title: A psychosocial resilience curriculum provides the "missing piece" to boost adolescent physical health: A randomized controlled trial of Girls First in India.
abstract: 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.
authors.affiliation: CorStone, 250 Camino Alto, Suite 100A, Mill Valley, CA, USA. Electronic address: kates@corstone.org.
authors.forename: Katherine Sachs
authors.initials: KS
authors.lastname: Leventhal
authors.affiliation: QURE Healthcare, 1000 Fourth St., Suite 300, San Rafael, CA, USA. Electronic address: ldemaria@qurehealthcare.com.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: DeMaria
authors.affiliation: Department of Psychology, Swarthmore College, 500 College Avenue, Swarthmore, PA, USA. Electronic address: jgillha1@swarthmore.edu.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Gillham
authors.affiliation: CorStone, A 91, Amritpuri, First Floor, Opp. Isckon Temple, East of Kailash, New Delhi, 110065, India. Electronic address: gracya@corstone.org.
authors.forename: Gracy
authors.initials: G
authors.lastname: Andrew
authors.affiliation: QURE Healthcare, 1000 Fourth St., Suite 300, San Rafael, CA, USA. Electronic address: jpeabody@qurehealthcare.com.
authors.forename: John
authors.initials: J
authors.lastname: Peabody
authors.affiliation: CorStone, 250 Camino Alto, Suite 100A, Mill Valley, CA, USA. Electronic address: stevel@corstone.org.
authors.forename: Steve M
authors.initials: SM
authors.lastname: Leventhal
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D000704:Analysis of Variance; D002648:Child; D017281:Cost of Illness; D003479:Curriculum / Q000639:trends*; D005260:Female; D006304:Health Status; D006801:Humans; D007182:Income; D007194:India / Q000453:epidemiology; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology; D010290:Parents; D011314:Preventive Health Services / Q000379:methods / Q000592:standards*
keywords: Adolescents; Girls; Health; India; Intervention; Psychosocial wellbeing; Randomized controlled trial; Resilience