项目和研究数量不断增加。尽管如此，在项目设计的实施方法方面仍存在许多问题，这些问题影响了资源的有效分配、项目的推广以及在不同环境下的复制。为了解决这些问题，我们进行了一项系统评价，以确定该领域的经验教训和证据基础中的差距。我们在四个电子数据库中进行了检索，以确定 1990 年至 2014 年间发表的评估针对中低收入国家少女的健康、社会和/或经济发展项目的研究。符合特定标准的 77 项研究被确定，其中 19 项研究的结果可得出与实施科学相关的结论。评估了以下问题的研究：多组分干预（与单一组分干预相比）在多大程度上改善了女孩的结果？除了女孩本身之外，让父母、监护人、丈夫等其他行为者参与（即多水平干预）有何附加价值？需要多少比例的女孩参与一个项目才能在社区层面带来规范和行为的改变？方案暴露程度更高是否与女孩获得更大的方案效益相关？补充“助推”活动能否延长项目结束后的效益？我们发现，多组分（与单一成分）方案以及更长时间的方案暴露（与较短的方案暴露相比）与女孩的更有利结果之间存在关联的证据，但这两个结论都存在方法学上的局限性。总体而言，很少有研究评估了助推器或方案饱和度，而且关于多水平与单水平方案的证据也不明确。很少有研究按照设计评估实施科学问题，这使得证据基础存在很大的差距。我们呼吁未来的研究明确检验这些实施科学问题，以便更有效地利用资源并改善女孩的结果。
