GROW Zambia: A pilot cluster-randomized trial of a spiritually-based character strengths training curriculum to enhance resilience among Zambian youth

Abstract

Few studies have examined the impact of resilience training on youth in lower/middle income countries (LMICs). This study assessed feasibility, acceptability, and efficacy of GROW, a 24-week character-based resilience curriculum rooted in positive psychology and spirituality and taught via storytelling. Our pilot design -a mixed method, cluster-randomized controlled trial -was conducted with 28 classes of 643 Zambian youth ages 10-13 (M = 11.39, SD = 0.95, 55.4% female). Classes were divided into initial-start and delayed-start intervention phases. In 17 focus groups, parents, teachers, GROW leaders, and children affirmed the program's excellent cultural fit. Adult stakeholders observed positive impacts on school attendance, academic performance, and students' character and behavior. Initial-start students showed a pre-post increase in psychological resilience (p < .05). Together, these findings suggest GROW has promise for improving early adolescents' positive development. This strengthens the evidence base for the potential impact of culturally appropriate, spiritually-oriented programs delivered by lay providers for LMIC youth.

Character Strengths as Moderators of the Relationship Between Adverse Childhood Experiences and Negative Health Outcomes

“…Alternatively, perhaps character strengths tap into a different form of resilience than would be necessary to alter the effects of ACEs on health. Seale and colleagues ( 2022 ) conducted a pilot study examining a spirituality-based character strengths curriculum to enhance resilience in Zambian youth in lower/middle income countries. The authors found positive influences on school attendance, academic performance, and character and behavior of the students.…”

A scoping review of the implementation and cultural adaptation of school-based mental health promotion and prevention interventions in low-and middle-income countries

“…Fifteen interventions were developed in the implementing country. Seven were adapted versions of evidence-based programmes from HICs (Trip et al, 2015;Dang et al, 2017;Arënliu et al, 2020;Nguyen et al, 2020;McCoy et al, 2021;Seale et al, 2021), two were adaptations of programmes from other LMICs (Jegannathan et al, 2014;Karmaliani et al, 2020) and one was adapted from an evidence-based programme previously implemented in humanitarian settings (Berger et al, 2018). Positive outcomes were found for 10 of the 13 universal mental health promotion programmes reviewed and for all five of the interventions that incorporated both promotion and prevention elements (see Tables 1 and 2), with most studies receiving a moderate or strong quality rating.…”

“…The adaptation process involved an initial assessment of the original programme with all stakeholders, subsequent adaptations including to language and content, piloting to check for cultural appropriacy and final adjustments following consultation with the implementation team. Youth involvement in the process was reported as facilitating natural cultural adaptation by Leventhal et al (2015), while involving the programme developers helped to ensure that the core components of the programme were retained (Dang et al, Eight studies reported the translation of programme language, while Seale et al (2021) highlighted that the delivery of GROW through English excluded some younger students and considered its future delivery in local Zambian dialects. Some studies referenced adding culturally relevant content to programmes to increase participant responsiveness.…”

“…Fifteen interventions were developed in the implementing country. Seven were adapted versions of evidence-based programmes from HICs (Trip et al, 2015 ; Dang et al, 2017 ; Kutcher et al, 2017 ; Arënliu et al, 2020 ; Nguyen et al, 2020 ; McCoy et al, 2021 ; Seale et al, 2021 ), two were adaptations of programmes from other LMICs (Jegannathan et al, 2014 ; Karmaliani et al, 2020 ) and one was adapted from an evidence-based programme previously implemented in humanitarian settings (Berger et al, 2018 ).…”

“…Eleven studies referenced the cultural adaptation of programmes, with only four studies reporting details (Berger et al, 2018 ; Nguyen et al, 2020 ; McCoy et al, 2021 ; Seale et al, 2021 ). The adaptation process involved an initial assessment of the original programme with all stakeholders, subsequent adaptations including to language and content, piloting to check for cultural appropriacy and final adjustments following consultation with the implementation team.…”