Prevention Science

, Volume 19, Issue 8, pp 1030–1042 | Cite as

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

  • Khudejha Asghar
  • Yana Mayevskaya
  • Marni Sommer
  • Ayesha Razzaque
  • Betsy Laird
  • Yasmin Khan
  • Shamsa Qureshi
  • Kathryn Falb
  • Lindsay StarkEmail author


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.


Pakistan Internal displacement Adolescent girls Violence Restricted movement 



The authors acknowledge financial support of the UK Department for International Development (DFID grant #40080602). The funding body had no role in the following: design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Ali, M., & Ushijima, H. (2005). Perceptions of men on role of religious leaders in reproductive health issues in rural Pakistan. Journal of Biosocial Science, 37, 115–122.CrossRefGoogle Scholar
  2. Baker, N. V., Gregware, P. R., & Cassidy, M. A. (1999). Family killing fields: Honor rationales in the murder of women. Violence Against Women, 5, 164–184. Scholar
  3. Berenson, A. B., Wiemann, C. M., & McCombs, S. (2001). Exposure to violence and associated health-risk behaviors among adolescent girls. Archives of Pediatrics & Adolescent Medicine, 155, 1238–1242.CrossRefGoogle Scholar
  4. Buckner, J. C., Mezzacappa, E., & Beardslee, W. R. (2003). Characteristics of resilient youths living in poverty: The role of self-regulatory processes. Development and Psychopathology, 15, 139–162.CrossRefGoogle Scholar
  5. Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London: Sage Publications.Google Scholar
  6. Cooney, M. (2014). Death by family: Honor violence as punishment. Punishment & Society, 16, 406–427. Scholar
  7. Critelli, F. M. (2010). Beyond the veil in Pakistan. Affilia: Journal of Women and Social Work, 25, 236–249. Scholar
  8. Donnan, H. (1988). Marriage among Muslims: Preference and choice in northern Pakistan. New York: E.J. Brill.Google Scholar
  9. Dumont, M., & Provost, M. A. (1999). Resilience in adolescents: Protective role of social support, coping strategies, self-esteem, and social activities on experience of stress and depression. Journal of Youth and Adolescence, 28, 343–363. Scholar
  10. Eves, R. (2006). Exploring the role of men and masculinities in Papua New Guinea in the 21st century: How to address violence in ways that generate empowerment for both men and women. Retrieved from Canberra, Australia:
  11. Falb, K. L., Tanner, S., Ward, L., Erksine, D., Noble, E., Assazenew, A., ... Stark, L. (2016). Creating opportunities through mentorship, parental involvement, and safe spaces (COMPASS) program: Multi-country study protocol to protect girls from violence in humanitarian settings. BMC Public Health, 16, 231.
  12. Fatusi, A. O., & Hindin, M. J. (2010). Adolescents and youth in developing countries: Health and development issues in context. Journal of Adolescence, 33, 499–508. Scholar
  13. Fergus, S., & Zimmerman, M. A. (2005). Adolescent resilience: A framework for understanding healthy development in the face of risk. Annual Review of Public Health, 26, 399–419. Scholar
  14. Fikree, F. F., & Pasha, O. (2004). Role of gender in health disparity: The south Asian context. BMJ : British Medical Journal, 328, 823–826.CrossRefGoogle Scholar
  15. Gliem, J., & Gliem, R. C. (2003). Calculating, Interpreting, and Reporting Cronbach’s Alpha Reliability Coefficient for Likert-Type Scales. Paper presented at the Midwest research to practice conference in adult. Columbus, OH: Continuing and Community Education.Google Scholar
  16. Grant, M. J., & Behrman, J. R. (2010). Gender gaps in educational attainment in less developed countries. Population and Development Review, 36, 71–89.CrossRefGoogle Scholar
  17. Hellman, C. M., Munoz, R. T., Worley, J. A., Feeley, J. A., & Gillert, J. E. (2017). A reliability generalization on the Children’s hope scale. Child Indicators Research Scholar
  18. Hidalgo, S., LaGuardia, D., Trudi, G., Sole, R., Moussa, Z., van Dijk, J., ... Zimmer, L. (2015). Independent Programme Evaluation (IPE) of UNHCR’s Response to the refugee influx in Lebanon and Jordan. Retrieved from
  19. IDMC (n.d.). Pakistan IDP Figures Analysis. Retrieved from
  20. Jejeebhoy, S. J., & Sathar, Z. A. (2001). Women's autonomy in India and Pakistan: The influence of religion and region. Population and Development Review, 27, 687–712. Scholar
  21. Johnson, M. K., Crosnoe, R., & Elder Jr., G. H. (2011). Insights on adolescence from a life course perspective. Journal of Research on Adolescence, 21, 273–280. Scholar
  22. Khan, S. N., & Nawaz, Z. (2016). Analysis of Socio-Economic Problems of Temporarily Dislocated People in Jalozai Camp District Nowshehra, Pakistan. Pakistan Journal of Peace & Conflict Studies, 1, 31–43.Google Scholar
  23. Khosla, V., Mikami, A., Frank, L., Popal, I., Debeljak, K., & Shaw, A. (2013). Combating violence against women through C4D: The "use your voice" campaign and its implications on audience-citizens in Papua New Guinea. International Journal of Communication, 7.Google Scholar
  24. Lule, E., Rosen, J., Singh, S., Knowles, J. C., & Behrman, J. R. (2006). Adolescent Health Programs. In D. T. Jamison, J. G. Breman, M. A. R., & et al. (Eds.), Disease Control Priorities in Developing Countries (2nd ed.). Washington, D.C.: The International Bank for Reconstruction and Development / The World Bank, Oxford University Press.Google Scholar
  25. Marshall, D. J. (2015). ‘We have a place to play, but someone else controls it’: Girls’ mobility and access to space in a Palestinian refugee camp. Global Studies of Childhood, 5, 191–205. Scholar
  26. Masten, A. S. (2014). Global perspectives on resilience in children and youth. Child Development, 85, 6–20. Scholar
  27. Miller, E., Das, M., Tancredi, D. J., McCauley, H. L., Virata, D., C, M., Nettiksimmons, J., et al. (2014). Evaluation of a gender-based violence prevention program for student athletes in Mumbai, India. Journal of Interpersonal Violence, 29, 758–778.CrossRefGoogle Scholar
  28. Mujeeb, A. (2015). Mental health of internally displaced persons in Jalozai camp, Pakistan. International Journal of Social Psychiatry, 61, 653–659. Scholar
  29. Mumtaz, Z., & Salway, S. (2005). ‘I never go anywhere’: extricating the links between women's mobility and uptake of reproductive health services in Pakistan. Social Science & Medicine, 60, 1751–1765. Scholar
  30. Nasrullah, M., Zakar, R., & Zakar, M. Z. (2014). Child marriage and its associations with controlling behaviors and spousal violence against adolescent and young women in Pakistan. Journal of Adolescent Health, 55, 804–809. Scholar
  31. National Institute of Population Studies (NIPS) [Pakistan], & ICF International. (2013). Pakistan Demographic and Health Survey 2012-13. Retrieved from Islamabad, Pakistan, and Calverton, Maryland, USA:Google Scholar
  32. Olofsson, N., Lindqvist, K., Shaw, B. A., & Danielsson, I. (2012). Long-term health consequences of violence exposure in adolescence: A 26–year prospective study. BMC Public Health, 12, 411–411. Scholar
  33. Ortner, S. B. (1978). The virgin and the state. Feminist Studies, 4, 19–35. Scholar
  34. Patel, S., & Gadit, A. M. (2008). Karo-Kari: A form of honour killing in Pakistan. Transcultural Psychiatry, 45, 683–694. Scholar
  35. Qayum, M., Mohmand, S., & Arooj, H. (2012). Frequency and physical factors associated with gender-based violence in the internally displaced people of Pakistan. Journal of the College of Physicians and Surgeons Pakistan, 22, 63–65. Scholar
  36. Rabbani, F., Qureshi, F., & Rizvi, N. (2008). Perspectives on domestic violence: Case study from Karachi, Pakistan. Eastern Mediterranean Health Journal, 14, 415–426.PubMedGoogle Scholar
  37. Rosenberg, M. (1979). Conceiving the self. New York: Basic Books.Google Scholar
  38. Ruane, R. A. (2000). Murder in the name of honor: Violence against women in Jordan and Pakistan. Emory International Law Review, 14, 1523.Google Scholar
  39. Saeed, A., & Farooq, S. (2017). “I Can't go out”: Mobility obstacles to Women's access to HIV treatment in KPK, Pakistan. Journal of the Association of Nurses in AIDS Care, 28(4), 561–574. Scholar
  40. Saeed, A., & Hanif, R. (2014). Effect of parental conditional regard on parent-adolescents relationship quality: Emotional state as moderator. Pakistan Journal of Psychological Research, 29, 315–331.Google Scholar
  41. Sarhad Rural Support Programme. (2016). Profiling of IDPs living in spontaneous settlements in Bannu. Retrieved from
  42. Schmitt, D. P., & Allik, J. (2005). Simultaneous administration of the Rosenberg self-esteem scale in 53 nations: Exploring the universal and culture-specific features of global self-esteem. Journal of Personality and Social Psychology, 89(4), 623–642. Scholar
  43. Snyder, C. R., Hoza, B., Pelham, W. E., Rapoff, M., Ware, L., Danovsky, M., et al. (1997). The development and validation of the Children's hope scale. Journal of Pediatric Psychology, 22, 399–421.CrossRefGoogle Scholar
  44. Stark, L., Sommer, M., Davis, K., Asghar, K., Assazenew Baysa, A., Abdela, G., . . . Falb, K. (2017). Disclosure bias for group versus individual reporting of violence amongst conflict-affected adolescent girls in DRC and Ethiopia. PLoS One, 12, e0174741. Scholar
  45. Stark, L., Asghar, K., Seff, I., Cislaghi, B., Yu, G., Gessesse, T., . . . Falb, K. (2018). How gender- and violence-related norms affect self-esteem among adolescent refugee girls living in Ethiopia. Global Mental Health, 5(e2).
  46. Ullah, A., Khan, K., & Mahmood, H. (2017). Understanding the nexus between conflict, displacement, and schooling: A case study of IDPs in Pakistan. Asian Journal of Peacebuilding, 5, 155–168.Google Scholar
  47. UNHCR. (2016). Global trends: Forced displacement in 2015. Retrieved from Geneva, Switzerland:
  48. UNICEF. (2011). The state of the World’s children 2011. Retrieved from New York:Google Scholar
  49. UNICEF. (2014a). A statistical snapshot of violence against adolescent girls. Retrieved from New York:
  50. UNICEF. (2014b). A study on early marriage in Jordan 2014. Retrieved from Amman, Jordan:
  51. Wilcoxon, F. (1945). Individual comparisons by ranking methods. Biometrics Bulletin, 1, 80–83. Scholar
  52. World Bank. (2005). Bridging the Gender Gap: Opportunities and Challenges (32244-PAK). Retrieved from
  53. Zimmerman, M. A., Bingenheimer, J. B., & Notaro, P. C. (2002). Natural mentors and adolescent resiliency: A study with urban youth. American Journal of Community Psychology, 30, 221–243. Scholar

Copyright information

© Society for Prevention Research 2018

Authors and Affiliations

  • Khudejha Asghar
    • 1
  • Yana Mayevskaya
    • 1
  • Marni Sommer
    • 1
  • Ayesha Razzaque
    • 2
  • Betsy Laird
    • 3
  • Yasmin Khan
    • 4
  • Shamsa Qureshi
    • 4
  • Kathryn Falb
    • 3
  • Lindsay Stark
    • 1
    Email author
  1. 1.Department of Population and Family HealthColumbia University Mailman School of Public HealthNew YorkUSA
  2. 2.IslamabadPakistan
  3. 3.International Rescue CommitteeNew YorkUSA
  4. 4.International Rescue CommitteeIslamabadPakistan

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