Opening the black box:A mixed-methods investigation of social and psychological mechanisms underlying changes in financial behaviour

We use a mixed-methods approach to open the ‘black box’ of a combined financial literacy and parenting intervention (‘Parenting for Lifelong Health’) to elucidate the key mechanisms through which changes in financial behaviour are realised. Drawing on qualitative data from 16 focus groups and 42 in-depth interviews, we find evidence for three pathways of change. Higher financial skills and, linked to this, higher financial confidence, a more optimistic future outlook and emotional support provided by peers and family members are described as key facilitators of improved financial behaviour. These mechanisms are cross validated in subsequent quantitative analyses based on standardised interviews from a randomised controlled trial with 552 households. A mediation analysis indicates that the programme’s effect on financial behaviour is significantly mediated by financial skills and self-efficacy (24% of total effect) and optimism (22% of total effect). We further show that the psychological factors are significantly reinforced by increased levels of social support in the family and wider community. Mediating variables remain robust in sensitivity analyses and are confirmed as significant paths when entered simultaneously into a structural equation path model. Our findings highlight possible target points for financial literacy interventions and motivate the inclusion of psychosocial programme components

Do saving promotion interventions help alleviate poverty in Sub-Saharan Africa? A systematic review and meta-analysis

Saving promotion interventions have gained momentum in international development over the recent years. Our analysis investigates whether saving promotion can effectively reduce poverty and economic hardship in Sub-Saharan Africa. In an extensive database search, 9330 records were screened and 27 randomised controlled trials on saving promotion interventions fulfilled the inclusion criteria. Robust-variance estimations of pooled effect sizes show small but significant impacts on poverty reduction, including increases in household expenditures and incomes, higher returns from family businesses, and improved food security. They also show positive impacts on more intermediate outcomes including total savings, pro-saving attitudes, financial literacy, and investments in small-scale family businesses. Our results do not show significant effects on assets, housing quality, education, or health. Findings from this analysis suggest that saving promotion schemes are highly relevant in reducing poverty in Sub-Saharan Africa, and that formal banking services in particular require adaptation to the needs of the poor

COVID-19 vaccine hesitancy in eight European countries: prevalence, determinants and heterogeneity

We examine heterogeneity in COVID-19 vaccine hesitancy across eight European countries. We reveal striking differences across countries, ranging from 6.4% of adults in Spain to 61.8% in Bulgaria reporting being hesitant. We experimentally assess the effectiveness of different messages designed to reduce COVID-19 vaccine hesitancy. Receiving messages emphasizing either the medical benefits or the hedonistic benefits of vaccination significantly increases COVID-19 vaccination willingness in Germany, whereas highlighting privileges contingent on holding a vaccination certificate increases vaccination willingness in both Germany and the United Kingdom. No message has significant positive effects in any other country. Machine learning-based heterogeneity analyses reveal that treatment effects are smaller or even negative in settings marked by high conspiracy beliefs and low health literacy. In contrast, trust in government increases treatment effects in some groups. The heterogeneity in vaccine hesitancy and responses to different messages suggests that health authorities should avoid one-size-fits-all vaccination campaigns

Measuring and monitoring national prevalence of child maltreatment: A practical handbook

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Assessing the perceived effect of non-pharmaceutical interventions on SARS-Cov-2 transmission risk: an experimental study in Europe

We conduct a large (N = 6567) online experiment to measure the features of non-pharmaceutical interventions (NPIs) that citizens of six European countries perceive to lower the risk of transmission of SARS-Cov-2 the most. We collected data in Bulgaria (n = 1069), France (n = 1108), Poland (n = 1104), Italy (n = 1087), Spain (n = 1102) and Sweden (n = 1097). Based on the features of the most widely adopted public health guidelines to reduce SARS-Cov-2 transmission (mask wearing vs not, outdoor vs indoor contact, short vs 90 min meetings, few vs many people present, and physical distancing of 1 or 2 m), we conducted a discrete choice experiment (DCE) to estimate the public’s perceived risk of SARS-CoV-2 transmission in scenarios that presented mutually exclusive constellations of these features. Our findings indicate that participants’ perception of transmission risk was most influenced by the NPI attributes of mask-wearing and outdoor meetings and the least by NPI attributes that focus on physical distancing, meeting duration, and meeting size. Differentiating by country, gender, age, cognitive style (reflective or intuitive), and perceived freight of COVID-19 moreover allowed us to identify important differences between subgroups. Our findings highlight the importance of improving health policy communication and citizens’ health literacy about the design of NPIs and the transmission risk of SARS-Cov-2 and potentially future viruses

Factors associated with adolescent pregnancy in Maharashtra, India: a mixed-methods study

Reducing the adolescent birth rate is paramount in achieving the health-related Sustainable Development Goals, given that pregnancy and childbirth are the leading cause of mortality among young women aged 15-19. This study aimed to explore predictors of adolescent pregnancy among girls aged 13-18 years in Maharashtra, India, during the COVID-19 pandemic. Using a mixed-methods approach, primary data were gathered from two regions in Maharashtra between February and April 2022. Quantitative data from face-to-face interviews with 3049 adolescent girls assessed various household, social, and behavioural factors, as well as the socioeconomic and health impacts of COVID-19. Qualitative data from seven in-depth interviews were analysed thematically. The findings reveal that girls from low socioeconomic backgrounds face a higher likelihood of adolescent pregnancy. Multivariable analysis identified several factors associated with increased risk, including older age, being married, having more sexual partners, and experiencing COVID-19-related economic vulnerability. On the other hand, rural residence, secondary and higher secondary education of the participants, and higher maternal education were associated with a decreased likelihood of adolescent pregnancy. In the sub-sample of 565 partnered girls, partner's emotional abuse also correlated with higher rates of adolescent pregnancy. Thematic analysis of qualitative data identified four potential pathways leading to adolescent pregnancy: economic hardships and early marriage; personal safety, social norms, and early marriage; social expectations; and lack of knowledge on contraceptives. The findings underscore the significance of social position and behavioural factors and the impact of external shocks like the COVID-19 pandemic in predicting adolescent pregnancy in Maharashtra, India

Economic wellbeing and associated mediating pathways to improved antiretroviral therapy adherence among adolescents living with HIV: A prospective cohort study in South Africa

Background: Adolescents living with HIV exhibit lower levels of adherence to antiretroviral treatment (ART) than other age groups. Poverty is a key barrier to ART adherence. This study aims at understanding how alleviating poverty through structural and internal pathways can help increase ART adherence among adolescents. Setting: Eastern Cape province, South Africa. Methods: 1,046 adolescents living with HIV were recruited from 53 public healthcare facilities and interviewed at three data collection waves with a retention rate of 89% and a mortality rate of 3%.Data was collected via face-to-face, device-assisted interviews. Hybrid probit regressions and a structural equation path analysis were used to estimate the association between poverty reduction (increased access to basic necessities) and the pathways by which it could improve ART adherence. Results: Self-reported ART adherence ranged from an average of 66% (n=615) at baseline to 75% (n=700) in the last wave. Within- and between-person improvements in economic wellbeing were associated with significant increases in adolescent ART adherence. On average, adolescents with access to three additional basic needs experienced a four percentage-point increase in the probability of ART adherence. Structural pathways to improved ART adherence included participants having enough money to travel to the clinic andsufficient food to eat when taking medication. Internal pathways included improved psychological wellbeing and reduced internalised HIV stigma. Conclusion: Poverty reduction programmes such as HIV-sensitive social protection can address structural and psychological pathways to increase ART adherence among economically disadvantaged adolescents by incentivising demand-side interventions and the provision of quality essential services

Is the Brief Child Abuse Potential Inventory (BCAPI) a valid measure of child abuse potential among mothers and fathers of young children in Germany?

Background In order to prevent child abuse, instruments measuring child abuse potential (CAP) need to be appropriate, reliable and valid. Objective This study aimed to confirm the 6-factor structure of the Brief Child Abuse Potential Inventory (BCAPI) in a German sample of mothers and fathers, and to examine longitudinal predictors of CAP. Participants and setting Two waves of data were collected from 197 mothers and 191 fathers of children aged 10–21 months for the “Kinder in Deutschland – KiD 0–3” in-depth study. Families were stratified based on prior self-report data for screening purposes. Methods 138 fathers and 147 mothers were included in the analysis (invalid: 25% mothers, 30% fathers). First, validity of reporting was examined. Second, confirmatory factor analysis (CFA) was employed to assess factor structure. Third, internal reliability and criterion validity were examined. Finally, multivariate poisson regressions investigated longitudinal predictors of CAP in mothers. Results A previously established six-factor structure was confirmed for mothers but not fathers. CFA failed for fathers due to large numbers of variables with zero variance. For mothers, internal consistency and criterion validity were good. BCAPI score at follow-up was associated with baseline BCAPI score (β = 00.08), stress (β = 0.06), education (β=-0.19) and alcohol use (β = .58). Conclusions Findings confirm the six-factor structure of the BCAPI among German mothers. The clinical use of the BCAPI in fathers is not recommended as it might produce data that are hard to interpret. Further research with fathers is needed to establish if this is due to limitations with this dataset or with the questionnaire

Mechanisms behind gender transformative approaches targeting adolescent pregnancy in low- and middle-income countries: a realist synthesis protocol

Introduction: Adolescent pregnancy is defined as pregnancy at the age of 19 or below. Pregnancy and childbirth complications are the most significant cause of death among 15–19-year-old girls. Several studies have indicated that inequitable gender norms can increase the vulnerability of adolescent girls, including violence exposure, early marriage, and adolescent pregnancy. To address these disparities, gender transformative approaches aim to challenge and transform restrictive gender norms, roles, and relations through targeted interventions, promoting progressive changes. This realist review aims to synthesise existing evidence from a broad range of data sources to understand how, why, for whom, and in what contexts gender transformative approaches succeed in reducing adolescent pregnancy in low- and middle-income countries. Method and analysis: We employ a five-step realist synthesis approach: (1) clarify the scope of review and assessment of published literature, (2) development of initial programme theories, (3) systematic search for evidence, (4) development of refined programme theories, and (5) expert feedback and dissemination of results. This protocol presents the results of the first three steps and provides details of the next steps. We extracted data from 18 studies and outlined eight initial programme theories on how gender transformative approaches targeting adolescent pregnancy work in the first three steps. These steps were guided by experts in the field of sexual and reproductive health, implementation science, and realist methodology. As a next step, we will systematically search evidence from electronic databases and grey literature to identify additional studies eligible to refine the initial programme theories. Finally, we will propose refined programme theories that explain how gender transformative approaches work, why, for whom, and under which circumstances. Ethics and dissemination: Ethics approval is not required because the included studies are published articles and other policy and intervention reports. Key results will be shared with the broader audience via academic papers in open-access journals, conferences, and policy recommendations. The protocol for this realist review is registered in PROSPERO (CRD42023398293)