Periodic Reporting for period 1 - FLOURISH (FAMILY-FOCUSED ADOLESCENT & LIFELONG HEALTH PROMOTION)
Berichtszeitraum: 2023-01-01 bis 2024-06-30
Adolescence is a critical period for mental health due to significant physical, emotional, and social changes. Approximately half of all mental health problems first appear during this age. In Eastern Europe, adolescents face heightened risks to their mental well-being from violence, poverty, inequality, and other adverse experiences. These challenges have been further intensified by the coronavirus pandemic and the ongoing conflict in Ukraine.
Evidence-based parenting programs that focus on caregiver-child/adolescent relationships and effective parenting practices are widely recommended to support adolescent mental health and well-being by addressing individual and family risk factors. Additionally, WHO guidelines recommend interventions aimed at enhancing interpersonal and emotion regulation skills among adolescents. Parenting for Lifelong Health (PLH; https://www.who.int/teams/social-determinants-of-health/parenting-for-lifelong-health(öffnet in neuem Fenster)) is a program developed by researchers, the WHO, and UNICEF to promote child and adolescent mental health, enhance caregiver-child/adolescent relationships, and prevent violence against children in low- and middle-income countries. Despite its potential, research on affordable and scalable evidence-based approaches for supporting adolescent mental health remains limited.
The FLOURISH project aims to adapt, optimize, and evaluate the PLH for Parents and Teens program and the Helping Adolescents Thrive (HAT) Comics for adolescents aged 10–14 and their caregivers in North Macedonia and the Republic of Moldova. Drawing on stakeholder co-production and intervention process evaluation, FLOURISH will evaluate the cost-effectiveness of intervention components and test the final intervention package in a randomized trial. This approach aims to promote the adoption and expansion of open-source, evidence-based family interventions for adolescents in low-resource settings, ultimately reducing risks for future non-communicable diseases.
FLOURISH will utilize the Multiphase Optimization Strategy (MOST) framework, progressing through three interconnected phases:
Phase 1 - Preparation: Adapting and pilot testing the program package.
Phase 2 - Optimization: Optimizing the adapted program and determining the most cost-effective package using a factorial trial.
Phase 3 - Evaluation: Evaluating the optimized program package through a randomized trial.
Evidence-based parenting programs that focus on caregiver-child/adolescent relationships and effective parenting practices are widely recommended to support adolescent mental health and well-being by addressing individual and family risk factors. Additionally, WHO guidelines recommend interventions aimed at enhancing interpersonal and emotion regulation skills among adolescents. Parenting for Lifelong Health (PLH; https://www.who.int/teams/social-determinants-of-health/parenting-for-lifelong-health(öffnet in neuem Fenster)) is a program developed by researchers, the WHO, and UNICEF to promote child and adolescent mental health, enhance caregiver-child/adolescent relationships, and prevent violence against children in low- and middle-income countries. Despite its potential, research on affordable and scalable evidence-based approaches for supporting adolescent mental health remains limited.
The FLOURISH project aims to adapt, optimize, and evaluate the PLH for Parents and Teens program and the Helping Adolescents Thrive (HAT) Comics for adolescents aged 10–14 and their caregivers in North Macedonia and the Republic of Moldova. Drawing on stakeholder co-production and intervention process evaluation, FLOURISH will evaluate the cost-effectiveness of intervention components and test the final intervention package in a randomized trial. This approach aims to promote the adoption and expansion of open-source, evidence-based family interventions for adolescents in low-resource settings, ultimately reducing risks for future non-communicable diseases.
FLOURISH will utilize the Multiphase Optimization Strategy (MOST) framework, progressing through three interconnected phases:
Phase 1 - Preparation: Adapting and pilot testing the program package.
Phase 2 - Optimization: Optimizing the adapted program and determining the most cost-effective package using a factorial trial.
Phase 3 - Evaluation: Evaluating the optimized program package through a randomized trial.
Following Annex 1 of the Grant Agreement, the work carried out during the reporting period of the FLOURISH project (01/01/2023 to 30/06/2024) aimed to achieve the project objectives for Phase 1, while also including preparations for Phase 2. In Phase 1, the Parenting for Lifelong Health (PLH) for Parents and Teens program and the Helping Adolescents Thrive (HAT) Comics were adapted to local contexts and languages through feedback from advisory focus groups, expert interviews, and input from program developers as well as clinical experts in the consortium. Various other materials essential for Phase 1 were prepared and translated, including ethical forms, informed consents, assessments, focus group/interview guides, and recruitment materials. Training materials were prepared for facilitators, research coordinators, data assessors, and supervisors. The trainings were conducted at ALTERNATIVA (IA) in North Macedonia and the Health for Youth Association (HYA) in the Republic of Moldova in collaboration. From September 2023 to January 2024, the adapted program was pilot tested among 64 adolescents aged 10-14 years and their caregivers in North Macedonia and Moldova. Based on findings from Phase 1, adjustments were made to the intervention content, the three intervention components (buddy, mental health, and incentives) and the assessment measures for Phase 2. These changes were submitted as ethical amendment for Phase 2 and approved by the IRB. Currently, preparations for Phase 2 are ongoing and include, final revisions of the intervention and the components, translations of assessment measures, intervention, and training material.
At this stage of the project, initial study results are in the process of preparation for publications and will be available at a later stage in this project. Main study results will be available after completion of the factorial trial and randomized trial later in the project.
The adapted intervention manual has been made available on the project website (https://www.flourish-study.org/(öffnet in neuem Fenster)) serving as a valuable resource for implementing organizations across Europe and worldwide. We have prepared study tools, such as interview guides, that are available for free use by other researchers and implementers.
The adapted intervention manual has been made available on the project website (https://www.flourish-study.org/(öffnet in neuem Fenster)) serving as a valuable resource for implementing organizations across Europe and worldwide. We have prepared study tools, such as interview guides, that are available for free use by other researchers and implementers.