Complex interventions to prevent adolescents from engaging in multiple risk behaviours; a realist enquiry

Cooper, Christina (2018) Complex interventions to prevent adolescents from engaging in multiple risk behaviours; a realist enquiry. Doctoral thesis, Northumbria University.

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Abstract

Background: Adolescent health risk behaviours are a key contributing factor to adolescent morbidity and mortality. Evidence suggests that many risk behaviours begun in adolescence impact significantly on longer term health and well-being. While many prevention programmes have been found to be moderately effective, they tend to have little success when replicated at scale. Current literature fails to address underlying causality, or broader contextual factors which may contribute to this failure. The purpose of this research is to gain a deeper understanding of how, why, for whom, and in what circumstances complex multiple risk behaviour prevention programmes are most successful in reducing or preventing health risk behaviours in adolescents.

Methods and analysis: A novel realist approach was used, combining realist synthesis of the existing literature with aspects of realist evaluation, and qualitative analysis of primary data from stakeholders, to explore causal mechanisms and contextual factors which contribute to programme success or failure. Data collection and analysis was conducted across four phases:
Phase One: Building the framework. Mapping the theoretical and conceptual landscape of adolescent risk behaviour prevention in the literature.
Phase Two: Formulating initial programme theories through broad literature searching, and screening, to identify patterns or ‘demi-regularities’, guided by data from professional stakeholders.
Phase Three: Refining programme theories through purposeful, in depth screening of the literature, along with collection and analysis of primary qualitative data, from young people and school nurses.
Phase Four: Testing programme theories through interviews with youth workers, informed by young people, based on a series of vignettes, to explore the relationships within and between specific programme theories.

Data Analysis: A realist logic of analysis was used to align data from each phase with context mechanism outcome configurations. Substantive theory was then sought to further understand, and explain these findings.

Results: The results of this study are complex and multifaceted. A broad range of context mechanism outcome configurations were formulated and tested, exploring key constructs such as implementation, leadership and support, programme deliverer and ethos, and sociocultural and interpersonal factors. Three overarching programme theories were identified, suggesting that complex multiple risk behaviour prevention programmes are most successful in reducing or preventing risk behaviour in adolescents when strongly grounded in theory, paying close attention to relationships, and wider contextual factors, such as family, community, culture, socioeconomic status, intersectionality, and health inequalities.

Discussion: Programme theories developed as part of this study provide key areas of focus for future adolescent risk behaviour prevention programmes, and the development of policy designed to guide practice. Furthermore, it is argued that future research could build upon these findings, and that findings can be generalised to other related issues, such as adolescent mental health, and the health and wellbeing of school staff.

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