Development Of A Complex Public Health Intervention To Reduce Anxiety Of Children Aged 13-15 Years Attending Government Sinhala Medium Schools In Colombo District, Sri Lanka

Abstract

Background: Anxiety disorders (AD) are the most prevalent psychological problem among adolescents. Both anxiety disorders and anxiety symptoms can lead to adverse outcomes. The aim of the study was to develop an evidence-based intervention package to reduce anxiety among school children aged 13-15 years.

Methods: Design: UK Medical Research Council guidance for development of complex interventions were followed. Identification of evidence based was done by literature-search and expert opinions. Most suitable theory was identified based on level of evidence through consensus of Advisory committee (AC) consisting of experts. Subcomponents of the selected theory were mapped with associated factors of the AD. Eleven KII were conducted with school principals, teachers, parents, and students. Framework of the intervention package with suitable deliverables was designed with consensus of the AC by triangulating the findings. This was further fine-tuned with by using Modified-Delphi technique with participation of broader group of experts. These Delphi items were systematically derived from findings of the systematic reviews, expert opinion, and inputs from intervention recipients. The content development was done based on the proposed framework. Modeling process was done by conducting four consultative meetings with stakeholders with the aim of ensuring content and consensual validity followed by a consensus workshop. Feasibility study and pretesting of deliverables were done. Participants: Advisory committee [n=6] and stakeholder group [n=11] in Delphi component & four consultative meetings and a wider stakeholder group [n=23] in 1-day consensus workshop were involved.

Results: Four RCTs and 12 RCTs/cRCTs were identified through literature review. Six types of intervention modalities were identified. CBT based intervention modality was shortlisted by AC considering the level of evidence. Five broad solutions, namely psycho education, realistic thinking, problem solving, graded exposure and relaxation techniques under CBT were mapped against the associated factors with consensus of the AC. Activities were developed under these broad solutions and most suitable options of these activities were selected by a stakeholder group using Modified Delphi technique. The intervention package was finalized by conducting a consensual workshop followed by feasibility study and pretesting of deliverables.

Conclusions: A CBT-based universal intervention package was developed to reduce anxiety among children with ToT workshop for teachers with a field training, eight weekly 40 minutes sessions for children and one 40-minute session for parents. Teachers’ guide, Student’s workbook and leaflet for parents were deliverables. A process evaluation framework was used to monitor implementation.