Resilience and Adolescent Health: An assessment of risks and assets in the Bañado Sur neighborhood of Asunción, Paraguay Open Access

Rios, Vanessa (2013)

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Background: Resilience describes the attainment of positive outcomes despite adversity and the process by which these outcomes are achieved. In a global health context where youth development often occurs in environments with accumulated risk factors, resilience-based interventions could serve to improve outcomes across multiple dimensions of health and wellbeing. However, while the utility of these interventions is limited by their contextual appropriateness, resilience research in developing countries and with marginalized populations remains scarce.

Methods: This qualitative study was conducted in the Bañado Sur neighborhood on the outskirts of Asunción, Paraguay, characterized by poverty and marginalization. In-depth interviews were conducted with 20 adolescents from this community who were identified as particularly resilient. Data were analyzed to understand how adolescents were able to effectively navigate their adverse environments and to characteristics of these positive deviants that could be applied to promote resilience across multiple outcomes among other youth in the community.

Results: Factors at the community, organizational, interpersonal, and individual level influenced adolescents' resilience by motivating them to persevere despite adversity, shaping their decision making, and helping them navigate towards resources. Resilience emerges from interactions among factors within these different social ecological strata. More so than any one factor in isolation, several factors were identified as pathways that connected youth to multiple assets and resources. Sports, school, religion, and Mil Solidarios, the community-based organization hosting the present study, were discussed as pathways by the participants.

Discussion: While many of the general findings of the present study were consistent with the broader resilience literature, some factors appear to have stronger implications for resilience among youth in the Bañado Sur, highlighting the importance of understanding youth resilience in a context-specific way. Particularly relevant to youth in the Bañado Sur were the perception of education as the means for social mobility, the importance of collective struggle, resilient role models, and social distancing skills. Additionally, the concept of resilience pathways has important implications: connecting youth to one of the identified pathways could have far-reaching effects on their resilience because of their effects across multiple levels of individuals' ecologies and dimensions of their lives.

Table of Contents

Table of Contents

Chapter 1: Introduction 1

1.1 Introduction and rationale 1

1.2 Purpose statement and research question 2

1.3 Significance statement 3

Chapter 2: Review of the Literature 4

2.1 Positive development and the emergence of resilience research 4

2.2 Defining resilience 5

2.3 Multidimensional risk and protective factors for adolescent health behaviors 7

Sexual and Reproductive Health (SRH) 7

Alcohol and Substance use 9

Violent behavior 11

2.4 Resilience-based interventions 12

2.5 International resilience literature 13

2.6 Positive deviance and public health 15

2.7 Summary 16

Chapter 3: Methods 18

3.1 Research design 18

3.2 Study site 18

3.3 Study Population 19

3.4 Data collection methods 21

3.5 Participant recruitment 21

3.6 Data collection process 22

3.7 Data preparation and analysis 23

3.8 Data quality and limitations 24

3.9 Ethical considerations 25

Chapter 4: Results 27

4.1 Community-level influences 27

Community solidarity 27

Giving back to the Bañado Sur 30

4.2 Organization-level influences 33

Mil Solidarios and schools 33

Soccer 35

Religion 39

4.3 Interpersonal-level influences 41

Family support 41

Responsibility to family 44

Peer relationships 46

Role models 50

4.4 Individual-level influences 51

Avoiding risky environments 52

Distancing skills and navigating the social environment 53

Refusal skills 55

Personal hopes and goals for the future 56

Self-efficacy 58

Chapter 5: Discussion and Recommendations 63

5.1. Summary of findings 63

5.2 Pathway Case Study 1: Francisco and Soccer 64

5.3 Contextually-specific findings 66

5.4 Pathway Case Study 2: Alejandra and School 67

5.5 Potential recommendations for Mil Solidarios' programs 70

Improving communication around important issues in the lives of adolescents 71

Providing different types of role models 72

Promoting mentoring relationships 73

Create opportunities for others' investment in youth 73

5.6 Limitations 75

Bibliography 76

Appendix 1 80

Appendix 2 81

Appendix 3 82

Appendix 4 88

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