Kaaren Mathias

Introduction: Literacy is a determinant of mental health, wellbeing, and social participation. Although literacy interventions improve educational and socioeconomic outcomes, their effects on mental health and social participation are poorly evidenced. We aimed to assess the feasibility and acceptability of a group-based literacy and numeracy intervention and explore its effects on literacy, mental health, numeracy, wellbeing, and social participation. We also estimated implementation costs. Methods: We conducted a mixed-methods study using an uncontrolled pre–post design among women in low- income urban communities in Lucknow, India. A total of 115 women were recruited to a 17-week group literacy intervention using the Accelerating Learning for All literacy intervention. Outcomes measured at baseline, midline, and endline used literacy and numeracy assessments and validated scales of mental distress, wellbeing, and social participation. Quantitative data were analysed using multilevel mixed-effects models. Qualitative interviews and focus groups were analysed thematically. Costs were calculated per participant. Results: The intervention was feasible and acceptable with functional recruitment of 71% (82/115), 74/82 participants (90%) completed it (retention), and mean attendance of 69% of scheduled sessions. In multilevel mixed-effects models, mean literacy scores increased by 29.5 (95% CI: 23.6, 35.3) between baseline and endline, while mean mental distress (SRQ20) decreased by 3.4 (95% CI: 2.2, 4.6), mean mental wellbeing (WEMWBS) improved by 2.6 (95% CI: 0.1, 5.1), while social exclusion (P scale) declined by 4.1 (95% CI: 1.6, 6.5). Qualitatively, participants described greater confidence, autonomy, financial literacy, and social support. Implementation enablers included local facilitators. Implementation cost was US$25 per participant. Conclusion: This low-cost literacy intervention was feasible and acceptable for women in low-income urban communities in India. Findings provide preliminary evidence of improvements in literacy, mental health, and social participation. Controlled studies are needed to establish causal effects, long-term outcomes, and scalability. What is already known on this topic: Literacy is a recognised upstream determinant of mental health through its influence on education, social participation, and health literacy. There is almost no evidence examining whether literacy interventions for women can directly improve mental health and wellbeing, particularly among highly disadvantaged populations. Further, little is known about the feasibility and effectiveness of brief literacy interventions in low-income, disadvantaged urban settings, where women with limited or no literacy skills are disproportionately concentrated. What this study adds: This study shows that a brief literacy intervention among low-income women in informal urban North India is both feasible and acceptable when implemented by local community members. It shows this can be implemented with modest financial cost (around US$25 per person). It shows that participation in the intervention was associated with improved social participation, mental health and mental wellbeing. How the study might affect research, practice or policy: Having demonstrated feasibility and acceptability, together with the promising associations observed in this study, it provides a strong rationale for rigorous randomised controlled trials to establish causality and determine whether this low-cost intervention can deliver meaningful and sustainable improvements in mental health and wellbeing at scale.

Objectives: To evaluate the pilot implementation of Parwarish (Parenting for Lifelong Health–Teens) programme on reducing violence against adolescents and improving parenting practices, mental health, gender attitudes, resilience and financial coping among families in disadvantaged communities in North India. Design: Pilot implementation study using a pre-post study design. Setting: Community-based implementation in three disadvantaged settings in North India, including urban informal settlements, rural agricultural areas and remote tribal communities. Participants: A total of 239 adolescents (aged 12–18 years) and 478 parents from 239 families were recruited using purposive and snowball sampling; all participants completed baseline assessment, with follow-up conducted within 6 weeks after intervention completion. Interventions: A 14-week group-based parenting intervention delivered weekly in community settings, focusing on communication, problem-solving, non-violent discipline and financial management, facilitated by trained community members. Primary and secondary outcome measures: Primary outcomes were parent and youth-reported maltreatment. Secondary outcomes included parenting practices, adolescent behaviour, mental health, resilience, gender-equitable attitudes and financial coping. Results: Significant improvements were observed across all outcomes. Among adolescents, positive parenting increased (β=13.7; 95% CI 12.43 to 14.98), youth behaviour improved (β=9.12; 95% CI 8.11 to 10.13), resilience increased (β=9.53; 95% CI 8.19 to 10.86) and harsh discipline decreased (β=−8.69; 95% CI −10.45 to −6.94). Among parents, positive parenting improved (β=10.6; 95% CI 9.43 to 11.85), youth behaviour improved (β=11.11; 95% CI 10.20 to 12.02), harsh discipline decreased (β=−10.60; 95% CI −12.23 to −8.96) and financial coping improved (β=−4.97; 95% CI −5.98 to −3.97). Conclusions: This low-cost, community-delivered pilot implementation of the Parwarish intervention was associated with improvements in parenting practices and in mental health and resilience among adolescents and parents. While causal inference is limited by the study design, the findings support further evaluation using controlled designs. It suggests potential for scale-up in similar low-resource settings. Trial registration number: ACTRN12622000858796.

Introduction: The COVID-19 pandemic led to increased risk of mental ill-health as well as new challenges in the implementation of community-based interventions. This study aimed to evaluate the implementation of a resilience and mental health intervention among young people in disadvantaged urban communities in Uttarakhand, India, during the COVID-19 pandemic. Material and Methods: Participants in this study included 426 school-going adolescents who lived in low-income neighborhoods in Dehradun, North India. They joined weekly peer-facilitated group sessions of 90 minutes and followed a structured intervention, Nae Disha. Qualitative interviews and focus group discussions with 79 people assessed implementation processes. We analyzed these using reflexive thematic analysis (inductive) and then fitted the categories that emerged into an adapted framework for the evaluation of complex health interventions. Results: In a context of emerging from a pandemic lockdown in disadvantaged, informal urban settlements, participants (facilitators and youth) reported improved coping, mental well-being, and hope for the future as well as improved relationships with household members and peers. Implementation factors that supported outcomes included contextually adapted innovations, use of WhatsApp for coaching and monitoring. Implementation measures taken to reduce COVID-19 transmission included small group sizes, responsiveness to community concerns, and smartphone use to coach facilitators. Discussion: This study found improved measures of mental health and resilience for young people participating in this group intervention set in low-income communities in North India, which are correlative, not causative. Key mechanisms that supported outcomes included recognizing concepts by using local dialects, feeling safe to participate, forming new peer friendships, and feeling safe and belonging. This group intervention was socially feasible, acceptable and cost-effective in a pandemic context and merits further research using a control group in other settings in South Asia.

Introduction In a context of eroding trust in health care, understanding high‐quality relationships between health care providers and service users is important. Engaged relationships are linked to greater engagement in therapy, increased access and utilisation of services and improved outcomes. This study aimed to examine how unregulated health workers (kaimahi) develop and sustain high‐quality relationships with whānau (families) in three effective non‐profit providers in Waitaha Canterbury, New Zealand. Methods We used a comparative case study design and qualitative methods to explore how kaimahi build and maintain relationships with whānau in three child and youth health services based in Christchurch, Canterbury. We conducted 28 semi‐structured interviews with kaimahi, supervisors, and whānau, and analysed the transcripts using reflexive thematic analysis. Findings Data suggested that relationships were developed and strengthened in these six ways: (1) when kaimahi responded to a family's immediate needs, (2) when kaimahi engaged with long‐term social determinants of health, (3) when kaimahi shared their own life experiences, (4) when families and kaimahi had a long duration of engagement, (5) when kaimahi were supported by peer relationships and professional development, and (6) when whānau perceived that kaimahi and the broader organisation practised their values and showed cultural safety. We synthesised these findings into a three‐circle framework that summarised the key factors that support the development of trusting relationships. Conclusions Trusting relationships between kaimahi and whānau are central to improving health equity. Our findings underscore that culturally grounded, relationship‐focused practices that are supported by responsive organisations and flexible contracts can create a virtuous cycle of trust and engagement, which support better health outcomes.

In resource‐poor settings in South Asia, there are many informal assets in communities that support mental health. Using participatory approaches and a ‘caring methodology’ we aimed to examine whether women's psychosocial support groups improved mental health knowledge, safe social spaces, and collective action. We also hoped to act collectively for mental health through the project and to reflexively consider how this methodology cared for participants and researchers. We conducted this community‐based qualitative study in 2016, across three sites in Dehradun district, Uttarakhand, Northern India. Data were collected through focus group discussions with women involved in support groups (N = 10, representing 59 women) and key informant interviews (N = 8), as well as field notes, journals, and reflexive discussions. We analysed data using thematic analysis. This research both researched care and provided mental health care. We found that support groups as well as caring methodologies led to increased mental health knowledge, safer social spaces, improved mental health and more equal gender relations. This methodology also supported women to act collectively to support each other and share their mental health knowledge with others. The caring methodology was constrained by stark asymmetries in literacy and educational status between researchers and participants.

Mental health problems are the leading cause of disease burden among young people in India. While evidence shows that youth mental health and resilience can be improved with group interventions in school settings, such an intervention has not been robustly evaluated in informal urban settings. This study aimed to evaluate whether the Nae Disha 3 group intervention could improve youth resilience, mental health and gender equal attitudes among disadvantaged young people from low-income urban communities in India. This cluster randomised controlled trial used an analytic sample of 476 adolescents and young adults aged 11-25 years from randomised clusters in urban Dehradun, India. The 251 intervention group participants were 112 boys and 139 girls, and the 225 young people in the wait-control group were 101 boys and 124 girls. Five validated tools measuring resilience gender equity and mental health were filled by participants at three different points in time. Difference in difference (DiD) analysis at T2 showed that scores improved among girls in intervention group, for adjusted model, resilience (DiD = 4.12; 95% CI: 2.14, 6.09) and among boys, for resilience (DiD = 5.82; 95% CI: 1.57, 9.74). The Nae Disha 3 intervention among disadvantaged urban youth moderately improved resilience for both young men and women, though it did not significantly impact mental health, self-efficacy, or gender-equal attitudes. We establish potential merit for this approach to youth mental health but recommend further research to examine active ingredients and the ideal duration of such group interventions.