Adolescent Mental Health and Intimate Partner Violence: Development and Pilot of the PREvention Program for Adolescent Relationship and Emotional Development (PREPARED)

Abstract

Intimate partner violence (IPV) is a pervasive global public health crisis and often emerges during adolescence. Mental health problems act as both a driver and consequence of IPV, through bi-directional associations. Both challenges are exacerbated in low resource settings, like rural Kenya, that face complex social, economic, and health challenges. To address these intersecting challenges, we developed and piloted a novel mental health promotion and IPV prevention intervention, the PREvention Program for Adolescent Relationship and Emotional Development (PREPARED). The entire project is guided by community based participatory research (CBPR) and was completed in partnership with a community advisory board (CAB). Study 1 is a formative study that qualitatively explores the drivers of and links between adolescent mental health and the emergence of IPV in rural southwestern Kenya. Study 2, a mixed-methods proof-of-concept study, evaluated intervention implementation and measured intervention-related changes. Study 1 resulted in a theoretical conceptualization of the intersection between mental health problems and IPV. Results highlighted mental health problems among adolescents and the early emergence of violence in dating relationships. Financial stress and familial conflict or neglect are frequent drivers of psychosocial distress among adolescents. In dating relationships, IPV was identified as a common occurrence that resulted from disagreements, financial expectations of a partner, perceived or actual infidelity, and boyfriends attempting to “correct” girlfriends’ behavior. Often, relationships occurred in secrecy, leaving survivors of violence with few options for support. Qualitative themes also informed points of intersection between mental health problems and IPV, such as substance use and sexual risk behaviors, as well as pathways linking mental health problems and IPV. These formative findings served as the foundation for the development of PREPARED, a 6-session, non-specialist peer provided intervention. In Study 2, PREPARED was piloted with 46 adolescents between the ages of 14-17 (M=15.47, SD=1.1). Two implementation settings were tested to reach youth who were enrolled in secondary school (N=22) and youth who were not enrolled in secondary school (N=24). Young adult non-specialist providers (N=10) were selected and trained to deliver the intervention. Implementation outcomes were assessed at the participant and facilitator levels through surveys, detailed tracking, and qualitative focus group discussions (FGDs). Participants also completed pre-post surveys and endline FGDs to assess changes in mental health and relationship attitudes and behaviors. Results support the feasibility and acceptability of a novel non-specialist peer provided mental health and IPV combined prevention intervention in a low health resource setting. The study also provides preliminary positive pre-post signals of change in mental health outcomes and some relationship-related processes among adolescents.