Periodic Reporting for period 1 - YiPEE (Youth co-Production for sustainable Engagement and Empowerment in health)
Période du rapport: 2023-01-01 au 2024-06-30
Adolescence is a time of rapid physical, social, and psychological development offering multiple opportunities for health promotion and disease prevention. Globally, however, many adolescents live in unstable environments, where poverty, conflict, or maltreatment is common, placing them at heightened risk of developing mental health problems. citiesRISE (cR) was established with the aim to improve youth mental health through working directly with youth and communities to develop evidence-based and scale-able interventions and implementation models. Primary prevention through health services can be problematic in this age group, with uptake requiring meaningful peer and community engagement. As a result, schools have been extensively used, but traditional top-down interventions can result in poor uptake, high dropout, and limited sustainability. A focus on inner strengths-focused interventions have been effective for improving youth mental health and wellbeing, with gratitude, kindness, and hope a potentially complementary set of traits to target.
The YiPEE project aims to improve the mental health and wellbeing of youth through co-designed and youth-led arts-based interventions in schools, working in Chennai, Nairobi, Cape Town and Stockholm. To achieve this, we set out 6 scientific objectives.
1. To formalize and co-design with youth a multi-component intervention and youth-informed and youth-activated implementation model rooted in formative evaluation of cR’s theory of change and bottom-up experience in 5 cities.
2. To build out a set of implementation processes, guidelines, and tools adaptable for various populations of vulnerable youth in LMICs, as well as HICs, and tailored specifically for NCDs.
3. To develop and adapt a set of contextually appropriate tools for supervision, fidelity, and data collection.
4. To contextualize and implement an evidence-based multi-component intervention targeting the inner, social, and environmental dimensions of well-being to address a range of mental health and NCD risk behaviour outcomes, using the youth-informed and -activated implementation model across four settings.
5. To evaluate the youth-informed and youth-activated implementation model and multi-component intervention, focusing on the following effectiveness and implementation outcomes: a) the extent to which the youth-driven implementation model is feasible, acceptable, adaptable, and cost-effective; b) the impact of the multi-component intervention, combining the inner, social, and environmental dimensions of well-being, on NCD risk reduction and mental health outcomes.
6. To drive widespread uptake of research findings and other expected program results through policy and advocacy efforts across social, cultural, country and regional contexts.
The results from this project will provide valuable insights into key mental health issues experienced by youth across diverse settings, and how a standardised approach to engaging youth through arts-based interventions in schools can be adapted to these different contexts. This will support policy makers in designing and delivering meaningful interventions through school-based initiatives.
The YiPEE project aims to improve the mental health and wellbeing of youth through co-designed and youth-led arts-based interventions in schools, working in Chennai, Nairobi, Cape Town and Stockholm. To achieve this, we set out 6 scientific objectives.
1. To formalize and co-design with youth a multi-component intervention and youth-informed and youth-activated implementation model rooted in formative evaluation of cR’s theory of change and bottom-up experience in 5 cities.
2. To build out a set of implementation processes, guidelines, and tools adaptable for various populations of vulnerable youth in LMICs, as well as HICs, and tailored specifically for NCDs.
3. To develop and adapt a set of contextually appropriate tools for supervision, fidelity, and data collection.
4. To contextualize and implement an evidence-based multi-component intervention targeting the inner, social, and environmental dimensions of well-being to address a range of mental health and NCD risk behaviour outcomes, using the youth-informed and -activated implementation model across four settings.
5. To evaluate the youth-informed and youth-activated implementation model and multi-component intervention, focusing on the following effectiveness and implementation outcomes: a) the extent to which the youth-driven implementation model is feasible, acceptable, adaptable, and cost-effective; b) the impact of the multi-component intervention, combining the inner, social, and environmental dimensions of well-being, on NCD risk reduction and mental health outcomes.
6. To drive widespread uptake of research findings and other expected program results through policy and advocacy efforts across social, cultural, country and regional contexts.
The results from this project will provide valuable insights into key mental health issues experienced by youth across diverse settings, and how a standardised approach to engaging youth through arts-based interventions in schools can be adapted to these different contexts. This will support policy makers in designing and delivering meaningful interventions through school-based initiatives.
In the first reporting period, we have completed the formative phase of the project, and have transitioned to the implementation phase.
The formative phase included several inter-linked research and youth engagement activities, with the key focus to develop and refine an intervention approach and develop a set of standardised guidelines, tools and training manuals. To achieve this we conducted a scoping review, interviews and group discussions with key stakeholders involved in citiesRISE’s previous projects to form a theory of change. This theory of change was used to develop the generic intervention “wireframe” - a set of guiding principles and structure for the multi-component intervention that uses a set of “core components". This means that in each implementation site, there are a set of principles that must be included as they are hypothesized to be the key ingredients to improving youth mental health. Then there are adaptable components, that should be co-designed with youth and key stakeholders to ensure the intervention is relevant for their context.
To support the adaptation of the “wireframe” and co-design with youth across all sites we developed:
i) a general implementation manual, relating to the formal research phase;
ii) a manual for facilitators of co-design workshops;
iii) guidance on the theoretical underpinning for the co-design method, which is based on Normalization Process Theory (NPT).
To evaluate the process of adaptation and co-design, as well as intervention delivery across all sites, we developed several tools and protocols that relate to supervision, fidelity and data collection, which were designed to support a realist approach to evalaution - allowing us to evaluate different initial programme theories that relate to co-design and implementation:
- Supervision: i) training manuals for the facilitators of the intervention; ii) intervention implementation monitoring tool.
- Fidelity: i) fidelity checklist; ii) intervention implementation monitoring tool.
- Data collection: i) a co-design workshop evaluation manual, with Standard Operating Procedure and data collection tools; ii) a protocol for the adaptation process, which includes an intervention change-log to track context-specific adaptations to the intervention; iii) process evaluation tools for implementation evaluation.
In the implementation phase, we completed co-design and followed by rapid optimization with schools in Chennai, resulting in a final intervention manual. The trial, a cluster randomized controlled trial (cRCT) with 30 schools, has been started, with school recruitment and randomization completed. The first stage of intervention contextualization with key stakeholders has been completed in Nairobi and Cape Town, and is planned in Stockholm.
The formative phase included several inter-linked research and youth engagement activities, with the key focus to develop and refine an intervention approach and develop a set of standardised guidelines, tools and training manuals. To achieve this we conducted a scoping review, interviews and group discussions with key stakeholders involved in citiesRISE’s previous projects to form a theory of change. This theory of change was used to develop the generic intervention “wireframe” - a set of guiding principles and structure for the multi-component intervention that uses a set of “core components". This means that in each implementation site, there are a set of principles that must be included as they are hypothesized to be the key ingredients to improving youth mental health. Then there are adaptable components, that should be co-designed with youth and key stakeholders to ensure the intervention is relevant for their context.
To support the adaptation of the “wireframe” and co-design with youth across all sites we developed:
i) a general implementation manual, relating to the formal research phase;
ii) a manual for facilitators of co-design workshops;
iii) guidance on the theoretical underpinning for the co-design method, which is based on Normalization Process Theory (NPT).
To evaluate the process of adaptation and co-design, as well as intervention delivery across all sites, we developed several tools and protocols that relate to supervision, fidelity and data collection, which were designed to support a realist approach to evalaution - allowing us to evaluate different initial programme theories that relate to co-design and implementation:
- Supervision: i) training manuals for the facilitators of the intervention; ii) intervention implementation monitoring tool.
- Fidelity: i) fidelity checklist; ii) intervention implementation monitoring tool.
- Data collection: i) a co-design workshop evaluation manual, with Standard Operating Procedure and data collection tools; ii) a protocol for the adaptation process, which includes an intervention change-log to track context-specific adaptations to the intervention; iii) process evaluation tools for implementation evaluation.
In the implementation phase, we completed co-design and followed by rapid optimization with schools in Chennai, resulting in a final intervention manual. The trial, a cluster randomized controlled trial (cRCT) with 30 schools, has been started, with school recruitment and randomization completed. The first stage of intervention contextualization with key stakeholders has been completed in Nairobi and Cape Town, and is planned in Stockholm.
When we conceived the project, we foresaw three areas of wider impact:
1) Improvements in mental health amongst youth, that can be directly attributable to the intervention and implementation model, as well as other work that may be use elements of this approach.
2) That the approach to co-design and youth engagement will support transformative ways of working, and ultimately more sustainable intervention effects.
3) An engaged youth, who have built their capacity through taking part in the intervention and have the support of their peers through youth networks.
While it is too early to tell if these impacts will be achieved, we have set the ground work for evaluating success against these three domains. The cRCT in Chennai and case study evaluations will allow us to directly observe whether shifts in youth mental health can be attributed to the multi-component, multi-level school-based intervention. The use of mixed-methods and ethnographic observations, that are grounded in realist evaluation, was designed to allow us to explore how the intervention works - and especially whether it results in shifts in power dynamics, a more engaged and empowered youth, and if ways of working within these environments shift.
We will have impact and process results to report in the next reporting period.
1) Improvements in mental health amongst youth, that can be directly attributable to the intervention and implementation model, as well as other work that may be use elements of this approach.
2) That the approach to co-design and youth engagement will support transformative ways of working, and ultimately more sustainable intervention effects.
3) An engaged youth, who have built their capacity through taking part in the intervention and have the support of their peers through youth networks.
While it is too early to tell if these impacts will be achieved, we have set the ground work for evaluating success against these three domains. The cRCT in Chennai and case study evaluations will allow us to directly observe whether shifts in youth mental health can be attributed to the multi-component, multi-level school-based intervention. The use of mixed-methods and ethnographic observations, that are grounded in realist evaluation, was designed to allow us to explore how the intervention works - and especially whether it results in shifts in power dynamics, a more engaged and empowered youth, and if ways of working within these environments shift.
We will have impact and process results to report in the next reporting period.