Evidence: Seeds of Prevention: The Impact on Health Behaviors of Young Adolescent Girls in Uttar Pradesh, India, A Cluster Randomized Control Trial

Participating organisations in the Global Alliance for Social and Behaviour Change - Building Informed and Engaged Societies were asked to identify, in their opinion, the 5 most compelling research and evaluation studies that demonstrate the direct impact of this field of work on a major development issue. This was one of the nominees. For the full compiled list, please click here. For the compilation of the key impact data across all research evidence identified, please click here.

Editor's note: Click here for a summary of this evaluation on The CI site.

Title of paper, article, book (chapter), publication?:

Seeds of Prevention: The Impact on Health Behaviors of Young Adolescent Girls in Uttar Pradesh, India, A Cluster Randomized Control Trial

Name(s) of author(s)?:

Nandita Kapadia-Kundu, Douglas Storey, Basil Safi, Geetali Trivedi, Rama Tupe, and G. Narayana

Who published this paper, article, book (chapter) or other publication?:

Social Science & Medicine, v. 120 (2014), 169-179.

What are the best extracts that highlight the evidence for the impact of a communication for development, social change, behaviour change, public engagement, or informed citizen strategy on a development issue and priority?:

Identifying early adolescence as a “gateway” moment, the Saloni study is a randomized control trial (RCT) to improve nutrition, hygiene and reproductive health behaviors in 30 schools in rural Uttar Pradesh (UP), India. A prevention model that includes Sadharanikaran, an ancient Indian theory of communication, guided the development of the intervention. The Saloni strategy includes a 10 session in-school intervention based on compassion, self efficacy, emotional well being, peer and parental support, packaged in the form of short, easy-to-use instructional modules. A diary designed to engage adolescent girls is provided to each girl. The intervention promoted 19 behaviors that included five health seeking, six nutrition, three reproductive health and five hygiene behaviors. A structured teacher's manual included 10 one-hour sessions that were conducted monthly. Systematic pretesting of the teacher's manual and the Saloni diary was conducted from February to April 2010. The strategy of using diaries to promote empowerment has been used effectively by women's self help groups in rural India (Noponen, 2003), but the approach has not been used with adolescent girls. Intergenerational communication was included in every session and role-plays were conducted with the girls on how to initiate dialogue with their parents on Saloni topics. AV support materials in the form of nine posters reinforced the Saloni behaviors and promoted intergenerational communication. The cluster RCT was conducted from January 2010 to October 2011 with adolescent girls (11-14 years of age) in Hardoi district. The trial is a two-level, nested RCT with the unit of randomization being the block with 15 schools in the intervention arm and 15 schools in the control arm. A sample of 1200 girls was randomly selected. The intervention had a significant impact on more than 13 preventive health behaviors. About 65% of girls in the intervention group had adopted 13 or more health behaviors at end line compared to only 4.5% of the control group. Behavioral impact was demonstrated in all three areas of nutrition, hygiene and reproductive health. The study provides evidence that early adolescence is indeed a “gateway moment” to build nutritional and health reserves.

To which development issue does this evidence and impact data relate?:

Adolescent nutrition, hygiene and reproductive health; health competence

To which strategic approach(es) does the evidence and impact data relate?:

School-based and home-based interventions, intergenerational (parent-child) communication

What research methodology (ies) was/were used to produce this evidence and impact data?:

A cluster RCT was conducted from January 2010 to October 2011 with adolescent girls (11-14 years of age) in Hardoi district. The trial is a two-level, nested RCT with the unit of randomization being the block with 15 schools in the intervention arm and 15 schools in the control arm. A sample of 1200 girls was randomly selected. Data were analyzed at the individual and cluster levels. Individual-level analysis includes adjusted chi-square analysis looking at a difference in proportions. The chi-square for the individual level analysis was adjusted for clustering using the Rao Scott statistic (Reed, 2004). In addition, cluster level analysis was done using a two-sample t-test for comparisons of means between baseline and endline for both the intervention and control groups.

What is the URL to access this paper, article, book (chapter) or other publication?:

https://www.sciencedirect.com/science/article/pii/S0277953614005693

Why was this research evidence found to be useful?:

• It validates an ancient Hindu theory of communication (Sadharanikaran) that features variables (empathy, emotional response and emotional support) that are uncommon in most of the social science theories used in SBCC work today.
• It is the only known cluster RCT of a school-based and home-based intervention for adolescent health.
• It demonstrates the efficacy of a multilevel, intergenerational communication approach (individual level and family level, school-based instruction supported by parent-child communication).
• The approach has the potential to break intergenerational cycles of malnutrition and morbidity (i.e., malnourished adolescent mothers have malnourished babies who grow up to be malnourished mothers who have malnourished babies ad infinitum.