Adaptation and Feasibility assessment of a primary suicide prevention intervention for school adolescents in Nigeria
Lead Research Organisation:
Lagos State University
Department Name: Dept of Behavioural Medicine
Abstract
Suicide is the second leading cause of death for adolescents worldwide. Although suicide is preventable, 79% of suicides occurred in low- and middle-income countries (LMICs) where resources and personnel to help those in need are scarce. A recent World Health Organization (WHO) publication have suggested that Nigeria have one of the highest rates of suicide in the world with estimated > 15 per 100,000 population.
Primary prevention interventions delivered before the onset of suicidal behaviours are the preferred strategy in many LMICs. They are mostly cost effective, can be delivered to all youths, and do not require screening. Most importantly, since mental illnesses which are the major risk factors for suicidal behaviours develop in 50% of affected individuals before the age of 14 years, the delivery of primary prevention intervention at this critical development period is of paramount importance. The primary prevention programme for adolescent suicide often focused on social skill-building, reducing stigma, and increasing suicide awareness, help-seeking, and mental health knowledge
Schools are particularly important in addressing the reduction of risk factors and promotion of protective factors prior to the onset of suicidal behaviours which have the potential to reduce adolescent suicide rate. Schools are also ideal for testing the effectiveness of preventive interventions in a particular culture and environment before scaling up to out-of-school adolescents.
In many low and middle income countries, using interventions with proven effectiveness in the western culture can save human and financial resources associated with generating evidence from the scratch. However, the differences in the norms, resources and delivery structure to the original context sometimes render such imported intervention ineffective or even harmful. It is necessary to ensure the appropriateness, feasibility and acceptability of such evidence based intervention due to differences in the mediating and contextual factors for the condition, culture, availability of personnel and health care practices.
In this study, we wish to find out the following
(1). If such intervention for adolescent suicide , developed and with proven effectiveness in Europe, can be culturally adapted to the context of the school systems of Nigeria ?;
(2). If the adapted intervention will be acceptable to the local stakeholders (the pupils, their parents, the school personnel)?
(3). If the intervention will be clinically and cost effective
(4) The possible challenges, barriers and facilitators to the adaptation, delivery and implementation of the intervention in secondary schools in Nigeria?;
The intervention to be evaluated in this study is the "Youth Aware of Mental health" (YAM) which is a universal preventive intervention delivered to all school adolescents. YAM's relevance and fit to the LMICs' school adolescent population and recent evidence of its superior clinical and cost-effectiveness compared with other suicide prevention interventions in Europe make it an ideal choice for suicide prevention in LMICs.
Through a series of qualitative and quantitative methods, we will adapt the intervention to the Nigerian school context. We will also evaluate the clinical and cost effectiveness of the intervention in Nigerian schools . We expect to demonstrate that the adapted intervention can be feasibility delivered, acceptable to the stakeholders and show evidence of clinical and cost effectiveness
We envisage that our study will produce an effective, culturally acceptable, and scalable intervention toolkit that will reduce the incidence of adolescent suicidal behaviors, increase mental health knowledge and help-seeking a and improve self-esteem, empathy and classroom climate
Primary prevention interventions delivered before the onset of suicidal behaviours are the preferred strategy in many LMICs. They are mostly cost effective, can be delivered to all youths, and do not require screening. Most importantly, since mental illnesses which are the major risk factors for suicidal behaviours develop in 50% of affected individuals before the age of 14 years, the delivery of primary prevention intervention at this critical development period is of paramount importance. The primary prevention programme for adolescent suicide often focused on social skill-building, reducing stigma, and increasing suicide awareness, help-seeking, and mental health knowledge
Schools are particularly important in addressing the reduction of risk factors and promotion of protective factors prior to the onset of suicidal behaviours which have the potential to reduce adolescent suicide rate. Schools are also ideal for testing the effectiveness of preventive interventions in a particular culture and environment before scaling up to out-of-school adolescents.
In many low and middle income countries, using interventions with proven effectiveness in the western culture can save human and financial resources associated with generating evidence from the scratch. However, the differences in the norms, resources and delivery structure to the original context sometimes render such imported intervention ineffective or even harmful. It is necessary to ensure the appropriateness, feasibility and acceptability of such evidence based intervention due to differences in the mediating and contextual factors for the condition, culture, availability of personnel and health care practices.
In this study, we wish to find out the following
(1). If such intervention for adolescent suicide , developed and with proven effectiveness in Europe, can be culturally adapted to the context of the school systems of Nigeria ?;
(2). If the adapted intervention will be acceptable to the local stakeholders (the pupils, their parents, the school personnel)?
(3). If the intervention will be clinically and cost effective
(4) The possible challenges, barriers and facilitators to the adaptation, delivery and implementation of the intervention in secondary schools in Nigeria?;
The intervention to be evaluated in this study is the "Youth Aware of Mental health" (YAM) which is a universal preventive intervention delivered to all school adolescents. YAM's relevance and fit to the LMICs' school adolescent population and recent evidence of its superior clinical and cost-effectiveness compared with other suicide prevention interventions in Europe make it an ideal choice for suicide prevention in LMICs.
Through a series of qualitative and quantitative methods, we will adapt the intervention to the Nigerian school context. We will also evaluate the clinical and cost effectiveness of the intervention in Nigerian schools . We expect to demonstrate that the adapted intervention can be feasibility delivered, acceptable to the stakeholders and show evidence of clinical and cost effectiveness
We envisage that our study will produce an effective, culturally acceptable, and scalable intervention toolkit that will reduce the incidence of adolescent suicidal behaviors, increase mental health knowledge and help-seeking a and improve self-esteem, empathy and classroom climate
Technical Summary
The objective of this project is to culturally adapt, assess the effectiveness and examine the barriers and facilitators to the implementation of Youth Aware of Mental Health (YAM) an evidence-based primary suicide prevention program for school adolescents in Nigeria
The 39-month project will involve
Work Package 1: Preliminary steps: including setting up of project team, ensuring stakeholders buy-in and constituting the Project Advisory Board.
Work Package 2: Developmental formative evaluation: This includes (1) Mapping and review of any existing school mental health/suicide prevention programs and policies: (2)Review of school systems; (3) Key-Informant Interviews (KIIs) and Focus Group Discussions (FGDs) with key stakeholders and (4) assessing the stakeholders for readiness to implement the intervention
Work Package 3: The Adaptation Process. We will use the Method for Program Adaptation through Community Engagement (M-PACE) and in several steps which involve the stakeholders, the end users, and the original developers of the YAM program, adapt the intervention to the local context
Work package 4: Pilot Testing and Feasibility Assessment. Using the Hybrid Type 1 Effectiveness/Implementation trial design and a cluster Randomised control Trial design we will pilot test the adapted intervention for effectiveness, feasibility, acceptability and factors necessary for the implementation and scale up
Work package 5: We aim to disseminate our findings to the international scientific community and key stakeholders
We envisage that our study will produce a testable, culturally acceptable, feasible, scalable, sustainable, affordable YAM intervention toolkit that will not only significantly reduce suicidal behaviours and associated mental health problems but will also be easily integrated into the routine school and clinical practices in Nigeria and other LMICs.
The 39-month project will involve
Work Package 1: Preliminary steps: including setting up of project team, ensuring stakeholders buy-in and constituting the Project Advisory Board.
Work Package 2: Developmental formative evaluation: This includes (1) Mapping and review of any existing school mental health/suicide prevention programs and policies: (2)Review of school systems; (3) Key-Informant Interviews (KIIs) and Focus Group Discussions (FGDs) with key stakeholders and (4) assessing the stakeholders for readiness to implement the intervention
Work Package 3: The Adaptation Process. We will use the Method for Program Adaptation through Community Engagement (M-PACE) and in several steps which involve the stakeholders, the end users, and the original developers of the YAM program, adapt the intervention to the local context
Work package 4: Pilot Testing and Feasibility Assessment. Using the Hybrid Type 1 Effectiveness/Implementation trial design and a cluster Randomised control Trial design we will pilot test the adapted intervention for effectiveness, feasibility, acceptability and factors necessary for the implementation and scale up
Work package 5: We aim to disseminate our findings to the international scientific community and key stakeholders
We envisage that our study will produce a testable, culturally acceptable, feasible, scalable, sustainable, affordable YAM intervention toolkit that will not only significantly reduce suicidal behaviours and associated mental health problems but will also be easily integrated into the routine school and clinical practices in Nigeria and other LMICs.
