Advancing mHealth-supported Adoption and Sustainment of an Evidence-based Mental Health Intervention in Sierra Leone

Last updated: April 25, 2025
Sponsor: Brown University
Overall Status: Active - Not Recruiting

Phase

N/A

Condition

N/A

Treatment

Youth Readiness Intervention (YRI)

Clinical Study ID

NCT05737667
2022003442
R01MH130320
  • Ages > 14
  • All Genders
  • Accepts Healthy Volunteers

Study Summary

This study will examine a new implementation strategy for the Youth Readiness Intervention (YRI), an evidence-based mental health intervention. The strategy will (a) leverage a delivery setting (schools) and workforce (teachers) used effectively in low- and middle- income countries; and (b) innovate with technology and mHealth tools to enhance mental health service delivery quality. The YRI will be implemented as an extracurricular resilience-building after school activity in Sierra Leone. Teachers will deliver the YRI and receive either mobile phone-supported supervision or standard in-person supervision. Mobile-based supervision will integrate WhatsApp, a free cross-platform messaging and voice service used widely throughout Africa, with mHealth digital tools. The mHealth tools will support supervision through key features, including voice activated content, fillable forms (i.e., YRI fidelity checklist), and visual dashboards to monitor fidelity. A hybrid type 3 implementation-effectiveness design will allow for evaluation of both mobile phone-based supervision as a new implementation strategy, and clinical effectiveness of the YRI on youth mental and behavioral health as secondary outcomes.

Eligibility Criteria

Inclusion

School Inclusion Criteria:

  • We will include secondary schools in the Western Region that are willing to providethe Youth Readiness Intervention (YRI) as an extracurricular activity

Exclusion

School Exclusion Criteria:

  • We will exclude schools that do not meet the inclusion criteria.

Teacher Inclusion Criteria:

  • We will include teachers who are (a) currently employed at a Western Region urban orrural secondary school; (b) willing to provide the YRI as an extracurricularactivity

Teacher Exclusion Criteria:

  • We will exclude teachers who do meet inclusion criteria.

Youth Inclusion Criteria:

  • We will include youth who are (a) currently enrolled in a secondary school in theWestern Region (urban or rural); (b) male or female aged 14-24; (c) able to attendafter school activities. We will require both youth assent and parental consent forall youth under age 18.

Youth Exclusion Criteria:

  • We will exclude youth who do not meet all inclusion criteria and/or who reportactive, severe suicidality or psychosis as determined by a study social worker.

Study Design

Total Participants: 1454
Treatment Group(s): 1
Primary Treatment: Youth Readiness Intervention (YRI)
Phase:
Study Start date:
February 15, 2023
Estimated Completion Date:
February 28, 2027

Study Description

This study will examine a new implementation strategy for the Youth Readiness Intervention (YRI), an evidence-based mental health intervention. The strategy will (a) leverage a delivery setting (schools) and workforce (teachers) used effectively in low- and middle- income countries; and (b) innovate with technology and mHealth tools to enhance mental health service delivery quality. The YRI will be implemented as an extracurricular resilience-building after school activity in Sierra Leone. Teachers will deliver the YRI and receive either mobile phone-supported supervision or standard in-person supervision. Mobile-based supervision will integrate WhatsApp, a free cross-platform messaging and voice service used widely throughout Africa, with new mobile-based digital tools. The mHealth tools will support supervision through key features, including voice activated content, fillable forms (i.e., YRI fidelity checklist), visual dashboards to monitor fidelity, and training videos to support school-based YRI delivery.

The Exploration, Preparation, Implementation, Sustainment framework, a broad multilevel, context-sensitive implementation science model, will guide the study. A hybrid type 3 implementation-effectiveness design will allow for evaluation of both mobile phone-based supervision as a new implementation strategy, and clinical effectiveness of the YRI on youth mental and behavioral health as secondary outcomes.

Aim 1 (Exploration and Preparation) will investigate barriers and facilitators to successful YRI implementation aided by mobile-based tools in Sierra Leone's secondary schools. A mixed methods evaluation with teachers, principals, and government ministry officials will inform co-development of an implementation blueprint prior to YRI delivery. User-centered design methods will be used to adapt the mHealth supervision app and incorporate WhatsApp to create an integrated user model of mobile phone-based supervision. Aim 2 (Implementation) will examine the feasibility, acceptability, cost, and fidelity to the YRI delivered by teachers receiving mobile-based supervision compared with those receiving standard supervision via a mixed methods approach. Aim 3 (Impact of Delivery Approach on YRI Effectiveness) will compare the effectiveness of the YRI in improving mental health, emotion regulation and daily functioning in youth (aged 14-24) when delivered in school settings by teachers who receive either mobile-based supervision (N=480 youth) or those who receive standard supervision (N=480 youth). Aim 4 (Sustainment) will (a) investigate mechanisms of adoption and sustainment of the YRI delivered by teachers through a mixed methods evaluation with teachers, youth, and principals; and (b) conduct a cost-effectiveness and return on investment analysis to evaluate relative costs vs. benefits of the YRI from a broad societal perspective, including educational outcomes.

Connect with a study center

  • Innovations for Poverty Action

    Freetown,
    Sierra Leone

    Site Not Available

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