Assessing the impact of a sport for development and peace intervention on the mental and physical health of adolescents in Mullaitivu, Sri Lanka

Introduction:
Mental disorders are a crucial contributor to the global disease burden. Exposure to conflict and conflict related stressors are risk factors for poor mental health in children and young adolescents. There is a growing body of evidence for the positive impact of sport and physical activity on the mental well-being of young people in developed, peaceful settings, but it is not clear whether these results can be replicated in post-conflict contexts. Despite this, sport and physical activity are increasingly incorporated into assistance for conflict-affected populations. This thesis assessed the impact of a Sport for Development and Peace (SDP) intervention on the mental and physical health of young adolescents in post-conflict Sri Lanka.
Methods:
I selected methods that balanced pragmatism and rigor and adapted them for use in a low- resource post-conflict setting. I assessed mental health using a locally devised measure, the Sri Lankan Index of Psychosocial Stress – Child Version (SLIPS-C), and physical health using the Multi Stage Fitness Test (MFT), BMI for age (BFA) and height for age (HFA). I tested the reliability and feasibility of the measurement protocols with two repeat measures studies (Kilinochchi study n = 38, Mullaitivu study n = 43). I conducted a cross sectional study (n = 367) in 8 schools which doubled up as the baseline for a pre post with control study (n = 214) in Mullaitivu.
Results:
Successive adaptations improved the intra-tester agreement for the SLIPS-C (Kilinochchi ICC = 0.701, Mullaitivu ICC = 0.878) and all variables showed a good level of reliability (ICC&GT;0.75). There were no significant differences in the main outcome variables between the intervention [V] and control [C] groups at baseline. The target group significantly underperformed when compared to global MFT, BFA and HFA norms. 214 students (47.4% female) were included in the final impact analysis; loss to follow up was 34.2%. Mean SLIPS-C score improved significantly in both groups ([V] = t (113) 2.46, p = 0.016); [C] = t (99) 5.04, p = &LT;0.001), but there was no significant difference between [V] and [C] groups at follow up. Adjusting for gender, age and ethnicity did not affect the significance of the results. Mean MFT score in the [V] cohort significantly deteriorated (t (99) = 3.39 p = 0.004), yet did not change significantly in the [C] group.
Discussion:
Successive rounds of field reliability tests improved the measurement protocols. I was able to draw limited conclusions about the impact of the intervention as it was implemented to a negligible degree, and the study was underpowered due to absenteeism. The results of the evaluation neither support nor disprove the supposition that SDP programmes can have an impact on mental health, as there was a community wide improvement in mental health. In evaluating the impact of sport in post-conflict countries, researchers face an array of theoretical, methodological and epistemological challenges. This thesis is a cautionary tale that highlights the complexity of evaluation in post-conflict zones and the relationships required to sustain it.

Advisor: Richards, J
Foster, C