Family-based sexual health interventions for adolescents in low- and middle-income countries: systematic analysis and meta-analysis

Family-based sexual health interventions (FBSHI) have received considerable attention for their success in promoting adolescent sexual health outcomes. However, their effectiveness in low- and middle-income countries (LMICs) is unclear. Systematic searches were conducted for studies published from January 2000 to October 2023 using five electronic databases. Studies were included if they included adolescents aged 10-19 y and their family members (parents, siblings or primary caregivers) in a key intervention component, evaluated the effectiveness of the interventions using an experimental or quasi-experimental design, assessed sexual and reproductive health outcomes reported by adolescents and were carried out in LMICs. The review included nine studies, with 2404 adolescent participants and their families. Meta-analysis was carried out using a random-effects model. The key themes that emerged from this systematic review were: (i) FBSHI significantly improved adolescents' sexual health knowledge; and (ii) the impact of FBSHI on molding adolescents' sexual health attitudes, practices and family communication around sexual health topics was inconsistent. The importance of conducting combined interventions that involved adolescents and their parents to elicit better outcomes was highlighted in the review. Future research should prioritize under-represented geographical regions such as Asia and include culturally adopted, contextually relevant material to increase the acceptability and effectiveness in LMIC settings.By synthesizing existing literature, this review contributes to gaining a comprehensive understanding of varying strategies that can be used to ensure the effectiveness of family-based sexual health interventions in promoting adolescent sexual health in the LMIC setting. The review also highlights areas not explored by the existing research and that need attention when conducting further research.