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Whittenbury K, Kroll L, Dubicka B, Bull ER. Exploring barriers and facilitators for mental health professionals delivering behavioural activation to young people with depression: qualitative study using the Theoretical Domains Framework. BJPsych Open 2022; 8:e38. [PMID: 35118935 PMCID: PMC8867899 DOI: 10.1192/bjo.2022.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Depression prevalence among young people is increasing, with growing pressures on specialist mental health services. Manualised behavioural activation therapy may be effective for young people, and can be delivered by a range of mental health professionals (MHPs). This study explored clinician perspectives of barriers and facilitators to implementing behavioural activation with young people in routine practice. AIMS We conducted a qualitative study with individual semi-structured interviews with MHPs, as part of a wider feasibility study. METHOD Participants were mental health professionals (therapists and supervisors) from two UK NHS sites delivering manualised behavioural activation for young people. Data were analysed with an inductive followed by deductive approach, applying the Theoretical Domains Framework (TDF) to understand key influences on practice change. Identified domains were mapped onto possible behaviour change techniques (BCTs) to support implementation, using the Theory and Techniques Tool (TTT). RESULTS Nine MHPs were interviewed. Thirteen of fourteen TDF domains were relevant, including perceived professional identity, beliefs about own capabilities and perceived positive or negative consequences of using manualised behavioural activation, social influences, memory and attention, and environmental resources. Fourteen theory-linked BCTs were identified as possible strategies to help clinicians overcome barriers (e.g. integrating behavioural practice/rehearsal, prompts and persuasive communications within training, and supervision). CONCLUSIONS Behavioural science approaches (TDF, TTT) helped conceptualise key barriers and facilitators for MHPs delivering manualised behavioural activation with young people. Interventions using BCTs to address identified barriers could help the implementation of new therapies into routine practice, working to bridge the research-practice gap in clinical psychology.
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Affiliation(s)
- Kate Whittenbury
- Faculty of Health and Education, Manchester Metropolitan University, UK
| | - Leopold Kroll
- Young People's Mental Health Research Unit, Pennine Care NHS Foundation Trust Headquarters, UK
| | - Bernadka Dubicka
- Young People's Mental Health Research Unit, Pennine Care NHS Foundation Trust Headquarters, UK; and Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Eleanor R Bull
- Faculty of Health and Education, Manchester Metropolitan University, UK; and Department of Anaesthesia, Manchester University NHS Foundation Trust, UK
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Visagie L, Loxton H, Swartz L, Stallard P. Cognitive behaviour therapy-based early intervention and prevention programme for anxiety in South African children with visual impairments. Afr J Disabil 2021; 10:796. [PMID: 33604268 PMCID: PMC7876962 DOI: 10.4102/ajod.v10i0.796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/26/2020] [Indexed: 11/18/2022] Open
Abstract
Background Anxiety is the most common psychological difficulty reported by youth worldwide and may also be a significant problem for children with visual impairments. Cognitive behaviour therapy (CBT) interventions have proven to be successful in treating childhood anxiety; however, mostly these are not suitable for children with visual impairments, as the materials used are not sufficiently accessible to this population. Objectives The present study was motivated by the dearth of research on this topic and aimed to examine the effects of a specifically tailored, group-based, universally delivered, CBT intervention for anxiety in children with visual impairments and to examine the influence of three predictor variables (i.e. age, gender and level of visual impairment) on prevention effects. Method A randomised wait-list control group design with pre-, post- and follow-up intervention measures was employed. The final sample of 52 children (aged 9–14) with varying degrees of visual impairment received the anxiety intervention. Participants were followed over a course of 10 months during which their anxiety symptoms were assessed quantitatively at four time points (T1–T4). Results The results indicated that the anxiety intervention did not significantly decrease symptoms of anxiety within the intervention groups. However, the intervention appeared beneficial for girls, younger children and legally blind participants. Conclusion This study demonstrated how CBT interventions can be adapted for use in children with visual impairments. Results obtained provide a foundation upon which future updated anxiety intervention programmes can be built, meeting the need for further research in this area.
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Affiliation(s)
- Lisa Visagie
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Helene Loxton
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Paul Stallard
- Department for Health, Faculty of Humanities and Social Sciences, University of Bath, Claverton Down, Bath, United Kingdom
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Bonnesen CT, Jensen MP, Madsen KR, Toftager M, Rosing JA, Krølner RF. Implementation of initiatives to prevent student stress: process evaluation findings from the Healthy High School study. HEALTH EDUCATION RESEARCH 2020; 35:195-215. [PMID: 32219401 PMCID: PMC7243719 DOI: 10.1093/her/cyaa003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/06/2020] [Indexed: 06/10/2023]
Abstract
Process evaluation of public health interventions is important for understanding intervention results and can help explain why interventions succeed or fail. This study evaluated implementation of a school-based intervention combining educational and environmental strategies to prevent stress among Danish high school students. We investigated dose delivered, dose received, fidelity, appreciation, barriers and facilitators at the 15 intervention schools using mixed methods and multiple data sources: questionnaires among students, teachers and school coordinators; semi-structured interviews with school coordinators; telephone interviews with student counsellors; and focus group interviews with students and teachers. Implementation varied by schools and classes. Half of the intervention schools delivered the environmental strategies. For the educational strategies, dose delivered differed according to intervention provider. Students reported a lower dose received compared with dose delivered reported by school staff. Overall, student counsellors, school coordinators and students-especially those with low perceived stress-were satisfied with the stress preventive initiatives while teacher satisfaction varied. Five main barriers and three facilitators for implementation were identified. The use of multiple data sources and data methods created new knowledge of the implementation process which is important for the interpretation of effect evaluation and development of future interventions.
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Affiliation(s)
- Camilla Thørring Bonnesen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Marie P Jensen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Katrine R Madsen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Mette Toftager
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Johanne A Rosing
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Rikke F Krølner
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
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Shelemy L, Harvey K, Waite P. Supporting students’ mental health in schools: what do teachers want and need? EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2019. [DOI: 10.1080/13632752.2019.1582742] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Lucas Shelemy
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Kate Harvey
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Polly Waite
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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School-based early intervention for anxiety and depression in older adolescents: A feasibility randomised controlled trial of a self-referral stress management workshop programme ("DISCOVER"). J Adolesc 2019; 71:150-161. [PMID: 30738219 DOI: 10.1016/j.adolescence.2018.11.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Schools may provide a convenient intervention setting for young people with mental health problems generally, as well as for those who are unwilling or unable to access traditional clinic-based mental health services. However, few studies focus on older adolescents, or those from ethnic minority groups. This study aims to assess the feasibility of a brief school-based psychological intervention for self-referred adolescents aged 16-19 years. METHODS A two-arm cluster randomised controlled trial was conducted in 10 inner-city schools with block randomisation of schools. The intervention comprised a one-day CBT Stress management programme with telephone follow-up (DISCOVER) delivered by 3 psychology (2 clinical and 1 assistant) staff. The control was a waitlist condition. Primary outcomes were depression (Mood and Feelings Questionnaire; MFQ) and anxiety (Revised Child Anxiety and Depression Scale; RCADS-anxiety subscale). Data were analysed descriptively and quantitatively to assess feasibility. RESULTS 155 students were enrolled and 142 (91.6%) followed up after 3 months. Participants were predominantly female (81%) and the mean age was 17.3 years, with equal numbers enrolled from Year 12 and Year 13. Over half (55%) of students were from ethnic minority groups. Intraclass correlations were low. Variance estimates were calculated to estimate the sample size for a full RCT. Preliminary outcomes were encouraging, with reductions in depression (d = 0.27 CI-0.49 to -0.04, p = 0.021) and anxiety (d = 0.25, CI-0.46 to -0.04, p = 0.018) at follow-up. CONCLUSIONS Results support the feasibility of a school-based, self-referral intervention with older adolescents in a definitive future full-scale trial (Trial no. ISRCTN88636606).
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McKeague L, Morant N, Blackshaw E, Brown JSL. Exploring the feasibility and acceptability of a school-based self-referral intervention for emotional difficulties in older adolescents: qualitative perspectives from students and school staff. Child Adolesc Ment Health 2018; 23:198-205. [PMID: 30197575 PMCID: PMC6120473 DOI: 10.1111/camh.12234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adolescents with emotional difficulties need accessible, acceptable and evidence-based mental health interventions. Self-referral workshops (DISCOVER workshops) were offered to stressed 16- to 19-year olds in 10 Inner London schools. METHOD Semistructured interviews were conducted with three groups of participants: students who attended a 1-day workshop (n = 15); students who initially showed interest in the DISCOVER workshop programme, but decided not to take part (n = 9); and school staff who helped organise the programme in their schools (n = 10). Students were purposively sampled to ensure that those from Black and minority ethnic (BME) backgrounds were represented. Data were analysed using thematic analysis. RESULTS The accounts generally indicate that the delivery and evaluation of this intervention is perceived as feasible and acceptable. Students, including those from BME backgrounds, described the setting as suitable and reported that the workshop helped them develop new understandings of stress and how to handle it. They expressed a preference for engaging and interactive activities, and valued a personalised approach to workshop provision. School staff felt that the workshop was in line with school values. They described some logistical barriers to providing the workshops in school settings, and expressed a desire for more information about the workshop in order to provide follow-up support. The main reason students gave for nonparticipation was limited time. CONCLUSIONS Findings are discussed in relation to increasing the feasibility of implementing school-based psychological interventions and the value of providing access to mental health support in schools.
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Affiliation(s)
- Lynn McKeague
- Department of PsychologyUniversity of WinchesterWinchesterUK
| | - Nicola Morant
- Division of PsychiatryUniversity College LondonLondonUK
| | - Emily Blackshaw
- Department of PsychologyInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - June S. L. Brown
- Department of PsychologyInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
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Exploring Students’ Participation in Universal, Depression and Anxiety, Prevention Programmes at School: A Meta-aggregation. SCHOOL MENTAL HEALTH 2017. [DOI: 10.1007/s12310-017-9230-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Visagie L, Loxton H, Stallard P, Silverman WK. Insights into the Feelings, Thoughts, and Behaviors of Children with Visual Impairments: A Focus Group Study Prior to Adapting a Cognitive Behavior Therapy–Based Anxiety Intervention. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2017. [DOI: 10.1177/0145482x1711100304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Anxiety is the most common psychological problem reported among children with visual impairments. Although cognitive behavior therapy interventions have proven successful in treating childhood anxiety, it is unclear whether they are suitable and accessible for children who have visual impairments. This study aimed to determine if and how traditional cognitive behavior therapy–based interventions could be adapted for use with this specific population by interviewing children with visual impairments themselves. Methods A qualitative research design was used. Sixteen children with visual impairments (aged 9 to 13 years) participated in two focus group interviews. Participants attended two special schools in the Western Cape, South Africa. Interviews were audio-recorded and transcribed verbatim, and content analysis was undertaken. Results Three primary themes emerged from the focus group data: (1) difficulties encountered by children with visual impairments; (2) existing coping strategies; and (3) insight into the concepts of feelings, thoughts and behaviors (central to cognitive behavior therapy). Discussion The emergent themes and their implications for the adaptation of a cognitive behavior therapy–based anxiety intervention are discussed. Implications for practitioners Results provide practitioners with guidelines to consider when using or adapting therapeutic techniques such as cognitive behavior therapy for children with visual impairments.
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Affiliation(s)
- Lisa Visagie
- Department of Psychology, Stellenbosch University, Wilcocks Building, Ryneveld and Victoria Streets, Stellenbosch, 7600, South Africa
| | - Helene Loxton
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Paul Stallard
- Department for Health, University of Bath, WH6.10, Claverton Down, Bath, BA2 7AD, UK
| | - Wendy K. Silverman
- Yale University School of Medicine, Child Study Center, 230 South Frontage Road, New Haven, CT 06520
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Hetrick SE, Cox GR, Witt KG, Bir JJ, Merry SN. Cognitive behavioural therapy (CBT), third-wave CBT and interpersonal therapy (IPT) based interventions for preventing depression in children and adolescents. Cochrane Database Syst Rev 2016; 2016:CD003380. [PMID: 27501438 PMCID: PMC8407360 DOI: 10.1002/14651858.cd003380.pub4] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Depression is common in young people. It has a marked negative impact and is associated with self-harm and suicide. Preventing its onset would be an important advance in public health. This is an update of a Cochrane review that was last updated in 2011. OBJECTIVES To determine whether evidence-based psychological interventions (including cognitive behavioural therapy (CBT), interpersonal therapy (IPT) and third wave CBT)) are effective in preventing the onset of depressive disorder in children and adolescents. SEARCH METHODS We searched the specialised register of the Cochrane Common Mental Disorders Group (CCMDCTR to 11 September 2015), which includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). We searched conference abstracts and reference lists of included trials and reviews, and contacted experts in the field. SELECTION CRITERIA We included randomised controlled trials of an evidence-based psychological prevention programme compared with any comparison control for young people aged 5 to 19 years, who did not currently meet diagnostic criteria for depression. DATA COLLECTION AND ANALYSIS Two authors independently assessed trials for inclusion and rated their risk of bias. We adjusted sample sizes to take account of cluster designs and multiple comparisons. We contacted trial authors for additional information where needed. We assessed the quality of evidence for the primary outcomes using GRADE. MAIN RESULTS We included 83 trials in this review. The majority of trials (67) were carried out in school settings with eight in colleges or universities, four in clinical settings, three in the community and four in mixed settings. Twenty-nine trials were carried out in unselected populations and 53 in targeted populations.For the primary outcome of depression diagnosis at medium-term follow-up (up to 12 months), there were 32 trials with 5965 participants and the risk of having a diagnosis of depression was reduced for participants receiving an intervention compared to those receiving no intervention (risk difference (RD) -0.03, 95% confidence interval (CI) -0.05 to -0.01; P value = 0.01). We rated this evidence as moderate quality according to the GRADE criteria. There were 70 trials (73 trial arms) with 13,829 participants that contributed to the analysis for the primary outcome of depression symptoms (self-rated) at the post-intervention time point, with results showing a small but statistically significant effect (standardised mean difference (SMD) -0.21, 95% CI -0.27 to -0.15; P value < 0.0001). This effect persisted to the short-term assessment point (up to three months) (SMD -0.31, 95% CI -0.45 to -0.17; P value < 0.0001; 16 studies; 1558 participants) and medium-term (4 to 12 months) assessment point (SMD -0.12, 95% CI -0.18 to -0.05; P value = 0.0002; 53 studies; 11,913 participants); however, the effect was no longer evident at the long-term follow-up. We rated this evidence as low to moderate quality according to the GRADE criteria.The evidence from this review is unclear with regard to whether the type of population modified the overall effects; there was statistically significant moderation of the overall effect for depression symptoms (P value = 0.0002), but not for depressive disorder (P value = 0.08). For trials implemented in universal populations there was no effect for depression diagnosis (RD -0.01, 95% CI -0.03 to 0.01) and a small effect for depression symptoms (SMD -0.11, 95% CI -0.17 to -0.05). For trials implemented in targeted populations there was a statistically significantly beneficial effect of intervention (depression diagnosis RD -0.04, 95% CI -0.07 to -0.01; depression symptoms SMD -0.32, 95% CI -0.42 to -0.23). Of note were the lack of attention placebo-controlled trials in targeted populations (none for depression diagnosis and four for depression symptoms). Among trials implemented in universal populations a number used an attention placebo comparison in which the intervention consistently showed no effect. AUTHORS' CONCLUSIONS Overall the results show small positive benefits of depression prevention, for both the primary outcomes of self-rated depressive symptoms post-intervention and depression diagnosis up to 12 months (but not beyond). Estimates of numbers needed to treat to benefit (NNTB = 11) compare well with other public health interventions. However, the evidence was of moderate to low quality using the GRADE framework and the results were heterogeneous. Prevention programmes delivered to universal populations showed a sobering lack of effect when compared with an attention placebo control. Interventions delivered to targeted populations, particularly those selected on the basis of depression symptoms, had larger effect sizes, but these seldom used an attention placebo comparison and there are practical difficulties inherent in the implementation of targeted programmes. We conclude that there is still not enough evidence to support the implementation of depression prevention programmes.Future research should focus on current gaps in our knowledge. Given the relative lack of evidence for universal interventions compared with attention placebo controls and the poor results from well-conducted effectiveness trials of universal interventions, in our opinion any future such trials should test a depression prevention programme in an indicated targeted population using a credible attention placebo comparison group. Depressive disorder as the primary outcome should be measured over the longer term, as well as clinician-rated depression. Such a trial should consider scalability as well as the potential for the intervention to do harm.
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Affiliation(s)
- Sarah E Hetrick
- The National Centre of Excellence in Youth Mental HealthOrygen35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | - Georgina R Cox
- The National Centre of Excellence in Youth Mental HealthOrygen35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | | | - Julliet J Bir
- University of AucklandDepartment of PsychiatryPrivate Bag 92109AucklandNew Zealand
| | - Sally N Merry
- University of AucklandDepartment of Psychological MedicinePrivate Bag 92019AucklandNew Zealand
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Bastounis A, Callaghan P, Banerjee A, Michail M. The effectiveness of the Penn Resiliency Programme (PRP) and its adapted versions in reducing depression and anxiety and improving explanatory style: A systematic review and meta-analysis. J Adolesc 2016; 52:37-48. [PMID: 27494740 DOI: 10.1016/j.adolescence.2016.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 07/14/2016] [Accepted: 07/16/2016] [Indexed: 01/17/2023]
Abstract
Mental health problems in children can be precursors of psychosocial problems in adulthood. The aim of this study is to assess the effectiveness of the universal application of a resilience intervention (PRP and derivatives), which has been proposed for large scale roll-out. Electronic databases were searched for published randomized controlled trials of PRP and derivatives to prevent depression and anxiety and improve explanatory style in students aged 8-17 years. Studies were meta-analysed and effect sizes with confidence intervals were calculated. The Quality Assessment Tool for Quantitative Studies of the Effective Public Health Practice Project was used to determine the confidence in the effect estimates. Nine trials from Australia, the Netherlands and USA met the inclusion criteria. No evidence of PRP in reducing depression or anxiety and improving explanatory style was found. The large scale roll-out of PRP cannot be recommended. The content and structure of universal PRP should be re-considered.
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Affiliation(s)
- Anastasios Bastounis
- School of Health Sciences, Queen's Medical Centre (QMC), University of Nottingham, Nottingham NG7 2UH, UK.
| | - Patrick Callaghan
- School of Health Sciences, Queen's Medical Centre (QMC), University of Nottingham, Nottingham NG7 2UH, UK
| | - Anirban Banerjee
- School of Health Sciences, Queen's Medical Centre (QMC), University of Nottingham, Nottingham NG7 2UH, UK
| | - Maria Michail
- School of Health Sciences, Queen's Medical Centre (QMC), University of Nottingham, Nottingham NG7 2UH, UK
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Early intervention for depression and anxiety in 16–18-year-olds: Protocol for a feasibility cluster randomised controlled trial of open-access psychological workshops in schools (DISCOVER). Contemp Clin Trials 2016; 48:52-8. [DOI: 10.1016/j.cct.2016.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 02/04/2016] [Accepted: 02/10/2016] [Indexed: 11/24/2022]
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Medeiros PFP, Cruz JI, R Schneider D, Sanudo A, Sanchez ZM. Process evaluation of the implementation of the Unplugged Program for drug use prevention in Brazilian schools. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:2. [PMID: 26739461 PMCID: PMC4704293 DOI: 10.1186/s13011-015-0047-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/23/2015] [Indexed: 11/10/2022]
Abstract
Background Most Brazilian schools do not have a continuous program for drug use prevention. To address this gap, the Ministry of Health adapted the European evidence-based program Unplugged to improve the drug use prevention efforts of Brazilian public schools. The aim of this study was to evaluate the process of program implementation in three Brazilian cities among middle school students between 6th and 9th grade (11 to 14 years old). Methods Mixed methods were used in this process evaluation study, including focus groups, fidelity forms, and satisfaction questionnaires. Study participants included 36 teachers, 11 school administrators, 6 coaches, 16 stakeholders, and 1267 students from 62 classes in 8 schools. Results The 12 Unplugged lessons were all implemented in 94 % of the classes. However, only 57 % of the classes were completed as described in the program's manual. The decision to exclude activities because of time constraints was made without a common rationale. Teachers reported difficulties due to the amount of time necessary to plan the lessons and implement the activities. In addition, they mentioned that the lack of support from school administrators was an obstacle to proper program implementation. The majority of students and teachers responded positively to the program, reporting changes in the classroom environment and in personal skills or knowledge. Conclusions The Unplugged program can be feasibly implemented in Brazilian public schools. However, it is necessary to reduce the number of activities per class and to restructure the format of the standard teaching schedule to ensure that the normal academic content is still taught while Unplugged is being implemented.
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Affiliation(s)
- Pollyanna F P Medeiros
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, 4° andar, São Paulo, SP, Brazil
| | - Joselaine I Cruz
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, 4° andar, São Paulo, SP, Brazil
| | - Daniela R Schneider
- Department of Psychology, Universidade Federal de Santa Catarina, School of Psychology, Florianopolis, Brazil
| | - Adriana Sanudo
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, 4° andar, São Paulo, SP, Brazil
| | - Zila M Sanchez
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, 4° andar, São Paulo, SP, Brazil.
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Garmy P, Berg A, Clausson EK. A qualitative study exploring adolescents' experiences with a school-based mental health program. BMC Public Health 2015; 15:1074. [PMID: 26487379 PMCID: PMC4618132 DOI: 10.1186/s12889-015-2368-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/29/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Supporting positive mental health development in adolescents is a major public health concern worldwide. Although several school-based programs aimed at preventing depression have been launched, it is crucial to evaluate these programs and to obtain feedback from participating adolescents. This study aimed to explore adolescents' experiences with a -based cognitive-behavioral depression prevention program. METHODS Eighty-nine adolescents aged 13-15 years were divided into 12 focus groups. The focus group interviews were analyzed using qualitative content analysis. RESULTS Three categories and eight subcategories were found to be related to the experience of the school-based program. The first category, intrapersonal strategies, consisted of the subcategories of directed thinking, improved self-confidence, stress management, and positive activities. The second category, interpersonal awareness, consisted of the subcategories of trusting the group and considering others. The third category, structural constraints, consisted of the subcategories of negative framing and emphasis on performance. CONCLUSIONS The school-based mental health program was perceived as beneficial and meaningful on both individual and group levels, but students expressed a desire for a more health-promoting approach.
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Affiliation(s)
- Pernilla Garmy
- Department of Health Science, Kristianstad University, Kristianstad, Sweden. .,Department of Clinical Sciences, Center for Primary Health Care Research, Malmö, Lund University, Lund, Sweden.
| | - Agneta Berg
- Department of Health Science, Kristianstad University, Kristianstad, Sweden. .,Department of Nursing, Health and Culture, University West, Trollhättan, Sweden.
| | - Eva K Clausson
- Department of Health Science, Kristianstad University, Kristianstad, Sweden.
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