Feasibility, acceptability, and preliminary effects of the GROW Hopes for Life-Schools intervention on character strengths, resilience, substance use, risky sexual behavior, and school attendance and performance among Zambian adolescents: results of a pilot cluster-randomized controlled trial

Abstract

Introduction Youth substance use preventive interventions are needed which are culturally adaptable, replicable, and designed for individuals with limited literacy. A previous trial of Global Resilience Oral Workshops (GROW), a 6-month spiritually-based character strengths/resilience training curriculum, was associated with increased hope and resilience and decreased alcohol use among Zambian youths ages 10–13. Herein, we describe feasibility, acceptability and preliminary signals of efficacy of GROW Hopes for Life-Schools (GROW-HFLS), a 12-month curriculum for older youths ages 13–17. Methods GROW-HFLS combines a character strengths/resilience component with a substance use prevention component delivered in 36 weekly 90-min after-school sessions by trained community members. Leaders use storytelling and positive psychology exercises to teach 25 character strengths and 12 practices for preventing/overcoming unhealthy substance use. Cultural adaptation was accomplished through iterative consultation with cultural informants, local branding, and integrating community members as interventionists. Feasibility/acceptability were assessed using attendance and retention rates. Efficacy measures were changes in character strengths/virtues (CSV), substance use, risky sexual behaviors, and school attendance/performance, assessed using a multi-site, cluster-randomized, wait-list minimal intervention control design. Eighth-grade students from eight urban and rural secondary schools were cluster-randomized to waitlist control (WLC, n = 226) or intervention (INT, n = 234) arms. CSVs, substance use, and sexual behaviors were assessed using computerized audio-assisted self-report questionnaires at baseline, 6-months and 12-months. School records on student attendance and performance were collected pre- and post-intervention. Results Median GROW-HFLS attendance was high (34/36 classes) with little decline over time. After 12 months, INT vs. WLC participants demonstrated significantly greater increases in school attendance and performance and in measures of hope, self-regulation, resilience, and perceived self-efficacy to refuse offers of alcohol. After 12-months, past 6-month alcohol use rates were low (3.7% INT, 5.6% WLC) with adjusted relative risk ratios [95% CI] for alcohol use, other substance use, and any sexual partners of 0.57(0.16–2.12), 0.45(0.12–1.69), and 0.43(0.13–1.43), respectively. Conclusion GROW-HFLS shows promise as a feasible, acceptable positive youth development program associated with improved school functioning and increases in multiple character strengths. Efficacy for substance use and risky sexual behaviors require further study. Training community members as group leaders offers a promising scalable prevention model.