Social groupwork for promoting psychological well-being of adolescents enrolled in sponsorship programs

Philosophical assumptions

Espousing a transformative world view (Mertens, 2008; Creswell and Creswell, 2017) we designed an interventional study for uplifting the PWB of a socially marginalized group of adolescents from low-income families. A transformative paradigm facilitates change in the lives of participants, addressing specific issues such as inequality, oppression, and alienation. In this study, our focal point was social stratification perpetuating the low PWB of adolescents. The SGW intervention was tailored to raise participants’ PWB to make them feel equal to their counterparts from more advantaged stratas of society.

Theoretical framework

The theoretical conceptualization of an intervention research study involves two stages: delineation of a problem theory, and of a program theory (Fraser and Galinsky, 2010). Delineation of a problem theory provides a clear understanding of the psycho-social conditions that produce problems, whereas, program theory underpins the intervention for achieving expected outcome.

With a person-in-environment perspective (Hare, 2004; Weiss-Gal, 2008), this study comprehended the psycho-social problems of adolescents induced by the low-income family environment. Ryff’s six-factor PWB model (Ryff, 2014, 1995), which combines different perspectives such as ‘fully functioning person’ (Rogers, 1961:183), ‘executive processes of personality’ (Neugarten, 1973:312), ‘self-actualization’ (Maslow, 1968), ‘individuation’ (Jung, 1958), ‘will to meaning’ (Frankl,1959), ‘personal development’ (Erikson, 1959), ‘basic life tendencies’ (Buhler,1935) and ‘maturity’ (Allport, 1961), provided a theoretical base for our SGW intervention program to augment the PSW of participants. The group was formed within the framework of empowerment theory (Zimmerman, 2000) in general, and particularly its personal construct, psychological empowerment (PE) (Zimmerman, 1995; Zimmerman et al., 1992).

Ethical statement

This study was approved by the Center for Research of the CHRIST (Deemed to be) University, Bengaluru, which constitutes the Institutional Review Board/Ethics Committee that approved this study, (approval number: CU:RCEC/00037/l/19).

The Child Sponsorship Program (CSP) of Rajagiri OutREACH gave consent to conduct this study and the same was approved by the Institutional Review Board/Ethics Committee of CHRIST (Deemed to be) University. Objectives of intervention were set in line with visions and missions of the center. The purpose of the study was well explained and written informed consent for participation and publication data was obtained from participants and their parents, prior to the study. Pseudonyms were assigned to all participants for deidentification in the recording and reporting.

Trial registration

This trial is registered at the Centre for Research/IRB of CHRIST (deemed to be) University. The trial registration number is CU.CFR.PhD.CWCL.REG.No.1730087.2017.

Research design

Our research design focused on the research question ‘is SGW effective in improving PSW of adolescents in sponsorship programs?’ (Kate, et al., 2018). We adopted a quasi-experimental, non- randomized control group design (Campbell and Stanley, 1963; Creswell and Creswell, 2017; Shadish et al., 2001) for the study. In this design both the intervention group (IG) and the comparison group (CG) took pre-test and post-test for measuring PWB before and after intervention while only the IG received the SGW intervention for raising their PWB. Inferences were made comparing scores of both groups.

A shorthand notation for this design is:

I - intervention group;

C - comparison group;

Y1 - measurement of PWB in pre-test;

Y2 - measurement of PWB in post-test;

X - social groupwork (intervention).

Sponsoring agency

Rajagiri OutREACH, a professional service wing of Rajagiri College of Social Sciences, Kochi, reaches out to the community at large through various programs including the child sponsorship program (CSP). Across the state of Kerala, there are 30 CSP centers of Rajagiri OutREACH, which mainly provide economic support to children (11-18 years) from lower socio-economic stratas, and promote studies and services aiming at uplifting marginalized children. Currently, there are 2,862 children enrolled with Rajagiri OutREACH, and among them 1,086 belong to the13-16 years age group.

Research setting

From the 16 total CSP centers in Kochi run by Rajagiri OutREACH, one center at Kalamassery was selected as the study setting with two criteria; first, the study excluded the centers with less than 40 adolescents in them, and second, one center was selected using random sampling (Levy and Lemeshow, 2013); by assigning unique numbers to each center and randomly picking one from them. Entry to and consent for conducting this study at the center were negotiated through proper channels (Høyland et al., 2015). Recruitment, intervention, and data collection with participants were done in this CSP center. The study was conducted over a period of two years from June 2018 to July 2020.

Preliminary study

Secondary data was garnered from the selected CSP center records that revealed the poor academic performance, behavior problems, and issue coping with family of registered adolescents. For an in-depth exploration of the problems of participants and for identifying risk factors and protective factors, we employed case study as a method of inquiry (Yin, 2018), and conducted twenty case studies among participants and their parents, with prior consent and appointment.

Delphi survey

Based on the conclusion drawn from the preliminary study the first author under the guidance of second author developed questionnaires and conducted a ‘Delphi survey’ (Hasson et al.,2000) among selected (purposive sampling) social work professors in South India. We e-mailed professors in three leading social work colleges in South India at Rajagiri College, Kalamassery, Marian College, Kuttikkanam and Christu Jayanthi College, Bangaluru, and nine out of the fifteen we contacted expressed their willingness for participation in the survey by returning the electronically signed consent form which was attached in the mail. The panelists reached consensus after three rounds, on the most suitable method to enhance the psychological well-being of adolescence enrolled with CSP (See Figure 1 for details).

Figure 1. Delphi survey process and results.

Figure 2. Participant flow.

Sampling

We did a two-stage sampling for this study. 1) Forty adolescents from the selected CSP center were selected for the study using the following inclusion/exclusion criteria.

Inclusion criteria

Exclusion criteria

The pretest was conducted for all the 40 participants.

2) Delphi survey results clearly stated that the ideal group size for SGW intervention is twenty. Therefore, twenty adolescents suggested by the CSP center considering the urgency of a solution to their problems such as poor academic performance and behavior problems, were assigned to the IG and the rest to CG, for ethical reasons outlined in the blinding section that the objectives of a SGW must go in line with that of the research settings, which in turn assist them to better handle the issues they are currently dealing with.

Blinding

We found that blinding of intervention to IG is impossible in SGW intervention as the objectives of group has to be described to group members in the group forming stage itself. Blinding of researcher was also impossible in this study since the researcher was administering the intervention which was developed by him. However, data collection was done by blinded research assistants and all participants were anonymized during data analysis. Further, the bilingual translators were also blinded in this study. This research kept CG unaware of the study objectives to reduce the risk of bias.

Tools for data collection

Socio-demographic details of participants were collected using a self-administered questionnaire (Joseph and Karalam, 2021). The 42-item version of Ryff’s PWB scale was administered for pre- and post-test, for collecting statistical data and estimating the effectiveness of intervention in raising PWB of participants. The scale is a six-point Likert scale ranging from strongly disagree to strongly agree. Ryff’s PSW scale has six subscales which measure “autonomy, environmental mastery, personal growth, positive relations, purpose in life, and self-acceptance” (Gao and McLellan, 2018:2). All items were translated into Malayalam (local language) and back translated into English once completed, ruling out discrepancies. The translation was done by a bilingual person and the accuracy is checked by the researcher. Pretesting was done by administering the scale to five adolescents and internal consistency was calculated statistically for each subscale after reversing the negatively phrased items. The average value obtained for Cronbach alpha coefficients was 0.79, which is > 0.7, indicating reliability of scale (Pallant, 2020).

Secondary outcomes such as improvement in academic performance, personal competence and social competence were measured through follow up, which was carried out using in-depth interviewing of parent (father/mother) of each participant received intervention. In addition, three FGD’s were conducted with teachers of three local schools that participants were attending.

Data collection

Socio-demographic data collection and pretests were done immediately after the selection process. Socio-demographic questionnaire and translated version of Ryff’s 42 item PWB scale (Joseph and Karalam, 2021) were distributed to participants, one after the other. Research assistants facilitated data collection which was taken place at the research setting. As it was done in the pretest, post-test to both IG and CG for assessing their PWB after the intervention was carried out in the research setting. In the preliminary study, qualitative data was collected using case study method in which the participants and parents were interviewed by the researcher at their dwellings. Secondary data was collected through reviewing records in the CSP center. Qualitative data on intervention was gathered by audio recording the sessions and participant reflections, noting down participant observations, writing researcher reflections, and collecting vignettes of group experience from participants. Follow-up interviews with parents were conducted at their houses and FGD’s in the respective schools.

Data analysis

All the quantitative data collected was analyzed statistically using IBM SPSS statistics 25, keeping a group as the smallest unit of analysis. Paired sample t-test was employed to test hypotheses. Concurrently, qualitative data was analyzed at individual level since the effect of a SGW needs to assessed at both group and individual level. Qualitative data was transcribed verbatim and translated from Malayalam into the target language English by a bilingual expert and tested accuracy using back translation of three transcripts. Content analysis of qualitative data was done using Atlas.ti8. We did not face an issue of missing data since we could keep data collection intact with the small sample size.

Social group work intervention

A social work intervention entails designing, testing, refining, administering, evaluating, and disseminating of a customized package. In this study we designed a social groupwork intervention in response to the concerns and needs assessed through the preliminary study among the selected adolescents enrolled in CSP, their family, and the sponsoring agency. The PE perspective contoured the groupwork program where PE refers to “empowerment at the individual level of analysis” (Zimmerman, 1995:581). The specifically designed SGW intervention was administered to the IG.

Purpose

The primary purpose of the social groupwork intervention was ‘enhancement of PWB of group members.’ The expected secondary outcomes of the intervention were set as improved i) personal competence, ii) academic competence, and iii) social competence of participants, bearing in mind the fact that the group objectives and activities “must be compatible with the mission and purpose of the sponsoring organization” (Gitterman and Salmon, 2009, p.93).

Duration

This SGW intervention was carried out in 16 sessions with a duration of two hours/session, over a period of two months.

Group model

Placing the locus of intervention at psychological upliftment of adolescents from lower socio-economic strata, we selected the empowerment model of social groups. “The empowerment model evolved in response to the plights of marginalized and oppressed individuals of our society” (Gitterman and Salmon, 2009:73). The empowerment model adapts a strengths perspective ((Zastrow, 2015) to counter helplessness and hopelessness. “A strengths-based approach operates on the assumption that people have strengths and resources for their own empowerment” (Pulla, 2012:3). The significance of PE surfaces here, as it holds intrapersonal, interactional, and behavioral aspects (Zimmerman,1995). In this SGW intervention study, we framed the group activities in line with the three strategies of empowerment: collective action, consciousness raising, and capacity building.

Collective action (CA) is a joint action by a group of individuals in the pursuit of enriching their lives. Personal empowerment remains impossible in the absence of collective action for marginalized groups because they need a collective empowerment as a deprived section of the society (Cislaghi et al., 2016). These SGW intervention activities were framed around the ideology of “collective action for a collective solution” (Hanish, 2000:114). The IG of adolescents from the disadvantaged strata of society was formed to act together to envision a better future, assuring their social mobility. Every group activity focused on instilling an altered perception of self; a transformation with an enlightened beliefs and attitudes in articulating aspirations.

Consciousness raising (CR) is the centrality of group process with marginalized groups (Bruley, 2013). CR activates introspection to examine the extent of suppression within individuals and aids them to relate with others so that they can comprehend the reasons for their oppression and can think of ways to step out of it as a group. Inspiring stories of successful personalities from the same social strata were narrated for encouraging participants to dream high and to make resolutions for a bright future. In addition, an awareness on the constitutional rights, concepts of equality, and a basic lesson on the laws of the residing country was provided to implant hopes in them to set life goals, and to lessen vulnerabilities.

Capacity building (CB) is the key strategy to alleviate social disparities through empowering the weaker section (Kaplan, 2000). This SGW intervention formulated activities to assist participants in their studies. Special tuition for those who had difficulty with particular subjects was arranged and peer learning promoted with members good at certain subjects. Training in sports and other leisure activities were also part of this intervention program. In addition, a session on kitchen gardening was organized to capacitate them in producing vegetables on their own.

Group development

We adopted a four-stage model of group development proposed by “Northen and Kurland” (Zastrow, 2015:22; Northen and Kurland, 2001), which highlights socio-emotional themes: a) inclusion–orientation, b) uncertainty–exploration, c) mutuality–goal achievement, and d) separation–termination, Activities grounded on the requirements of the group assisted group development through the stages towards realization of its goals (Lindsay and Orton, 2014).

Inclusion–orientation

Post intake of members, the intervention sessions commenced as scheduled. Icebreaking techniques gave a head start by opening up the self-introduction of members, which helped them to get acquainted with other members, to reduce anxiety, and to facilitate group interaction. The GWR elucidated the objectives of the group; have faith in self, make academic progress, articulate aspirations, avoid vulnerabilities, improve familial and social relationships, and strive for a bright future.

Gaining group members’ trust was a major task for GWR. People from disadvantaged groups have enough reasons to distrust a GWR from upper stratas because of the presence of overt as well as covert discrimination in society (Northern and Kurland, 2001). Due to this, we demystified the SGW intervention, explaining it is aimed at their well-being and empowerment. We deliberately maintained sensitivity to their feelings, treated them with respect, and behaved courteously by shaking hands, greeting warmly etc.

Interdependence is imperative in a group as it steers interactions, leading to the formation of group behavior (Johnson and Johnson, 2005). Group games demand interdependence, which catalyzes reciprocal interactions (Evans et al., 2012). We conducted group games such as hula hoop games, relay races, and scavenger hunts to expediate ‘group cohesion’ (Carron and Brawley, 2012). We awarded prizes for enticing members to participate actively and for motivating them to continue in the group.

We considered developing group norms in fostering helping behavior among members (Gonzalez-Mulé et al., 2014), and we shared certain norms such as mutual support, mutual respect, respect to privacy, self- disclosure stays harmless, give every task a try, it is alright to fail the tasks, open communication, conflict constructively, commitment to group and procedural norms.

Uncertainty–exploration

The first theme here is “group members’ uncertainty regarding issues of power and control” (Zastrow, 2015:22), which is inherent but not an obstacle to overcome. We employed an ‘I am good at’ strategy for assigning roles.

Anticipating raising the consciousness of members to realize their value and growth potential, we administered bibliotherapy. Reading and listening to literature analogous with life experiences of individuals can constructively affect their attitudes and beliefs so that they alter and reshape their thoughts and behavior for an upgraded lifestyle (Hynes, 2019; Lenkowsky, 1987). We started this session reading out the Malayalam (native language) version of “King’s reiterated affirmation of ‘I have a dream’” speech (Sundquist, 2009:1). Resource people including social work professors and catholic priests narrated them stories of APJ Abdul Kalam, Abraham Lincoln, Nelson Mandela, and K. R. Narayanan. The speakers explained to them their constitutional rights, government schemes and reservations for higher studies and employment, the need for performing well in academics, staying away from illicit activities, and keeping personal integrity. In addition, members recited popular poems describing the notion of ‘equality’.

At this point, group members were asked to write down their ambition and ways to achieve it.

Mutuality–goal achievement

This stage was characterized by greater mutual acceptance, mutual aid, and self-disclosure. Group members were encouraged to work with unity to attain the immediate objective; better the academic performance that they set in the previous stage. Knowledge acquisition that activates self-determination was the opening process here, since an individual’s “knowledge, skills, and beliefs … lead to self-determination” (Field and Hoffman, 2002:114). Towards CB, the group was provided with academic supporting grammar sessions, mathematics, and science tuition. Members good at certain topics led peer learning sessions, motivating them to focus on studies regardless of their situations. Additionally, professional training in football and swimming were given to boost their morale through sustained reciprocal interaction and interpersonal relations in the group. They benefitted from a skill training session on kitchen gardens, which covered modules on planting vegetables in limited space, selecting seeds, organic pesticides and fertilizers, and effective ways of domestic waste management. This aimed to enable them to contribute to their household by growing vegetables, which is expected to improve their connectedness with family, and to mitigate coping issues with unpleasant family environments.

Separation–termination

The ending of a group encompasses three aspects such as relationship between members, relationship with GWR and group as a whole ((Kurland and Salmon, 1998). “A successful termination is not an emotionally traumatic event for the members” (Gitterman and Salmon, 2009:168). We informed the group that it is about to end and encouraged members to reminisce about their group experience. GWR recapitulated the objectives and the group’s efforts to attain them. They made an affirmation on the requirement of keeping up the momentum they achieved through the intervention..

A procedural review was made using the records we kept, that included the day, date, and time of sessions, name of attendees, list of activities, name of resource person and designation, summary of the session, participants’ reflections, GWR’s reflections, and plan for the next session.

Group members prepared vignettes on their group experiences and handed them over to the GWR as a token of their gratitude.

For a statistical analysis of the effectiveness of SGW intervention, post-test using Ryff’s PSW scale was carried out among both the IG and CG. After the completion of analysis, this SGW intervention program was administered to the CG for ethical reasons that every participant has an equal right to receive the intervention. It was carried out by the same resource persons, in the same research setting.

Fidelity of intervention

“Greater attention needs to be given to fidelity both in the development of social, psychological, and behavioral interventions and in their execution. Fidelity is imperative in all stages and phases of intervention research, design, and implementation” (Gearing et al., 2011:83). Though assessing fidelity in intervention research is important, it is rarely done (Hardeman et al., 2008). In this study we assessed fidelity through three phases: delving, designing, and delivering. An intervention must be tailor-made to meet the concerns of the population; therefore, a precise exploration of their problems is crucial. We maintained fidelity using a detailed preliminary study in the first phase, and in the second phase we designed an SGW intervention with well-defined objectives, after an extensive literature review, and consulting with experts using the Delphi survey. In the third phase, we implemented the intervention for the target group with no deviation from the pre-defined protocol. All sessions were conducted under the supervision of social work experts.

Primary outcomes

Data collected from IG and CG using Ryff’s 42-item PWB scale before and after the intervention were analyzed statically using IBM SPSS Statistics 25. The tests were conducted against the null hypothesis, H(o): There is no significant difference between the PWB levels of participants before and after the intervention; and alternative hypothesis, H(a): There is a significant difference between the PWB levels of participants before and after the intervention.

For comparing scores obtained for PWB of participants before and after the intervention, we employed a paired sample t-test for both IG (n = 20) and CG (n = 20) separately. Tests results are shown in Tables 3 and 4.

Interpretation

For IG (Table 3), the p value obtained was <0.05 for all the six dimensions of PWB and for the total PWB; therefore, null hypothesis was rejected and alternative hypothesis was accepted. Whereas, for the CG (Table 4), the p value obtained was >0.05. Therefore, we accepted the null hypothesis. Hence, it was concluded that PWB of members of IG was raised through the intervention, while CG members’ PWB remained unchanged significantly. Thus, this analysis indicates that the social group work intervention successfully raised PWB of adolescents in the IG.

Qualitative evaluation and outcomes

Content analysis (Drisko and Maschi, 2016) of the preliminary case studies unfurled the needs and concerns of adolescents in the CSP. The risk factors identified were: low family income, stressful life events, addiction of parents, parental conflicts, single parenting, absence of social support, and absence of self-esteem and aspirations.

Based on these results, we postulated that adolescents in the CSP need psychological support, family support, and community support along with financial support, and this study developed a program for providing them an enhanced PSW.

A concomitant analysis of qualitative data collected through the intervention process enabled refining of the intervention.

The first session was characterized with members’ anxiety about an unknown situation. Based on this observation, more group games included in the next two sessions in order to reduce their anxiety and to improve group interaction. Further, the objectives of the intervention were explained well to make participants understand that the intervention is aiming at their development.

There were two members good at singing and they sang their favorite songs. They both were assigned to start the following sessions with a song alternatively.

Another member was good at drawing, and he was assigned to create the welcome board for the resource people. Establishing specific roles and developing mutual trust, the group advanced further.

In the ‘goal setting’ session, all the participants shared the goals that they wrote down in the group with a lessened inhibition. Nonetheless, all were encouraging others well with cheers and applause.

An analysis of vignettes provided a real picture about the impact of this SGW intervention program.

This qualitative outcome in congruence with the results of statistical tests that showed a significant growth in the PWB of participants, proved the effectiveness of SGW intervention in raising PWB of under privileged adolescents.

Follow-up

Thematic analysis of qualitative data collected from IG members’ parents, and their school teachers post intervention confirmed the secondary outcomes of SGW. Themes identified were gaining confidence to open up, articulating aspirations, showing academic progress, reducing truancy and involving in family matters.

These results ascertained the effectiveness of SGW in meeting the projected secondary outcomes. Being the best fit for raising PWB of CSP enrollees in the social and cultural context of research setting, these results defined the external validity and generalizability of the SGW developed and administered.

Limitations of the study

In a quasi-experimental design, a potential pitfall is the imperfect matching of groups due to the heterogeneity within groups because of the variations in living environments and family histories of members (Butler and Hickman, 2011). Another limitation is possible selection bias as this design lacks random selection of participants (White and Sabarwal, 2014), though it offers a practical option for avoiding ethical concerns in conducting impact evaluations of an intervention with a group that is already a part of another program or agency. Besides, an interference of confounding factors is likely to occur in any experimental or interventional study. Moreover, a possible shortcoming surfaces while administering Ryff’s inventory to adolescents in that they may respond in a socially desirable way rather than their real response to the statements (Seifert, T.A., 2005).

Underlying data

Harvard Dataverse: Social Groupwork for Promoting Psychological Well-being of Adolescents Enrolled in Sponsorship Programs. https://doi.org/10.7910/DVN/V6EBAX (Joseph, 2021).

The project contains the following underlying data:

Extended data

Zenodo. Social Group Work for Promoting Psychological Well-being of Adolescents Enrolled in Sponsorship Programs. https://doi.org/10.5281/zenodo.4962858 (Joseph and Karalam, 2021).

This project contains the following extended data:

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Reporting guidelines

Zenodo: TREND checklist for ‘Social Group Work for Promoting Psychological Well-being of Adolescents Enrolled in Sponsorship Programs’. https://doi.org/10.5281/zenodo.4962858.

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).