What programmes are needed to improve self-esteem among young people with disabilities?

Challenge #1: Negative attitudes towards young people with disabilities influence their self-esteem.

• The majority of the self-esteem improving interventions found in the literature are performed in non-mainstream settings, limiting opportunities for interaction between peers with and without disabilities which can improve emotional peer support practices for young people with disabilities.
• There is no clear picture on the extent to which peer interactions happen for young people with disabilities in settings such as the classroom, school, and outside intervention contexts which highlight the motivational factors that can be building blocks to means of participation, involvement, and self-expression within peer group self-esteem improving programmes.   

Challenge #2: The evidence base for self-esteem interventions is limited, and mostly based on studies in high-income countries (HICs)

• As the majority of self-esteem interventions for youth with disabilities have thus far been implemented in high income countries (HICs), the effectiveness and cost-effectiveness of these programmes is not well-established in LMICs.
• Current evidence-based self-esteem interventions lack approaches that target different levels of young people with disabilities’ environments (families, communities, schools, and organisations such as education, health, OPDs and NGOs), which is crucial in LMICs.
• There is also limited data on young people with disabilities’ perspectives on participating in self-esteem interventions. 

Challenge #3: That research which does exist has limitations which impact our understanding of effectiveness and best practices for implementation  

• For self-esteem interventions to be successful, they must reflect the norms, culture, context, and constraints of LMICs, but there is a gap in the research regarding key challenges, identified needs, and successful/unsuccessful programmes.
• Environmental factors such as family social demographics, accessibility, and community support for interventions and young people with disabilities affect attendance at and participation in intervention in LMICs, but because of the lack of research in these settings, evidence on their influence is lacking.
• Existing trials in interventions that improve self-esteem are small scale and often lack data or opportunities to explore differences in participant outcomes based on sociodemographic characteristics such as disability type.
• Programming approaches also often rely on delivery through institutions such as schools, specialist centers, and medical facilities, and these are concentrated in urban areas.
• Self-esteem intervention trials may demonstrate the social and economic importance but the extent to which effects are maintained over time is unclear.

Challenge #4: Interventions to improve self-esteem tend to be elective and short-term

• Interventions to improve self-esteem tend to be self-selective, and so oversubscribed by those who are willing to participate, leading to an under-representation of boys in such programming.
• Self-esteem interventions which solely target young people with disabilities may not have impacts on social inclusion, possibly contributing to isolation and undermining peer relationships.
• Short-term self-esteem interventions do not account for the impact long-term participation in programmes have on young people with disabilities’ attitude towards school and self-concept, thus making it hard to measure improved academic performance or improvement in longer term wellbeing and mental health.
• Targeted interventions implemented in mainstream schools may fail to reach young people with disabilities attending mainstream schools as useful knowledge about peers who offer and receive support or whether these are young people with disabilities is limited.