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Development of a school-based programme for mental health promotion and prevention among adolescents in Nepal and South Africa

Laurenzi, Christina A., du Toit, Stefani, Mawoyo, Tatenda, Luitel, Nagendra P., Jordans, Mark J.D., Pradhan, Indira, van der Westhuizen, Claire, Melendez-Torres, G.J., Hawkins, Jemma ORCID:, Moore, Graham ORCID:, Evans, Rhiannon ORCID:, Lund, Crick, Ross, David A., Lai, Joanna, Servili, Chiara, Tomlinson, Mark and Skeen, Sarah 2024. Development of a school-based programme for mental health promotion and prevention among adolescents in Nepal and South Africa. SSM Mental Health 5 , 100289. 10.1016/j.ssmmh.2023.100289

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Introduction Adolescence is a critical time for mental health promotion and prevention and establishing healthy behaviours. Implementing universal, school-based psychosocial interventions can improve short- and long-term health trajectories for adolescents. While these interventions may offer important opportunities for fostering skills and relationships, few school-based interventions have been developed for and tested in low- and middle-income countries (LMICs) where adolescent mental health needs may be significant and under-served. This manuscript details the development of a multi-component, universal school-based intervention, Health Action in ScHools for a Thriving Adolescent Generation (HASHTAG), for adolescents aged 12–15 years in Nepal and South Africa. Methods and results We describe HASHTAG's development over four phases, combining methods and results as each phase was iteratively conducted between 2018 and 2021. Phase 1 included a systematic review and components analysis, building from WHO guidelines for adolescent mental health. Seven components were strongly supported by the evidence: emotional regulation, stress management, mindfulness, problem-solving, interpersonal skills, assertiveness training, and alcohol and drug education. Phase 2 encompassed site selection, theory of change development, and formative research engagements; research teams in each site engaged adolescents and key adult stakeholders to identify priorities for intervention. Stakeholders voiced preferences for external facilitators and key content and delivery for intervention sessions. These findings informed Phase 3, a draft manual of HASHTAG, including a whole-school component, called Thriving Environment in Schools, and a classroom-based, six-session component, Thrive Together. In Phase 4, participants engaged in consultative workshops to review and contextualise content by country, preparing HASHTAG for implementation in a feasibility trial. Minor adaptations were made in Nepal, including using school nurses and adjusting take-home materials; both country's workshops identified practical considerations for implementing activities. Conclusions HASHTAG was designed around core evidence-based components to increase translatability across LMICs, while enabling country-specific tailoring to enhance feasibility. Future research will test whether this multi-component, whole-school approach can improve adolescent mental health.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Social Sciences (Includes Criminology and Education)
Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer)
Additional Information: License information from Publisher: LICENSE 1: URL:, Start Date: 2023-12-07
Publisher: Elsevier
ISSN: 2666-5603
Date of First Compliant Deposit: 16 January 2024
Date of Acceptance: 7 December 2023
Last Modified: 16 Jan 2024 13:45

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