The Looking Forward Project: A pragmatic adaptive trial of hope-focused mentoring to improve mental health and social outcomes for young women who are not in education, employment or training in deprived coastal areas

BACKGROUND: Young women who are not in education, employment, or training (NEET) are growing significantly in number. They have poorer mental health and social outcomes relative to young women who work and/or study and compared to NEET young men. Gender disparities are compounded in deprived coastal areas, in which NEET young women especially lack self-agency and aspirations. Research by our group and others shows that greater hope reduces the risks of staying NEET and of having mental health problems. We have developed a hope-focused intervention (called HOPEFUL) for this group. HOPEFUL is a flexible modular programme, delivered over 3-12 weeks, for creating a hopeful mindset and learning skills in setting and pursuing personally meaningful goals. Support is provided by a youth-initiated mentor; someone that NEET young women select from their existing network. AIMS AND OBJECTIVES: We aim to generate evidence on the feasibility, effectiveness, and cost-effectiveness of the HOPEFUL intervention. Our specific objectives are to test the feasibility of conducting a randomised controlled trial (RCT) to evaluate HOPEFUL and refine its design, and then conduct a definitive RCT with an economic and process evaluation. RESEARCH QUESTIONS: Our key feasibility research question is, is it feasible to recruit NEET young women and mentors to a trial of HOPEFUL vs. standard support, with a primary outcome of hope? Our key definitive RCT research question is, does HOPEFUL improve hope and secondary outcomes of mental health symptoms, wellbeing, loneliness, and help-seeking of NEET young women in deprived coastal areas at the primary endpoint of 16 weeks and secondary endpoint of 12 months post-randomisation? Secondary research questions pertain to: evaluating intervention cost-effectiveness; how NEET young women and mentors experience HOPEFUL and its safety and acceptability; and mechanisms of proposed intervention effects and contextual moderators. METHODS: NEET young women (16-24 years) will be recruited from young people’s services provided and commissioned by local authorities and the charity and voluntary sector, including employability, and sexual health services. A feasibility trial (N=70) will be followed (assuming warranted) by a definitive RCT (N=248). The trials will compare HOPEFUL plus standard support to standard support alone, with 1:1 randomisation, stratified by local authority area (East Sussex, Brighton & Hove, Kent, Medway, Norfolk) and age (16-18 versus 19-24 years). Feasibility outcomes will be assessed at baseline and post-intervention (16 weeks), and RCT outcomes additionally at longer-term follow-up of 12-months. The RCT includes an economic and a multi-method, multi-perspective process evaluation. TIMELINES: Total duration: 54 months. Months 1-12: feasibility trial. Months 13-14: analysis against pre-specified progression criteria and protocol amendments. Months 15-54: Definitive RCT. ANTICIPATED IMPACTS AND DISSEMINATION: We will disseminate findings using tailored outputs for participants, the public, academic, health and social care professionals. In the short-term, evidence generated through this project will raise the UK profile of youth-initiated mentoring and support local implementation. In the long-term, we anticipate practice impacts through scaled-up access to HOPEFUL; ultimately benefitting the health and social outcomes of NEET young women and their networks, with associated economic and societal gains.