Promoting Adolescent Girls’ Well-Being in Pakistan: a Mixed-Methods Study of Change Over Time, Feasibility, and Acceptability, of the COMPASS Program Khudejha Asghar 1 & Yana Mayevskaya 1 & Marni Sommer 1 & Ayesha Razzaque 2 & Betsy Laird 3 & Yasmin Khan 4 & Shamsa Qureshi 4 & Kathryn Falb 3 & Lindsay Stark 1 # Society for Prevention Research 2018 Abstract Promoting resilience among displaced adolescent girls in northern Pakistan may buffer against developmental risks such as violence exposure and associated longer-term consequences for physical and mental well-being. However, girls’ access to such programming may be limited by social norms restricting movement. A mixed-method evaluation examined change over time, feasibility, and acceptability of the COMPASS program in three districts of Khyber-Pakhtunkhwa province through a single- group within-participant pretest-posttest of adolescent girls aged 12–19 enrolled in the intervention (n = 78), and qualitative in- depth interviews with girls following posttest completion (n = 15). Primary outcomes included improvements in movement, safety, and comfort discussing life skills topics with caregivers, operationalized quantitatively as number of places visited in the previous month, number of spaces that girls felt safe visiting, and comfort discussing puberty, education, working outside the home, and marriage, respectively. Secondary outcomes included psychosocial well-being, gendered rites of passage, social support networks, perceptions of support for survivors of violence, and knowledge of services. Quantitative pretest-posttest findings included significant improvements in movement, psychosocial well-being, and some improvements in social support, knowledge of services, and gendered rites of passage; findings on safety and comfort discussing life skills topics were not significant. Qualitative findings illuminated themes related to definitions of safety and freedom of movement, perceptions and acceptability of program content, perceptions of social support, and perceptions of blame and support and knowledge of services in response to violence. Taken together, findings illustrate positive impacts of life skills programming, and the need for societal changes on gender norms to improve girls’ safety in public spaces and access to resources. Keywords Pakistan . Internal displacement . Adolescent girls . Violence . Restricted movement Introduction Globally, adolescence marks the period of greatest risk of interpersonal violence for girls (UNICEF 2014a). In addition to physical and sexual violence from caregivers and other adult authority figures, adolescent girls in South Asian con- texts are subject to forms of violence such as early and forced marriage, Bdowry murders^ or honor killings, and acid attacks (Fikree and Pasha 2004). Long-term effects of violence expo- sure during adolescence include increased risk of HIV, phys- ical injury and disability, poor mental well-being, and suicidal ideation (Berenson et al. 2001; Fatusi and Hindin 2010; Olofsson et al. 2012). Vulnerability to victimization may be amplified during political insecurity, as displacement has been associated with higher rates of early marriage (Sarhad Rural Support Programme 2016; UNICEF 2014b). Restrictions on adolescent girls’ movement in more conser- vative or rural South Asian communities may be a barrier to accessing violence prevention or response services (World Bank 2005). For example, purdah ideology in Pakistan man- dates gender segregation and promotes the restriction of * Lindsay Stark ls2302@cumc.columbia.edu 1 Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave B-4 Suite 432, New York, NY 10032, USA 2 Islamabad, Pakistan 3 International Rescue Committee, 122 E 42nd St, New York, NY 10168, USA 4 International Rescue Committee, Islamabad, Pakistan Prevention Science https://doi.org/10.1007/s11121-018-0890-9