Promoting Adolescent Girls’ Well-Being in Pakistan: a Mixed-Methods Study of Change Over Time, Feasibility, and Acceptability, of the COMPASS Program

Abstract

Promoting resilience among displaced adolescent girls in northern Pakistan may buffer against developmental risks such as violence exposure and associated longer-term consequences for physical and mental well-being. However, girls' access to such programming may be limited by social norms restricting movement. A mixed-method evaluation examined change over time, feasibility, and acceptability of the COMPASS program in three districts of Khyber-Pakhtunkhwa province through a single-group within-participant pretest-posttest of adolescent girls aged 12-19 enrolled in the intervention (n = 78), and qualitative in-depth interviews with girls following posttest completion (n = 15). Primary outcomes included improvements in movement, safety, and comfort discussing life skills topics with caregivers, operationalized quantitatively as number of places visited in the previous month, number of spaces that girls felt safe visiting, and comfort discussing puberty, education, working outside the home, and marriage, respectively. Secondary outcomes included psychosocial well-being, gendered rites of passage, social support networks, perceptions of support for survivors of violence, and knowledge of services. Quantitative pretest-posttest findings included significant improvements in movement, psychosocial well-being, and some improvements in social support, knowledge of services, and gendered rites of passage; findings on safety and comfort discussing life skills topics were not significant. Qualitative findings illuminated themes related to definitions of safety and freedom of movement, perceptions and acceptability of program content, perceptions of social support, and perceptions of blame and support and knowledge of services in response to violence. Taken together, findings illustrate positive impacts of life skills programming, and the need for societal changes on gender norms to improve girls' safety in public spaces and access to resources.

Mobilising social support to improve mental health for children and adolescents: A systematic review using principles of realist synthesis

“…Most interventions were provided by volunteers, community workers or psychological therapists. Only four studies [ 43 , 49 , 51 , 56 ] were conducted in middle-income countries (South Africa, India and Pakistan), whilst the rest were from high-income countries (North America, Europe, Australia, Japan). Tables 1 – 3 provide details about studies in relation to their programme components, contextual factors, population, mechanisms for improving children’s mental health, and findings on outcomes.…”

“…How is social support mobilised, to which populations and in which context? Sixteen studies [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] focused on providing or mobilising social support to improve adolescents' mental health (S5 Table ). Interventions mobilised social support by: modelling healthy PLOS ONE relationships and social skills; offering safe spaces or opportunities for young people to practice their social skills; encouraging youth to seek help for social support; or changing perceptions of the benefits of social support.…”

“…Two studies were about universal preventative interventions, which addressed transition to employment and mental health of young male athletes. Three studies [49,51,56] took place in low-and middle-income countries. Does an increase in social support lead to improved children's mental health, and what are the mechanisms by which this is (expected to be) achieved?…”

Gendered stereotypes and norms: A systematic review of interventions designed to shift attitudes and behaviour

“…Further to this common theory of change, several strategies were identified which appear to have enhanced the delivery and impact of these interventions. These included the use of participant peers to lead, support and heighten learning [49,77,79,81,86,90,92,93,103,109,110,111,113,115,116,117], involvement of multiple levels of the ecological framework (not just addressing the individual) [51,52,53,54,55,56,58,59,60,70,72,74,81,86,91,97,98,102,117,118], developing participants into agents of change [49,52,58,60,72,81,98,117,118], using modelling and role models [49,51,…”

Preventing violence against refugee adolescent girls: findings from a cluster randomised controlled trial in Ethiopia

“…In Pakistan, the evaluation assessed the acceptability of the programme to adolescent girls and parents/caregivers in their context and measured changes in girls’ social and health outcomes over the course of the programme. 24 This article presents findings from the evaluation implemented in Ethiopia.…”