“I was told to live happily… without telling me how”: Experiences of married adolescents, their spouses and families with a life skills intervention in rural Pakistan – a qualitative study.

Background: Adolescent marriage and early childbearing remain common in rural Pakistan, yet few interventions support young couples as they transition into parenthood. This study explores the perceived impact and implementation of Preparing for Parenthood (PPP), a life skills intervention designed for married adolescents and their families. Methods: A qualitative design was used to explore participants’ and delivery agents’ experiences of the PPP intervention. Data were collected through 12 in-depth interviews and 4 focus group discussions with adolescent women, their spouses, and family members, and programme trainers alongside brief post-intervention surveys. Thematic analysis was used to analyse data. Results: The PPP intervention was perceived as relevant, acceptable, and empowering. Participants reported improved communication, emotional regulation, problem-solving, and decision-making - core life skills that enhanced their confidence and preparedness for parenting. Home-based delivery by trusted female PPP trainer and recruitment via community health workers supported engagement, especially in mobility-restrictive, patriarchal settings. Challenges included limited male participation, family gatekeeping (especially from mothers-in-law), and the burden of domestic work. Participants suggested context-appropriate adaptations such as mobile content, male facilitators, and media-based delivery to address these barriers. Conclusions: This study highlights the value of life skills interventions in equipping married adolescents with the socioemotional competencies necessary for effective parenting. Home-based, culturally grounded delivery models - when paired with flexible, gender-sensitive approaches - can foster empowerment and improve outcomes in low-resource, gender-restrictive settings.