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

每年，每五名10-19岁的青少年中就有一人经历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，能够保护青少年免受精神障碍的影响，所有青少年都可以获得，而且成本低廉，易于维持。其中一种干预措施是促进心理健康，其重点是改善积极的行为和保护心理健康的特征。我们的研究旨在开发一种心理健康促进干预措施，利用体育运动来参与和改善尼泊尔偏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了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进行体育运动。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，以及(Iii)尼泊尔心理健康和体育专家。我们将就我们的研究计划和结果征询整个项目的小组的意见。青少年群体将特别帮助我们了解如何确保我们的干预措施是可获得的，方法是以参与体育运动的障碍为主题拍摄照片，并与研究团队讨论这些问题。我们会邀请全港市民参加一个游乐场，透过艺术、讲座和体育活动，加深他们对青少年精神健康的认识，并让他们有机会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关于社区对以体育为基础的干预的优先次序和偏好的宝贵信息。为了发展我们干预的理论和内容，我们将利用利益相关者团体、摄影研究和游乐会的所有信息，以及尼泊尔和其他低收入和中等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岁的青少年男孩和女孩中测试干预措施。我们将决定是体育教练还是青少年本身最适合提供干预，以及干预应该以社区还是学校为基础。使用我们在尼泊尔适应和验证的工具，我们将衡量干预对青少年心理健康和其他心理健康促进指标的影响。我们的研究将导致对尼泊尔干预措施进行更大范围的评估。它还将在以体育为基础的精神健康促进方面贡献重要的知识，可供其他低收入和中等收入国家的政府、研究人员和组织使用。我们将开创利益相关者参与干预发展研究的先例，为尼泊尔未来的研究建立强有力和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.