Developing & testing the feasibility of a sports-based mental health promotion intervention for adolescents in Nepal: a community engagement approach

每年，10-19岁的青少年中有五分之一经历过抑郁或焦虑等精神障碍，而且这一比例还在上升。我们在尼泊尔开展工作，这是一个低收入国家，那里有大量青少年面临精神障碍的风险，但缺乏精神卫生保健。需要一种干预措施，可以保护青少年免受精神障碍的影响，所有青少年都可以获得，并且便宜且易于维持。其中一项干预措施是促进心理健康，其重点是改善保护心理健康的积极行为和特征。我们的研究旨在开发一种心理健康促进干预措施，利用体育来参与和改善尼泊尔远西部地区凯拉利农村社区青少年的心理健康。我们决定把重点放在体育运动上，因为有证据表明，体育活动可以改善心理健康，青少年参与体育运动得到国家和全球青少年政策的支持，尼泊尔各地的青少年已经通过全国体育俱乐部网络参加体育运动。为了制定干预措施，我们将与三个利益攸关方群体合作：（i）青少年，（ii）家长和教师，（iii）尼泊尔心理健康和体育专家。我们将在整个项目中就我们的研究计划和研究结果征求小组的意见。青少年小组将特别帮助我们了解如何确保我们的干预措施是可访问的，通过拍摄参与体育运动的障碍主题的照片，并与研究团队讨论这些问题。我们会邀请全港市民参加嘉年华会，透过艺术、讲座及运动，让他们认识青少年的精神健康，并让他们尝试一些促进精神健康的体育活动。我们将利用这个机会收集有关社区对体育干预的优先事项和偏好的宝贵信息。为了发展我们干预的理论和内容，我们将利用来自利益相关者群体、摄影研究和游乐场的所有信息，沿着来自尼泊尔和其他中低收入国家体育干预研究的证据。我们将通过与利益相关者团体和研究团队的研讨会来完善干预理论。最后，我们将在200名10-19岁的青春期男孩和女孩中测试干预。我们将决定是体育教练还是青少年自己最适合提供干预，以及干预是否应该基于社区或学校。我们将使用我们在尼泊尔调整和验证的工具，衡量干预措施对青少年心理健康的影响和促进心理健康的其他指标。我们的研究将导致对尼泊尔干预措施的更大评估。它还将为以体育为基础的心理健康促进提供重要知识，可供在其他低收入和中等收入国家工作的政府，研究人员和组织使用。我们将为利益相关者参与干预发展研究开创先例，为尼泊尔未来的研究建立强大而持久的社区伙伴关系。

Each year, one in five adolescents aged 10-19 experiences a mental disorder like depression or anxiety, and the rate is rising. We work in Nepal, a low-income country, where there is a large population of adolescents at risk of mental disorders, but a lack of mental health care. An intervention is needed that can protect adolescents from mental disorders, is accessible to all adolescents, and is cheap and easy to sustain. One such intervention is mental health promotion, which focuses on improving positive behaviours and characteristics that protect mental health. Our research aims to develop a mental health promotion intervention that uses sports to engage and improve the mental health of adolescents in a rural community in Kailali, a district in the Far-Western Region of Nepal. We decided to focus on sports because there is evidence that sports activities improve mental health, adolescent participation in sports is supported by national and global adolescent policy, and adolescents across Nepal are already playing sport through a national network of sports clubs. To develop the intervention, we will work in partnership with three stakeholder groups of: (i) adolescents, (ii) parents and teachers, and (iii) Nepalese mental health and sports experts. We will consult groups throughout the project on our research plans and findings. The adolescent group will specifically help us to understand how to ensure our intervention is accessible, by taking photos on the theme of barriers to participating in sports, and discussing these with the research team. The whole community will be invited to a funfair where, through art, talks and sports, we will help them to learn more about adolescent mental health, and provide opportunities for them to try out some mental health promoting sports activities. We will use this opportunity to collect valuable information about the community's priorities and preferences for a sports-based intervention. To develop the theory and content of our intervention, we will draw on all the information from the stakeholder groups, the photography study, and the funfair, along with evidence from studies of sports interventions in Nepal and other low- and middle-income countries. We will refine the intervention theory through workshops with the stakeholder groups and research team. Finally, we will test the intervention among 200 adolescent boys and girls aged 10-19. We will decide whether sports coaches or adolescents themselves are best to to deliver the intervention, and whether the intervention should be based in communities or schools. Using tools that we have adapted and validated in Nepal, we will measure the intervention's effects on adolescent mental wellbeing and other indicators of mental health promotion.Our research will lead to a larger evaluation of the intervention in Nepal. It will also contribute important knowledge on sports-based mental health promotion that can be used by governments, researchers and organisations working in other low- and middle-income countries. We will set a precedent for stakeholder involvement in intervention development research, building a strong and lasting community partnership for future research in Nepal.