Co-adapting a school-based mental health literacy intervention for adolescents in Cambodia and Vietnam

Given rising rates of mental health difficulties among young people, early intervention is crucial to mitigate personal and societal costs. Interventions should be locally adapted to ensure acceptability and sustainability, particularly in low- and middle-income countries (LMICs), where health systems are often under-resourced. Vietnam and Cambodia are LMICs with young populations, recent histories of conflict and ongoing vulnerabilities, including poverty and urban-rural inequality. While many adolescents experience common mental disorders, access to care is limited by stigma, low mental health literacy and reliance on urban, medicalised services. Community-based interventions are therefore needed; however, evidence on adapting such interventions in LMICs remains limited. This article describes the co-adaptation of a school-based mental health literacy intervention in Vietnam and Cambodia.

The intervention, within the Mental health capacity Building and stRengthening In Global HealTh systems study, was adapted from the co-created Adolescent Mental Health Promotion intervention implemented in Vietnam and Tanzania. Adaptations to content and delivery were developed through workshops across four study sites (two in each country). Facilitated by local research teams, the workshops engaged adolescents alongside parents, teachers and other stakeholders. Activities included topic ranking, workbook exercises and group discussions. Adaptations were synthesised across sites using spreadsheets, and feedback from stakeholder advisory groups informed the final intervention design.

Key adaptations included delivery by two trained facilitators per session (one teacher, one external provider, with an additional back-up teacher in Cambodia), inclusion of peer-led co-facilitation of some sessions and the addition of new topics: 'the Internet', 'Eating disorders and body image' and 'Self-harm and suicide'.

Co-adaptation was strengthened by early and diverse stakeholder engagement and participatory workshops that enabled all stakeholders, including adolescents, to voice their views. Responsive adaptations will likely continue throughout delivery via participant input, research team discussions and consultations with stakeholder advisory groups.