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Authors: Swetha Sampathkumar (Cardiff University), Nina Heinrichs (Department of Psychology, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany), Rhiannon Evans (Cardiff University), Lara Barg (Department of Psychology, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany), Graham Moore (Cardiff University), Marija Raleva (Institute for Marriage- Family- and Systemic Practice, Alternativa, Skopje, North Macedonia;), Galina Lesco (Asociatia Obsteasca Sanatate Pentru Tineri, Health for Youth Association, Chisinau, Republic of Moldova), Viorel Babii (Health for Youth Association, Chisinau, Republic of Moldova), Ivo Kunovski (Institute for Marriage- Family- and Systemic Practice, Alternativa, Skopje, North Macedonia;), Heather Foran (University of Klagenfurt, Department of Health Psychology, Klagenfurt, Austria), Janina Mueller (University of Klagenfurt, Department of Health Psychology, Klagenfurt, Austria), Judit Simon (Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria), Dennis Wienand (Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria), Bethan Pell (Cardiff University), Yulia Shenderovich (Cardiff University)
Background: Adolescence is a time of both risk and opportunity for mental health, and adolescents in Eastern Europe are exposed to risks due to inequality, poverty, and war in Ukraine. Programmes strengthening the adolescent-caregiver relationship are an evidence-based solution to prevent adolescent mental health problems. Parenting for Lifelong Health (PLH) is an open-access programme targeting parenting practices and adolescent health. The FLOURISH study is adapting and evaluating PLH for Parents and Teens with additional adolescent-focused components in North Macedonia and Republic of Moldova to prevent mental health problems and promote wellbeing for adolescents between 10-14 years. We present the adaptation process and process evaluation findings of the pilot study.
Method: The programme was iteratively adapted, with two rounds of advisory group consultations and interviews in both countries. In the pilot, three programme groups were delivered to 64 adolescent-caregiver pairs in North Macedonia and Republic of Moldova (October 2023- January 2024). Fidelity was measured by supervisors through a structured observation assessment tool. Post-programme focus groups were conducted with adolescents, caregivers, and staff, and the transcripts analysed using thematic and framework analysis.
Results: The findings from advisory groups and focus groups confirmed perceived need and relevance of the programme. The programme was generally implemented as intended, with average 80% fidelity to the PLH programme recorded. Facilitators made responsive modifications to some content to make it more acceptable to younger adolescents.
Focus groups suggested that adolescents, parents, and staff found the adapted programme feasible and acceptable. They also suggested further adaptations, e.g., changing order and length of sessions, modifying materials to make them more engaging and age suitable.
Discussion: The pilot findings are being used to inform adaptations for the next phase, the factorial trial with around 720 families, testing different combinations of the programme components, which will be followed by a randomised controlled trial.
| Conflict of interest | No potential conflict of interest |
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