App-based guided problem-solving intervention for adolescent mental health: a pilot cohort study in Indian schools

Abstract

BackgroundThis paper describes the pilot evaluation of ‘POD Adventures’, a lay counsellor-guided problem-solving intervention delivered via a smartphone app in Indian secondary schools.ObjectiveTo test the feasibility and acceptability of POD Adventures for adolescents with a felt need for psychological support, and to explore the intervention’s effects on self-reported mental health symptoms, prioritised problems, stress and well-being.MethodsWe used a mixed-methods pre-post cohort design. Participants were self-referred from grades 9–12 in two coeducational government-aided secondary schools in Goa, India. The intervention was delivered in two formats, ‘mixed’ (comprising individual and small group sessions) and ‘group’ (small group sessions only).Findings248 participants enrolled in the study and 230 (92.7%) completed the intervention. Outcomes at 4 weeks showed significant improvements on all measures that were maintained at 12 weeks. Large effects were observed on problem severity scores (4 weeks, d=1.47; 12 weeks, d=1.53) while small to moderate effects were seen on mental health symptoms, stress and well-being. 22 students completed qualitative interviews about their experience of the intervention. Participants found POD Adventures easy to use, engaging and helpful in solving their problems. They were satisfied with the guidance provided by the counsellor irrespective of delivery format.ConclusionsPOD Adventures was feasible to deliver with guidance from lay counsellors in Indian schools, acceptable to participants and associated with large improvements in problem severity and mental health symptom severity.Clinical implicationsPOD Adventures has promise as an early intervention for adolescents with a felt need for psychological support in low-resource settings.

Testing the effects of the Shamiri Intervention and its components on anxiety, depression, wellbeing, and academic functioning in Kenyan adolescents: study protocol for a five-arm randomized controlled trial

“…Digital and other remote mental health interventions may be especially valuable in LMICs, given their widespread availability, low costs, and growing evidence base [ 87 – 91 ]. Although much of the evidence on digital mental health interventions for youths come from high-income countries, early efforts are already underway to adapt and evaluate online and smartphone-based self-help interventions in LMICs (e.g., [ 22 , 92 , 93 ]). Additionally, future research is needed to understand how to effectively develop and implement stepped-care systems in LMICs [ 94 , 95 ].…”

A Guided Internet-Based Problem-Solving Intervention Delivered Through Smartphones for Secondary School Pupils During the COVID-19 Pandemic in India: Protocol for a Pilot Randomized Controlled Trial

“…Competing demands for time may be another engagement barrier and has been previously observed in PRIDE studies conducted in Indian schools [ 16 , 18 ]. Counsellor guidance and reminders via SMS text messaging or app notifications offered to participants in the intervention arm may positively impact retention [ 36 ].…”

“…Guidance will be provided by 2 bilingual English- and Konkani-speaking lay counsellors. They have 2 years of experience in delivering a face-to-face (analogue) problem-solving intervention [ 17 ] and 1 year of experience in facilitating use of the POD Adventures app in school-based group sessions [ 18 ]. Although college graduates, the counsellors do not possess formal training in psychotherapy or experience beyond the scope of low-intensity problem-solving.…”

“…POD Adventures is part of the PRIDE research program (2016-2022), which was conceived to address the scarcity of evidence-based interventions for common adolescent mental health problems in India and low-resource settings more broadly. This has involved the development and evaluation of a suite of transdiagnostic psychological interventions that can be delivered by nonspecialist ("lay") counsellors in under-resourced school settings [16][17][18]. POD Adventures was conceptualized as an open-access, early intervention to promote adaptive coping and mitigate risks for developing more severe and socially disabling mental health problems in the longer term.…”

“…Co-design workshops with young people and iterative piloting suggested that the optimal delivery mode for POD Adventures involved small group sessions with up to 6 students working independently on smartphones under the supervision of a counsellor. This offline, school-based format was evaluated in 2019-2020 as part of an uncontrolled cohort study (N=248), with findings suggesting that the intervention was acceptable, engaging, and feasible to deliver in school settings [18]. This paper describes the protocol for a pilot randomized controlled trial on POD Adventures delivered in an alternative internet-based format, necessitated by COVID-19-related school closures in 2020-2021.…”