NEET and resilient: The lived experiences of a sample of South African emerging adults.

There is scant understanding of what supports African emerging adults who are not in employment, education or training (i.e., NEET) to show resilience to NEET-related challenges. This article narrows that gap by reporting an iterative phenomenological study with nine African emerging adults (mean age: 23.44; 66% female) who were NEET for the 18-month duration of the study and living in a resource-constrained community in South Africa. We interviewed each young person three times (June 2021; December 2021; June 2022). A reflexive thematic analysis of these interview transcripts showed that being NEET is a multifaceted challenge. Supported by a mix of personal, relational and environmental resources, young people managed this challenge by resisting or recuperating from destructive coping mechanisms and believing in a successful future self. These findings point to the importance of young people and their social ecologies (families, peers, service providers and policymakers) recognising and enacting their co-responsibility for resilience to the compound challenges of being NEET.

Factors Contributing to the Resilience of Sub-Saharan African Widows: A Scoping Review.

This scoping review aims to synthesize the factors contributing to the resilience of African widows, a topic that has been overlooked. This oversight is concerning, considering the substantial population of African widows, as well as the increasing number of young widows in Africa. We conducted a comprehensive search across various databases (including Academic Search Complete, Africa-wide, PsycARTICLES, PsychINFO, Humanities Sources Worldwide, Proquest, Pubmed, Scopus, Wiley Online, and Taylor & Francis) to identify studies of the resilience of widows living in Africa. From an initial pool of 124 records, we carefully evaluated 19 papers for inclusion. Employing a narrative synthesis approach, we synthesized the findings from the eight selected studies. This analysis revealed that the resilience of African widows is a multifaceted socio-ecological process, primarily facilitated by personal and relational resilience factors. Notably, there is a limited emphasis on the role of cultural resources, which may be attributed to the prevalence of dehumanizing cultural practices experienced by African widows. In conclusion, our findings underscore the need for greater attention to macrosystemic resources, including culturally supportive practices, to bolster the resilience of African widows.

Multisystemic approaches to researching young people's resilience: Discovering culturally and contextually sensitive accounts of thriving under adversity.

As our understanding of the process of resilience has become more culturally and contextually grounded, researchers have had to seek innovative ways to account for the complex, reciprocal relationship between the many systems that influence young people's capacity to thrive. This paper briefly traces the history of a more contextualized understanding of resilience and then reviews a social-ecological model to explain multisystemic resilience. A case study is then used to show how a multisystemic understanding of resilience can influence the design and implementation of resilience research. The Resilient Youth in Stressed Environments study is a longitudinal mixed methods investigation of adolescents and emerging adults in communities that depend on oil and gas industries in Canada and South Africa. These communities routinely experience stress at individual, family, and institutional levels from macroeconomic factors related to boom-and-bust economic cycles. Building on the project's methods and findings, we discuss how to create better studies of resilience which are able to capture both emic and etic accounts of positive developmental processes in ways that avoid the tendency to homogenize children's experience. Limitations to doing multisystemic resilience research are also highlighted, with special attention to the need for further innovation.

Multisystemic supports and adolescent resilience to depression over time: A South African mixed methods study.

In sub-Saharan countries, like South Africa, there is scant understanding of adolescent resilience to depression over time; the multisystemic resource combinations that support such resilience; and whether more diverse resource combinations yield better mental health dividends. In response, we conducted a longitudinal concurrent nested mixed methods study with 223 South African adolescents (mean age: 17.16 years, SD = 1.73; 64.60% girls; 81.60% Black). Using longitudinal mixture modeling, the quantitative study identified trajectories of depression and associations between trajectory membership and resource diversity. Using a draw-and-write methodology and reflexive thematic analyses, the qualitative study explored the resource diversity associated with each trajectory. Taken together, these studies identified four depression trajectories (Stable Low; Declining; Worsening; Chronic High) with varying resource diversity at baseline and over time. Resource diversity was inclusive of personal, relational, contextual, and culturally valued resources in both the Stable Low and Declining trajectories, with emphasis on relational supports. Personal resources were emphasized in the Worsening and Chronic High trajectories, and culturally valued and contextual resources de-emphasized. In summary, resource constellations characterized by within and across system diversity and cultural responsiveness are more protective and will be key to advancing sub-Saharan adolescent mental health.

The association between family adversity and youth mental health outcomes.

BACKGROUND: The association between family adversity and young people's mental health outcomes in communities that experience economic instability has not been well explored in the South African context. Furthermore, the overtime interaction between resilience factors, family adversity, and young people's psychological functioning in African settings, like South Africa, is under-investigated. PURPOSE: This study investigates the relationship between family adversity and conduct problems and depression at two-time points in a sample of youths in two South African communities stressed by their dependency on economically volatile oil and gas industries. METHOD: This article draws on longitudinal data generated by the Resilient Youth in Stressed Environments (RYSE) study in South Africa, which included 914 and 528 (wave 1 and 3) adolescents and emerging adults (14-27-year-olds; M age = 18.36 years) living in Secunda/eMbalenhle and Sasolburg/Zamdela. Participants were sampled at baseline (wave 1) and 18-24 months later (wave 3). They self-reported experience of community violence, family adversity, resilience-enabling resources, conduct difficulties, and depression symptoms. Regression analyses were used to examine the unadjusted and adjusted association of family adversity on conduct problem and depression. RESULTS: About 60% of participants reported high family adversity. Regressions, however, revealed no association between family adversity and conduct problems and depression cross-sectionally and over time. Individual resilience, biological sex, and experience of victimization in the community, however, were associated with conduct difficulty while all three resilience factors were associated with decreased depression among participants. CONCLUSION: Our study sheds light on the risk and protective factors for mental health outcomes of adolescents and youths who reside in volatile, turbulent communities and experience ongoing familial challenges. To effectively support the mental well-being of young individuals in such contexts, interventions must consider the potential ambivalence of the resilience factors they aim to strengthen.

Multisystemic Resources Matter for Resilience to Depression: Learning From a Sample of Young South African Adults.

This article interrogates the continuing emphasis on personal sources of resilience; it also amends the inattention to the protective factors and processes (PFPs) that support the mental health resilience of African emerging adults. To that end, we report a study that explored which PFPs distinguished risk-exposed South African 18- to 29-year-olds with negligible depression symptoms from those who reported moderate to severe symptoms. Using an arts-based approach, young people volunteered the PFPs they had personally experienced as resilience-enabling. An inductive thematic analysis of visual and narrative data, generated by young people self-reporting high exposure to family and community adversity (n = 233; mean age: 24.63, SD: 2.43), revealed patterns in the PFPs relative to the severity of self-reported depression symptoms. Specifically, young people reporting negligible depression symptoms reported a range of PFPs associated with psychological, social, and ecological systems. In contrast, the PFPs identified by those reporting more serious depression symptoms were mostly restricted to personal strengths and informal relational supports. In the interests of youth mental health, the findings direct society's attention to the criticality of facilitating young people's access to a composite of resources rooted in personal, social, and ecological systems.

Resilience to COVID-19 challenges: Lessons for school psychologists serving school-attending youth with experiences of marginalization.

This special issue is focused on the lessons learned from the COVID-19 health crisis, showcasing new cross-cultural research from different countries, such as rural/urban US, South Africa, and Australia. The aim οf the special issue is to highlight new knowledge related to pandemic-related impacts, as well as underscore variables that will promote children's resilience and especially vulnerable and marginalized children. We argue that all adults associated with schools (e.g., teachers, school psychologists, administrators, aides, parents, and social workers) need to synergize in creating a caring school community that is purposefully committed to supporting student resilience, especially among students with experiences of marginalization. A multisystemic resilience approach has been adopted and the focus has been on caring adults in the school communities and how they can support the most vulnerable students if the adults (school psychologists parents, caregivers, teachers, and other role-players) take co-ownership of championing student resilience in times of crisis. The studies included in this special issue highlight important issues especially for school psychologists, such as girls' school engagement as a buffering factor to school disruptions, the value of multigenerational supports, the value of spirituality in dealing with crises, the sense of supportive connectedness with schools and finally teacher empowerment to support student wellbeing.

Student resilience to COVID-19-related school disruptions: The value of historic school engagement.

Does historic school engagement buffer the threats of disrupted schooling - such as those associated with the widespread COVID-19-related school closures - to school engagement equally for female and male high school students? This article responds to that pressing question. To do so, it reports a study that was conducted in 2018 and 2020 with the same sample of South African students (n = 172; 66.30% female; average age in 2020: 18.13). A moderated moderation model of the 2018 and 2020 data showed that historic levels of school engagement buffered the negative effects of disrupted schooling on subsequent school engagement (R² = .43, ß = -5.09, p < .05). This protective effect was significant for girl students at moderate and high levels of historic school engagement, but not at lower levels of historic school engagement. Disrupted schooling did not significantly affect school engagement for male students at any level of historic school engagement. In addition, student perceptions of teacher kindness were associated with higher school engagement and having experienced an adverse event at school with lower school engagement. The results point to the importance of facilitating school engagement and enabling school environments - also when schooling is disrupted.

The role of multisystemic resilience in fostering critical agency: UK adolescents during the COVID-19 Pandemic.

Critical agency (CA) refers to an individual's feeling of power in relation to social inequalities. Research has demonstrated that high CA is associated with positive adolescent outcomes, however, less is known about what supports are important for its development. Moreover, a large majority of the literature is based on studies from the US and various countries in Africa; although the UK is saturated with inequalities there is little research within a UK context. In this paper we examine (a) the validity of using an existing measure of CA with a sample of UK adolescents and (b) the extent to which resilience supports account for variance in CA. Our analysis identified two distinct factors of CA: justice-oriented and community-oriented. High CA in both factors was explained by resilience supports associated with peer relationships (p < 0.01). Our findings push us towards new relational, ecological ways of understanding adolescent CA. We close by instantiating a translational framework for those devising policies in support of youth resilience and CA. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-023-04578-1.

Respiratory health among adolescents living in the Highveld Air Pollution Priority Area in South Africa.

BACKGROUND: Air pollution is a global, public health emergency. The effect of living in areas with very poor air quality on adolescents' physical health is largely unknown. The aim of this study was to investigate the prevalence of adverse respiratory health outcomes among adolescents living in a known air pollution hotspot in South Africa. METHODS: Ambient air quality data from 2005 to 2019 for the two areas, Secunda and eMbalenhle, in the Highveld Air Pollution Priority Area in Mpumalanga province, South Africa were gathered and compared against national ambient air pollution standards and the World Health Organization Air Quality Guidelines. In 2019, adolescents attending schools in the areas completed a self-administered questionnaire investigating individual demographics, socio-economic status, health, medical history, and fuel type used in homes. Respiratory health illnesses assessed were doctor-diagnosed hay fever, allergies, frequent cough, wheezing, bronchitis, pneumonia and asthma. The relationship between presence (at least one) or absence (none) of self-reported respiratory illness and risk factors, e.g., fuel use at home, was explored. Logistic regression was used to estimate the odds ratio and 95% confidence interval (CI) of risk factors associated with respiratory illness adjusted for body mass index (measured by field assistants), gender, education level of both parents / guardians and socio-economic status. RESULTS: Particulate matter and ozone were the two pollutants most frequently exceeding national annual air quality standards in the study area. All 233 adolescent participants were between 13 and 17 years of age. Prevalence of self-reported respiratory symptoms among the participants ranged from 2% for 'ever' doctor-diagnosed bronchitis and pneumonia to 42% ever experiencing allergies; wheezing chest was the second most reported symptom (39%). Half (52%) of the adolescents who had respiratory illness were exposed to environmental tobacco smoke in the dwelling. There was a statistically significant difference between the presence or absence of self-reported respiratory illness based on the number of years lived in Secunda or eMbalenhle (p = 0.02). For a one-unit change in the number of years lived in an area, the odds of reporting a respiratory illness increased by a factor of 1.08 (p = 0.025, 95% CI = 1.01-1.16). This association was still statistically significant when the model was adjusted for confounders (p = 0.037). CONCLUSIONS: Adolescents living in air polluted areas experience adverse health impacts Future research should interrogate long-term exposure and health outcomes among adolescents living in the air polluted environment.

Investigating the Interrelations Between Systems of Support in 13- to 18-Year-Old Adolescents: A Network Analysis of Resilience Promoting Systems in a High and Middle-Income Country.

Adolescents' ability to function well under adversity relies on a network of interrelated support systems. This study investigated how consecutive age groups differ in the interactions between their support systems. A secondary data analysis of cross-sectional studies that assessed individual, caregiver, and contextual resources using the Child and Youth Resilience Measure (Ungar & Liebenberg, 2005) in 13- to 18-year-olds in Canada (N = 2,311) and South Africa (N = 3,039) was conducted applying network analysis. Individual and contextual systems generally showed the highest interconnectivity. While the interconnectivity between the individual and caregiver system declined in the Canadian sample, a u-shaped pattern was found for South Africa. The findings give first insights into cross-cultural and context-dependent patterns of interconnectivity between fundamental resource systems during adolescence.

Family Resilience in a Resource-Cursed Community Dependent on the Oil and Gas Industry.

The economic and social well-being of rural, "resource-cursed" communities can depend on the boom-bust cycles of a single industry like oil and gas. This study used a constructivist, inductive approach to identify the challenges placed on families in one such community and the processes that strengthen family resilience. Semi-structured interviews were conducted with 35 adult residents (30-76 years old, 19 women) from a community in Alberta, Canada, that has specialized in oil and gas extraction for 70 years and experienced its worst economic downturn while the study was underway. Results showed that many families have experienced an endless cycle of poor work-life balance and income instability throughout the economic cycle. Family life often lacked social cohesion as a consequence of demanding work schedules and economic pressures. Additional challenges were the perceived negative effects of rigid gender roles, substance abuse, family conflicts, and domestic violence. Crucial strengthening processes for family resilience were fundamental financial and living standard adaptations (e.g., living within or below one's economic means; having both spouses become earners), maintaining regular contact by having a flexible home routine, and mutually agreeing to change roles during busts (former earners take responsibility for caregiving and running of the household and vice versa). Alternatively, accepting economic volatility and its impact on normal family life processes were essential for family resilience. Findings suggest the need for clinicians to help families foster resilience in communities that depend on resource extraction industries with concurrent adaptations required by individuals, families, and socio-political and economic systems.

El bienestar económico y social de las comunidades rurales "malditas por los recursos" puede depender de los ciclos de auge y caída de una industria única como la del petróleo y el gas. En este estudio se usó un método constructivista e inductivo para identificar las dificultades que enfrentan las familias en una comunidad de este tipo y los procesos que fortalecen la resiliencia familiar. Se realizaron entrevistas semiestructuradas con 35 adultos residentes (de entre 30 y 76 años, 19 mujeres) de una comunidad de Alberta, Canadá, que se ha especializado en la extracción de petróleo y gas durante 70 años y sufrió su peor recesión económica mientras el estudio estaba en marcha. Los resultados indicaron que muchas familias han pasado por un ciclo interminable de desequilibrio entre la vida personal y la laboral, y por la inestabilidad de ingresos durante todo el ciclo económico. La vida familiar con frecuencia careció de integración social como consecuencia de horarios de trabajo demandantes y presiones económicas. Otras dificultades fueron los efectos negativos percibidos de los roles de género rígidos, el abuso de sustancias, los conflictos familiares y la violencia doméstica. Los procesos de fortalecimiento esenciales para la resiliencia familiar fueron las adaptaciones fundamentales de los niveles de vida y económicos (p. ej.: vivir dentro o por debajo de los medios económicos propios; hacer que ambos cónyuges sean asalariados), mantener contacto periódico teniendo una rutina flexible en el hogar y acordar mutuamente cambiar de roles durante las recesiones (los exasalariados asumen la responsabilidad del cuidado y el funcionamiento del hogar, y viceversa). Alternativamente, aceptar la volatilidad económica y su efecto en los procesos normales de la vida familiar fue esencial para la resiliencia familiar. Los resultados indican la necesidad de que los profesionales clínicos ayuden a las familias a fomentar la resiliencia en las comunidades que dependen de las industrias de extracción de recursos mediante adaptaciones simultáneas necesarias para las personas, las familias y los sistemas sociopolíticos y económicos.

A systematic review of the South African work on the well-being of young people (2000-2016).

Burgeoning research on the well-being of young people in recent years has made it difficult to identify conceptual gaps in the literature. We conducted a review of South African research in this area to better understand the use and measurement of the construct, as well as factors associated with it. The search of multiple databases identified 28 studies published in academic journals between 2000 and 2016. Within this period, studies that referred to well-being and its related subjective components varied significantly in terms of how they defined and operationalised these constructs, resulting in a fragmented body of work. The review highlights the need for a coherent research agenda in this area given the centrality of well-being research in promoting optimal outcomes in young people. Recommendations for strengthening South African research in this area are provided.

Resilience over time: Learning from school-attending adolescents living in conditions of structural inequality.

INTRODUCTION: Cross-sectional studies offer inadequate understandings of adolescent resilience. Nevertheless, few longitudinal studies account for the resilience of school-attending adolescents challenged by the structural disadvantages associated with South African township residence. This prompts two questions: (i) Do the same (or different) resilience-enabling resources inform township-dwelling, school-attending adolescents' resilience accounts when they self-explain their resilience at two distinct points in time? (ii) Which resilience-enabling resources, if any, become significantly more (or less) salient over time and how do township-dwelling, school-attending adolescents explain the resilience-enabling value of these resources? METHODS: To answer the aforementioned, we conducted a longitudinal qualitative study with 140, township-dwelling, school-attending, South African adolescents (62.1% girls; mean age: 13.8 years [Time 1]; 15.8 years [Time 2]). They completed a draw-and-write activity. This generated visual and narrative data that we analysed using multiple methods (content analyses, chi square tests of frequency counts, and thematic analysis). RESULTS: A comparison of school-attending adolescents' accounts of their resilience at two points in time revealed the longevity of nine, generic resilience-enabling resources. A comparison of how frequently adolescents reported these resources at Time 1 and 2 showed significant increases for education, faith-based supports, and peer support. A comparison of adolescents' reasons for identifying these three resources showed that education promises an improved future, while all three facilitate respite from hardship and/or mastery over current challenges. CONCLUSION: The salience of education, faith-based supports, and peer support can be explained using developmental, contextual and cultural perspectives. This explanation prompts pragmatic and cautionary lessons for resilience advocates.

Seeking and Finding Positive Youth Development Among Zulu Youth in South African Townships.

A cross-sectional study explored the presence and power of developmental assets in a sample of youth from rural South African townships. Learners (female = 58%; Mage  = 17.1; N = 505) attending three township high schools completed self-report measures of developmental assets and thriving outcomes. Participants reported contextual assets (e.g., family, school, community) in the vulnerable ranges, with gender, family structure, and school type accounting for some differences. Correlation and regression analyses revealed that five asset contexts (family, school, community, personal, social) were uniquely predictive of thriving outcomes. Discussion focuses on contextual expressions of positive youth development among Zulu township youth in challenging environments.

Multisystemic factors predicting street migration of children in Kenya: A multilevel longitudinal study of families and villages.

BACKGROUND: Street-migration of children is a global problem with sparse multi-level or longitudinal data. Such data are required to inform robust street-migration prevention efforts. OBJECTIVE: This study analyzes longitudinal cohort data to identify factors predicting street-migration of children - at caregiver- and village-levels. PARTICIPANTS AND SETTING: Kenyan adult respondents (n = 575; 20 villages) actively participated in a community-based intervention, seeking to improve factors previously identified as contributing to street-migration by children. METHODS: At two time points, respondents reported street-migration of children, and variables across economic, social, psychological, mental, parenting, and childhood experience domains. Primary study outcome was newly reported street-migration of children at T2 "incident street-migration", compared to households that reported no street-migration at T1 or T2. For caregiver-level analyses, we assessed bivariate significance between variables (T1) and incident street-migration. Variables with significant bivariate associations were included in a hierarchical logistical regression model. For community-level analyses, we calculated the average values of variables at the village-level, after excluding values from respondents who indicated an incident street-migration case to reduce potential outlier influence. We then compared variables between the 5 villages with the highest incidence to the 15 villages with fewer incident cases. RESULTS: In regression analyses, caregiver childhood experiences, psychological factors and parenting behaviors predicted future street-migration. Lower village-aggregated depression and higher village-aggregated collective efficacy and social curiosity appeared significantly protective. CONCLUSIONS: While parenting and economic strengthening approaches may be helpful, efforts to prevent street migration by children should also strengthen community-level mental health, collective efficacy, and communal harmony.

Resilience of sub-Saharan children and adolescents: A scoping review.

The population of sub-Saharan children and adolescents is substantial and growing. Even though most of this population is vulnerable, there is no comprehensive understanding of the social-ecological factors that could be leveraged by mental health practitioners to support their resilience. The present study undertakes a narrative scoping review of empirical research (quantitative, qualitative, and mixed) on the resilience of children and adolescents living in sub-Saharan Africa to determine what enables their resilience and what may be distinctive about African pathways of child and adolescent resilience. Online databases were used to identify full-text, peer-reviewed papers published 2000-2018, from which we selected 59 publications detailing the resilience of children and/or adolescents living in 18 sub-Saharan countries. Studies show that the resilience of sub-Saharan children and adolescents is a complex, social-ecological process supported by relational, personal, structural, cultural, and/or spiritual resilience-enablers, as well as disregard for values or practices that could constrain resilience. The results support two insights that have implications for how mental health practitioners facilitate the resilience of sub-Saharan children and adolescents: (i) relational and personal supports matter more-or-less equally; and (ii) the capacity for positive adjustment is complexly interwoven with African ways-of-being and -doing.

Resilience to depression: the role of benevolent childhood experiences in a South African sample.

Background: Studies elsewhere show that benevolent childhood experiences (BCEs) have protective mental health value. However, this protective value has never been investigated in an African context. Given the need to better understand what might support mental health resilience among African young people, this study explores the relationship between BCEs and depressive symptoms among a South African sample of young adults living in a community dependent on the economically volatile oil and gas industry. Methods: A sample of young adults in an oil and gas community in South Africa (N = 313, mean age 20.3 years, SD = 1.83, range from 18 to 26; majority Black African) completed self-report questionnaires to assess BCEs and depressive symptoms (Beck Depression Inventory-II). The analysis controlled for socio-demographics and experience of family adversity. Multinomial logistic regressions were used to examine the association of BCEs with depressive symptoms using STATA 17. Results: The majority (86.4% of the sample) reported all 10 BCEs. Of the 10 BCEs, having at least one good friend was the most reported (94%) compared to 75% of the sample reporting having a predictable home routine, such as regular meals and a regular bedtime. The unadjusted multinomial logistic regression analysis indicated that having at least one good friend, comforting beliefs, and being comfortable with self were associated with lower odds of moderate depression. The adjusted results showed no association between BCEs and the depression of young adults in this sample. Conclusion: In this South African sample, our results do not show protective associations between BCEs and depression. This could be as a result of the homogeneity in our sample. It is also possible that the BCEs explored could not counteract the effect of chronic risk factors in the lives of the young people in this study context. Further research is needed to understand this complexity.

South African emerging adults' capacity for resilience in the face of COVID-19 stressors.

Little is known about resilience responses to COVID-19 stressors from emerging adults in minority world contexts. In this cross-sectional study, we explored the association between self-reported COVID-19 stressors and capacity for resilience in 351 emerging adults (Meanage = 24.45, SD = 2.57; 68% female) who self-identified as Black African. We were interested in whether age, gender and neighbourhood quality influenced this association. The main findings were that higher pandemic stress was associated with a greater capacity for resilience. Older participants showed higher levels of resilience, while there was no gender difference in this regard. Those who perceived their neighbourhoods as being of a good quality also showed greater capacity for resilience, despite all participants residing in disadvantaged communities. The theoretical and practical implications of these results are considered.

Flourishing Communities: A new model to promote sustainable community leadership and transformation in semi-rural Kenya.

Communities often face numerous challenges and opportunities - situations that may be reduced to specific domains by researchers, policy makers and interventionists. This study informs and animate a new "flourishing community" model that seeks to build collective capacity to respond to challenges and opportunities. Our work is a response to children living on the streets, whose families face myriad challenges. The Sustainable Development Goals make explicit the need for new, integrative models that acknowledge the interplay of challenges and opportunities within communities through the flow of everyday life. Flourishing communities are generative, supportive, resilient, compassionate, curious, responsive, self-determined, and build resources across economic, social, educational, and health domains. Integrating theoretical models - specifically, community-led development, multi-systemic resilience, and the "broaden and build" cycle of attachment - provide a testable framework to understand and explore hypothesized relationships between survey-collected, cross-sectional variables with 335 participants. Higher collective efficacy, a common byproduct of group-based microlending activities, was correlated with higher sociopolitical control. This correlation was mediated by higher positive emotion, meaning in life, spirituality, curiosity, and compassion. Further research is required to understand replicability, cross-sectoral impact, mechanisms of integrating health and development domains, and implementation challenges of the flourishing community model. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.