Addressing rates of low mood and anxiety among adolescent girls: Co-production of programme theories with adolescent girls and professionals

<b>Background: </b>From early adolescence, girls face greater risk of experiencing low mood and anxiety, with recent evidence that this may be worsening. This is increasingly recognised as a critical public health issue, with an imperative for research that meaningfully progresses our understanding of how to reduce the risk of these experiences, including research that asks adolescent girls themselves.<br/><br/><b>Aims: </b>We set out to explore what adolescent girls think can be done to reduce rates of low mood and anxiety among their population, and to understand how such options can be enacted.<br/><br/><b>Design and methods: </b>We adopted a co-produced qualitative design, conducting focus groups in 2022 with 32 adolescent girls aged 16 to 18 years in England. We analysed data with content analysis to construct candidate ‘programme theories’, or models for intervention, and refined these through discussion with four professionals.<br/><br/><b>Study registration:</b> We pre-registered the project on the Research Registry (ID researchregistry7803) and shared a protocol and data generation documents.<br/><br/><b>Results: </b>We produced five candidate programme theories: A) social media education and campaigning; B) school staff training and culture change on gender stereotypes; C) comprehensive approach to sexual harassment in schools;<br/>D) social hobby spaces in schools and/or communities; and E) relationally-grounded whole school approach to mental health and wellbeing. Guided by the Medical Research Council guidance for complex interventions, for each we describe required resources, activities, mechanisms, outcomes, and key considerations for context and successful implementation.<br/><br/><b>Limitations:</b> While the study offers valuable, co-produced insights into adolescent girls’ mental health, limitations include a relatively small and self-selecting adolescent sample and underrepresentation of certain demographic groups, which may have meant some perspectives were not included; a small sample size of professional participants which may have limited discussion and affected transferability of insights across varied contexts and approaches to mental health provision; limited engagement with wider stakeholder groups which could have augmented and contextualised findings more deeply, and context-specific constraints such as recruitment in England only and timing of data collection (shortly before high-stakes exams following COVID-19 restrictions) that may affect wider applicability.<br/><br/><b>Conclusions:</b> These co-produced candidate programme theories provide valuable insights on opportunities to develop, extend and challenge the ways in which we currently work to improve the mental health of adolescent girls.<br/><br/><b>Future work: </b>Future research should employ multi-method, participatory approaches across diverse populations and contexts to refine and test these youth-informed programme theories and explore their implementation in varied educational, social, and cultural settings.