Taking Stock: An Adaptable Research and Partnership Model for Developing Puberty Education in 10 Countries

Marni Sommer; Margaret L. Schmitt

doi:10.9745/GHSP-D-22-00498

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TABLE 1.

The 5 Steps of the Puberty Book Development Model

Step	Description of Activities and Objectives
1. Engage stakeholders and obtain formal approvals	Objective: To generate buy-in from the government and identify appropriate data collection sites, usually 1 urban and 1 rural site in each country. Activities: Examine existing puberty resources in the select country, including meeting with key government stakeholders (e.g., ministry of education, ministry of health) to determine if a gap in puberty education exists and that a book would serve as a useful contribution. Capture inputs from additional actors, such as youth-serving NGOs, local researchers, and advocates knowledgeable about youth issues.
2. Conduct participatory research	Objectives: To capture adolescent stories about growing up, questions about puberty, and recommendations for what other girls and boys need to know as they reach puberty; to capture adults’ perspectives on beliefs and issues of importance. Activities: Conduct participatory activities with adolescent girls and/or boys (aged 15–19 years) in and out of school. Interview adults (e.g., parents, teachers, health workers, and religious leaders) who interact in young peoples’ lives in the local context.
3. Draft book content	Objective: To include content that combines basic puberty guidance grounded in local education curricula, a selection of written stories directly authored by girls and boys, and a series of questions and facts. Activities: Draft written content. Local stakeholders review draft and provide inputs. A local illustrator, translator, and publisher develop an illustrated draft of the book for field-testing.Note: In many countries, the books are dual language, with the languages being taught in schools on the same page to enable improved comprehension. The language selection for the book is carefully determined by the local government. Hiring of local talent supports investment in the local economy and ensures that the content is socially and culturally appropriate to the context.
4. Field-test and finalize	Objectives: To ensure the book content is appropriate and meaningful to youth and acceptable to the adults in their lives, including parents, government, and key stakeholders; and to ensure the literacy level is correct for the average reader and that youth feel that the images align with the words on each page. Activities: Field-test with girls or boys aged 10–14 years; significant time is spent reviewing each page for the illustration and text used. Youth-recommended edits are prioritized when finalizing the book content in each context. Field-test with primary school teachers, parents or caregivers, health and education members of government, and other relevant stakeholders.
5. Distribute and review	Objective: To disseminate the book. Activities: In many countries, 10,000–15,000 pilot book copies were distributed to local stakeholders that supported the book development process, along with other youth actors (e.g., schools and youth centers that participated in the data collection, youth-serving NGOs, UN agencies, and government champions). Submit the book for review by government education bodies as a supplementary reader in schools. In some countries, after approval has been received, additional translations of the book(s) are created, usually by government request.Note: In terms of their usage, the books are designed for young people to receive and read on their own, ideally taking them home to share with siblings, parents, or family members or youth who are out of school. However, in some contexts, NGOs or schools have opted to incorporate the books into clubs or programming, with teachers or peer educators interacting with youth as they read.

Abbreviations: NGO, nongovernmental organization; UN, United Nations.

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TABLE 2.

Illustrative List of Participatory Activities Used With Girls and Boys

Activity Type	Description	Adaptation for Girls	Adaptation forBoys
Individual (boys and girls)	Puberty questions: Girls and boys are asked to write 3 anonymous questions they have about puberty or body changes. The team provides responses to the questions during subsequent group sessions.
	Story writing: During different sessions, each youth is given prompts for writing anonymous stories about puberty experiences, including their advice for younger youth. Note: Some of the story writing requires preparatory activities, such as explaining the meaning of “peer pressure.”	In most countries, girls write 1 story. Menstrual stories: Girls are asked to write a 1-page story about their first period, including how they felt, how they managed, who they told, and advice for younger girls. Note: One country book included peer pressure stories for girls.	In most countries, boys write 3 stories. Body change stories: Boys are asked to write a 1-page story about erections or wet dreams, including how they felt when they experienced it for the first time, how they managed, who they told, and advice for younger boys. Note: Boys also write stories about experiences of peer pressure and of engaging in or witnessing violence.
	Myths about puberty: Each girl or boy is asked to write down the period or puberty myths that they have heard.	Instructions focus on myths about menstruation.	Instructions focus on myths about all types of puberty body changes.
Group (girls only)	Drawing: In small breakout groups, girls are asked to draw and label what a “girl friendly” toilet at school would appear like.
Group (girls only)	100 million [insert local currency]: In small breakout groups, girls imagine that they have an enormous amount of local currency and use it to list all the ways they would improve the school environment for girls experiencing puberty and menstruation.

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TABLE 3.

Illustrative List of Peer-Reviewed Puberty Evidence Generated From the Model

Country	Peer-Reviewed Evidence
Cambodia	Scandurra et al., 2016⁶ Connolly and Sommer, 2013²⁰
Ethiopia	Blake et al., 2017²¹ Smiles et al., 2017²²
Ghana	Sommer and Ackatia-Armah, 2012²³
Madagascar	Sommer et al., 2020²⁴
Pakistan	Mumtaz et al., 2019²⁵
Tanzania	Sommer et al., 2015⁷^,^a Sommer et al., 2014¹⁴^,^a Teizazu et al., 2023²⁶ Sommer, 2011²⁷ Sommer, 2009²⁸^,^a
USA	Schmitt et al., 2022²⁹ Schmitt et al., 2022³⁰ Schmitt et al., 2021³¹
Cross-country	Sommer et al., 2015¹⁶

↵a The studies leading to these articles included the integration of the methodologies aimed at the book development in each country but were also part of larger studies with additional funding sources.