Optimising a complex intervention for youth mental health using multi-criteria decision analysis [Abstract]

Simon, J., Wienand, D., Radloff, M., Piolanti, A., Babii, V., Calovska, N., Heinrichs, N., Raleva, M., Shenderovich, Y. ORCID: https://orcid.org/0000-0002-0254-3397 and Foran, H. 2026. Optimising a complex intervention for youth mental health using multi-criteria decision analysis [Abstract]. European Journal of Public Health 36 (S5) , ckag169.1990. 10.1093/eurpub/ckag169.1990

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Abstract

Introduction Majority of adolescents live in more restricted resource settings with additional socioeconomic stressors, adverse childhood experiences, and limited mental health services access. The FLOURISH (Family-Focused Adolescent & Lifelong Health Promotion) project adapts, implements, and evaluates a parenting intervention for adolescent mental health promotion in North Macedonia and Moldova. We used a new multi-criteria decision analysis (MCDA) approach to assess intervention component combinations for optimised delivery. Methods In a factorial cluster trial, adolescents (10-14 years) and caregivers received the Parenting for Lifelong Health (PLH) Teens intervention with 3 randomized add-on components for mental health (HAT), peer support and engagement in 2025. Conceptual model-based outcome data were collected at baseline and follow-up alongside detailed cost information. A 6-step MCDA framework was used for optimisation. Evaluation criteria, measures and weights reflecting joint outcomes were defined by formal stakeholder elicitation process. Change scores were analysed using multi-level regression and valued as cost per combined benefit score (CBS). Results We assessed eight component combinations against seven outcomes for 640 families. Core PLH cost €162 per family and yielded a CBS of 42 (€3.86 per CBS). PLH+HAT was most effective with a CBS of 75 at €248 per family (€2.63 per CBS). It dominated all two or three add-on combinations, and was of better value than other single add-on combinations. Compared to PLH, PLH+HAT had more heterogeneous impacts across outcomes. Discussion MCDA successfully informed optimised component selection for a complex youth mental health promotion intervention in restricted resource settings. PLH only and PLH+HAT combinations both yielded similar incremental cost per CBS. Additional qualitative information indicated further optimisation needs for HAT with PLH only considered for further implementation. Key messages • Adolescent mental health promotion requires effective, cost-effective and scalable interventions, especially in more resource restricted settings, as investigated in FLOURISH. • Multi-criteria decision analysis proved to be a viable and helpful tool to optimise complex parenting interventions for further implementation.

Item Type:	Short Communication
Date Type:	Publication
Status:	Published
Schools:	Schools > Social Sciences (Includes Criminology and Education) Schools > School of Social and Spatial Sciences
Publisher:	Oxford University Press
ISSN:	1101-1262
Last Modified:	02 Nov 2026 16:01
URI:	https://orca.cardiff.ac.uk/id/eprint/190607

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