Evidence and gap map finds significant variability with which randomised trials on whole-school approaches promoting mental health and preventing risk behaviours in adolescence integrate all 8 dimensions of a whole-school approach.
EGM in Brief
There is significant variability with which randomised controlled trials of whole-school interventions addressed the eight domains of a whole-school approach, ranging from 7% of interventions explicitly referencing the government policies and resources domain to 100% addressing the school curriculum domain. Despite different intervention foci, there is a clear overlap of intervention strategies within each domain.
What Is This EGM About?
Adolescence is a vulnerable period for the onset of mental disorders and risk behaviours. Whole-school interventions hold vast potential in improving mental health and preventing risk behaviours in this vulnerable period. These interventions are modelled on the World Health Organisation’s Health-Promoting Schools Framework, which advocates for change across eight domains. These include the (i) school curriculum, (ii) school social-emotional environment, (iii) school physical environment, (iv) school governance and leadership, (v) school policies and resources, (vi) school and community partnerships, (vii) school health services, and (viii) government policies and resources. Through offering a holistic approach to health promotion and prevention and involving the key stakeholders in an adolescent’s life, including their peers, parents and teachers, whole-school interventions are theoretically more likely than other forms of school-based approaches to improve mental health and prevent risk behaviours in adolescents. However, vague instruction on what is to be implemented, how and by whom presents challenges for stakeholders in identifying concrete intervention strategies to address the eight domains and thus in realising the potential of the Framework. Mapping how whole-school interventions address the eight domains enables appraisal of current practice against the recommendations of the Health-Promoting Schools Framework. This allows for identification of critical evidence gaps in need of future research, with the aim of fostering optimal translation of the Framework into practice to promote mental health and prevent risk behaviours in adolescence.
What is the Aim of This EGM?
To map how randomised controlled trials of whole-school interventions promoting mental health and preventing risk behaviours in adolescence address the eight domains of a whole-school approach.
What Studies Are Included?
A total of 28 studies reported in 58 publications were included in our EGM. The majority of interventions implemented by studies classified as either substance use prevention or multiple risk behaviour interventions. Most studies targeted students in lower secondary school grade levels, with only 5 studies targeting students in grades 10–12. There was minimal representation of studies set in low- and middle-income countries (5 of 28 studies). The interventions implemented by studies ranged from 9 weeks to 3 years in duration.
What Are the Main Findings?
Though 100% of studies involved students in the evaluation stage and 61% in the implementation of intervention strategies, only 39% involved students in the planning and 29% in the design of whole-school interventions. There was significant variation in how frequently whole-school interventions addressed each of the eight domains, ranging from 7% to 100%. This included 100% of interventions addressing the school curriculum domain, 64% the school social-emotional environment domain, 46% the school physical environment domain, 50% the school governance and leadership domain, 61% the school policies and resources domain, 93% the school and community partnerships domain, 29% the school health services domain and 7% the government policies and resources domain. Despite different intervention foci, there was a clear overlap in the intervention strategies implemented within each domain.
What Do the Findings of the Map Mean?
Our EGM identifies several critical gaps for future research. These include the need to investigate (i) whether certain domains of a whole-school approach are critical to intervention success; (ii) whether addressing more domains translates to greater impact; and (iii) the relative effectiveness of overlapping intervention strategies within each domain, so that the most effective can be prioritised. Our EGM identifies the need for more studies to involve older adolescent populations and those from low- and middle-income settings. We highlight four crucial factors for stakeholders to consider in the design and planning of whole-school interventions, alongside exploration of their potential impact on intervention success. These include (i) the provision of training and support mechanisms for those delivering interventions; (ii) the decision of whether an intervention targets a single issue or multiple issues; (iii) the optimal time duration for implementation; and (iv) the involvement of students in the design and planning phases to ensure that interventions mirror their real-world needs, preferences and interests.
How Up-to-Date Is This EGM?
The searches were all conducted on the 4th of September 2023.