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Introduction: Adolescence is a critical time for mental health promotion and prevention and establishing healthy behaviours. Implementing universal, school-based psychosocial interventions can improve short- and long-term health trajectories for adolescents. While these interventions may offer important opportunities for fostering skills and relationships, few school-based interventions have been developed for and tested in low- and middle-income countries (LMICs) where adolescent mental health needs may be significant and under-served. This manuscript details the development of a multi-component, universal school-based intervention, Health Action in ScHools for a Thriving Adolescent Generation (HASHTAG), for adolescents aged 12–15 years in Nepal and South Africa. Methods and results: We describe HASHTAG's development over four phases, combining methods and results as each phase was iteratively conducted between 2018 and 2021. Phase 1 included a systematic review and components analysis, building from WHO guidelines for adolescent mental health. Seven components were strongly supported by the evidence: emotional regulation, stress management, mindfulness, problem-solving, interpersonal skills, assertiveness training, and alcohol and drug education. Phase 2 encompassed site selection, theory of change development, and formative research engagements; research teams in each site engaged adolescents and key adult stakeholders to identify priorities for intervention. Stakeholders voiced preferences for external facilitators and key content and delivery for intervention sessions. These findings informed Phase 3, a draft manual of HASHTAG, including a whole-school component, called Thriving Environment in Schools, and a classroom-based, six-session component, Thrive Together. In Phase 4, participants engaged in consultative workshops to review and contextualise content by country, preparing HASHTAG for implementation in a feasibility trial. Minor adaptations were made in Nepal, including using school nurses and adjusting take-home materials; both country's workshops identified practical considerations for implementing activities. Conclusions: HASHTAG was designed around core evidence-based components to increase translatability across LMICs, while enabling country-specific tailoring to enhance feasibility. Future research will test whether this multi-component, whole-school approach can improve adolescent mental health.

Background: In South Africa, health and care service providers (SPs) face many interconnected challenges at work, including inadequate training and supervision and high levels of burnout. Nyamekela4Care (N4C) was developed as an integrated intervention for SP teams, to support their ability to provide high-quality care through providing a structure for operating regular team meetings that includes training, empathic skills development, administration, case sharing and self-care. We aimed to determine the feasibility, acceptability, and preliminary effectiveness of the N4C intervention as a support package for SPs in resource-constrained settings. Methods: This study utilized a mixed-methods, repeated measures design. Purposive sampling was used to recruit 42 SPs from two healthcare service settings in South Africa where teams of primary care clinic staff work together with home-visiting community health workers from community-based organisations. Data were collected across three timepoints. Self-report data were collected directly from participants at all timepoints, alongside qualitative interviews, investigating participants’ wellbeing, work satisfaction, work-related knowledge, and acceptability of N4C. A repeated measures ANOVA was applied to the data to test the preliminary effectiveness of N4C. Qualitative interview data were analysed using a thematic analysis approach to identify pertinent themes in the data. Results: The N4C intervention was found to be acceptable, with low uptake of the intervention at one site limiting interpretation of its feasibility. Qualitative data demonstrated that the intervention resulted in improved collaboration between organisations; improved capacity to practice self-care in certain cases; and improved work-related knowledge. Quantitative data identified a significant increase in work-related knowledge, but no significant differences for any other outcomes. The success of implementation may have been impeded by contextual factors such as uncertainty regarding contractual agreements for staff, staff attrition, lack of commitment and skill of some of the operational leadership and the small number of N4C meetings held. Conclusion: While participants noted improvements in work-related knowledge, self-care and intersectoral collaboration as benefits of the intervention, the implementation of N4C, particularly at one site, limited our ability to assess its feasibility and impact. Further areas for quality of care intervention research are discussed.