Impact of youth-led sexual and reproductive health initiatives on adolescents' and caregivers' knowledge, attitudes and self-confidence in displacement settings in Gaza: A quasi-experimental pre-post study.

BACKGROUND: Adolescents and caregivers in displacement settings face increased sexual and reproductive health (SRH) risks. OBJECTIVES: To evaluate the impact of youth-led SRH initiatives on knowledge, attitudes, and self-confidence among adolescents and caregivers in displacement settings in the Gaza Strip. DESIGN: Single-group quasi-experimental pre-post study without a concurrent control group. METHODS: The study was conducted from August to December 2025, among 1,521 internally displaced participants recruited by convenience sampling from Gaza City, the Middle Area, and Khan Younis. Participants attended 42 interactive, culturally sensitive sessions facilitated by trained youth volunteers. SRH knowledge (12 items), attitudes, and self-confidence (2 items) were assessed before and after the intervention. Data were analyzed using SPSS, version 25, with p < 0.05 considered statistically significant. RESULTS: Post the intervention, good/positive knowledge increased from 37.6% to 88.4%, while good/positive attitudes and self-confidence increased from 9.9% to 76.8%. Total knowledge increased significantly (mean change, 1.01; 95% CI, 0.977-1.026; t=50.143; df=1520; P<0.001), as did attitudes and self-confidence (mean change, 1.30; 95% CI, 1.231-1.369; t=36.983; df=1520; P<0.001). All individual items showed significant improvements (Holm-adjusted P<0.001). Knowledge improvement did not differ between adolescents and caregivers (t=0.00; df=1519; P=1.000), whereas adolescents had greater improvement in attitudes and self-confidence (1.40 vs. 1.28; t=2.42; df=1519; adjusted P=0.032). CONCLUSIONS: Youth-led, culturally sensitive SRH education was associated with substantial short-term improvements in knowledge, attitudes, and self-confidence among adolescents and caregivers in displacement settings. However, the single-group pre-post design and immediate post-intervention assessment preclude definitive causal conclusions. Further controlled studies are recommended.