Promoting Resilience and Mental Health Among Young People in Pandemic Settings: An Implementation Study

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.