Project HASHTAG: Health Action in Schools for a Thriving Adolescent Generation

在全球范围内，青少年容易受到精神障碍、伤害和不健康的生活方式选择的影响，而生活在逆境中的年轻人更是如此。针对青少年的早期干预方案可以促进心理健康，预防精神障碍，防止危险行为和其他不健康的生活方式选择。这些方案有可能对青少年的健康和他们晚年的健康作出积极贡献。由于全球约80%的青少年在上学，在学校环境中提供的干预方案可以惠及很大比例的青少年。我们审查了以学校为基础的干预方案的证据，发现大多数方案来自高收入国家，并且只关注一个问题，如吸烟或酗酒或暴力。由于许多心理和身体健康不良的风险因素，如饮酒和危险的性行为，同时发生，针对一系列因素的方案可能更有效和更具成本效益。在资源匮乏的情况下，此类方案可能对政策制定者更具吸引力。然而，仅仅以课堂为基础的课程不太可能影响整个学校并保持更好的健康效益。将更广泛的学校氛围与以课堂为基础的方案相结合，在以前的研究中有效地减少了欺凌和精神健康症状。本研究的目的是通过在低收入和中等收入国家制定和调整一个多层次的、对性别敏感的学校干预方案来解决证据差距，该方案旨在通过促进积极的心理健康，针对一系列消极的心理和身体健康结果，预防精神障碍(特别是抑郁和焦虑)，以及预防高危青少年的一系列危险行为。我们建议在南非和尼泊尔两个地方发展这项计划(Project Hashtag)，共同制订两项策略：与青少年、家长、教师和学校管理人员共同制订更广泛的学校氛围计划和以课堂为本的计划。对于第一项策略，将进行学校层面的评估、规划和行动过程，以改善学校氛围。学校气氛是指教职员工和学生对学校环境的看法，受学校组织结构、教职员工和学生之间的关系以及他们的态度和行为影响。学校气候改善战略通过提高教师、教职员工和学生的承诺，并加强以课堂为基础的战略的内容，支持以课堂为基础的干预措施的作用。对于第二个策略，11-12岁的青少年将参加一个名为一起茁壮成长(TT)的团体计划，以使他们掌握在证据审查中确定的在促进心理健康、预防心理健康问题和危险行为方面有效的技能。为了开发和测试这些策略，Hashtag项目将包括两个阶段。在发展阶段，我们将与利益攸关方面谈，并观察学校环境和师生互动，以：(I)制定TES大纲，(Ii)与每个国家两所学校的青少年、家长、教师和其他利益攸关方一起收集关于TT的建议。这些建议将为一个干预发展小组制定技术转让方案草案的工作提供参考。在可行性阶段，我们将在每个国家的四所学校实施TES和TT策略之前和之后使用问卷对学生进行评估。我们将评估问卷是否包含有关学校氛围、精神健康和危险行为的必要信息。我们还将评估执行该方案所需的进程是否运作良好。计划完成后，我们会访问学生和持份者，了解他们对计划的意见，以及在学校推行计划是否可行，以及有甚麽因素会阻碍或有助推行计划。

Adolescents globally are vulnerable to mental disorders, injuries and unhealthy lifestyle choices, and this is heightened in young people who live in adversity. Early intervention programmes for adolescents can promote mental health, prevent mental disorders, and prevent risky behaviours and other unhealthy lifestyle choices. These programmes have the potential to make positive contributions to adolescents' health, and to their health in later life. Since about 80% of young adolescents globally are in school, intervention programmes delivered in the school setting could reach a large proportion of adolescents. We reviewed the evidence for school-based intervention programmes and found that most programmes come from high-income countries, and focus on one issue only, such as tobacco or alcohol use, or violence. Since many risk factors for poor mental and physical health, such as alcohol use and risky sexual behaviour, occur together, a programme targeting a range of factors could be more effective and more cost-effective. Such programmes may be more attractive to policymakers in low resourced settings. However, classroom-based programmes alone are unlikely to impact whole schools and sustain improved health benefits. Combining broader school climate and classroom-based programmes has been effective in reducing bullying and mental health symptoms in previous studies.The aim of this study is to address the evidence gap by developing and adapting a multilevel, gender-sensitive school intervention programme in low- and middle-income countries (LMICs) targeting a range of negative mental and physical health outcomes by promoting positive mental health; preventing mental disorders (specifically, depression and anxiety); and preventing a range of risk behaviours in young at-risk adolescents. We propose to develop the programme (Project HASHTAG) in two LMICs, South Africa and Nepal, co-producing two strategies: a broader school climate and classroom-based programme with adolescents, parents, teachers and school managers.For the first strategy, a school-level assessment, planning and action process, Thriving Environment in Schools (TES), will be conducted to improve school climate. School climate is defined as staff and students' perceptions of the school environment, which is influenced by the school organisational structure, relationships among staff and students, and their attitudes and behaviours. School climate improvement strategies support the role of classroom-based interventions by boosting commitment from teachers, staff and students, and by reinforcing content of classroom-based strategies. For the second strategy, adolescents ages 11-12 will participate in a group programme known as Thrive Together (TT), to equip them with skills identified in the evidence review as being effective in promoting mental health, and preventing mental health problems and risky behaviours.To develop and test these strategies, Project HASHTAG will comprise two phases. In the development phase we will interview stakeholders, and observe school environments and staff-student interactions to: (i) develop an outline of TES and (ii) gather suggestions for TT, with adolescents, parents, teachers, and other stakeholders in two schools per country. These suggestions will inform the work of an intervention development group in producing a TT programme draft. In the feasibility phase, we will assess the students before and after the TES and TT strategies are implemented in four schools per country using questionnaires. We will assess whether the questionnaires capture the necessary information on school climate, mental health and risky behaviours. We will also evaluate whether the processes needed to implement the programme work well. After programme completion, we will interview students and stakeholders about their opinions of the programme and whether it is feasible to implement in schools, and what will hinder or help this implementation.