Peer-facilitated community-based interventions for adolescent health in low- and middle-income countries: A systematic review

Abstract

BackgroundAdolescents aged 10–19 represent one sixth of the world’s population and have a high burden of morbidity, particularly in low-resource settings. We know little about the potential of community-based peer facilitators to improve adolescent health in such contexts.MethodsWe did a systematic review of peer-facilitated community-based interventions for adolescent health in low- and middle-income countries (LMICs). We searched databases for randomised controlled trials of interventions featuring peer education, counselling, activism, and/or outreach facilitated by young people aged 10–24. We included trials with outcomes across key areas of adolescent health: infectious and vaccine preventable diseases, undernutrition, HIV/AIDS, sexual and reproductive health, unintentional injuries, violence, physical disorders, mental disorders and substance use. We summarised evidence from these trials narratively. PROSPERO registration: CRD42016039190.ResultsWe found 20 studies (61,014 adolescents). Fourteen studies tested interventions linked to schools or colleges, and 12 had non-peer-facilitated components, e.g. health worker training. Four studies had HIV-related outcomes, but none reported reductions in HIV prevalence or incidence. Nine studies had clinical sexual and reproductive health outcomes, but only one reported a positive effect: a reduction in Herpes Simplex Virus-2 incidence. Three studies had violence-related outcomes, two of which reported reductions in physical violence by school staff and perpetration of physical violence by adolescents. Seven studies had mental health outcomes, four of which reported reductions in depressive symptoms. Finally, we found eight studies on substance use, four of which reported reductions in alcohol consumption and smoking or tobacco use. There were no studies on infectious and vaccine preventable diseases, undernutrition, or injuries.ConclusionsThere are few trials on the effects of peer-facilitated community-based interventions for adolescent health in LMICs. Existing trials have mixed results, with the most promising evidence supporting work with peer facilitators to improve adolescent mental health and reduce substance use and violence.

Peer education for HIV prevention among high-risk groups: a systematic review and meta-analysis

“…We then performed a quality assessment of each study included using an 8-point scale which was first used in a meta-analysis in 200 9 [8] and has subsequently been cited by other researchers [24][25][26][27]. One point was awarded for each of the following items: (1) prospective cohort; (2) control or comparison group; (3) pre/post intervention data; (4) random assignment of participants to the intervention; (5) follow-up rate of 80% or more; (6) comparison groups equivalent in terms of social-demographic measures; (7) comparison groups equivalent at baseline in terms of outcome measures; and (8) sample size≥100.…”

<p>Does Youth-Friendly Service Intervention Reduce Risky Sexual Behavior in Unmarried Adolescents? A Comparative Study in West Gojjam Zone, Northwest Ethiopia</p>

“…29 In the current study, the peer-education strategy may have provided inadequate SRH information (intensity and duration), resulting in limited or temporary effects in promoting SRH behavior and improving adolescents' sexual health. 61 In line with this, researchers have reported that a peer-education intervention was ineffective in facilitating young people's behavioral change or influencing social norms concerning adolescent SRH. 62 In this study, a significant difference was observed between program and nonprogram areas for attitudes of adolescents toward SRH issues.…”

Community youth teams facilitating participatory adolescent groups, youth leadership activities and livelihood promotion to improve school attendance, dietary diversity and mental health among adolescent girls in rural eastern India: protocol for a cluster-randomised controlled trial

“…Our global systematic review found that peerfacilitated interventions could be beneficial across a range of areas of health, with the strongest evidence for mental health [20]. Our review of Indian national and local adolescent health programmes found that many existed but had been designed and implemented by multiple governmental and non-governmental agencies, resulting in a lack of coordination and overlap.…”

“…We will use the Food and Nutrition Technical Assistance tool to measure mean dietary diversity score (based on 24-h recall) [19]. For mental health problems, we will compare the mean score on the Brief Problem Monitor-Youth (BPM-Y) across trial arms [20]. The BPM-Y includes items on internalising (depression and anxiety), externalising (conduct disorder and oppositional defiant disorder) and attention problems.…”