Adaptation, acceptability and preliminary impacts of a sexual health and financial literacy intervention for indigenous adolescents in Ecuador: A mixed-methods pilot study

Objectives To assess the acceptability, feasibility and preliminary impacts of a group-based financial literacy and reproductive health intervention adapted for indigenous youth in Ecuador. Study design Mixed-methods quasi-experimental pilot study. Methods This study (November 2023–June 2024) enrolled 47 adolescents, ages 15–19, from Cotacachi, Ecuador. Using the ADAPT-ITT framework, we adapted an existing entrepreneurship curriculum to the local context, and integrated curriculum with an existing reproductive health education platform. Twenty-nine adolescents received the school-based group intervention over 4 months, with 18 control participants. Qualitatively, focus groups elicited intervention acceptability from 11 youth. Quantitatively, Wilcoxon rank-sum tests and MANOVA compared empowerment and health outcomes between intervention participants and controls. Adjusted linear and logistic regression estimated intention-to-treat effects of the intervention on outcomes. Results The study recruited 96.7 % and 60.0 % of the target sample for the intervention (29/30) and control (18/30) conditions, respectively. Regression results showed positive associations between the intervention and financial literacy ( β = 1.33, p < 0.01) and sexual health knowledge ( β = 1.52, p < 0.01), and modest positive associations (p > 0.10) with entrepreneurial self-efficacy, engagement in income-generating activities, gender empowerment, and less-frequent penetrative sex. All focus group participants valued the financial management and entrepreneurship components of the intervention; most stated that the curriculum improved their decision-making around sex and relationships. Conclusions This pilot evidence supports acceptability and potential benefits of an economic empowerment and reproductive health intervention for indigenous youth at high risk of pregnancy in Ecuador. A randomized trial is needed to test the effectiveness of the intervention on longer-term income generation and pregnancy reduction.