Award Title: NIHR Global Health Research Group on Adolescent Health and Wellbeing
Funder: Department of Health and Social Care

Abstract: The UN Global Strategy for Women’s, Children’s and Adolescents’ Health (2015 – 2030) outlines how countries need to realise rights to physical and mental health and wellbeing in combination with social and economic opportunities to shape prosperous and sustainable societies. Embedded within the UN Sustainable Development Goals, and recognising national disparities, this strategy is especially pertinent to the adolescent population, as it is set against a backdrop of unparalleled global change, shaping the health and wellbeing of the largest population of adolescents in human history. Adolescence is recognised as a critical phase in life for achieving human potential, influenced by interaction with the social environment, shaping and supporting the acquisition of physical, cognitive, emotional, social, and economic resources which form the foundation for later life health and wellbeing, and influence future generations. Despite their key role in society, adolescents and young adults have until recently been overlooked in global health and social policy. This may be a key reason why fewer concrete health gains from economic development can be identified for them relative to other age groups. The literature points to a need for contextualised research that can inform intervention strategies to mitigate adverse conditions and nurture elements that can provide material and social protection and resilience for adolescents, enabling them to maximise their life chances. In Malawi, the setting for this research, despite some efforts there has been limited progress towards meeting the needs of adolescents (26.1% of the population). For example, programming intended to extend health services to adolescents remains problematic, with essentially no universal health coverage for the youngest age groups, adverse social norms that preclude the use of contraception before the first birth, and many service-side barriers in achieving ‘Youth Friendly’ health services. The current COVID-19 pandemic is also magnifying these challenges, and the impacted service provision in health and education sectors has had disastrous impacts on adolescents through school closures and exacerbation of poverty owing to economic shutdown._x000D_
With this backdrop in mind, our interdisciplinary group will use a socio-ecological model to focus on the health and wellbeing of adolescents in Malawi. We will take a multifaceted transdisciplinary approach to understanding the context of both urban and rural settings through a formative research phase, generating new knowledge on the best preventive and nurturing strategies for adolescent health and wellbeing. This formative work will support the co-creation, testing and evaluation of pilot interventions and prototypes in collaboration with adolescents, influencers, parents, and other sector stakeholders, building on established linkages and with full participation of youth through our engagement programme. Interventions will focus on (1) water, sanitation and hygiene, (2) gender, sexual and reproductive health rights, and (3) inspiring social and emotional wellbeing including mental health. These areas will be supported by an examination of policy and economic frameworks needed to support long term synergy of investments and real change. A key outcome will be to ensure more effective peer, parental and multisectoral support, and novel approaches to contextualise and trial multi-sectoral intervention strategies which can be taken to scale

Lay Abstract: The United Nations estimate that there are more young people (10-24 year olds) alive today than at any other time in human history, the majority of which live in low and middle income countries. Within these settings, adolescence is affected by the multiple health and wellbeing burdens that are exacerbated by poverty including HIV and other infectious diseases, undernutrition, and gender norms that underpin poor sexual and reproductive health, injury and violence, and non- communicable diseases. Despite this, adolescents are often the most neglected group in health care service provision, particularly those in early adolescence (10–14 years), a time considered critical in shaping their future lives. _x000D_
In Malawi, the setting for this research, despite social mobilization to prohibit child marriage, engagement of traditional leaders in moving away from unhealthy cultural traditions, and expansion of youth-friendly health services, there has been limited progress towards meeting the needs of adolescents. For example, national rates for completion of the full eight years of primary school remain low (44% male; 37% female). Adverse gender norms weigh heavily on girls and young women such that age-specific fertility for adolescents remains high, and there is an unmet need for family planning services. Programming intended to extend health services to adolescents remains highly problematic, with essentially no universal health coverage for the youngest age groups, highly adverse social norms that preclude the use of contraception before the first birth and many service-side barriers. Additionally, the current COVID-19 pandemic is magnifying the challenges for communities and for service provision in health and education sectors and has impoverished a whole generation of adolescents and limited their life chances. _x000D_
With this backdrop in mind, this interdisciplinary group will focus on the health and wellbeing of adolescents in Malawi. We will take an all round approach to understanding young people’s lives in both urban and rural settings through an extensive formative phase. We will undertake  ‘co-creation’, testing and evaluation of promising approaches to some of the identified challenges in collaboration with adolescents, influencers, parents, and others active in development work. With a focus on (1) gender, sexual and reproductive health rights, (2) aspirations and wellbeing including mental health, and (3) water, sanitation and hygiene, work in these areas will be supported by an examination of policy and economic frameworks that are needed to support long term change._x000D_
We anticipate that our holistic approach to examining the lives of adolescents can bring immediate benefits, as well as benefits throughout their future adult lives and for the next generation of children. In order to achieve these aims we need to gain a clear understanding of the opportunities and barriers to adolescent health and wellbeing in low income settings such as Malawi, while recognising and examining important gendered, regional and rural-urban differences. A key outcome will be to ensure more effective peer, parental and multisectoral support, and availability of new approaches to bring forward and test new ways to mitigate adverse conditions and foster elements that can provide material and social protection, and resilience for adolescents, enabling young people to maximise their life chances.

Research Activity Codes: 5.6 PSYCHOLOGICAL AND BEHAVIOURAL;6.6 PSYCHOLOGICAL AND BEHAVIOURAL;8.2 HEALTH AND WELFARE ECONOMICS;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health Categories: GENERIC HEALTH RELEVANCE