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.
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.
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DOI：
10.2196/46757
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发表时间：
2023-10-04
影响因子：
2.2
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中科院分区：
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教育环境是促进儿童心理健康和适应能力的理想环境。2019冠状病毒病大流行的挑战表明，教师和学校辅导员在学生心理健康方面发挥着重要作用。因此，必须制定和实施具有成本效益的干预措施，使他们能够及早发现和解决精神健康问题，特别是在武装冲突后地区，以减轻这一人群的精神障碍负担。本研究旨在将现有的以患者为中心的数字干预称为DIALOG+，从成人临床环境调整到青少年教育环境，并评估实施该干预作为提高生活质量，心理健康和恢复力的工具的可行性，可接受性和估计效果。我们在哥伦比亚托利马冲突后地区的两所公立学校开展了一项探索性混合方法研究。本研究分三个阶段进行。在适应阶段，与学生和教师进行焦点小组讨论，以确定DIALOG+在学校环境中使用所需的变化。探索阶段包括探索性集群随机对照试验。共有14个小组，每个小组有1名教师和5名学生，被随机分配到实验组（对话+S）或积极对照组（照常咨询）。两组教师每月进行一次干预，持续6个月。通过筛选量表，收集干预前后心理健康症状、生活质量、自尊、恢复力和家庭功能的信息。最后，巩固阶段通过焦点小组讨论，探讨教师和学生在DIALOG+S中的经验。参与者在适应阶段提出的变化突出了学校环境对青少年心理健康的核心重要性。在探索阶段，70名平均年龄为14.69岁（SD 2.13）的参与者被纳入研究。干预组筛查量表得分的变化表明DIALOG+S干预具有改善心理健康方面的潜力，特别是生活质量、恢复力和情绪症状。巩固阶段表明，利益相关者认为在学校环境中使用这种干预措施是可行的、可接受的，并且是一种丰富的体验，产生了参与者感知的心理健康和行为的变化。我们的结果令人鼓舞，表明DIALOG+S干预措施是可行和可接受的，是在哥伦比亚冲突后地区的学校环境中促进福祉、预防和确定心理健康问题的一个有希望的机会。有必要进行规模更大、动力更充分的研究，以适当评估干预措施的有效性和潜在影响，并完善实施计划。国际标准随机对照试验号（ISRCTN）注册表ISRCTN14396374；https://www.isrctn.com/ISRCTN14396374 rr2 - 10.2196/40286
Educational settings are ideal for promoting mental well-being and resilience in children. The challenges of the COVID-19 pandemic made evident the important role that teachers and school counselors play in the mental health of their students. Therefore, it is imperative to develop and implement cost-effective interventions that allow them to identify and address mental health problems early, especially in post–armed conflict areas, to reduce the burden of mental disorders in this population. This study aimed to adapt an existing patient-focused digital intervention called DIALOG+ from an adult clinical setting to an adolescent educational setting and to assess the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for promoting quality of life, mental well-being, and resilience. We conducted an exploratory mixed methods study in 2 public schools in postconflict areas in Tolima, Colombia. This study was conducted in 3 phases. In the adaptation phase, focus groups were conducted with students and teachers to identify changes required in DIALOG+ for it to be used in the school setting. The exploration phase consisted of an exploratory cluster randomized controlled trial. A total of 14 clusters, each with 1 teacher and 5 students, were randomly allocated to either the experimental (DIALOG+S) group or to an active control group (counseling as usual). Teachers in both groups delivered the intervention once a month for 6 months. Through screening scales, information was collected on mental health symptoms, quality of life, self-esteem, resilience, and family functionality before and after the intervention. Finally, the consolidation phase explored the experiences of teachers and students with DIALOG+S using focus group discussions. 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, 70 participants with a mean age of 14.69 (SD 2.13) years were included. Changes observed in the screening scale scores of the intervention group suggest that the DIALOG+S intervention has the potential to improve aspects of mental health, especially quality of life, resilience, and emotional symptoms. The consolidation phase showed that stakeholders felt that using this intervention in the school setting was feasible, acceptable, and an enriching experience that generated changes in the perceived mental health and behavior of participants. Our results are encouraging and show that the DIALOG+S intervention is feasible and acceptable as a promising opportunity to promote well-being and prevent and identify mental health problems in the school context in a postconflict 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. International Standard Randomised Controlled Trial Number (ISRCTN) registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374 RR2-10.2196/40286