Implementing a school-based mental health literacy programme for adolescents: barriers, facilitators and preliminary outcomes

A novel school-based mental health literacy (MHL) programme titled 'Do You M.I.N.D.?' was implemented in Singapore to improve knowledge, attitudes, and help-seeking among secondary school students. The present study examined its implementation barriers, facilitators, and preliminary impact on students' MHL. A mixed-methods design was used. Qualitative data were collected through semi-structured interviews with 22 key informants and six session observations guided by the Consolidated Framework for Implementation Research. Quantitative data were collected through a 21-item pre- and post-intervention questionnaire with 841 Secondary One students. Pre-post differences were analysed using Wilcoxon signed-rank tests and difference-in-difference (DiD) analyses, with a significance level set at 0.05. Findings revealed that key facilitators included the relative advantage of the interactive sessions that incorporated Virtual Reality, understanding students' mental health needs and resources, engaging school administrators, and executing with implementation fidelity and fit. However, this relative advantage was lost when the programme shifted to Zoom video conferencing during the COVID-19 pandemic, which served as a salient barrier alongside implementation complexity, insufficient available resources, and challenges in engaging students and teachers. Pre-post data showed overall improvements in MHL, with face-to-face delivery yielding significantly better scores for two items. The programme shows promise in enhancing students' MHL, with the study providing insights for refining content and implementation strategies. The reduced effectiveness during online delivery underscores the importance of maintaining interactive elements in future adaptations. These results highlight the need for sustained resources, stakeholder engagement and support, and delivery models that preserve programme interactivity to optimize outcomes.