Development and Implementation of DIALOG+S in the School Setting as a Tool for Promoting Adolescent Mental Well-Being and Resilience in a Post–Armed Conflict Area in Colombia: Exploratory Cluster Randomized Controlled Trial (Preprint)

Abstract

BACKGROUND Mental health interventions in school contexts have great potential in the prevention and early identification of mental health disorders in adolescents. Exploring the active role of the teachers and school counsellors in the mental health of their students is imperative especially after the challenges imposed by the COVID-19 pandemic. OBJECTIVE Our research aimed to adapt an existing patient-centered digital intervention called DIALOG+ from an adult clinical setting to an adolescent educational setting. We aimed to evaluate the feasibility, acceptability, and estimated effect of implementing this intervention as a tool to mitigate the impact of social difficulties and to promote quality of life, mental well-being and resilience. METHODS We conducted an exploratory mixed methods study in public schools in post-conflict areas in Tolima, Colombia. The study was carried out in 3 phases. The adaptation phase identified changes that the intervention required to be used in the school setting. The exploration phase consisted of an exploratory cluster randomized trial with teachers and school counsellors where data about adolescent's mental health symptoms and well-being were collected before and after the use of DIALOG+S. Lastly, a consolidation phase explored the experiences of and acceptability to teachers and students of DIALOG+S through focus group discussions. RESULTS The changes suggested by participants in the adaptation phase highlighted the central importance of the school setting in the mental health of adolescents. In the exploratory phase a total of 70 participants with a mean age of 14.6 years were included. Changes seen in the intervention group suggest that the intervention has the potential to improve aspects of their mental health, especially regarding their quality of life and resilience. The consolidation phase showed that stakeholders felt that the use of this intervention in the school setting was feasible and acceptable and thought that using it was an enriching experience that generated changes in the perceived mental health and the behavior of participants. CONCLUSIONS Our results are encouraging and show that the DIALOG+S intervention is feasible and acceptable as a promising opportunity to promote well-being and to prevent and identify mental health problems in the school context of a post-conflict area in Colombia. Larger, fully powered studies are warranted to properly assess the efficacy and potential impact of the intervention and to refine implementation plans. CLINICALTRIAL ISRCTN Registry ISRCTN14396374 INTERNATIONAL REGISTERED REPORT RR2-10.2196/40286