Objective. To evaluate a family- and church-based intervention for adolescents and caregivers in rural
Kenya to improve family relationships, reduce HIV risk, and promote mental health.
Method. The intervention was developed using community-based participatory methods and focused on
strengthening family communication. Modules addressed economic, relationship, and HIV-related topics
using evidence-based behavioral strategies alongside culturally-grounded content. A stepped wedge
cluster randomized trial was conducted with 124 families (237 adolescents ages 10 to 16; 203 caregivers)
from four churches. Participants completed interviewer-administered surveys over 5 rounds. Primary
outcomes included family communication, HIV risk knowledge, self-efficacy, and beliefs. Secondary
outcomes included parenting, social support, mental health, and adolescent sexual behavior. We estimated
intent-to-treat effects via ordinary least squares regression with clustered standard errors.
Results. Relative to controls, the intervention group reported better family communication across domains
at 1- and 3-months post-intervention and higher self-efficacy for risk reduction skills and HIV-related
knowledge at 1-month post-intervention. Sexually active youth in the intervention reported fewer highrisk
behaviors at 1-month post-intervention, including unprotected sex or multiple partners. Male
caregivers in the intervention reported higher parental involvement at both time points, and youth reported
more social support from male caregivers at 3-months post-intervention. No effects on secondary
outcomes of parenting, social support, and mental health were detected.
Conclusions. This intervention holds promise for strengthening positive family processes to protect
against negative future outcomes for adolescents. Implementation with religious congregations may be a
promising strategy for improving sustainability and scalability of interventions in low-resource settings.