NIHR Global Health Research Group on Promoting Children’s and Adolescent’s Mental Wellbeing in sub-Saharan Africa.

Research Question What is the effectiveness of a culturally adapted whole school mindfulness intervention to promote mental wellbeing amongst children and adolescents 7-14 years (CA) in sub-Saharan Africa (SSA)? Background Poor mental wellbeing is the leading cause of illness among adolescents in SSA, with an estimated prevalence rate of 1 in 7. However, CA mental wellbeing is an under-researched issue; there is a lack of community awareness and few evidence-based interventions to promote it. CA mental wellbeing has been negatively impacted by COVID-19, making it even more urgent to find culturally acceptable, affordable, and cost-effective interventions to sustainably improve CA wellbeing. Aim To identify, design, implement, and evaluate a culturally acceptable, affordable and cost-effective mindfulness intervention for promoting CA mental wellbeing. Objectives Objective 1: Identify and build networks of policy actors, implementers and community members, including CA, that have a stake in improving CA mental wellbeing. Objective 2: Identify current policies for promoting CA mental wellbeing in Ethiopia and Rwanda and examine their effectiveness. Objective 3: Provide an enhanced understanding of the distinct mental wellbeing challenges that face CA and how these challenges are affected by gendered power relationships. Objective 4: Co-design a whole-school mindfulness intervention for implementation in schools to promote CA mental wellbeing that is culturally acceptable to policy actors, implementers, and communities, including CA. Objective 5: Generate evidence on the intervention's efficacy, cultural acceptability, affordability, and cost-effectiveness ready for a multi-centre trial. Objective 6: Build an African led transdisciplinary global health research group on promoting CA mental wellbeing and population wellbeing more generally. Methods Co-design and implement an affordable and acceptable whole-school intervention to promote CA mental wellbeing with policy actors and community members, including CA. Evaluate the intervention using critical realist principles combined with a quasi-experimental control trial enabling an understanding of what works for whom in what circumstances. A deep understanding will be developed by researching CA's, their families', communities' and teachers' experiences, intervention performance, and implementation costs. Capacity will be built by training future African research leaders in multidisciplinary applied health research in four overlapping phases: 1 context and situational analysis (year 1); 2 train teacher educators and teachers in mindfulness and co-design an intervention with policy actors and community members, including CA; 3 deliver an intervention in school delivered by teachers designed to promote CA mental wellbeing (year 3); 4 an impact evaluation (year 4). Impact 1 Through the intervention, promoted CA wellbeing. 2 Involving policy actors, communities, including CA, and economic analysis to ensure the affordability, cultural acceptability, and cost-effectiveness of the intervention, thereby providing a pathway for evidence take-up with an intervention ready for a multi-centre trial. 3 Enhanced the capacity of African researchers to lead and conduct research and implement interventions to promote mental wellbeing, thereby building skills to sustainably transform the promotion of CA mental wellbeing in sub-Saharan Africa.