The development and feasibility of a co-produced mental health and well-being intervention for adolescents in the Northern Ireland post-primary setting

Research shows that poor mental health is a growing concern worldwide particularly among young people. One of the main causes is believed to be the internalisation of stress often associated with the proliferation of examinations that they are required to undertake at school. Early interventions have been acknowledged as a way to prevent and reduce these mental health issues. However, while a number of programmes have been developed, the majority have not involved key stakeholders in the design process. Therefore, the aim of this study was to develop and test the feasibility of a co-produced school-based intervention to improve mental health and well-being in young people. The study was primarily based on stages one and two of the Medical Research Council framework for developing complex interventions, with a pragmatic mixed methods approach used to identify intervention components and outcomes. Co-produced through a six-step process with key stakeholders (students and teachers), the intervention was tested and refined in the school setting over three stages in Year 9 students aged between 12 and 14 years. Based on a review of extant literature and qualitative data collection in schools, the multi-component R.E.A.C.T. (Reducing Exam Anxiety through Activity and Coping Techniques) programme was created to reduce test anxiety and improve mental well-being. The six-week group-based intervention, underpinned by self-regulatory, behavioural and cognitive theoretical components, involved physical activity and psychoeducation elements based on recommendations from teachers and students. Quantitative findings suggested small improvements among the intervention group across the outcome measures (test anxiety, self-efficacy, physical activity) although no statistically significant differences were found. However, qualitative feedback revealed that students were less anxious around examination periods indicating that the programme has value in reducing test anxiety. The results also suggested that the intervention was feasible for teachers to deliver and could be incorporated into the school setting. The findings of this study highlighted the importance of engaging students and teachers in the research process to co-produce interventions. They also suggest the feasibility of a future full Randomised Controlled Trial to determine the effectiveness of the R.E.A.C.T. programme using a larger sample of schools.