A cluster randomised feasibility trial assessing an interactive film intervention to improve wellbeing of young people in school settings in the North of England

Background

Adolescence is a critical period for the onset of mental illness. A partnership of a health and care network and filmmakers developed an interactive film for youth wellbeing. While such films have potential as a cost-effective preventative tool, their effectiveness remains unproven. This study aimed to assess the feasibility and acceptability of a randomised controlled trial of the interactive film intervention to improve wellbeing in school-aged youth.

Methods

In a mixed-methods cluster randomised feasibility trial in North East England (2021–2022), students in years 10 (14–15 years) and 12 (16–17 years) from three schools were recruited and randomised to the following conditions: (1) watching the film in class, (2) watching the film in class with support from youth workers or (3) regular class activities. Feasibility outcomes included willingness of schools to participate, participant recruitment, and retention, which were assessed quantitatively and qualitatively. Data were analysed descriptively and with the use of thematic analysis.

Results

School recruitment targets were met, although this was challenging due to resource constraints and the COVID-19 pandemic. Questionnaires were completed before watching the film by 172 students (48% of the recruitment target). Follow-up targets for retention were met at 3 months (n = 138) and 6 months (n = 136). Retention of year 10 students was high (96%), but year 12 students had lower retention (60%). Qualitative findings showed students and teachers supported the intervention and trial and measurements; however, consent-taking required more time. Communication and resource issues within schools were challenging and need addressing before moving to a larger trial.

Conclusion

Although some trial aspects were feasible and acceptable, particularly the intervention, others, such as recruitment, retention and school communication, posed challenges. We recommend future feasibility studies should address barriers such as randomisation, communication with schools, recruitment of older students (16–18 years), consent and measurement alignment before moving to a larger-scale trial.

Trial registration

ClinicalTrials.gov Identifier: NCT06807931. Retrospectively registered 04 February 2025 https://clinicaltrials.gov/study/NCT06807931.

Interactive Films in Schools: Feasible Tool for Boosting Youth Wellbeing

What is it about?

The study examined the feasibility of a cluster randomised controlled trial using an interactive film intervention to improve wellbeing, resilience, and help-seeking attitudes among young people aged 14-18 in schools in the North East and North Cumbria. The methodology followed the CONSORT guidelines for pilot and feasibility trials and involved recruiting schools, randomising them, and assessing participant recruitment, retention, and consent processes. Data collection tools and analysis methods were evaluated for their suitability, while the intervention's acceptability and feasibility were also assessed. Ethical approval was obtained, and incentives were provided to schools and students for participation. The results highlighted that three out of seven progression criteria showed strong indications to proceed, while four showed partial achievement, indicating the feasibility of the approach. The study emphasized the need to review certain methods like school randomisation and outcome measures before proceeding to a full-scale trial.

Why is it important?

"This study is important as it explores the feasibility of implementing an interactive film intervention aimed at improving the mental wellbeing of young people in school settings, specifically in deprived areas of the North East and North Cumbria. Given the increased prevalence of mental health issues among adolescents, with significant long-term consequences for individuals and society, this research addresses a pressing need for effective mental health interventions. By focusing on school-based strategies, the study aligns with current efforts to enhance mental health literacy and support among young people, potentially reducing the stigma and reluctance to seek help. The findings underscore the potential for film-based approaches to engage young audiences and improve understanding of mental health, providing insights that could inform the development of more effective, scalable interventions.

Key Takeaways:

1. Feasibility and Acceptance: The study confirms that it is feasible to recruit and retain schools and participants for a randomised controlled trial, indicating that the interactive film intervention is acceptable within school settings and that data collection methods are practical.

2. Progression Criteria: Three out of seven progression criteria were fully met, suggesting strong potential to proceed with a larger trial. Four additional criteria showed medium potential, and none were unmet, highlighting the trial's overall viability.

3. Areas for Improvement: Before a full-scale trial, certain aspects such as school randomisation, participant recruitment processes, consent clarity, and outcome measure applicability need to be reviewed and improved to ensure the efficacy and robustness of future interventions.