This study provides the first evidence of the effects of an economic empowerment intervention—over and above usual care for orphaned children—on children’s well-being, including self-rated health and mental health functioning. It is important to note that since the study used a randomized experimental design, the observable differences between the two groups during the study period could, with some degree of confidence, be attributable to the effects of the economic intervention as implemented. Specifically, we find that the SUUBI program intervention is associated with increased levels of self-esteem, an important measure of adolescents’ mental health and psychological well-being. The positive impacts of the SUUBI program and self-esteem on self-rated health are also noteworthy. We find self-esteem to have a positive impact on self-rated health functioning.
What aspects of the SUUBI program enhance children’s mental health and health functioning? We cannot provide a clear answer to this question because the SUUBI economic intervention was implemented as a package/bundle of economic empowerment services. All children in the treatment group received—over and above the usually provided care for orphaned children in Uganda—an economic empowerment intervention, as a package/bundle, comprised of a matched savings account and the associated workshops on financial management, plus a mentorship component with peer mentors on life options and career planning. Future studies may consider evaluating each program component of the SUUBI intervention by using a standardized questionnaire that measures participants’ attitudes toward specific program features. In addition, future studies should vary the elements of the economic empowerment packages so that the effectiveness of each specific element can be discerned.
Given that the research literature documents that increases in self-esteem have been associated with both positive and negative behavioral outcomes, one concern of note is whether increased self-esteem could be associated with increased sexual risk behavior or intentions to engage in sexual risk behavior. To investigate that issue, we regressed a composite of five sexual behavior intentions survey items captured at Wave 2 onto the Wave 2 self-esteem score (there was insufficient actual sexual behavior reported to investigate sexual behavior directly). Results from this analysis indicated that in this sample self-esteem was negatively associated with intentions to engage in sexual risk behavior (B = −.15, SE = .03, Z = −5.83, p < .001).
Overall, our findings have implications for theory. First, while theory suggests that positive links exist between assets and children’s well-being (Sherraden, 1991
), there have been only a few studies empirically testing this association. This study contributes to the emerging body of empirical evidence regarding the relationship between assets and children’s well-being. Specifically, the study finds that asset ownership plays a significant role in children’s mental and physical health. The results of this study also suggest that asset theory—hitherto primarily applied to studies in Western industrialized countries—can be applied to other cultures, including poor developing countries like Uganda, where many families and children face severe socio-economic hardship—including inadequate health services—which may hamper children’s physical and psychosocial development. Indeed, without interventions to improve economic well-being, these phenomena will likely only serve to keep children in these poor countries in a vicious cycle of poverty, perpetuating children’s poor mental health and health functioning.
There are some limitations that should be noted. First, with the exception of saving data which came directly from financial institutions holding the children’s savings accounts, the rest of the data used in this paper was from children’s self-report. Therefore, it is susceptible to the shortcomings of self-reporting, including social desirability. Future work would benefit from a more comprehensive understanding of psychosocial outcomes and their relationships to objective health status from multiple informants (including parents, teachers, and clinicians) and multiple methods (e.g., direct observation, clinical interviews, and laboratory test results; Demo, Small, & Savin-Williams, 1987
). Second, the data presented in this paper were based on two data points: baseline and at 10-month post-treatment. Future studies may benefit from a relatively longer follow-up period, with more data points. Third, while family income and educational attainment of parents are key measures of socioeconomic status—and hence frequently used in explaining the well-being of children—the survey did not include items on family income due to the difficulty in obtaining reliable and accurate data on this item when children are the respondents (Currie, Elton, Todd, & Platt, 1997
; Goodman et al., 2000
). In regards to parents’ educational attainment, the study did collect this information but this particular item had too many observations reported as “I don’t know
” for meaningful analysis (28% of mother’s education and 57% of father’s education were reported as “I don’t know
”). A follow-up study on SUUBI has incorporated a survey where the children’s caregivers/parents will be respondents as well. This addition is expected to strengthen the data quality for those specific items that require caregivers’ responses. Additionally, an exclusive focus on school-going adolescents in a rural setting, where many of the poorest orphans may not be in school, may mean that the participants in this study have different behavioral trends than other orphaned children not currently attending school. Future studies may benefit from a more inclusive criteria, including all orphaned children regardless of whether they are enrolled in school or not. Last but not least, although the measures used in the study had been pilot-tested in a similar project in Uganda (Ssewamala et al., 2008
), further testing of these measures used is needed. In particular, even though the standardized Tennessee Self Concept Scale (TSCS) used in this study has been used extensively on children of African descent and tested in several international settings (see Fitts & Warren, 1996
), there is a need to further test its validity and reliability with African children in a poor sub-Saharan African country like Uganda. Moreover, in future research, it would be useful to have other measures of mental health (for instance, scales measuring anxiety or depression). As Davis-Kean and Sandler (2001)
have argued, more research is needed to clearly understand how children evaluate their self-esteem and other aspects of mental health.
Overall, even with the aforementioned limitations the findings of this study indicate that in rural Uganda, asset ownership matters for AIDS-orphaned children’s well-being, including health and mental health functioning.