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

Asghar, Khudejha; Mayevskaya, Yana; Sommer, Marni; Razzaque, Ayesha; Laird, Betsy; Khan, Yasmin; Qureshi, Shamsa; Falb, Kathryn; Stark, Lindsay

doi:10.1007/s11121-018-0890-9

Published: 10 April 2018

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

Khudejha Asghar¹,
Yana Mayevskaya¹,
Marni Sommer¹,
Ayesha Razzaque²,
Betsy Laird³,
Yasmin Khan⁴,
Shamsa Qureshi⁴,
Kathryn Falb³ &
Lindsay Stark¹

Prevention Science volume 19, pages 1030–1042 (2018)Cite this article

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Abstract

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.

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References

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.
Article Google Scholar
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. https://doi.org/10.1177/107780129952005.
Article Google Scholar
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.
CAS Article Google Scholar
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.
Article Google Scholar
Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London: Sage Publications.
Google Scholar
Cooney, M. (2014). Death by family: Honor violence as punishment. Punishment & Society, 16, 406–427. https://doi.org/10.1177/1462474514539537.
Article Google Scholar
Critelli, F. M. (2010). Beyond the veil in Pakistan. Affilia: Journal of Women and Social Work, 25, 236–249. https://doi.org/10.1177/0886109910375204.
Article Google Scholar
Donnan, H. (1988). Marriage among Muslims: Preference and choice in northern Pakistan. New York: E.J. Brill.
Google Scholar
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. https://doi.org/10.1023/a:1021637011732.
Article Google Scholar
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: http://menengage.org/wp-content/uploads/2014/06/Eves_Masculinity_and_Violence_in_PNG_2006.pdf
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. https://doi.org/10.1186/s12889-016-2894-3.
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. https://doi.org/10.1016/j.adolescence.2010.05.019.
Article PubMed Google Scholar
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. https://doi.org/10.1146/annurev.publhealth.26.021304.144357.
Article Google Scholar
Fikree, F. F., & Pasha, O. (2004). Role of gender in health disparity: The south Asian context. BMJ : British Medical Journal, 328, 823–826.
Article Google Scholar
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
Grant, M. J., & Behrman, J. R. (2010). Gender gaps in educational attainment in less developed countries. Population and Development Review, 36, 71–89.
Article Google Scholar
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 https://doi.org/10.1007/s12187-017-9467-6.
Article Google Scholar
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 http://www.unhcr.org/5551f5c59.html
IDMC (n.d.). Pakistan IDP Figures Analysis. Retrieved from http://www.internal-displacement.org/south-and-south-east-asia/pakistan/figures-analysis
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. https://doi.org/10.1111/j.1728-4457.2001.00687.x.
Article Google Scholar
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. https://doi.org/10.1111/j.1532-7795.2010.00728.x.
Article PubMed PubMed Central Google Scholar
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
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.
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.
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. https://doi.org/10.1177/2043610615586105.
Article Google Scholar
Masten, A. S. (2014). Global perspectives on resilience in children and youth. Child Development, 85, 6–20. https://doi.org/10.1111/cdev.12205.
Article PubMed Google Scholar
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.
Article Google Scholar
Mujeeb, A. (2015). Mental health of internally displaced persons in Jalozai camp, Pakistan. International Journal of Social Psychiatry, 61, 653–659. https://doi.org/10.1177/0020764015573083.
Article PubMed Google Scholar
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. https://doi.org/10.1016/j.socscimed.2004.08.019.
Article Google Scholar
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. https://doi.org/10.1016/j.jadohealth.2014.06.013.
Article PubMed Google Scholar
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:
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. https://doi.org/10.1186/1471-2458-12-411.
Article PubMed PubMed Central Google Scholar
Ortner, S. B. (1978). The virgin and the state. Feminist Studies, 4, 19–35. https://doi.org/10.2307/3177536.
Article Google Scholar
Patel, S., & Gadit, A. M. (2008). Karo-Kari: A form of honour killing in Pakistan. Transcultural Psychiatry, 45, 683–694. https://doi.org/10.1177/1363461508100790.
Article PubMed Google Scholar
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. https://doi.org/10.2012/jcpsp.6365.
Article PubMed Google Scholar
Rabbani, F., Qureshi, F., & Rizvi, N. (2008). Perspectives on domestic violence: Case study from Karachi, Pakistan. Eastern Mediterranean Health Journal, 14, 415–426.
CAS PubMed Google Scholar
Rosenberg, M. (1979). Conceiving the self. New York: Basic Books.
Google Scholar
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
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. https://doi.org/10.1016/j.jana.2017.03.010.
Article PubMed Google Scholar
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
Sarhad Rural Support Programme. (2016). Profiling of IDPs living in spontaneous settlements in Bannu. Retrieved from https://www.humanitarianresponse.info/system/files/documents/files/profiling_report_of_spontaneous_settlements_in_bannu_-_ocha_21july.pdf
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. https://doi.org/10.1037/0022-3514.89.4.623.
Article PubMed Google Scholar
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.
CAS Article Google Scholar
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. https://doi.org/10.1371/journal.pone.0174741.
Article Google Scholar
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). https://doi.org/10.1017/gmh.2017.28.
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
UNHCR. (2016). Global trends: Forced displacement in 2015. Retrieved from Geneva, Switzerland: http://reliefweb.int/sites/reliefweb.int/files/resources/576408cd7.pdf
UNICEF. (2011). The state of the World’s children 2011. Retrieved from New York:
UNICEF. (2014a). A statistical snapshot of violence against adolescent girls. Retrieved from New York: https://www.unicef.org/publications/index_76212.html#.
UNICEF. (2014b). A study on early marriage in Jordan 2014. Retrieved from Amman, Jordan: www.unicef.org/mena/UNICEFJordan_EarlyMarriageStudy2014%281%29.pdf
Wilcoxon, F. (1945). Individual comparisons by ranking methods. Biometrics Bulletin, 1, 80–83. https://doi.org/10.2307/3001968.
Article Google Scholar
World Bank. (2005). Bridging the Gender Gap: Opportunities and Challenges (32244-PAK). Retrieved from https://openknowledge.worldbank.org/handle/10986/8453
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. https://doi.org/10.1023/a:1014632911622.
Article PubMed Google Scholar

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Funding

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.

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Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave B-4 Suite 432, New York, NY, 10032, USA
Khudejha Asghar, Yana Mayevskaya, Marni Sommer & Lindsay Stark
Islamabad, Pakistan
Ayesha Razzaque
International Rescue Committee, 122 E 42nd St, New York, NY, 10168, USA
Betsy Laird & Kathryn Falb
International Rescue Committee, Islamabad, Pakistan
Yasmin Khan & Shamsa Qureshi

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Khudejha Asghar
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Yana Mayevskaya
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Marni Sommer
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Ayesha Razzaque
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Betsy Laird
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Yasmin Khan
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Shamsa Qureshi
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Kathryn Falb
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Lindsay Stark
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Asghar, K., Mayevskaya, Y., Sommer, M. et al. Promoting Adolescent Girls’ Well-Being in Pakistan: a Mixed-Methods Study of Change Over Time, Feasibility, and Acceptability, of the COMPASS Program. Prev Sci 19, 1030–1042 (2018). https://doi.org/10.1007/s11121-018-0890-9

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Published: 10 April 2018
Issue Date: November 2018
DOI: https://doi.org/10.1007/s11121-018-0890-9

Keywords

Pakistan
Internal displacement
Adolescent girls
Violence
Restricted movement