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Co-producing school-based mental health and wellbeing interventions: A mixed methods intervention development study

Reed, Hayley ORCID: 2021. Co-producing school-based mental health and wellbeing interventions: A mixed methods intervention development study. PhD Thesis, Cardiff University.
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School-based mental health and wellbeing interventions demonstrate mixed and sometimes limited effectiveness, partially attributed to a lack of fit with school needs and contexts. Increased support for stakeholder co-production to address these issues has led to a growing number of school-based health co-production intervention studies. Whilst there is an emergent effectiveness literature about these, our understanding of the different co-production types, their intervention theories and properties, and stakeholders’ experiences of them is lacking. This thesis aimed to address this through developing programme theory for the co-production of school-based health interventions. To achieve this, a mixed methods intervention development study with two sequential phases was undertaken. Phase 1 aimed to build promising intervention theory, predominantly through a systematic review of co-production studies. Subsequently, phase 2 aimed to refine this theory by delivering in two schools the co-production intervention, focusing on mental health and wellbeing; and assessing it through a process evaluation. The phase 1 systematic review described three co-production types, with the system-level capacity-building type chosen for phase 2. This type involved the establishment of Research Action Groups (RAGs) with multiple school and external stakeholders that developed school-specific wellbeing plans. It was chosen because it provided a strong evidence base to develop theory from and was found to more likely lead to stakeholders’ health ideas being delivered than other types. Theoretical gaps were addressed through stakeholder involvement, and a pilot of participatory methods to elicit students’ understandings of wellbeing. Phase 2 involved two contextually diverse case study secondary schools developing RAGs with researcher support. The process evaluation assessed implementation, context, mechanisms of change, and social validity between cases and across stakeholders. Successful implementation was due to intervention alignment with schools’ perceived needs and duties, the redistribution of school resources to interventions, and intervention flexibility which accommodated school priorities and schedules. Further, the intervention adequately resourced, guided, and empowered RAGs to share problem-setting decision-making. This led to a high level of agreement between stakeholders and across schools that resultant plans were relevant and implementable in the contexts created. However, major differences between schools on intervention embeddedness and the favourability of baseline conditions for student wellbeing and voice were found. In one case study this resulted in agents supporting the delivery of co-production, engaging in co-production processes, and the school adopting three plan priorities. Whilst in the other, the lack of staff and SMT engagement and support resulted in no plan priorities being adopted. Challenges were also found in both case studies with engaging families and undertaking problem-solving decision-making. Refinements to co-production theory to address these challenges were made.

Item Type: Thesis (PhD)
Date Type: Completion
Status: Unpublished
Schools: Social Sciences (Includes Criminology and Education)
Subjects: H Social Sciences > H Social Sciences (General)
Date of First Compliant Deposit: 19 May 2022
Last Modified: 18 May 2023 01:30

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