Process evaluation of a youth resilience intervention in urban North India during the COVID-19 pandemic – a mixed methods study

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Young people are among the groups identified to be at higher risk of anxiety, stress and distress in India, especially if they already experience structural disadvantage. The global COVID-19 pandemic has led to dramatic social restrictions that were introduced to limit spread of COVID-19. Young people confined to their households during lockdowns experience greater risk for mental ill-health during the pandemic with changes in daily routine, increased violence in families and lack of access to peers, teachers and physical activity. Many have lost family members and peers due to COVID-19 infection. Nae Disha (New Pathways – developed by Burans, a community mental health initiative) is a four month long community based youth resilience and mental health intervention evidenced to be effective in reducing anxiety and depression, and improving gender equality attitudes. This study’s aim was to evaluate the implementation processes in conducting Nae Disha in disadvantaged urban communities in North India during the COVID 19 pandemic, while limiting transmission of the SARS-Cov-2 respiratory virus. Nae Disha was implemented from September to December 2020, following the first wave of the Indian COVID-19 pandemic, in three urban and peri-urban sites in Uttarakhand, North India, among 426 school-going adolescents from the ages of 13 to 18. A total of 79 people contributed to this process evaluation through individual interviews or focus group discussions. Basic descriptive statistics was used to analyse socio-demographic data using Microsoft Excel. Interviews and FGDs were recorded, transcribed and translated, and data analysed using thematic analysis. The mechanisms supporting implementation are; use of local facilitators, appropriate sequencing of modules and confronting content, and a dynamic and engaging format of session delivery (group sessions with games relevant to topic), specific to the context in the communities. The changing pandemic context required agile changes to implementation, that increased facilitator workload and fatigue. This study illustrates the value of psychosocial groups as a platform that is socially feasible, acceptable, and cost-effective, that can improve mental health outcomes through increased social networks, as well as through the opportunity to share strategies and approaches for improved mental health. This process evaluation indicates that the low cost Nae Disha intervention can be facilitated in restricted pandemic settings with dynamic changes to implementation strategy, to reduce virus transmission.