Title: NIHR Global Health Research Group on Promoting Children’s and Adolescent’s Mental Wellbeing in sub-Saharan Africa.
Funder: Department of Health and Social Care

Abstract: Research Question _x000D_ What is the effectiveness of a culturally adapted whole school mindfulness intervention to promote mental wellbeing amongst children and adolescents 7-14 years (CA) in sub-Saharan Africa (SSA)?_x000D_ Background _x000D_ Poor mental wellbeing is the leading cause of illness among adolescents in SSA, with an estimated prevalence rate of 1 in 7. However, CA mental wellbeing is an under-researched issue; there is a lack of community awareness and few evidence-based interventions to promote it. CA mental wellbeing has been negatively impacted by COVID-19, making it even more urgent to find culturally acceptable, affordable, and cost-effective interventions to sustainably improve CA wellbeing._x000D_ Aim_x000D_ To identify, design, implement, and evaluate a culturally acceptable, affordable and cost-effective mindfulness intervention for promoting CA mental wellbeing. _x000D_ Objectives _x000D_ Objective 1: Identify and build networks of policy actors, implementers and community members, including CA, that have a stake in improving CA mental wellbeing. _x000D_ Objective 2: Identify current policies for promoting CA mental wellbeing in Ethiopia and Rwanda and examine their effectiveness._x000D_ Objective 3: Provide an enhanced understanding of the distinct mental wellbeing challenges that face CA and how these challenges are affected by gendered power relationships. _x000D_ Objective 4: Co-design a whole-school mindfulness intervention for implementation in schools to promote CA mental wellbeing that is culturally acceptable to policy actors, implementers, and communities, including CA._x000D_ Objective 5: Generate evidence on the intervention's efficacy, cultural acceptability, affordability, and cost-effectiveness ready for a multi-centre trial._x000D_ Objective 6: Build an African led transdisciplinary global health research group on promoting CA mental wellbeing and population wellbeing more generally._x000D_ Methods _x000D_ Co-design and implement an affordable and acceptable whole-school intervention to promote CA mental wellbeing with policy actors and community members, including CA. Evaluate the intervention using critical realist principles combined with a quasi-experimental control trial enabling an understanding of what works for whom in what circumstances. A deep understanding will be developed by researching CA's, their families', communities' and teachers' experiences, intervention performance, and implementation costs. Capacity will be built by training future African research leaders in multidisciplinary applied health research in four overlapping phases:_x000D_ 1 context and situational analysis (year 1);_x000D_ 2 train teacher educators and teachers in mindfulness and co-design an intervention with policy actors and community members, including CA;_x000D_ 3 deliver an intervention in school delivered by teachers designed to promote CA mental wellbeing (year 3);_x000D_ 4 an impact evaluation (year 4). _x000D_ Impact_x000D_ 1 Through the intervention, promoted CA wellbeing._x000D_ 2 Involving policy actors, communities, including CA, and economic analysis to ensure the affordability, cultural acceptability, and cost-effectiveness of the intervention, thereby providing a pathway for evidence take-up with an intervention ready for a multi-centre trial._x000D_ 3 Enhanced the capacity of African researchers to lead and conduct research and implement interventions to promote mental wellbeing, thereby building skills to sustainably transform the promotion of CA mental wellbeing in sub-Saharan Africa.

Lay abstract: Aim_x000D_ To design and test a mindfulness intervention to promote the mental wellbeing of children and adolescents (7-14 years, CA) living in sub-Saharan Africa (SSA) so that they can enjoy their childhood and develop to their full potential and as adults play a full role in society. The intervention will be designed to make CA more resilient so that they can cope better with the everyday stresses of life, feel good about themselves and function well. It will improve the wellbeing of all CA, including those with mental health problems._x000D_ Background_x000D_ Poor mental wellbeing is a major problem in SSA, and most adults with mental illness developed it when they were adolescents. The World Health Organisation says that improving CA's mental wellbeing is an urgent priority and that this can best be done by introducing preventative interventions in schools. However, spending on preventative and treatment mental health services for CA is a low priority for governments and donors. Improving mental wellbeing improves people’s lives, making them happier, less likely to develop mental and physical illnesses and better able to play a full role in society. In addition, it reduces healthcare expenditure. _x000D_ Design_x000D_ In Rwanda and Ethiopia, working with parents, CA, community members, teachers, and policymakers, we will research ways of providing an affordable and acceptable mindfulness intervention that promotes CA wellbeing. The development of the intervention will be led by Rwandan and Ethiopian teacher-educators working with primary school teachers. Teachers involved in developing the intervention will train other teachers in their schools. Teachers will deliver the intervention as part of the primary school curriculum, so it will reach virtually all children. _x000D_ After looking at the local context and what services already exist and talking to community members, teachers and policymakers, the team developing the intervention will work with parents, CA, and policymakers to agree on the mindfulness intervention and how to deliver and evaluate it. We will test the intervention to provide policymakers with high-quality evidence on how well it works and the costs and benefits of it being delivered in all schools. The evaluation of the intervention will include talking to CA, their parents and their teachers about their experiences of the intervention and the CA will take psychometric tests before and after a year of the intervention. _x000D_ Community Involvement _x000D_ Community engagement and involvement are central to our project. We will involve adults and CA from all sections of the community to ensure all views are represented. Our leadership group and the International Advisory Board include community representatives to ensure that parents’ and CA voices drive our agenda. Teachers and local reference groups will be involved at every stage of development, delivery, and evaluation. Women and girls will have equal representation with men and boys on reference groups. We will enable parents, CA, and teachers to make their voices heard by policymakers._x000D_ Impact_x000D_ Collaborating with policymakers, parents, CA, and teachers throughout the project will give us the best chance of policymakers using our findings to promote the mental welling being of CA in Rwanda, Ethiopia, and sub-Saharan Africa more generally. Our project will also train the next generation of African research leaders in applied health research.

Research activity codes: 5.6 PSYCHOLOGICAL AND BEHAVIOURAL;6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH