Adolescent resilience-building in urban slums: a multifaceted trial of life skills education in India (ANUMATI)

Background

Around 12 million of India’s 250 million adolescents live in urban slums – environments with extreme stressors that can adversely affect wellbeing and increase the risk of mental illness and other non-communicable diseases (NCDs). Our pilot research has identified a major deficiency in resilience-building strategies for young people in India’s slums and we seek to address this problem in this proposal.

Life-skills education is an evidence-based approach to equipping young people with appropriate knowledge and skills to improve communication, assertiveness, self-awareness, decision-making, problem solving, critical and creative thinking to become resilient to life stressors. In this proposal, we are partnering with adolescents with lived experience in urban slums to co-design a multifaceted implementation strategy for life skills education comprising either an in-person 16 week education program or a peer-led social media program. We hypothesise that both implementation vehicles will be superior to enhanced usual care in improving well-being. A secondary hypothesis is that the social media program will be more cost-effective than the in-person program.

Aims

The ANUMATI implementation trial aims to evaluate the feasibility, clinical effectiveness and cost-effectiveness of two community-based implementation strategies for life skills education.

Project plan

It will be conducted in three phases:

1. Intervention co-design and user acceptance testing – Building on our pilot work with 4 Adolescent Expert Advisory Groups, we will review and adapt existing programs and establish local theories of change for each implementation strategy.

2. Effectiveness testing – a three-arm hybrid type 2 cluster randomised controlled trial will be conducted in 102 slum clusters (34 clusters per arm) in New Delhi and Hyderabad cities with 2550 adolescents at high risk of depression. Adolescents in slum clusters will either receive the in-person life-skills education program, a peer-led social media program, or enhanced usual care for 12 months. The primary outcomes will be difference in WHO-5 Well-Being Index Scores at end of study with secondary outcomes focussing on depression scores, tobacco use, physical activity, alcohol and other substance use

3. Policy analysis for scale up – a theory-driven process evaluation will understand the factors influencing adoption, scale and spread of the two programs. The cost-effectiveness of each program will be compared with each other and enhanced usual care. Policy analysis and a business case for investment will be developed to identify the key decision points to spread and scale either or both programs, should they prove clinically and cost effective.

This proposal builds on a strong foundation of India-led implementation research and is supported by an international expert advisory group. Adolescents from urban slums have been involved from the outset and policy makers are being engaged through regular policy symposia. The findings will generate evidence on scalable strategies to enhance resilience and reduce NCD risk factors for young people living in resource-limited settings both in India and elsewhere.

Principal investigators

Funding organisations

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