A Feasibility Study of a Co-adapted Mindfulness-based Intervention for Adolescents aged 13-16 in Guwahati, India.

With mental health problems including suicide for adolescent in India steadily increasing, the need for preventive action is urgent. There are major knowledge gaps about what works, at scale, to prevent poor mental health and improve adolescent wellbeing, in low resource settings. One approach is school-based prevention programmes, built on evidence-based practices such as mindfulness. Mindfulness-based interventions (MBIs) have been introduced in schools globally, including in India, as a promising way to improve adolescent mental health and wellbeing. Most MBIs for adolescents have been developed in Western settings. The World Health Organisation (WHO) recommends that where research and development capacity is limited, evidence-based programmes developed in one context or country could be adapted for delivery in another.
This doctoral work engaged local stakeholders to adapt, and feasibility test an MBI originally developed for adolescents in the UK. The study aimed to discover if the MBI could be adapted into a suitable and acceptable school-based prevention intervention for adolescents (13-16y) in Assam. A partnership was established with MIND India, an Institute of Positive Mental Health & Research. The doctorate delivered three sequential studies, based on the exploration (Study 1), preparation (Study 2), and implementation (Study 3) phases for intervention development and testing.
Study 1 was a consultation with n=14 in-country experts on adolescent mental health needs in India and on the co-adaptation, design and feasibility testing of the intervention. Study 2 co-adapted an MBI and other intervention components with n=19 adolescent end users (aged 13-18y). Study 3 determined the feasibility of the co-adapted MBI (n= 39 adolescents) to inform whether progression to a controlled trial of effectiveness was warranted. The interventions’ primary outcome was wellbeing, and a number of secondary outcomes were tested. A theory of change and logic model were produced.
Study 1 findings endorsed a school-based universal prevention approach, the use of mindfulness and engaging with adolescent young people in co-adaptation research.
Study 2 indicated the strong appetite that young people in Guwahati had for school wellbeing programmes and their knowledge on what is needed to support the wellbeing of people their age. Findings indicated an openness to mindfulness, and that solutions to cope with difficult times was a priority. Collecting data about mental health was also acceptable to them and their guardians. Acceptance of all core components of the proposed MBI was established meaning that only surface changes were required to assure culturally appropriate language and activities.
Study 3 demonstrated that the co-adapted MBI met feasibility thresholds with 77% of participants attending at least 5 out of 8 sessions, and 95% of participants who completed the post-intervention evaluation recommending the programme to their peers. The study indicated that progression to an effectiveness trial is warranted and highlights the advantages of continued partnership with adolescents in India to promote acceptable community prevention approaches for wellbeing.
Overall, the thesis has contributed new knowledge to meaningful participation in wellbeing programme development by adolescents in India and has aided the prevention agenda by establishing the feasibility of a community-based approach. Findings extend knowledge about mindfulness approaches with adolescents in India, including via school-based delivery.