Feasibility, acceptability and implementation of a whole-family mental health intervention for displaced adolescent girls in Colombia: A mixed-methods pilot randomized controlled trial

Abstract

Adolescent girls affected by displacement face substantial mental-health risks. The Sibling Support for Adolescent Girls in Emergencies (SSAGE) is a 12-week, gender-transformative, family-based program designed to improve adolescent girls' mental health in humanitarian settings. This mixed-methods pilot randomized controlled trial (RCT) assessed SSAGE's feasibility, acceptability and potential effects among 186 Venezuelan migrant and Colombian returnee families in Colombia. Adolescent girls aged 13-19 years, their male siblings and caregivers participated in parallel sessions on gender dynamics, communication and relationships. Implementation outcomes drew on the Mental Health Implementation Science Tools (acceptability and feasibility subscales), attendance records and qualitative interviews. Analyses followed an intent-to-treat approach using adjusted linear and logistic regression models. Quantitative analyses did not identify measurable changes in adolescent girls' mental health outcomes at endline; however, attendance was modest, with only ~10% of families meeting the predefined protocol threshold. Implementation findings revealed strong participant satisfaction and high acceptability of SSAGE content and mentor relationships. Engagement was constrained by economic hardship, transportation and venue barriers, and some caregivers' acute emotional distress, which likely limited feasibility and potential impact. SSAGE shows promise as a gender-transformative, family-based approach, but successful delivery in urban migrant settings will require tailored and refined implementation strategies.