Engagement-related process factors in services for street-connected children and young people in low and middle income countries: a thematic synthesis

A recent Cochrane/ Campbell systematic review of interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street-connected children and young people, supported by the International Initiative for Impact Evaluation (3ie), identified 11 studies evaluating 12 different interventions which met the inclusion criteria (Coren et al. 2013). The research studies had to contain a comparison group and look at street-connected children and young people between the ages of 0 and 24. None of the included studies were from low- and middle-income countries (LMICs), or involved process evaluations. The current thematic synthesis focused on engagement processes and strategies in studies pertaining to LMICs but excluded from the review on methodological grounds, complemented by studies identified through a search update conducted in March 2013. We included twenty-seven qualitative or mixed methods studies, which examined broad range of interventions and services adopted in 21 LMICs. The synthesis methods were primarily qualitative. On the basis of our findings, we conceptualised engagement as consisting of outreach and sustaining phases. Three separate dimensions emerged in the sustaining phases: meeting multiple needs, relations to adult service users, and community and family engagement. Our synthesis outlines challenges and dilemmas of engagement in each of these areas. The data also highlighted some common shortcomings in the service sector in LMICs, including lack of appropriate professional training and service development, lack of funding, and lack of co-operation with other relevant agencies. Innovative approaches to engagement, such as participatory initiatives and partnerships with universities, are also discussed.