Advancing socioecological mental health promotion intervention: A mixed methods exploration of Phase 1 Agenda Gap findings

Abstract

IntroductionProtecting and promoting the mental health of youth under 30 years of age is a priority, globally. Yet investment in mental health promotion, which seeks to strengthen the determinants of positive mental health and wellbeing, remains limited relative to prevention, treatment, and recovery. The aim of this paper is to contribute empirical evidence to guide innovation in youth mental health promotion, detailing the early outcomes of Agenda Gap, an intervention centering youth-led policy advocacy to influence positive mental health for individuals, families, communities and society.MethodsLeveraging a convergent mixed methods design, this study draws on data from n = 18 youth (ages 15 to 17) in British Columbia, Canada, who contributed to pre- and post-intervention surveys and post-intervention qualitative interviews following their participation in Agenda Gap from 2020-2021. These data are supplemented by qualitative interviews with n = 4 policy and other adult allies. Quantitative and qualitative data were analyzed in parallel, using descriptive statistics and reflexive thematic analysis, and then merged for interpretation.ResultsQuantitative findings suggest Agenda Gap contributes to improvements in mental health promotion literacy as well as several core positive mental health constructs, such as peer and adult attachment and critical consciousness. However, these findings also point to the need for further scale development, as many of the available measures lack sensitivity to change and are unable to distinguish between higher and lower levels of the underlying construct. Qualitative findings provided nuanced insights into the shifts that resulted from Agenda Gap at the individual, family, and community level, including reconceptualization of mental health, expanded social awareness and agency, and increased capacity for influencing systems change to promote positive mental health and wellbeing.DiscussionTogether, these findings illustrate the promise and utility of mental health promotion for generating positive mental health impacts across socioecological domains. Using Agenda Gap as an exemplar, this study underscores that mental health promotion programming can contribute to gains in positive mental health for individual intervention participants whilst also enhancing collective capacity to advance mental health and equity, particularly through policy advocacy and responsive action on the social and structural determinants of mental health.

Identifying mechanisms of youth mental health promotion: A realist evaluation of the Agenda Gap programme

“…More details regarding the history of Agenda Gap and the core programme content have been published elsewhere [25]. Outcomes of interest include benefits at the individual level (e.g., self-efficacy, strengthened positive mental health), interpersonal and familial levels (e.g., improved ability to support or share mental health knowledge with family/peer groups), and community and societal levels (e.g., youth-centred policy and systems change in school and community contexts) (see Jenkins et al [5] for overview of programme outcomes).…”

“…While the broad early impacts of Agenda Gap have been detailed elsewhere [5], this paper provides additional insights into the outcomes of the programme. Aligned with our past mixed methods findings, the present analysis shows programme outcomes across individual, interpersonal, and community levels [5] At the individual level, our realist evaluation data show that Agenda Gap contributed to improved mental health, coping skills, and confidence among participants alongside sustained interest and engagement. At the interpersonal level, outcomes centered on increased sense of trust and healthy youth-adult relationships, as well as new capacity among participants to support the mental health of friends and family.…”

“…Through its strengths-based orientation, mental health promotion advances positive mental health and equity by building on the capacities of individuals and their communities to respond to upstream determinants, or root factors, shaping mental health and illness [4]. Specifically, mental health promotion is designed to address the social and structural determinants of mental health, such as the presence of social supports, safe and healthy environments, and access to education and meaningful employment, that influence health and well-being across socioecological levels-that is, for individuals, families, communities, and whole populations [3][4][5][6][7].…”

“…For example, research has documented growth in leadership skills and health promoting behaviours, feelings of empowerment, sense of responsibility and problem solving, and self-confidence [8][9][10][11]. Beyond the individual level, mental health promotion programming for youth has been found to strengthen relationships within peer and family networks, shift community norms and practices, and change social conditions to reduce health and social inequities [5,12,13].…”