Safeguarding in adolescent mental health research: navigating dilemmas and developing procedures.

Mental disorders are prevalent during adolescence. Self-harm and suicide are more common in adolescents with a probable mental disorder, with one in four reporting to have attempted self-harm. Research involving adolescents is, therefore, likely to include participants experiencing mental ill health, even if mental health is not the primary focus. Researchers should adopt procedures and principles that safeguard adolescent mental health in their research practice. Yet there are gaps between theory and practice of research with adolescents in relation to their mental health, and limited guidance is available.We discuss emerging safeguarding dilemmas and procedures in adolescent mental health research. Our experiences of safeguarding adolescent mental health are grounded in the UK National Institute for Health and Care Research-funded SMART Schools Study. Drawing from this secondary school-based study, we focus on how our research team encountered and addressed a high prevalence of participants (aged 12-13 and 14-15 years) reporting thoughts and behaviours related to self-harm or suicide (24% of participants). This included reviewing our existing risk mitigation processes and consulting with several committees including young people with lived experiences of mental health.We present the SMART Schools study safeguarding approach for adolescent mental health. This encompasses key safeguarding principles, study procedures and relevant justifications. We address school and university roles and responsibilities, pupil understanding, and efficient, effective and secure communication pathways. We embed guidance throughout this article for researchers working with adolescents in the context of mental health. Lastly, we present five key recommendations to safeguard the mental health of adolescents participating in research, including (1) appointing a safeguarding lead within the research team; (2) codesigning a bespoke study safeguarding approach; (3) adopting a responsive approach to mental health safeguarding; (4) being transparent about the study mental health safeguarding approach and (5) report the implementation and outcomes of safeguarding approaches.Trial registration number ISRCTN77948572.

Smartphones, social Media and Adolescent mental well-being: the impact of school policies Restricting dayTime use-protocol for a natural experimental observational study using mixed methods at secondary schools in England (SMART Schools Study).

INTRODUCTION: Smartphone and social media use is prevalent during adolescence, with high levels of use associated with lower levels of mental well-being. Secondary schools in the UK have introduced policies that restrict daytime use of smartphones and social media, but there is no evaluation on the impact of these policies on adolescent mental well-being. The SMART Schools Study aims to determine the impact of daytime restrictions of smartphone and social media use on indicators of adolescent mental well-being, anxiety, depression, physical activity, sleep, classroom behaviour, attainment and addictive social media use. METHODS AND ANALYSIS: This is a natural experimental observational study using mixed methods. Secondary schools within a 100 mile radius of the recruiting centre in the West Midlands (UK) have been categorised into two groups: Schools that restrict (intervention) and permit (comparator) daytime use of smartphones. We aim to recruit 30 schools (20 restrictive, 10 permissive) and 1170 pupils aged 12-13 and 14-15 years. We will collect data on mental well-being, anxiety and depressive symptoms, phone and social media use, sleep and physical activity from pupil surveys, and accelerometers. Policy implementation measures and data on individual pupil factors will be collected through school staff surveys, and website/policy analysis. Six case study schools will explore individual, school and family/home factors that influence relationships between school smartphone policies, smartphone/social media use, and mental well-being. Economic evaluation will be completed through a cost-consequence analysis from an education sector perspective. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of Birmingham's Research Ethics Committee (ERN_22-0723). Parents/carers of pupil participants can complete a form to opt their child out of the study. Pupil, school staff and parent/carer participants are asked to complete online/written consent (or assent). Findings will be disseminated through policy briefings, resources for schools, social media, reports, and open access publications. TRIAL REGISTRATION NUMBER: ISRCTN77948572.

#Skinny girls: young girls' learning processes and health-related social media.

This paper provides in-depth knowledge into young girls' learning processes in relation to physical activity, diet/nutrition and body image. Data were generated from interviews with 49 girls (age 13-15) in England. The practical epistemological analysis technique was used to explore young people as both producers and consumers, or prosumers, of content and knowledge. The data illustrate that adolescent girls navigate two interrelated health-related paradoxes within publicly private spaces: (i) skinny fat and (ii) naturally fake. Skinny fat refers to how participation in social media represents a continuous struggle of becoming skinny, but at the same time not trying too hard to become too skinny. Naturally fake refers to how having a 'natural' look is highly valued, but equally, it is acceptable to be 'fake'. Overall, adolescent girls are competent users of social media, who are able to navigate the complexity of the medium and its contents. At the same time, the adolescent girls sometimes found themselves, unintentionally, exposed to risks (e.g. bullying or body dysmorphia), particularly when social media was experienced publicly in a temporal order, connected to the past or present, and without control of potential future effects and impacts. Relevant adults should acknowledge young people's vast competence of life on social media and further empower young people to self-regulate their learning through social media, and in ways that help them to learn from experiences about their health and bodies to shape future actions.

The effectiveness of gaming interventions for depression and anxiety in young people: systematic review and meta-analysis.

BACKGROUND: Recent research has investigated the use of serious games as a form of therapeutic intervention for depression and anxiety in young people. AIMS: To conduct a systematic review and meta-analysis into the effectiveness of gaming interventions for treating either depression or anxiety in individuals aged 12-25 years. METHOD: An electronic search was conducted on the 30 March 2020, using PsycINFO, ISI Web of Science Core Collection, Medline and EMBASE databases. Standardised effect sizes (Hedge's g) were calculated for between-participant comparisons between experimental (therapeutic intervention) and control conditions, and within-participant comparisons between pre- and post-intervention time points for repeated measures designs. RESULTS: Twelve studies (seven randomised controlled trials (RCTs) and five non-randomised studies) were included. For RCTs, there was a statistically significant and robust effect (g = -0.54, 95% CI -1.00 to -0.08) favouring the therapeutic intervention when treating youth depression. For non-RCTs, using a repeated measures design, the overall effect was also strong (g = -0.75, 95% CI -1.64 to 0.14) favouring therapeutic intervention, but this was not statistically significant. Interestingly, we found no statistically significant effect for treating youth anxiety. CONCLUSIONS: There is preliminary evidence to suggest that gaming interventions are an effective treatment for youth depression, but not anxiety. Further research is warranted to establish the utility, acceptability and effectiveness of gaming interventions in treating mental health problems in young people.

Social media use informing behaviours related to physical activity, diet and quality of life during COVID-19: a mixed methods study.

BACKGROUND: This mixed methods study explored how social media use informed physical activity and diet-related behaviours, and self-perceived Quality of Life (QoL) during COVID-19, and assessed the contextual factors that drive social media use for health-related behaviour change in diverse groups. During the COVID-19 lockdown periods there were reported changes to social media use and health behaviours, and this gave an opportunity to investigate potential relationships. METHODS: An explanatory sequential research design of two parts was used: (1) An online survey that assessed social media use in relation to physical activity levels, diet quality and QoL (n = 786; Mage 45.1 ± 19.1 (range 16-88) years; Female =69%); (2) 20 purposive focus groups (n = 69; Mage = 52.88 ± 18.45 years, Female n = 68%) to understand the contextual factors that drive social media use for health-related behaviour change. Descriptive and thematic analysis were conducted. RESULTS: Participants in this study reported that social media facilitated the self-management of behaviours related to physical activity, diet and QoL, through access to information to inform workouts and dietary quality, and the opportunities for interaction with peers, family members and within social groups. Contextual factors including work, home and lifestyle arrangements, pre-existing health-related knowledge and behaviours, and the perceived value of social media for health influenced the relationship between social media use and self-reported outcomes. Social media influencers, peers/family members, and official organisations influenced the application of health-related information accessed via social media. CONCLUSIONS: The evidence shows that participants were critical users of social media and were able to use social media to derive benefit for their health and wellbeing. Detailed guidance for those who use social media, as well as those who recommend and endorse social media content is required to maximise the potential of social media to support health behaviours. Future public health strategies and social media interventions should acknowledge diversity in contextual factors driving social media use for health behaviour change.

The effect of social media interventions on physical activity and dietary behaviours in young people and adults: a systematic review.

BACKGROUND: The objectives of this systematic review were to update the evidence base on social media interventions for physical activity and diet since 2014, analyse the characteristics of interventions that resulted in changes to physical activity and diet-related behaviours, and assess differences in outcomes across different population groups. METHODS: A systematic search of the literature was conducted across 5 databases (Medline, Embase, EBSCO Education, Wiley and Scopus) using key words related to social media, physical activity, diet, and age. The inclusion criteria were: participants age 13+ years in the general population; an intervention that used commercial social media platform(s); outcomes related to changes to diet/eating or physical activity behaviours; and quantitative, qualitative and mixed methods studies. Quality appraisal tools that aligned with the study designs were used. A mixed methods approach was used to analyse and synthesise all evidence. RESULTS: Eighteen studies were included: randomised control trials (n = 4), non-controlled trials (n = 3), mixed methods studies (n = 3), non-randomised controlled trials (n = 5) and cross-sectional studies (n = 3). The target population of most studies was young female adults (aged 18-35) attending college/university. The interventions reported on positive changes to physical activity and diet-related behaviours through increases in physical activity levels and modifications to food intake, body composition and/or body weight. The use of Facebook, Facebook groups and the accessibility of information and interaction were the main characteristics of social media interventions. Studies also reported on Instagram, Reddit, WeChat and Twitter and the use of photo sharing and editing, groups and sub-groups and gamification. CONCLUSIONS: Social media interventions can positively change physical activity and diet-related behaviours, via increases in physical activity levels, healthy modifications to food intake, and beneficial changes to body composition or body weight. New evidence is provided on the contemporary uses of social media (e.g. gamification, multi-model application, image sharing/editing, group chats) that can be used by policy makers, professionals, organisations and/or researchers to inform the design of future social media interventions. This study had some limitations that mainly relate to variation in study design, over-reliance of self-reported measures and sample characteristics, that prevented comparative analysis. Registration number: PROPSERO; CRD42020210806 .

Young People's health-related learning through social media: What do teachers need to know?

International regulatory bodies have argued that young people should be better supported to engage safely, responsibly and effectively with social media. This paper considers ways in which the introduction of structured social media engagement in schools could bring educational benefits for young people, particularly in supporting them to deal with challenges relating to health and wellbeing. New evidence is provided on: (i) the value of social media as a health-related learning tool to bridge informal and formal learning contexts; (ii) how teachers should be supported to better understand and respond to young people's learning needs; and (iii) the school-based policies, expectations and resources that will help teachers to offer relevant support.

#Gymlad - young boys learning processes and health-related social media.

Recent systematic reviews identify that the factors mediating and/or moderating the relationship between social media and health outcomes are sparse. There have also been few attempts to analyse gender specific uses of social media. This paper investigated young boys health-related learning in relation to social media. Data were generated from class activities and interviews and from a large data set that included 1346 young people. The approach to the empirical data adopted was Practical Epistemology Analysis (PEA). The findings reveal two main purposes of young boys engagement with social media: (i) communicating with friends, and (ii) accessing health-related information. Irony and humour were central learning mechanisms used by young boys to participate within health-related social media, and in a way that enabled them to engage with, uphold, and handle health discourses associated with masculinity - such as being ripped - without fear of 'literal' peer ridicule and within a context of acceptable 'banter'. There was evidence that young people were critical users and generators of social media, who were clearly thinking through what they see, do, and use online. Hence, this paper provides a fresh evidence-based perspective on the potentially positive role of social media as a health-related learning resource. PEA is illustrated as a new methodological approach for investigating learning in the context of social media. The evidence generated can be used to inform future evaluations of social media use, the design of educative support for young people, and guidance and training for key stakeholders.

Young people and their engagement with health-related social media: new perspectives.

Young people are increasingly turning to social media for health-related information in areas such as physical activity, diet/nutrition and body image. Yet, there are few robust empirical accounts of the content and form of the health-related material young people access and attend to, or the health-related content they create and share. Furthermore, there is little guidance from research or policy on young people's engagement with health-related social media. This leaves many relevant adults ill-equipped to protect young people from the negative influences of social media and to optimize the potential of social media as a medium for health promotion. This article presents new evidence on young people's engagement with social media and the influences they report on their health-related behaviors. The research was undertaken with 1296 young people (age 13-18) using a participatory mixed methods design. Initially, a public pedagogy [Giroux, 2004. Public pedagogy and the politics of neo-liberalism: Making the political more pedagogical. Policy Futures in Education, 2, 494-503] theoretical framework was used to guide data analysis but this was found to be limiting. An adapted framework was developed, therefore, drawing on Miller et al. [2016. How the world changed social media. London: UCL Press] and Lomborg [2011. Social media as communicative genres. Journal of Media and Communication Research, 51, 55-71] to account for the unique ways in which pedagogy operates in a social media context. Young people accessed and used a range of health-related information on body transformations, diet/nutritional supplements or recipes and workouts/exercises, albeit in different ways. Moreover, young people identified five forms of content that influenced their understandings and behaviours: (i) automatically sourced content; (ii) suggested or recommended content; (iii) peer content; (iv) likes; (v) reputable content. The findings also suggest that relevant adults can reduce risk and realize more of the positive impacts of social media for young people by focusing on content, and the ways in which content is shaped in the interplay between interactive functionalities of social media (e.g. likes and followers) and young people's social uses of social media (e.g. friends, information).

Sustained Professional Development on Cooperative Learning: Impact on Six Teachers' Practices and Students' Learning.

PURPOSE: It has been argued, extensively and internationally, that sustained school-based continuous professional development (CPD) has the potential to overcome some of the shortcomings of traditional one-off CPD programs. Yet, the evidence base on more effective or less effective forms of CPD is contradictory. The mechanisms by which sustained support should be offered are unclear, and the impacts on teachers' and students' learning are complex and difficult to track. The purpose of this study was to examine the impact of a sustained school-based, tailored, and supported CPD program on teachers' practices and students' learning. METHOD: Data are reported from 6 case studies of individual teachers engaged in a yearlong CPD program focused on cooperative learning. The CPD program involved participatory action research and frequent interaction/support from a boundary spanner (researcher/facilitator). Data were gathered from 29 video-recorded lessons, 108 interviews, and 35 field journal entries. RESULTS: (a) Individualized (external) support, (b) departmental (internal) support, and (c) sustained support impacted teachers' practices of cooperative learning. The teachers adapted their practices of cooperative learning in response to their students' learning needs. Teachers began to develop a level of pedagogical fluency, and in doing so, teachers advanced students' learning. CONCLUSIONS: Because this study demonstrates impact, it contributes to international literature on effective CPD. The key contribution is the detailed evidence about how and why CPD supported 6 individual teachers to learn-differently-and the complexity of the learning support required to engage in ongoing curriculum development to positively impact student learning.