Discussion
Ayushmann Bharat [
SAID
The current study assessed the effectiveness of SRH education among vernacular school-going adolescent girls. At baseline assessment, adolescent school-going girls lacked adequate knowledge pertaining to SRH. However, post-intervention, there was a significant increase in KAP in the intervention arm when compared to the control arm. There are studies conducted across various countries to assess the effectiveness of SRH education among adolescent girls, with outcomes having an increase in knowledge pertaining to SRH [In our study, the intervention was provided by a community physician, with the intervention delivered using PowerPoint presentations and handbooks. The KAP increased in all domains, such as puberty, menstrual health, pregnancy, contraception, RTIs/STIs and HIV/AIDS following the intervention. In our study at baseline, about 50–60% of adolescent girls were aware of pubertal changes, and forty per cent of students said they were not comfortable when puberty-related topics were discussed. After the intervention, awareness on puberty increased to 94.8%. Our finding was similar to an interventional study conducted in Kerala among school-going adolescent girls, where pubertal awareness increased from 32 to 83.9%, where intervention was delivered through interactive and quiz sessions [In our study at baseline, only 20–30% of adolescent girls were aware of pregnancy and contraception. However, after the intervention, knowledge on pregnancy, different contraception and emergency contraception methods increased to 90%. In an interventional study conducted in Gujarat, knowledge pertaining to contraception increased from 10 to 32% among adolescent boys and girls [The current study design was ideal for knowing the real effectiveness of an intervention package. Even though the study was conducted during the ongoing COVID-19 pandemic, the study achieved an adequate sample size. Other randomized studies had lesser sample sizes. The intervention package was comprehensive and included all the topics pertaining to SRH; hence intervention was effective in improving KAP among all domains in the intervention arm. Efforts were made by the authors of the study to include all the participants at the follow-up who were present at baseline through phone calls to students and informing parents and teachers regarding the importance of the study, which resulted in less attrition even though the study was conducted during COVID-19 pandemic. Our study demonstrated that schools act as an excellent platform for imparting SRH education.A few limitations of our study include, the study was conducted only among adolescent girls studying in vernacular (Odia) medium schools. From various study findings, it was observed that adolescent boys had more knowledge of SRH when compared to girls; the former could not be assessed in our study. Our follow-up period was 3 months; hence there is a need for long-term follow-up in further studies. The effectiveness of intervention can be compared between urban and rural areas and in all types of schools, such as private and English medium schools. Our study did not assess the contraceptive practices among adolescent girls; where only the knowledge component was assessed. The gap between the awareness and utilization of contraceptive methods needs to be assessed. Also, the study did not assess sexual activity following intervention which recommends further studies to assess contraceptive usage, sexual activity, and incidence of teenage pregnancies. There are no randomized trials conducted which assessed these domains in an Indian setting owing to cultural taboos. Hence, there is a need for further evidence to strengthen the interventions pertaining to adolescent SRH.Scale-up assessment: considering the seven key categories for scaling up in the sense of global health, an assessment of the current strategy was done [The intervention was delivered through schools, which are already established educational institutions. Training teachers and frontline workers to deliver SRH education could potentially be integrated into existing educational programs. Thus, the model can be implemented with existing educational institutional mechanisms, infrastructure, and human resources, including field functionaries of the health department, NGOs and other private stakeholders engaged in implementing health programs at the micro level, indicating a great fit between intervention and any adopting organization. The intervention provided is a collaborative approach with permission obtained from school mass education. National health programs, namely Ayushmann Bharat [