5. Discussion
anxiety, anemia, micronutrient deficiency
EVENTS, ANEMIA
This study evaluates the impact of delivering PACE++ curriculum for adolescent girls in community settings of rural Bihar. Based on the quasi-experimental study design, the study focused on domains related to gender attitudes, empowerment and dietary practices. The five salient findings of the study are as follows. First, TARA intervention had a positive impact on domain scores of intervention group comprising of adolescent girls who participated in all or most of program meetings and events. Second, the DID and PSM analyses confirm that the impact are specifically significant for the domains of attitudes toward gender equity norms, nutritional knowledge and understanding of employee related rights and responsibilities. Third, the effect size–as discerned through Cohen’s d–is of policy interest as all the domain scores show small to medium size program impact on the intervention group. Fourth, the intervention group demonstrated a positive change in dietary diversity practices whereby consumption from five or more food groups increased significantly over the intervention period. Fourth, maternal education and household wealth status have an independent influence on domain scores. In particular, maternal education is found to have significant association with empowerment related scales of self-esteem and self-efficacy. Household wealth status has a positive bearing on expected score of dietary practices. Finally, the expected domain scores of school-going adolescent girls is higher than those who have discontinued formal education.The study, however, is not devoid of limitations. First, during endline about two-third of the intervention area sample reported greater exposure to the program and was treated as the intervention group. This exposure-based attrition of sample may bias significance of program impact across domain scores. The adopted sampling approach, however, was necessary to check for overall program participation and to ensure that the sample was drawn randomly from the community and was not necessarily restricted to the program participants to discern broader implications of the program. Nevertheless, the analysis focused only on regular participants to estimate the magnitude of the impact. Second, the construction of the domain scores relied on established scales for the domains related to gender equity (GEM scale) and empowerment (self-esteem and self-efficacy scale). The scale for diet and nutrition apply well-established dietary diversity indicators and knowledge of most widely prevalence micronutrient deficiency (anemia). Whereas in the absence of relevant scale for employment related indicators, the items reflecting employee rights and responsibilities was utilized that provide a balance between awareness of employee duties and being informed regarding basic rights to safeguard employees from exploitation. This also suggests a need for developing valid and reliable scale for adolescents to assess the effect of like-skills training on employability in developing country contexts [Life skills–particularly soft skills related to self-efficacy, communication and leadership—are inextricably linked to equity and empowerment whose relevance increases manifold for women and girls across the developing world [The TARA intervention aimed at leveraging the PACE curriculum and delivering it in a rural community setting that has wide policy relevance in the Indian context. Given the large scale of the informal sector, there might be limited work platforms to provide such training modules for adolescent girls. The SHG platforms that are supported by the government provide an important avenue to empower adolescent girls, develop their resilience and support their aims and aspirations [The program impact size of the intervention is of policy interest as it demonstrates possibility of improving adolescent well-being through outreach based on community platforms. The effect size as discerned by Cohen’s d is encouraging enough to be considered for wider scale up of such initiatives using existing platforms such as JEEViKA and other self-help group and adolescent forums. The effect size is also comparable to similar to other adolescent girl programmes delivered through school-based initiatives [The program impact of TARA intervention is driven by a sound theory of change rooted in the positive youth development framework [It is worth noting that the impact of the intervention on domain scores pertaining to self-esteem and self-efficacy is relatively small. This finding is partly associated with higher baseline scores on these indicators whereas greater improvements in self-esteem are noted especially when the initial scores are lower [Before concluding, it is also important to outline the lessons learnt from program intervention during the pandemic period. The direct engagement with TARA groups immediately alerted the wide sense of fear and anxiety among adolescents that manifested in psychosocial and mental health concerns. The impact could be disproportionately on adolescent girls from economically unprivileged background. The COVID-19 protocols also implied that all efforts were counselling and information sharing were to be through digital mediums and its efficacy can be a challenge for those lacking access to mobile devices and internet. This also curtailed the program effect as the results demonstrate greater benefits for those who were regular participants. Such impact, however, was unavoidable and similar concerns are widespread across other remote and rural settings of India that have weak IT infrastructure as well as poor means for digital communication [