Leung Claudia L, Goka Priscilla Kukua, Atangongo Barnabas, Bingle Mohammed Mansur Musah, Adu Ishmael, Atchulo Abdul Rashid, Boateng Laud, Huang Keng-Yen, Laiteerapong Neda, Limann Gbana, Volerman Anna, Amadu Peter Mintir, Koomson William Frank Hill
University of Chicago Biological Sciences Division.
University for Development Studies School of Medicine.
Res Sq. 2025 May 8:rs.3.rs-6279575. doi: 10.21203/rs.3.rs-6279575/v1.
Adolescents in low- and middle-income countries (LMICs) face significant mental health challenges, yet their voices are often underrepresented in intervention design. Co-design approaches, such as human-centered design, offer a promising approach to tailor interventions to specific needs and context; however, this requires careful adaption in LMICs where resources, design experience, and cultural factors impact engagement and efficacy. This study documents how human-centered design was adapted to engage adolescents in co-designing a school-based mental health intervention, highlighting the contextualization of co-design methods to the Ghanaian sociocultural context and the unique participation of youth.
Guided by the first two phases of human-centered design, we conducted two workshops with 24 students from 12 public senior high schools in Tamale, Ghana. Workshop 1 (Inspiration) explored adolescent perspectives on mental health using structured case-based discussions guided by the Consolidated Framework for Implementation Research (CFIR). Workshop 2 (Ideation) focused on identifying preferred mental health prevention strategies using interactive, choice-based activities. To accommodate cognitive and sociocultural factors, workshops incorporated structured facilitation, visual analogies, peer-driven engagement, and scaffolded decision-making. Qualitative data from discussions, facilitator notes, and artifacts were analyzed thematically.
Workshop 1 (Inspiration) identified key adolescent mental health concerns, including stigma, confidentiality fears, and peer and family influences. Gender-segregated discussions provided insights into culturally-specific challenges, such as substance use norms among boys and gendered expectations limiting girls' access to support. Workshop 2 (Ideation) led to the prioritization of five school-based prevention strategies: teacher training, mental health curricular integration, mentorship programs, teaching positive thinking and mindfulness, and using entertainment-based methods for mental health education. Adolescents shifted from viewing mental health challenges as individual struggles to recognizing the role of schools and communities in prevention. An adolescent advisory board was formed to sustain youth engagement in intervention refinement.
Contextualized co-design methods can meaningfully engage adolescents in LMICs, leading to culturally grounded and actionable mental health interventions. Structured facilitation enhances the feasibility and authenticity of youth-driven co-design, contributing methodological insights for implementation science in resource-limited settings. This study provides a replicable framework to apply to diverse LMIC contexts and health topics and elevates youth voices in shaping effective, sustainable interventions.
低收入和中等收入国家（LMICs）的青少年面临重大的心理健康挑战，但在干预设计中他们的声音往往未得到充分体现。共同设计方法，如以用户为中心的设计，为根据特定需求和背景量身定制干预措施提供了一种有前景的方法；然而，在资源、设计经验和文化因素会影响参与度和效果的低收入和中等收入国家，这需要谨慎调整。本研究记录了如何调整以用户为中心的设计，让青少年参与共同设计一项基于学校的心理健康干预措施，突出了共同设计方法在加纳社会文化背景下的情境化以及青少年的独特参与。
以前两个阶段的以用户为中心的设计为指导，我们在加纳塔马利的12所公立高中与24名学生举办了两次工作坊。工作坊1（灵感启发）使用由实施研究综合框架（CFIR）指导的结构化案例讨论，探讨青少年对心理健康的看法。工作坊2（构思）专注于通过互动式、基于选择的活动确定首选的心理健康预防策略。为了适应认知和社会文化因素，工作坊采用了结构化引导、视觉类比、同伴驱动参与和支架式决策。对讨论、主持人笔记和工件中的定性数据进行了主题分析。
工作坊1（灵感启发）确定了青少年关键的心理健康问题，包括污名化、对保密性的担忧以及同伴和家庭的影响。按性别分组的讨论提供了对特定文化挑战的见解，例如男孩中的物质使用规范以及性别期望限制女孩获得支持。工作坊2（构思）导致优先考虑五项基于学校的预防策略：教师培训、心理健康课程整合、指导计划、教授积极思维和正念以及使用基于娱乐的方法进行心理健康教育。青少年从将心理健康挑战视为个人挣扎，转变为认识到学校和社区在预防中的作用。成立了一个青少年咨询委员会，以维持青少年对干预措施优化的参与。
情境化的共同设计方法可以让低收入和中等收入国家的青少年有意义地参与进来，从而产生基于文化且可行的心理健康干预措施。结构化引导提高了青少年驱动的共同设计的可行性和真实性，为资源有限环境中的实施科学提供了方法学见解。本研究提供了一个可复制的框架，可应用于不同的低收入和中等收入国家背景及健康主题，并提升青少年在塑造有效、可持续干预措施方面的声音。
