Strengthening the Evidence base on effective scHool based intErventions for pRomoting adolescent health programme

SEHER is a four-year project towards the promotion of youth and adolescent health supported by The John D and Catherine T MacArthur Foundation, USA  and United Nations Population Fund (UNFPA) and is run in collaboration with London School of Hygiene and Tropical Medicine, Public Health Foundation of India and SCERT, Bihar. The primary beneficiaries are youth attending the targeted schools in Nalanda district, Bihar and the secondary beneficiaries are teachers and parents.



Second, only to families, schools have profound effects on children and adolescents. With rates of secondary school retention increasing in many lower-income countries, there is pressing need to understand how to create school environments that promote engagement, health, and wellbeing.



We conducted a cluster-randomised trial to assess the effectiveness and cost-effectiveness of a multicomponent whole-school health promotion intervention (SEHER) among grade 9 students of 74 government-run secondary schools in Bihar, India. Schools were randomised (1:1:1) using minimisation to one of three arms: the SEHER intervention delivered by a lay school counsellor (the SEHER Mitra (SM) arm), the SEHER intervention delivered by a teacher (Teacher as SM (TSM) arm), and a control Education Program delivered in all participating schools. The primary outcome was school climate measured with the Beyond Blue School Climate Questionnaire (BBSCQ). Secondary outcomes were

bullying, violence, depressive symptoms, attitudes towards gender equity, and knowledge of reproductive and sexual health.



Students were assessed at the start and end of the academic year (i.e. June 2015-March 2016; 8 months apart). We randomised 25 schools to the SM arm (4524 participants), 24 to the TSM arm (4046 participants), and 25 to the control arm (4465 participants). The final survey included 14,414 participants (SM=5316; TSM=4475; control=4623). At the endpoint participants in the SM-delivered intervention schools had substantially higher school climate scores than those in the control arm (BBSCQ baseline-adjusted mean difference (aMD) 7·43; 95%CI 5·88-8·99; Effect Size (ES)=1.86 95%CI:1.81,1.91) and the TSM-delivered intervention (BBSCQ aMD 7·91, 95%CI 6·34-9·47; ES=1.98 95%CI:1.93, 2.03). There was no effect of the TSM-delivered intervention compared with control (BBSCQ aMD -0·47, 95%CI -2·03-1·08; ES=-0.12 95%CI:-0.17,-0.07). Participants in schools with the SM-delivered intervention had significant improvements in the secondary outcomes of depression, bullying, violence, attitude towards gender equity, and knowledge of reproductive and sexual health compared with both the TSM and control arms. The cost-effectiveness analysis showed that the SM-delivered intervention is cost-effective at an additional per-student cost of $2.03 (95%CI $1.51, $2.57) per unit increase in school climate score; $12.17 (95%CI $7.94, $26) per unit decrease in depression score; and $17.97 (95%CI $13.97, $25.2) per student for reduction in frequency in bullying.

Current status: We have extended the evaluation of SEHER intervention in the same 74 randomly assigned schools to evaluate the incremental effects of receiving interventions and dose-response among grade IX and X students.







Prof. Vikram Patel, Principal Investigator |

Sachin Shinde, Director |

Prachi Khandeparkar, Director |



Sachin Shinde completed his Ph.D. degree on the SEHER project from London School of Hygiene and Tropical Medicine.

Prachi Khandeparkar received a short-term SHARE research fellowship (6 months duration) to study depression among the school-going adolescents in Bihar.



Shinde S, Pereira B, Khandeparkar P, Sharma A, Patton G, Ross DA, Weiss HA, Patel V. The development and pilot testing of a health promotion intervention (SEHER) for secondary school in Bihar. Global Health Action 2017; 10:1, 1385284, DOI:10.1080/16549716.2017.1385284

Shinde S, Weiss HA, Pereira B, Khandeparkar P, Sharma A, Gupta R, Ross DA, Patton G, Patel V. Impact of a school health promotion intervention on school climate, and health outcomes for adolescents in Bihar, India: a cluster randomised trial. Abstract presented at the 11th World Congress on Adolescent Health, New Delhi, India; 2017.

Khandeparkar P, Pereira B, Shinde S, Gupta R, Sharma A, Wissow L, Patel V. A qualitative study of understanding depression and help-seeking behavior among rural school-going adolescents in India. Abstract presented at the 11th World Congress on Adolescent Health, New Delhi, India; 2017.

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