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

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

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)

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

Building financial resilience in the context of deprivation: experimental evidence from a family financial literacy and parenting programme in South Africa

Background: Living in poverty exposes individuals to multiple risks. These include food insecurity, restricted access to educational, financial, and medical institutions, vulnerability to income shocks, indebtedness, and poor mental health. In response, many development programmes seek to build financial resilience among the poor by helping them build security buffers against emergencies and secure their basic needs with volatile incomes. Popular intervention strategies have capitalised on promoting budgeting and saving skills. However, effectiveness of these programmes has often been limited, particularly when targeted at low-income participants. Therefore, it is essential both for policy and research to determine which programme designs can most effectively foster financial resilience whilst improving financial management and decision making. This thesis begins by depicting the financial lives of the poor and illustrating the poverty-linked adversities they face. The concept of financial resilience is introduced to define the outcomes analysed in the thesis and motivate a theory of change. DPhil Paper 1 summarises experimental research of existing resilience-building programmes in Sub-Saharan Africa. Based on this comprehensive review, gaps in previous programmes and evidence are highlighted and potential new intervention strategies drawing on psychological and social aspects are discussed. The empirical part of the thesis reports on a cluster randomised controlled trial to evaluate the economic impact of a family-based financial literacy and parenting programme targeting poor households in the Eastern Cape province of South Africa (DPhil Paper 2). Mechanisms underlying changes in financial behaviour are elucidated in DPhil Paper 3. Methodology &amp; Results: Paper 1 – The first paper synthesises and critically appraises existing randomised controlled trials on the effectiveness of saving and budgeting promotion programmes in Sub-Saharan Africa. An extensive search of 28 academic and policy-focused databases was conducted and 27 relevant programme evaluations were identified. Data extraction and quality ratings were carried out independently by the candidate and another review author. Standardised effect sizes were pooled across studies for each outcome category using robust variance estimation. Heterogeneity in effect sizes was examined in a series of meta-regressions, considering the impact of programme curriculum, target population, and study design characteristics. The meta-analysis provides evidence for a small (standardised mean differences between 0.01 and 0.07) but significant impact of saving and budgeting promotion programmes on poverty reduction, including increases in household expenditures and incomes, higher returns from family businesses, and improved food security. Results also show positive and significant effects (standardised mean differences between 0.04 and 0.12) on intermediate outcomes, including total savings, pro-saving attitudes, financial literacy, and investments in small-scale family businesses. Findings from meta-regressions suggest that providing access to formal banking schemes is more effective than delivering programmes with educational and/or motivational focus. Further to this, findings point to reduced programme effectiveness for female participants. This paper is published in World Development (5-year IF: 3.35). Paper 2 – The second paper draws on primary data from a randomised field experiment with 552 families in the Eastern Cape, South Africa. 40 villages and townships were randomly assigned to either participate in a combined parenting and financial literacy programme (treatment arm, 270 families) or receive a one-day hygiene workshop (control arm, 282 families). Different specifications of regression analyses (adjusting for baseline variables or not) with clustered standard errors are used to estimate the intent-to-treat effect of the parenting and financial literacy intervention five to nine months after programme delivery. Experimental evidence points to significant improvements in financial behaviours, with higher saving and lower borrowing rates among treatment group participants at post-test. There is further evidence for substantial effects on household economic welfare, expressed in significantly reduced financial distress, better resilience to economic shocks, and a greater capacity to secure a range of basic needs (standardised mean differences ranging from 0.10 to 0.62). There is tentative evidence that programme effects are higher (with regards to some outcomes) for rural dwellers but diminished for women who are not the household heads. This paper is published in the Journal of Development Economics (5-year IF: 3.43). Paper 3 – The final paper builds on findings from DPhil Paper 2 by applying a mixed-methods framework to elucidate the pathways underlying changes in financial behaviour. Thematic analysis was applied to data collected in focus group discussions and in-depth interviews with programme participants, aiming to identify distinct narratives on the mechanisms of change. Qualitative evidence elicits three driving factors for changes in financial behaviour, namely (a) a higher confidence in financial management skills, (b) a more optimistic future outlook, and (c) increased socio-emotional support provided by peers and family members. These mechanisms were then cross-validated using mediation analysis and a structural equation model. Quantitative results point to higher levels of financial self-efficacy and optimism as well as improved parent-child relationships and community social support in the intervention group. Together, these factors can be seen to translate into optimisations in financial behaviour. Conclusion: This thesis argues that financial behaviour and financial decision making in poor families is shaped by a complex interplay of psychological and social factors. It follows that programme curricula that leverage these influences – in addition to standard financial literacy training – have the potential to achieve greater impact. To test this argument, the thesis presents evidence on the beneficial economic impacts of a multi-faceted parenting and financial literacy programme for poor families in the Eastern Cape, South Africa. Despite the evidence presented, this thesis acknowledges that future, more complex research designs are needed to confirm the causal impact of psychological and social programme components. In addition, findings from this thesis, and particularly from the systematic review, highlight reduced effectiveness for female programme participants. Therefore, gender-sensitive programming that tackles prevailing gender norms and power dynamics within household bargaining processes is necessary and should be integrated into financial curricula. This thesis paves the way for more holistic programmatic innovations to alleviate financial hardship in highly vulnerable and deprived populations.</p

Building financial resilience in the context of deprivation: experimental evidence from a family financial literacy and parenting programme in South Africa

Background: Living in poverty exposes individuals to multiple risks. These include food insecurity, restricted access to educational, financial, and medical institutions, vulnerability to income shocks, indebtedness, and poor mental health. In response, many development programmes seek to build financial resilience among the poor by helping them build security buffers against emergencies and secure their basic needs with volatile incomes. Popular intervention strategies have capitalised on promoting budgeting and saving skills. However, effectiveness of these programmes has often been limited, particularly when targeted at low-income participants. Therefore, it is essential both for policy and research to determine which programme designs can most effectively foster financial resilience whilst improving financial management and decision making. This thesis begins by depicting the financial lives of the poor and illustrating the poverty-linked adversities they face. The concept of financial resilience is introduced to define the outcomes analysed in the thesis and motivate a theory of change. DPhil Paper 1 summarises experimental research of existing resilience-building programmes in Sub-Saharan Africa. Based on this comprehensive review, gaps in previous programmes and evidence are highlighted and potential new intervention strategies drawing on psychological and social aspects are discussed. The empirical part of the thesis reports on a cluster randomised controlled trial to evaluate the economic impact of a family-based financial literacy and parenting programme targeting poor households in the Eastern Cape province of South Africa (DPhil Paper 2). Mechanisms underlying changes in financial behaviour are elucidated in DPhil Paper 3. Methodology &amp; Results: Paper 1 â The first paper synthesises and critically appraises existing randomised controlled trials on the effectiveness of saving and budgeting promotion programmes in Sub-Saharan Africa. An extensive search of 28 academic and policy-focused databases was conducted and 27 relevant programme evaluations were identified. Data extraction and quality ratings were carried out independently by the candidate and another review author. Standardised effect sizes were pooled across studies for each outcome category using robust variance estimation. Heterogeneity in effect sizes was examined in a series of meta-regressions, considering the impact of programme curriculum, target population, and study design characteristics. The meta-analysis provides evidence for a small (standardised mean differences between 0.01 and 0.07) but significant impact of saving and budgeting promotion programmes on poverty reduction, including increases in household expenditures and incomes, higher returns from family businesses, and improved food security. Results also show positive and significant effects (standardised mean differences between 0.04 and 0.12) on intermediate outcomes, including total savings, pro-saving attitudes, financial literacy, and investments in small-scale family businesses. Findings from meta-regressions suggest that providing access to formal banking schemes is more effective than delivering programmes with educational and/or motivational focus. Further to this, findings point to reduced programme effectiveness for female participants. This paper is published in World Development (5-year IF: 3.35). Paper 2 â The second paper draws on primary data from a randomised field experiment with 552 families in the Eastern Cape, South Africa. 40 villages and townships were randomly assigned to either participate in a combined parenting and financial literacy programme (treatment arm, 270 families) or receive a one-day hygiene workshop (control arm, 282 families). Different specifications of regression analyses (adjusting for baseline variables or not) with clustered standard errors are used to estimate the intent-to-treat effect of the parenting and financial literacy intervention five to nine months after programme delivery. Experimental evidence points to significant improvements in financial behaviours, with higher saving and lower borrowing rates among treatment group participants at post-test. There is further evidence for substantial effects on household economic welfare, expressed in significantly reduced financial distress, better resilience to economic shocks, and a greater capacity to secure a range of basic needs (standardised mean differences ranging from 0.10 to 0.62). There is tentative evidence that programme effects are higher (with regards to some outcomes) for rural dwellers but diminished for women who are not the household heads. This paper is published in the Journal of Development Economics (5-year IF: 3.43). Paper 3 â The final paper builds on findings from DPhil Paper 2 by applying a mixed-methods framework to elucidate the pathways underlying changes in financial behaviour. Thematic analysis was applied to data collected in focus group discussions and in-depth interviews with programme participants, aiming to identify distinct narratives on the mechanisms of change. Qualitative evidence elicits three driving factors for changes in financial behaviour, namely (a) a higher confidence in financial management skills, (b) a more optimistic future outlook, and (c) increased socio-emotional support provided by peers and family members. These mechanisms were then cross-validated using mediation analysis and a structural equation model. Quantitative results point to higher levels of financial self-efficacy and optimism as well as improved parent-child relationships and community social support in the intervention group. Together, these factors can be seen to translate into optimisations in financial behaviour. Conclusion: This thesis argues that financial behaviour and financial decision making in poor families is shaped by a complex interplay of psychological and social factors. It follows that programme curricula that leverage these influences â in addition to standard financial literacy training â have the potential to achieve greater impact. To test this argument, the thesis presents evidence on the beneficial economic impacts of a multi-faceted parenting and financial literacy programme for poor families in the Eastern Cape, South Africa. Despite the evidence presented, this thesis acknowledges that future, more complex research designs are needed to confirm the causal impact of psychological and social programme components. In addition, findings from this thesis, and particularly from the systematic review, highlight reduced effectiveness for female programme participants. Therefore, gender-sensitive programming that tackles prevailing gender norms and power dynamics within household bargaining processes is necessary and should be integrated into financial curricula. This thesis paves the way for more holistic programmatic innovations to alleviate financial hardship in highly vulnerable and deprived populations.</p

RVE Meta-Analysis R Code

Pooled effect sizes were computed using robust variance estimation (RVE) meta-analysis.    This methodology is particularly well suited when aggregating effect sizes across studies that (a) report multiple effect sizes for the same overarching construct (such as poverty), (b) conduct multi-arm trials with slight variations in the treatment assigned, and (c) report results disaggregated by sub-groups.Pooled effect sizes were computed using robust variance estimation (RVE) meta-analysis.    This methodology is particularly well suited when aggregating effect sizes across studies that (a) report multiple effect sizes for the same overarching construct (such as poverty), (b) conduct multi-arm trials with slight variations in the treatment assigned, and (c) report results disaggregated by sub-groups. We calculated effect sizes for intermediate outcomes and distal outcomes. <i>Intermediate outcomes </i>included (a) increases in total savings, (b) financial literacy, and (c) savings attitudes, (d) investments in profitable business. We further calculated <i>distal outcomes</i> comprising: (a) business profits, (b) food security, (c) investments in and status of health, (d) investments in education and educational attainment, and (e) household poverty measured through assets or expenditure/income

RVE R Code

First we calculate pooled effect sizes for each outcome<div><br></div><div>Then we run a meta-regression for aggregated outcomes savings, consumption, investment</div><div><br></div><div>Then we display forest plots for each outcome</div

FDR Adjustment R Code

R Code used for false discovery adjustment of main effects and heterogeneity analyse

Datasets for each Outcome Category

Data from 27 randomised controlled trials included in this systematic review was independently extracted by two review authors and entered into a <a>pre-piloted data extraction </a>form. If information was missing, study authors were contacted with up to four follow-up Emails.We calculated standardised effect sizes for intermediate outcomes and distal outcomes.  Standardised effect sizes are scale-free and provide comparable information about the magnitude and direction of each effect and can thus be aggregated across studies. For continuous outcome measures, standardised mean differences (SMDs) were calculated. To adjust for potential bias from small sample sizes, we used Hedges’ g correction for all effect sizes. For outcomes that were measured on a continuous scale in some studies and dichotomised in other studies (e.g. increases in saving amounts), we transformed odds ratios into SMDs and used Hedges’ g correction as described above. <i>Intermediate outcomes </i>included (a) increases in total savings, (b) financial literacy, and (c) savings attitudes, (d) investments in profitable business. It is crucial to account for potential crowd-out effects that can arise from the shifting of resources to the saving device endorsed by the interventions. We have therefore made efforts to focus on <i>total </i>household<i> </i>savings and otherwise sought to aggregate all information on savings held in different places to reach an average effect. <i>Distal outcomes</i> included (a) business profits, (b) food security, (c) investments in and status of health, (d) investments in education and educational attainment, and (e) household poverty measured through assets or expenditure/income. <div><div><div> </div> </div> </div