Teen motHers' ReproductIve and behaVioral Health intErvention in Barbados

Teen pregnancy remains a significant public health concern in many parts of the world, including Latin America and the Caribbean (LAC). Young mothers in these regions often experience high rates of repeat, unplanned pregnancies, mental health challenges, limited educational opportunities, and reduced access to reproductive and behavioral health care. Despite the need, there are few published, evidence-based interventions targeting this population in the Caribbean, and even fewer that take a holistic, integrated approach.

This study introduces THRIVE - Teen motHers' ReproductIve and behaVioral health intErvention - a novel, integrated care program designed to support the overall health and development of young mothers in Barbados who became pregnant during adolescence. The THRIVE program provides education and support in both reproductive and behavioral health, recognizing that these domains are deeply interconnected in the lives of young mothers.

The study is a randomized controlled trial (RCT). It is designed to assess whether the THRIVE intervention improves participants' mental health, parenting confidence, and reproductive health outcomes compared to standard care. It also aims to reduce the risk of repeat adolescent pregnancy and promote engagement in school or professional development.

Background and Rationale Studies in high-income countries have shown that teen pregnancy prevention efforts are most effective when they include empowerment through education and psycho-social support. However, in LAC regions such as Barbados, there is a lack of published evidence on whether similar approaches can be successfully adapted and implemented. Many existing programs narrowly focus on a single health domain (e.g., sexual health education or treatment of depressive symptoms) and often overlook the broader context of a teen mother's life, including parenting stress, family support, and barriers to education or employment.

THRIVE was developed in response to this gap. It is a culturally appropriate, multidimensional intervention that integrates reproductive and behavioral health education tailored specifically for young mothers in Barbados. This study seeks to generate scientific evidence on the feasibility, acceptability, and preliminary effectiveness of THRIVE, laying the foundation for future longitudinal studies in the region.

Study Design This is a two-arm, randomized controlled, double-blinded Phase 0 clinical trial involving a total of 50 participants, with 25 randomized to the THRIVE intervention group and 25 to the control group receiving standard care. Participants are young women between the ages of 10 and 25 who became pregnant between the ages of 10 and 19, are from low-income households (defined as an annual income of ≤ BDS $20,000 or USD ~$10,000), and report mood-related symptoms such as sadness or lack of interest following childbirth.

Intervention: THRIVE Program

The THRIVE intervention group will participate in seven biweekly sessions, delivered either in person at accessible community sites (e.g., Rotary Club of Barbados) or via virtual conferencing platforms. Each session includes:

• A brief health check (e.g., vital signs)
• A 40-minute interactive psychoeducation module
• A 15-minute assessment and feedback session

The THRIVE curriculum integrates topics across five key domains:

• Reproductive Health Education - contraception, safe sex, STI prevention
• Behavioral Health Support - managing stress, anxiety, depression, and mood
• Parenting Skills - building confidence in parenting, positive discipline
• Social Support - identifying and using family and community resources
• Professional Development - goal setting, school re-engagement, job readiness

Each module includes clear learning objectives, practical tools, and opportunities for self-reflection. Participants are encouraged to apply what they learn between sessions. They will also receive light snacks, printed materials, and regular follow-up contact.

The control group will continue receiving the usual care provided through local clinics or community partners. They will undergo the same assessments as the intervention group but will not receive any THRIVE modules.

Study Objectives and Outcomes The primary objective of the study is to evaluate whether the THRIVE intervention improves young mothers' overall health, mood, and parenting skills. The secondary objective is to assess whether the program reduces the likelihood of repeat, unintended pregnancy and improves participants' engagement with school or professional opportunities.

Researchers will assess outcomes through structured interviews and validated measurement tools at baseline and follow-up. The measures include:

• Mental health symptoms (depression, anxiety, stress)
• Parenting attitudes and behaviors
• Use of contraception and reproductive health practices
• Social support
• School or job engagement
• Repeat pregnancy incidence (as self-reported)

All participants will complete assessments via structured interviews administered by trained research assistants or volunteer medical students. The data will be collected using secure digital tools and analyzed using statistical methods appropriate for small randomized trials.

Participant Support and Ethical Considerations The THRIVE study has been designed to prioritize the dignity, safety, and autonomy of participants. Written informed consent will be obtained from all participants. For those under 18, both parental/guardian consent and participant assent will be required.

Participants are free to withdraw from the study at any time without consequence. The research team is trained to identify signs of distress, abuse, or unsafe situations, and will provide referrals to appropriate services if needed.

To support participation, all individuals who complete study assessments will receive an incentive. Snacks and drinks will also be provided during in-person sessions. Participants in both groups will be treated with equal respect and receive the same level of follow-up care and attention.

This study will be conducted in accordance with the latest version of the Declaration of Helsinki and is currently pending reviewing and approval by the Institutional Review Board (IRB) of Ross University School of Medicine. The THRIVE protocol also adheres to national and institutional ethical standards for research involving human participants.

Innovation and Community Impact THRIVE represents one of the first published, structured interventions of its kind in the Caribbean. It integrates health, education, and psychosocial care into one coordinated program - a unique model in this context. The study will not only address the immediate needs of participants but will also contribute data to help shape public health policy and practice in the Caribbean and beyond.

Through partnerships with local clinics, schools, and organizations such as the Rotary Club of Barbados, the THRIVE study strengthens community capacity for supporting vulnerable young mothers and promotes intergenerational health improvement.

The findings will be shared with local stakeholders and published in peer-reviewed journals to expand the body of knowledge on adolescent pregnancy prevention in low- and middle-income countries (LMICs).

Future Directions

While this is a pilot study, the long-term goal is to use findings from THRIVE to:

• Inform the development of larger-scale interventions and cohort studies
• Guide educational and health policy initiatives across the LAC region
• Establish best practices for integrated care models for adolescent mothers

The THRIVE model has the potential to be adapted to other LAC countries and similar contexts globally, ultimately contributing to the global effort to reduce repeat adolescent pregnancy, improve mental health, and support the next generation of healthy, empowered mothers.

Important Administrative Note:

This study was originally registered under the administrative affiliation of Ross University School of Medicine (RUSM). While the study concept originated and was developed by the Sponsor-Investigator, the original IRB submission to RUSM experienced delays due to institutional backlog and administrative constraints. As of October 4, 2025, no participants have been enrolled under RUSM IRB oversight, and no data has been collected.

Following consultation with the Caribbean Public Health Agency Ethics Review Committee (CANREC), the Sponsor-Investigator was advised that ethical review and approval should be obtained through a local Institutional Review Board in Barbados. The study will not proceed until local IRB approval has been secured.

The Organization's Unique Protocol ID "RUSM20240405-CANREC20250903" reflects the administrative history of the project, including initial registration under RUSM on April 5, 2024, and subsequent guidance provided by CANREC beginning September 3, 2025. This identifier is maintained for administrative continuity only.

Inclusion criteria

• Young mothers aged 10 to 25 years residing in Barbados
• Experienced adolescent pregnancy between ages 10 and 19 years
• Living in low-income households with annual income BDS $20,000 (~USD 10,000) or below
• Screen positive for depressed mood symptoms using the Patient Health Questionnaire-2 (PHQ-2), indicating feeling "little interest or pleasure in doing things" and/or feeling "down, depressed, or hopeless" over the past 2 weeks
• Able to provide informed consent or assent (with parental consent if under legal age)
• Willing to complete study questionnaires and attend scheduled visits

Exclusion criteria

• History of heart disease, head trauma, hypertension, diabetes, psychiatric, or neurological conditions
• Severe cognitive or medical conditions preventing participation
• Enrollment in conflicting interventional studies
• Insufficient proficiency in study languages without access to interpretation (if applicable)