Development of a school-based programme for mental health promotion and prevention among adolescents in Nepal and South Africa.
Christina A Laurenzi, Stefani du Toit, Tatenda Mawoyo, Nagendra P Luitel, Mark J D Jordans, Indira Pradhan, Claire van der Westhuizen, G J Melendez-Torres, Jemma Hawkins, Graham Moore, Rhiannon Evans, Crick Lund, David A Ross, Joanna Lai, Chiara Servili, Mark Tomlinson, Sarah Skeen
Author Information
Christina A Laurenzi: Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
Stefani du Toit: Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
Tatenda Mawoyo: Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
Nagendra P Luitel: Research Department, Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal.
Mark J D Jordans: Research Department, Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal.
Claire van der Westhuizen: Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa.
G J Melendez-Torres: Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
Jemma Hawkins: DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), Cardiff University, Cardiff, Wales, United Kingdom.
Graham Moore: DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), Cardiff University, Cardiff, Wales, United Kingdom.
Rhiannon Evans: DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), Cardiff University, Cardiff, Wales, United Kingdom.
Crick Lund: Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa.
David A Ross: Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
Joanna Lai: UNICEF, New York, NY, USA.
Chiara Servili: Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland.
Mark Tomlinson: Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
Sarah Skeen: Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
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.
