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. 2023 Oct 24;2023(10):CD014722. doi: 10.1002/14651858.CD014722.pub2

ISRCTN80690743.

Study name Project HASHTAG: testing a school‐based intervention to improve adolescent mental health in Nepal and South Africa
Methods Study design: cluster‐RCT
Country: Nepal and South Africa
Participants School‐going adolescents in South Africa (grade 8) and Nepal (grade 7‐9)
Inclusion criteria: 
a. school‐going adolescents in South Africa (grade 8) and Nepal (grade 7‐9)
Exclusion criteria:
not specified
Stated purpose: as this is a feasibility trial, we will evaluate the feasibility of the intervention and trial procedures.
Interventions Intervention:
HASHTAG
HASHTAG is a multi‐level intervention for young people in grade 8 or equivalent that aims to promote positive mental health and prevent mental health conditions (specifically, depression and anxiety) and reduce risk behaviours. The HASHTAG intervention comprises two modules: 1) Thriving Environment in Schools (TES), a whole‐school intervention, and 2) Thriving Together (TT), a group‐based intervention delivered directly to young adolescents. TES is a school climate improvement strategy that seeks to modify adolescents’ social and emotional environment through a whole‐school approach to create a school culture of connectedness and supportive relationships. It will include 1) School Action Groups, 2) teacher‐focused workshops, and 3) mental health awareness raising activities. TT will be delivered to students in grade 8 in South Africa and grade 7‐9 in Nepal. It will include six 90‐minute weekly sessions focused on emotional regulation, stress management, problem‐solving, interpersonal skills and relationships, and assertiveness training.
Control:
Enhanced treatment as usual (eTAU: control arm schools will receive a shortened version of the student sessions after follow‐up interviews are complete).
Outcomes Participants' outcomes of interest for this review

  1. Quality of life (positive mental health) – Stirling Children’s Wellbeing Scale (15 items); a culturally‐suitable adaptation of Resilience Scale (8 items), and Multidimensional Student Life Satisfaction Scale (family subscale, 7 items, South Africa only)

  2. Diagnosis of mental disorders (depression incidence) – Patient Health Questionnaire 9 – Adolescent version (PHQ‐A), scores at or above a threshold of 10

  3. Mental health symptoms/depression – Patient Health Questionnaire‐9 ‐ Adolescent version (PHQ‐A)

  4. Diagnosis of mental disorders (anxiety incidence) – Generalized Anxiety Disorder‐7 (GAD‐7), scores at or above a threshold of 10

  5. Mental health symptoms/anxiety – Generalized Anxiety Disorder‐7 (GAD‐7)

  6. Psychological functioning and impairment ‐ Strengths and Difficulties Prosocial Scale (5 items), and World Health Organization Disability Assessment (WHODAS)

  7. Social outcomes (social support) – Social Connectedness Scale (SCS) and Oslo Social Support Scale (OSSS)


Economic outcomes
Nil
Time points: baseline, post‐intervention (immediately post‐intervention)
Starting date 18 July 2019 (recruitment start date: 1 March 2021)
Contact information Prof Mark Tomlinson, markt@sun.ac.za
Notes Source of funding: Medical Research Council (UK)
Prospective trial registration number: ISRCTN80690743