Addressing rates of low mood and anxiety among adolescent girls: Co-production of programme theories with adolescent girls and professionals.

BACKGROUND: From early adolescence, girls face greater risk of experiencing low mood and anxiety, with recent evidence that this may be worsening. This is increasingly recognised as a critical public health issue, with an imperative for research that meaningfully progresses our understanding of how to reduce the risk of these experiences, including research that asks adolescent girls themselves. AIMS: We set out to explore what adolescent girls think can be done to reduce rates of low mood and anxiety among their population, and to understand how such options can be enacted. DESIGN AND METHODS: We adopted a coproduced qualitative design, conducting focus groups in 2022 with 32 adolescent girls aged 16-18 years in England. We analysed data with content analysis to construct candidate 'programme theories', or models for intervention, and refined these through discussion with four professionals. RESULTS: We produced five candidate programme theories: (A) social media education and campaigning, (B) school staff training and culture change on gender stereotypes, (C) comprehensive approach to sexual harassment in schools, (D) social hobby spaces in schools and/or communities and (E) relationally grounded whole-school approach to mental health and well-being. Guided by the Medical Research Council guidance for complex interventions, for each we describe required resources, activities, mechanisms, outcomes and key considerations for context and successful implementation. LIMITATIONS: While the study offers valuable, coproduced insights into adolescent girls' mental health, limitations include a relatively small and self-selecting adolescent sample and under-representation of certain demographic groups, which may have meant some perspectives were not included; a small sample size of professional participants which may have limited discussion and affected transferability of insights across varied contexts and approaches to mental health provision; limited engagement with wider stakeholder groups which could have augmented and contextualised findings more deeply, and context-specific constraints such as recruitment in England only and timing of data collection (shortly before high-stakes exams following COVID-19 restrictions) that may affect wider applicability. CONCLUSIONS: These coproduced candidate programme theories provide valuable insights on opportunities to develop, extend and challenge the ways in which we currently work to improve the mental health of adolescent girls. FUTURE WORK: Future research should employ multimethod, participatory approaches across diverse populations and contexts to refine and test these youth-informed programme theories and explore their implementation in varied educational, social and cultural settings. FUNDING: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR135295.