Effects of health empowerment intervention on resilience of adolescents in a tribal area: A study using the Solomon four-groups design Kaushik Sarkar a, * , Aparajita Dasgupta a , Multipada Sinha b , Bhaskar Shahbabu a a Department of Preventive & Social Medicine, All India Institute of Hygiene & Public Health, Kolkata, India b Jadavpur University, Kolkata, India article info Article history: Received 3 June 2016 Received in revised form 9 May 2017 Accepted 21 May 2017 Available online xxx Keywords: Resilience Health locus of control Self-determination Adolescent health Mental health Life skills education Empowerment abstract Rationale: Resilience prevents the emergence of stress-related mental health problems among adoles- cents. Adolescents in tribal areas of India are more prone to develop such problems. Objectives: The primary objective was to determine the effect of combined life skills-based health empowerment intervention on the resilience of school-going adolescents in a tribal area. The secondary objectives were to determine the effect of the intervention on internal health locus of control and self- determination and to compare the effect of intervention on resilience between non-tribal and tribal adolescents. Methods: We conducted this quasi-experimental study using a Solomon four-group design among 742 adolescents in two schools of Purulia, West Bengal, India. Students of the pretested group were examined for resilience using the Child Youth Resilience Measurement scale. A life skills education-based health empowerment intervention was administered among students of the experimental group. Post-test data on resilience, self-determination, internal health locus of control and pathological behaviour was ob- tained 3 months after the completion of intervention. A multi-level general linear mixed model was constructed to determine the effect of intervention on resilience. Results: Resilience was less among tribal adolescents at baseline. The intervention significantly improved resilience [b Adjusted ¼ 11.19 (95% CI ¼ 10.55,11.83], with a greater increase for tribal adolescents [b tribal- nontribal ¼ 1.53 (95% CI ¼ 0.03, 3.03)]. The intervention also significantly improved internal health locus of control (marginal mean increment 1.38 ± 0.05), self-determination (marginal mean increment 3.71 ± 0.09) and reduced pathological behaviour of the adolescents. Conclusion: Our study informed the current health policy that the existing life skills education-based programme should be reviewed and modified to include generic life skills, and the life skills education-based programme should be coupled with developmental interventions aimed at improving adult education and family climate for optimum effect on mental health and health behaviour of adolescents. © 2017 Elsevier Ltd. All rights reserved. India is home to more than 243 million adolescents (UNICEF, 2011); a large proportion of them suffer from some form of mental and behavioural problems (Sunitha and Gururaj, 2014). Certain unhealthy behaviours (e.g., substance abuse) and most mental health problems are linked to the negative affect state and unsuccessful coping in the presence of stress (Fennell et al., 1981; Ragland, 1996; Revell et al., 1985; Sunitha and Gururaj, 2014). Many Indian adolescents are highly vulnerable because of poor education, early marriage, lack of autonomy, gender inequality, limited access to health care facilities, etc. (Population Council & UNICEF, 2013). Indian adolescents residing in tribal areas are exposed to an even greater risk of developing stress-related mental health problems because they face greater adversity in life course and are deprived of even the basic amenities (Islam, 2013; Rao et al., 2006). In recent years, a growing number of studies have focussed on successful coping to prevent the emergence of mental and * Corresponding author. Department of Preventive & Social Medicine, All India Institute of Hygiene & Public Health, 110 C. R. Avenue, Kolkata, 700073, India. E-mail address: dr.kaushiks@yahoo.in (K. Sarkar). Contents lists available at ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed http://dx.doi.org/10.1016/j.socscimed.2017.05.044 0277-9536/© 2017 Elsevier Ltd. All rights reserved. Social Science & Medicine xxx (2017) 1e10 Please cite this article in press as: Sarkar, K., et al., Effects of health empowerment intervention on resilience of adolescents in a tribal area: A study using the Solomon four-groups design, Social Science & Medicine (2017), http://dx.doi.org/10.1016/j.socscimed.2017.05.044