Implementing a school-based mental health literacy programme for adolescents: barriers, facilitators and preliminary outcomes.

Overall improvements in mental health literacy were observed from pre- to post-intervention across the student sample.

• A 21-item pre- and post-intervention questionnaire was administered to 841 Secondary One students.
• Pre-post differences were analysed using Wilcoxon signed-rank tests and difference-in-difference (DiD) analyses.
• Significance level was set at 0.05.
• The programme targeted knowledge, attitudes, and help-seeking behaviours among secondary school students.

Face-to-face delivery of the programme yielded significantly better mental health literacy scores than online delivery for two questionnaire items.

• Face-to-face sessions incorporated Virtual Reality and interactive elements.
• Online delivery via Zoom video conferencing occurred during the COVID-19 pandemic.
• The shift to Zoom was identified as a salient barrier, as the relative advantage of interactive sessions was lost.
• Reduced effectiveness during online delivery was specifically noted for two items on the 21-item questionnaire.

Key facilitators of programme implementation included interactive session design, understanding students' needs, engaging school administrators, and implementation fidelity.

• The relative advantage of interactive sessions incorporating Virtual Reality was identified as a primary facilitator.
• Understanding students' mental health needs and available resources was identified as a facilitator.
• Engaging school administrators and executing with implementation fidelity and fit were also noted as facilitators.
• These themes were identified through semi-structured interviews with 22 key informants and six session observations.
• Analysis was guided by the Consolidated Framework for Implementation Research (CFIR).

Key barriers to programme implementation included the shift to online delivery, implementation complexity, insufficient resources, and challenges in engaging students and teachers.

• The COVID-19 pandemic necessitated a shift to Zoom video conferencing, which was identified as a salient barrier.
• Implementation complexity was noted as a barrier.
• Insufficient available resources posed challenges to implementation.
• Difficulties in engaging both students and teachers were identified as barriers.
• Barriers were identified via qualitative semi-structured interviews with 22 key informants and guided by CFIR.

A mixed-methods design combining qualitative interviews, session observations, and a quantitative pre-post questionnaire was used to evaluate the programme.

• Qualitative data were collected through semi-structured interviews with 22 key informants.
• Six session observations were conducted.
• Qualitative data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR).
• Quantitative data were collected from 841 Secondary One students using a 21-item questionnaire.
• The programme, titled 'Do You M.I.N.D.?', was implemented in Singapore.