From hope to health: improving sexual and reproductive health knowledge among adolescent orphan girls through the ‘HopeBox’ intervention in Bangladesh

Abstract

Background: Orphaned adolescent girls face critical barriers to accessing accurate sexual and reproductive health (SRH) knowledge, which predisposes them to risky sexual behaviours and their consequences. We aimed to evaluate the effectiveness of the 'HopeBox' intervention in improving SRH knowledge among orphaned adolescent girls living in orphanages in Bangladesh. Methods: We adopted a pre- and post-test design to conduct the study from January 2022 to September 2025 among orphaned adolescent girls in three government-run orphanages in Dhaka, Faridpur, and Chuadanga, Bangladesh. We enrolled 173 eligible participants. We performed descriptive analyses to explore the distribution of sociodemographic variables and SRH indicators. We used McNemar's tests to assess significant changes before and after the intervention. Generalised estimating equations with Firth penalisation were used to evaluate intervention effects after adjusting for relevant covariates and addressing data separation issues. Results: All five SRH knowledge indicators improved significantly: menstruation (34.73%), pregnancy avoidance (36.42%), contraceptive methods (37%), correct contraceptive use (32.92%), and sexually transmitted diseases (STDs) prevention (12.71%). After adjusting for covariates, participants in the post-intervention phase had substantially higher odds of demonstrating knowledge across all indicators, including menstruation (adjusted odds ratio (aOR) = 17.77; 95% confidence interval (CI) = 7.75-40.75), pregnancy avoidance (aOR = 21.86; 95% CI = 9.73-49.14), contraceptive methods (aOR = 41.73; 95% CI = 15.74-110.65), correct contraceptive use (aOR = 165.40; 95% CI = 28.42-962.79), and STDs prevention (aOR = 26.28; 95% CI = 5.65-122.23). Conclusions: The 'HopeBox' intervention improved SRH knowledge among orphaned adolescent girls, highlighting the need to scale up 'HopeBox' for orphan and vulnerable adolescents in Bangladesh to ensure equitable, appropriate, and accurate SRH knowledge.