Study design and sampling
’s primary caregiver
SECONDARY, RECRUITMENT, STAGGERED
The study uses data collected from 1,260 adolescent girls in a three-arm randomized controlled trial funded by the National Institute of Mental Health. To be included in the study, participants had to be: 1) female; 2) age 14–17 years; 3) enrolled in the first year of secondary school in one of the five districts in Southern Uganda (i.e., Rakai, Kyotera, Masaka, Lwengo, Kalungu); and 4) living in a family (not in institutions, orphanages, or streets). Participants were identified using recruitment procedures validated in prior studies conducted in the area [Participants randomized to the usual care condition received standard adolescent sexual and reproductive health sexual education provided to all secondary school students in Uganda. The curriculum covers topics related to risk taking behaviors, such as substance use, sexual risk behaviors and delaying sex, safer sex practices and contraception, sexual risk possibility situations and ways of avoiding them, gender equality and delaying marriage.Participants in treatment arm 1 (hereafter YDA) were enrolled in a savings program at formal financial institution (bank) with savings being matched on a 1:1 rate. The bank account was opened in the name of adolescent, and, in compliance with Uganda law, adolescent’s primary caregiver had to be a co-signed until adolescent reaches 18 years of age. The matching funds were intended to cover costs of adolescent’s education and skill training. Participant’s access to the matching funds were conditional upon completion of 12 financial management workshops over 12 months offered by the community agency (Reach the Youth-Uganda) in collaboration with banks holding the YDAs and covering basic principles of financial management.Participants in treatment arm 2 (hereafter YDA + MFG) received an MFG family-strengthening intervention in addition to being enrolled in YDAs described above. The MFG intervention was offered as a 16-week (one session per week) family dialogue and family strengthening curriculum delivered by a trained community health worker and a trained peer parent under the supervision of a project staff. Each session lasted for 45–60 minutes and involved a group of 12–20 families. The intervention targets family processes referred to as the 4 Rs (Rules, Responsibility, Relationships, and Respectful Communication) and 2Ss (Stress and Social Support). Sessions covered topics related to behavioral health knowledge, identifying and building family support system, strengthening family communication, and mobilizing family resources in response to environmental stressors. The intervention was adapted to the context of Uganda [Randomization was conducted to school level (n = 42 schools) to avoid cross-contamination. First, stratified random sampling was used to assign schools to four strata based on student population size (medium vs. large) and geographical location (urban vs. rural). Second, the restricted randomization technique was used within the four strata to randomly assign each of the 42 schools to one of the three study arms. The attrition rate at 12 months was 3.3%, with 41 participants dropping out of the study. Additionally, at 24 months, 54 participants dropped out of the study, resulting in a total attrition rate of 7.5% (see The interventions were administered over a 24-month period, with data collected at baseline (preintervention), during intervention (12-months) and 24-months follow-up (after the intervention). Given the number of schools receiving the treatment (n = 31), the process of intervention delivery was staggered. Specifically, the intervention was delivered in a set of schools at a time. Once this was complete, the team moved on to the next set of schools. For schools randomized to treatment arm 2, the YDA intervention component was administered continuously for 24 months. As such, follow-up data were collected at 12 and 24-months postintervention initiation to allow schools equal amount of time for treatment and follow-up. A 90-minute structured survey was administered by Ugandan interviewers who were trained on Good Clinical Practice and obtained the Collaborative Institutional Training Initiative Certificate before interacting with study participants. Voluntary written informed assent and consent were obtained from adolescent participants as well as their caregivers, respectively. The study protocol was approved by the Washington University in St. Louis Review Board (#201703102) and by in-country local IRBs in Uganda: Uganda Virus Research Institute (UVRI–GC/127/17/07/619), and Uganda National Council of Science and Technology (UNCST–SS4406). The study protocol is registered at 