Intensive Group Learning and On-Site Services to Improve Sexual and Reproductive Health Among Young Adults in Liberia: A Randomized Evaluation of HealthyActions.
Young Liberians, particularly undereducated young adults, face substantial sexual and reproductive health (SRH) challenges, with low uptake of contraceptive methods, high rates of unintended pregnancy, and low levels of knowledge about HIV status. The purpose of this study was to assess the impact of a 6-day intensive group learning intervention combined with on-site SRH services (called HealthyActions) among out-of-school young adults, implemented through an existing alternative education program, on uptake of contraception and HIV testing and counseling (HTC).



The intervention was implemented among young women and men ages 15-35 who were enrolled in alternative basic education learning sites in 5 counties of Liberia. We conducted a randomized evaluation to assess program impact. Baseline data were collected in January-March 2014, and endline data in June-July 2014. Key outcomes of condom use, contraceptive use, and HTC were estimated with difference-in-difference models using fixed effects. All analyses were conducted in Stata 13.



We assessed outcomes for 1,157 learners at baseline and 1,052 learners at endline, across 29 treatment and 26 control sites. After adjusting for potential confounders, learners in the HealthyActions intervention group were 12% less likely to report never using a condom with a regular partner over the last month compared with the control group (P = .02). Female learners who received HealthyActions were 13% more likely to use any form of modern contraception compared with learners in control sites (P<.001), with the greatest increase in the use of contraceptive implants. Learners in HealthyActions sites were 45% more likely to have received HTC (P<.001).



Providing intensive group learning in a supportive environment coupled with on-site health services improved SRH outcomes among participating learners. The focus of HealthyActions on participatory learning for low-literacy populations presents an adaptable solution for health programming across Liberia and the region.
Population Services International, Washington, DC, USA rfirestone@psi.org.
Rebecca
R
Firestone
Population Services International, Yangon, Myanmar.
Reid
R
Moorsmith
Education Development Center, Inc., Washington, DC, USA.
Simon
S
James
Population Services International, Monrovia, Liberia.
Marilyn
M
Urey
Population Services International, Washington, DC, USA.
Rena
R
Greifinger
Population Services International, Monrovia, Liberia.
Danielle
D
Lloyd
Education Development Center, Inc., Pasig City, Philippines.
Lisa
L
Hartenberger-Toby
Independent Consultant, Harvard T.H. Chan School of Public Health, Boston, MA.
Jewel
J
Gausman
Education Development Center, Inc., Advancing Youth Project, Monrovia, Liberia.
Musa
M
Sanoe
D000293:Adolescent; D000328:Adult; D003153:Community Health Services; D017280:Condoms; D003267:Contraception / Q000379:methods / Q000706:statistics & numerical data*; D003268:Contraception Behavior; D003271:Contraceptive Agents, Female; D005260:Female; D006126:Group Processes; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007988:Liberia; D008297:Male; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D011314:Preventive Health Services; D015397:Program Evaluation; D012111:Residence Characteristics; D021841:Safe Sex; D012736:Sex Education / Q000379:methods*; D000074384:Sexual Health / Q000193:education*; D055815:Young Adult
D003271:Contraceptive Agents, Female
Health Serv Res. 2011 Dec;46(6pt2):2057-78
21517835
J Adolesc Health. 2015 Jan;56(1 Suppl):S7-14
25528980
Bull World Health Organ. 2010 Jul 1;88(7):527-34
20616972
J Health Popul Nutr. 2011 Apr;29(2):113-22
21608420
Niger Postgrad Med J. 2014 Jun;21(2):122-7
25126865
Afr J Reprod Health. 2014 Sep;18(3):133-41
25438518
J Adolesc Health. 2015 Jan;56(1 Suppl):S1-6
25528975
J Adolesc Health. 2010 Mar;46(3 Suppl):S75-91
20172462
Lancet. 2012 Apr 28;379(9826):1641-52
22538179
BMJ. 2008 Aug 07;337:a506
18687720
J Interpers Violence. 2012 Nov;27(17):3514-31
22610827
J Adolesc Health. 2001 Dec;29(6):436-46
11728893
Int Peacekeep. 2010;17(3):343-60
20873024
J Adolesc Health. 2015 Jan;56(1 Suppl):S22-41
25528977
AIDS Care. 2015;27(6):697-702
25599113