A multicomponent secondary school health promotion intervention and adolescent health: An extension of the SEHER cluster randomised controlled trial in Bihar, India

Shinde, Sachin; Weiss, Helen A.; Khandeparkar, Prachi; Pereira, Bernadette; Sharma, Amit; Gupta, Rajesh; Ross, D. A.; Patton, George C.; Patel, Vikram

doi:10.1371/journal.pmed.1003021

Cited by 48 publications

(116 citation statements)

References 21 publications

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“…(8,18) As previously discussed, the role of individual-level factors and whether they were modi able were not explored as part of the study's negative results. (18,30,31) This study assesses how training, supervision, and experience can in uence individual-level teacher factors that may underlie teachers' ability to deliver effective indicated child mental health care. It uniquely contributes to an exploration of whether teachers may be able to deliver indicated care to ll the care gap.…”

Section: Discussionmentioning

confidence: 99%

Perceptions, Attitudes, and Knowledge of Teachers Serving as Mental Health Lay Counselors in a Low and Middle Income Country: A Mixed Methods Pragmatic Pilot Study

Cruz

Lamb

Giri³

et al. 2020

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Background: Low and middle-income countries (LMICs) have a dire need for trained mental health professionals, especially for children. While teachers’ child development expertise potentially positions them to serve as lay counselors, they have rarely delivered indicated child mental health care in LMICs. As part of assessing the feasibility of teachers serving as lay counselors, we explored teachers’ perceptions about serving as mental health lay counselors on top of typical professional duties and their attitudes towards and knowledge about mental health after serving as lay counselors.Methods: In 2018, 20 primary school teachers from five rural, low cost private schools in Darjeeling, India, received training and supervision to serve as lay mental health counselors in their classrooms. Using mixed methods, we measured teacher mental health attitudes and knowledge and perceptions of serving as lay counselor with study-specific assessments and through semi-structured interviews. Pre-training, post-training, and post-intervention mean scores were compared using paired t tests. Post-intervention interviews were coded for teachers’ mental health attitudes and knowledge and perceptions of serving as lay counselor. Results: Interviews revealed teachers qualitatively having more inclusive mental health attitudes, expressing a willingness to serve as lay counselor, and retaining mental health knowledge as applicable to what may be used during instructional time. By contrast, quantitatively, teachers’ attitudes appeared to become more inclusive on the study-specific survey pre versus post-training, but reverted to pre-training levels post-intervention. Teachers’ mental health counseling knowledge on the quantitative study-specific assessment did not change pre-training versus post-training versus post-intervention.Conclusions: Training, supervision, and serving as lay counselors led to teachers’ willingness to serve as lay counselors. Teachers served as lay counselors by incorporating therapeutic techniques into their student interactions during class time and as part of their typical instruction, not through delivering one-on-one office-like traditional care. Their changes in attitudes and knowledge reflected those expected within an “education as therapy” emerging system of care. Quantitative measures of knowledge and attitude changes did not capture these nuanced changes.Trial Registration: The parent feasibility trial was registered on January 01, 2018 with Clinical Trials Registry – India (CTRI), reg. no. CTRI/2018/01/011471, ref. no. REF/2017/11/015895. http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=21129&EncHid=&modid=&compid=%27,%2721129det%27

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Section: Discussionmentioning

confidence: 99%

Perceptions, Attitudes, and Knowledge of Teachers Serving as Mental Health Lay Counselors in a Low and Middle Income Country: A Mixed Methods Pragmatic Pilot Study

Cruz

Lamb

Giri³

et al. 2020

Preprint

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“…We previously reported strong effects of the SEHER intervention on school climate, violence and bullying, depression and attitude towards gender norms after one academic year of exposure, and dose-response effects after two years, in the SM arm of the trial. On the other hand, there was no evidence of an intervention effect on any outcome either after one or two years of intervention in the TSM arm [9][10].…”

Section: Box 1: Overview Of the Seher Trialmentioning

confidence: 77%

“…Comparison schools received the Adolescence Education Program (AEP), a classroom-delivered life-skills curriculum, which was conducted in all schools in all arms. Full details of the intervention and the evaluation have been reported elsewhere [8][9][10]. Box 1 provides an overview of the SEHER interventions and trial.…”

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confidence: 99%

What makes multicomponent school-based health promotion interventions work? A qualitative study nested in the SEHER trial in Bihar, India.

Shinde

Khandeparkar

Pereira

et al. 2020

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Background A cluster-randomized controlled trial in secondary schools in Bihar, India, reported the effectiveness of a multi-component, school health promotion intervention (SEHER) when delivered by lay counsellors (“SEHER Mitra” (SM); meaning “friend” in the local language), but not when delivered by a teacher (“Teacher as SEHER Mitra” (TSM)) compared with the government-run Adolescence Education Program (AEP). This nested qualitative study explored what key factors determined the effectiveness of the intervention and the difference in effectiveness by the delivery agent. Methods We purposively selected 12 intervention schools (6 each from the two intervention arms) based on the size of school. In these schools, we conducted semi-structured interviews with 12 principals, 12 AEP teachers, 12 other teachers, and 11 students who participated in SEHER counselling services. We conducted focus group discussions with girl students (n = 14), boy students (n = 12) SMs (n = 2), TSMs (n = 2), and supervisors (n = 1). Data analysis followed a framework approach to thematic analysis. Results Three overarching themes were identified – i.e. stakeholders’ understanding of SEHER; SEHER intervention planning and implementation, and other issues in the implementation process. All the stakeholders from both the arms strongly believed that the SEHER program was important in imparting health knowledge and life skills to secondary school students. The following factors facilitated the successful implementation of SEHER in SM-arm schools: a shared understanding of the SEHER program by the whole school community, influential school-level leadership, engagement of, and collaboration with, all stakeholders including students in program activities, the trust of the school community in the SMs, full-time availability of SMs for program activities, and prompt actions on students’ concerns by the SMs. Barriers to effective implementation of SEHER in TSM-arm schools included: lack of communication and poor relationship-building between the TSMs, principals and other teachers, TSMs’ perceptions that they were overburdened with academic and non-academic responsibilities, students’ lack of clarity about the TSM’s role, concerns about confidentiality, inaction on students’ concerns, and lack of support from other teachers and the department of education. Conclusions The embedded qualitative study identified important facilitators and barriers to the effective implementation of the intervention when delivered by two different delivery agents. Trial registration: www.clinicaltrials.gov/ NCT02484014

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“…Recent guidance for healthcare workers provides examples of good communication practices for talking to adolescents about illness [ 72 ]. Clinics and schools may serve as channels to promote supportive communication between ALHIV and service providers in these settings, as well as to support adolescent-caregiver communication by offering relevant advice to families [ 73 , 74 ]. Additional research is needed to test the effect of improved adolescent-provider communication on adolescent mental health, as well as whether providers can support adolescent-caregiver communication.…”

Section: Discussionmentioning

confidence: 99%

Relationships with caregivers and mental health outcomes among adolescents living with HIV: a prospective cohort study in South Africa

et al. 2021

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Background Mental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source of resilience. However, there is a lack of longitudinal research in sub-Saharan Africa on which aspects of adolescent-caregiver relationships can promote mental health among adolescents living with HIV. We draw on a prospective longitudinal cohort study undertaken in South Africa to address this question. Methods The study traced adolescents aged 10–19 initiated on antiretroviral treatment in government health facilities (n = 53) within a health district of the Eastern Cape province. The adolescents completed standardised questionnaires during three data collection waves between 2014 and 2018. We used within-between multilevel regressions to examine the links between three aspects of adolescent-caregiver relationships (caregiver supervision, positive caregiving, and adolescent-caregiver communication) and adolescent mental health (depression symptoms and anxiety symptoms), controlling for potential confounders (age, sex, rural/urban residence, mode of infection, household resources), n=926 adolescents. Results Improvements in caregiver supervision were associated with reductions in anxiety (0.98, 95% CI 0.97–0.99, p=0.0002) but not depression symptoms (0.99, 95% CI 0.98–1.00, p=.151), while changes in positive caregiving were not associated with changes in mental health symptoms reported by adolescents. Improvements in adolescent-caregiver communication over time were associated with reductions in both depression (IRR=0.94, 95% CI 0.92–0.97, p<.0001) and anxiety (0.91, 95% CI 0.89–0.94, p<.0001) symptoms reported by adolescents. Conclusions Findings highlight open and supportive adolescent-caregiver communication and good caregiver supervision as potential factors for guarding against mental health problems among adolescents living with HIV in South Africa. Several evidence-informed parenting programmes aim to improve adolescent-caregiver communication and caregiver supervision, and their effect on depression and anxiety among adolescents living with HIV should be rigorously tested in sub-Saharan Africa. How to improve communication in other settings, such as schools and clinics, and provide communication support for caregivers, adolescents, and service providers through these existing services should also be considered.

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A multicomponent secondary school health promotion intervention and adolescent health: An extension of the SEHER cluster randomised controlled trial in Bihar, India

Cited by 48 publications

References 21 publications

Perceptions, Attitudes, and Knowledge of Teachers Serving as Mental Health Lay Counselors in a Low and Middle Income Country: A Mixed Methods Pragmatic Pilot Study

Perceptions, Attitudes, and Knowledge of Teachers Serving as Mental Health Lay Counselors in a Low and Middle Income Country: A Mixed Methods Pragmatic Pilot Study

What makes multicomponent school-based health promotion interventions work? A qualitative study nested in the SEHER trial in Bihar, India.

Relationships with caregivers and mental health outcomes among adolescents living with HIV: a prospective cohort study in South Africa

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