Innovation summary

Mental ill-health is a leading cause of the disease burden among young people. In India, young people with mental health problems often experience social exclusion, impacting their ability to meaningfully participate in their communities, with peers or seek care. The risk of mental ill-health also increases with poverty, adversity, low skills and knowledge1-2.

Nae Disha is a peer-led mental health intervention that aims to increase and strengthen key psycho-social assets in adolescents to moderate the impacts of adversity and has been implemented primarily in Uttarakhand state.

It consists of an 18-module youth development and positive psychology curriculum which is implemented in groups weekly by peer facilitators. The project demonstrated that young people’s social inclusion and mental health can be improved through a low-resource short term peer-led intervention involving group discussions and a supportive curriculum.

Impact summary

  • A total of 1900 adolescents have participated in the intervention to date
  • Reported a decrease in the proportion of adolescents scoring in the ‘abnormal’ range of Strengths and difficulties by more than half (from 42.6% to 20.3% (p<0.001)

“I used to get angry a lot and even broke things. I was always stressed but now things are different. I am now able to understand the problem and have changed the way I interact and behave.”

- Female Nae Disha participant, 23 years old.

Innovation details

Mental illness is the leading burden of disease for young people, and those affected experience restrictions in social participation that compromise recovery. Poor mental health among young people is associated with reduced access to education, underemployment and lack of social networks. India scores low on levels of gender equality when compared globally3, leaving many young Indian women at a social and economic disadvantage that cumulatively and differentially impacts their wellbeing4. Young women are also at greater risk of mental distress, due to prevalent attitudes around hegemonic masculinity which socially values males over females5.

Intervention components and delivery

Nae Disha is a participatory, peer-led, community-based initiative that responds to global calls for action on evidence-based interventions in low resource settings such as India to increase mental health, social inclusion and resilience among young people aged 12-24 years. The programme runs for 18 weeks by group facilitators that are locally recruited young women (aged 20-30) who expressed enthusiasm to work in youth resilience. Criteria for recruit included being female and having completed secondary school education.

They were given 5 days of training that addressed group facilitation skills as well as curriculum content and a 2-day refresher training of after completion of eight modules. Young women were formed into eight groups with 12–15 participants per group that met in the home of one of the group members by agreement with their household members, for 15 consecutive weeks. They facilitated Nae Disha in pairs. A team leader supported facilitators with planning, reporting and stepped in if a peer facilitator was unable to attend. A Nae Disha field coordinator supported all aspects of the intervention delivery and performed monitoring and support.

Key drivers

Putting youth in charge

  • Facilitators are young community members and by implementing the programme with peer facilitators there is a high level of engagement and trust between group facilitators and young people

Feasible intervention components

  • Groups have 10 - 15 members and implementing in small to medium sized groups allows high levels of participation to support young people to build trust, connection and peer friendships
  • Group sessions are interactive and fun. Games, role plays, group discussions and participation by all are key to securing positive outcomes and engagement by young people

Maintaining strong support systems

  • Facilitators are trained, with strong coach support through fortnightly meetings, rehearsals and refreshers, and visits from a Facilitator Coach to ensure the fidelity of the innovation 

Challenges

Young people with low literacy require more highly skilled facilitation and coaching support

  • Young people with limited literacy need extra focus on concrete examples, role plays and games
  • Human resources for training and coaching are significant but if done well support great outcomes

Learning can be limited by meeting location

  • Holding meetings in homes of young people can mean that there is limited space for games and parents and other onlookers limit participation

Attendance is challenging

  • Young people with paid work or substance abuse problems can find regular attendance difficult

Gender norms can limit participation

  • Young women with limited freedom of movement require extra support such as accompaniment to and from group meetings

Continuation

  • We are completing a community-based Randomised Controlled Trial in 2020 to further evaluate effectiveness
  • 2020 will also see the start of a scaled-up version of implementation in Government schools (Uttarakhand) which is currently being evaluated
  • The National Institute of Empowerment of People with Disability (in India) has adapted Nae Disha for young people with disability and plans to roll-out within all of their Institutes nationally in 2020

Partners

Funders

Evaluation methods

The innovation uses the following research methods for evaluation.

Pre-post (uncontrolled) qualitative evaluation using psychometric measures:

  1. The Connor-Davidson resilience scale (CD- RISC) uses 25 items on a 5-point Likert scale to measure coping ability and resilience7.
  2. The Schwarzer's General Self-Efficacy Scale is built on ten-items, was developed for use in diverse cultures, has been validated in Asia8 and is positively correlated with depression, anxiety and optimism8-9.
  3. The Patient Health Questionnaire (PHQ-9) is a screening tool for depressive symptoms validated for use in India and among adolescents10-11.
  4. The Generalised Anxiety Disorder scale (GAD-7) is a screening tool validated to assess anxiety symptoms in diverse settings12.
  5. The GEMS gender attitudes scale assessed attitudes to gender equality and covers areas such as sexual and reproductive health, sexual relations, violence and domestic13.

Performed a realist evaluation (qualitative) to explore, understand and identify the mechanisms that lead to changes in behaviour linked to particular contexts, thereby leading to certain outcomes (desired and/or unintended). Realist evaluation specifically addresses the following questions:

  1. For whom does this intervention work (or not)?
  2. How does it work (or not) i.e. by what mechanism?
  3. And in what contexts does it work (or not)?

We are in the process of conducting a Randomised Controlled Trial which is using qualitative methods to evaluate changes in gender relations as well as quantitative measures to evaluate changes in participation, mental health and resilience.

Cost of implementation

We have not formally measured the cost of this innovation.

Impact details

  • 1900 young people participated through program implementation in multiple sites and settings in Uttarakhand
  • 75% mean reduction in social exclusion 
  • 67% mean improvement in mental health i.e. reduced levels of depression and anxiety (measures used were PHQ9 – a measure of depression, and GAD7 – a measure of anxiety) (unpublished data)
  • The Nae Disha programme and curriculum was adopted by the National Institute of Empowerment of People with Disability (in India) to be rolled out in all of their institutes for young people with disabilities in 2020

Pre-post quantitative evaluation results:

  • Significant improvements in resilience and mental health (two different studies) p<0.00011,3.
  • In one study the improvements in mental health and gender attitudes were still highly significant 9 months after completion of intervention but the improvements in resilience were not sustained1.
  • In the other study measures were only taken at baseline and end-line and were all highly significant at that juncture3.

References

  1. Matias K, Pandey A, Armstrong G, Diksha P, Kermode M. Outcomes of a brief mental health and resilience pilot intervention for young women in an urban slum in Dehradun, North India: a quasi-experimental study. International Journal of Mental Health Systems. 2018. DOI: 10.1186/s13033-018-0226-y
  2. Mathias K, Singh P, Butcher N, Grills N, Srinivasan V, Kermode M. Promoting social inclusion for young people affected by psycho-social disability in India – a realist evaluation of a pilot intervention. Global Public Health. 2019;1744-1706. DOI: 10.1080/17441692.2019.1616798
  3. Kermode M, Grills N, Singh P, Mathias K. Improving social inclusion for young people affected by psychosocial disability in Uttarakhand, India: a pilot intervention. Community Mental Health journal (under review). 2020.
  4. United Nations Development Programme. Sustaining Human Progress: reducing vulnerabilities and building resilience—Human Development Report 2014. Geneva: United Nations Development Programme (UNDP); 2014.
  5. Qadir F, Khan M, Medhin G, Prince M. Male gender preference, female gender disadvantage as risk factors for psychological morbidity in Pakistani women of childbearing age—a life course perspective. BMC Public Health. 2011;11(1):745.
  6. Loganathan S, Murthy RS. Living with schizophrenia in India: gender perspectives. Transcult Psychiatry. 2011;48(5):569–84.
  7. Connor KM, Davidson JR. Development of a new resilience scale: The Connor‐Davidson resilience scale (CD‐RISC). Depress Anxiety. 2003;18(2):76-82
  8. Schwarzer R, Bäßler J, Kwiatek P, Schröder K, Zhang JX. The assessment of optimistic self‐beliefs: comparison of the German, Spanish, and Chinese versions of the general self‐efficacy scale. Applied Psychology. 1997;46(1):69-88
  9. Schwarzer R. Measurement of perceived self-efficacy: psychometric scales for cross-cultural researach: Präsident d. Freien Univ.; 1993
  10. Patel V, Araya R, Chowdhary N, King M, Kirkwood B, Nayak S, et al. Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires. Psychol Med. 2008;38(2):221-8.
  11. Leventhal KS, DeMaria LM, Gillham J, Andrew G, Peabody JW, Leventhal S. Fostering emotional, social, physical and educational wellbeing in rural India: the methods of a multi-arm randomized controlled trial of Girls First. Trials. 2015;16(1):481
  12. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-7.
  13. Pulerwitz J, Barker G. Measuring attitudes toward gender norms among young men in Brazil development and psychometric evaluation of the GEM scale. Men and Masculinities. 2008;10(3):322-38.

Research

Tools

Multimedia

Reports

Associates

Kaaren Mathias
How useful did you find this content?: 
0
Your rating: None
0
No votes yet
Log in or become a member to contribute to the discussion.

Submit your innovation

Create your own page to tell the MHIN community about your innovation.

Country

India

Affiliated organizations

Burans

Gallery

Similar content

node teaser-image

TrustCircle: Helping Improve Emotional Resiliency and Well-Being for All

TrustCircle utilizes peer-centered mHealth & AI technology to improve emotional resiliency & well-being for all with focus on prevention & early intervention.
Region: 
Africa
Middle East
North America
Central America and the Caribbean
South America
Asia
Europe
Oceania
Population: 
Children and adolescents
Adults
Older adults
Families and carers
Disability
Disorder: 
All disorders
5244 reads
node teaser-image

Early Adolescent Skills for Emotions (EASE): a psychological intervention for young adolescents and their caregivers

EASE is a group psychological intervention delivered by non-specialist providers to improve the mental health of adolescents.
Region: 
Africa
Middle East
Asia
Population: 
Children and adolescents
Disorder: 
All disorders
6226 reads
node teaser-image

RISING SUN - Reducing the Incidence of Suicide in Indigenous Groups – Strengths United through Networks Toolkit

The RISING SUN toolkit was the culmination of a community-based and consensus-building process to identify common outcomes and their measures for evaluating suicide prevention efforts across the circumpolar North.
Region: 
North America
Asia
Europe
Population: 
Children and adolescents
Families and carers
Minority populations
Disorder: 
Depression/anxiety/stress-related disorders
Alcohol/drug use disorders
Self-harm/suicide
1947 reads
node teaser-image

The NALAM study: Village workers promoting mental health

Emphasis on personalized and diverse social care delivered by grassroots mobilizers
Region: 
Asia
Population: 
Adults
Disorder: 
Epilepsy/seizures
Psychosis/bipolar disorder
2153 reads