Study protocol for a Critical Realist pilot cluster-randomised controlled trial of a whole-school-based mindfulness intervention (SBMI) promoting child and adolescent mental wellbeing in Rwanda and Ethiopia

AbstractO_ST_ABSBackgroundC_ST_ABSThis research uses a critical realist approach to understand how and why school-based mindfulness interventions designed to promote child and adolescent mental wellbeing work or do not. Poor mental wellbeing is the leading cause of illness among children and adolescents in sub-Saharan Africa, with an estimated prevalence of 1 in 7. There is evidence that school-based mindfulness interventions promote child and adolescent wellbeing. Still, few interventions have been trialled in SSA, and none have examined how and why mindfulness interventions work. MethodsUsing a Critical Realist pilot cluster-randomised controlled trial; we will evaluate a school-based mindfulness intervention compared to the regular curriculum over one school year. Incorporating mindfulness into the primary school curriculum will provide proactive reach to all CA. The intervention will be codesigned by teacher educators, schoolteachers, policy actors and community members, including CAs. In each country, three schools will be selected and randomised as pilot, intervention, or control/waitlist. The mindfulness intervention will be integrated into the school curriculum and taught to all children attending the schools by classroom teachers trained to deliver it. Quantitative research will be used to measure the outcome of the intervention, and qualitative research to answer how and why questions. The primary outcome is improved mental wellbeing of pupils measured by the Acholi Psychological Assessment Instrument. Secondary outcomes will include subjective quality of life, school 'climate', school performance, and satisfaction with school. Pupils, teachers and main carers in intervention and control/waitlist schools will fill in questionnaires before and after the intervention and process evaluation will be carried out in intervention schools. The cost-effectiveness of the mindfulness intervention will be assessed. DiscussionThe evaluation will provide new interdisciplinary knowledge, and methods, to understand and sustainable impacts on CA mental wellbeing in these settings. Independent research and intervention teams will run the trial. Registration of Project: Research Registry 8799, Mar 31 2023