Feasibility & Acceptability of a Culturally Adapted Socio Emotional Learning Intervention for Pakistani Adolescents

Feasibility and Acceptability of Implementing and Scaling up a Culturally Adapted Universal Socio-emotional Intervention for School-going Adolescents in Rawalpindi, Pakistan: A Feasibility Cluster Randomized Controlled Trial (cRCT)

The aim of the study is to improve socioemotional learning skills of adolescents in public school settings of Rawalpindi, Pakistan. The objective of the present study is to evaluate the feasibility and acceptability of culturally adapted social and emotional learning intervention through feasibility cluster randomized controlled trial.

In the current study, 4 schools will be randomized to intervention and control arms, stratified by gender.

The study participants will be adolescents studying in government schools.

Study Overview

• Status: Enrolling by invitation
• Conditions: Mental Health
• Intervention / Treatment: Behavioral: Magnificent Mei & Friends Comic Series

Detailed Description

The current study is a two-arm, single-blinded, feasibility cluster randomized controlled trial that will be conducted in 4 middle and high schools in Rawalpindi, Pakistan. 4 schools, stratified by gender, will be randomized on a 1:1 allocation ratio into intervention (n = 2) and enhanced treatment-as-usual (n=2) arms. Approximately 120 adolescents of both genders, aged 10-14, studying in grade 6 of elementary public schools will be included in the study. A facilitator will deliver the intervention in the classrooms. The intervention components are empirically supported and include emotional regulation, stress management, problem solving, assertiveness, drug and alcohol knowledge, and interpersonal skills. The treatment as usual across both arms will be enhanced by conducting a 40-minute awareness-raising seminar on promoting mental health among adolescents through schools. The objective of the study is to evaluate the feasibility and acceptability of culturally adapted social and emotional learning intervention along with evaluating the preliminary impact of the culturally adapted intervention on the knowledge, attitude, and practice of Social and Emotional Abilities (SEA) in school-going adolescents in Rawalpindi, Pakistan.

• Study Type: Interventional
• Enrollment (Estimated): 120
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Islamabad, Pakistan, 540007
    • NUST

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. Students enrolled in Grade 6
2. Present at school on the day of the baseline assessment, the endpoint outcome assessment, or both

Exclusion Criteria:

The adolescents will be excluded if the they

1. are at high risk of imminent suicide as reported by the students themselves or parents/primary caregivers, or identified by the trained assessment team during assessments.
2. have acute medical conditions who require immediate or ongoing inpatient medical or psychiatric care, as reported by students themselves or parents/primary caregivers or identified by the trained assessment team during assessments.
3. have deafness, blindness and speech difficulties or with severe mental, neurological or substance use disorders (e.g., psychosis, mutism, intellectual disability, autism or drug dependence) identified by the trained assessment team during assessments.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Magnificent Mei & Friends Intervention; It is a multicomponent universal intervention that has been designed to promote socioemotional life skills among adolescents 10-14. Based on evidence based effective program components, the intervention has potential to improve adolescent mental health and reduce risky behavior. It is resource-effective where the facilitator learns skills through self-study and reflection. The intervention comprises empirically supported strategies, delivered via group sessions in classroom. Each session is further subdivided; the individual subdivided session lasts from 20 minutes to 30 minutes. The intervention material consists of 1. Magnificent Mei and Friends Comic Series 2. Facilitator's Guide to the Magnificent Mei & Friends Comic Series. The comics represent life scenarios and situations young adolescents face in their daily lives. With the help of the comics, the facilitator teaches social and emotional skills to adolescents.	Behavioral: Magnificent Mei & Friends Comic Series; It is a multicomponent universal intervention that has been designed to promote socioemotional life skills among adolescents 10-14. Based on evidence-based effective program components, the intervention has potential to improve adolescent mental health and reduce risky behavior. It is resource-effective where the facilitator learns skills through self-study and reflection. The intervention comprises empirically supported strategies, delivered via group sessions in classroom. Each session is further subdivided; the individual subdivided session lasts from 20 minutes to 30 minutes. The intervention material consists of 1. Magnificent Mei and Friends Comic Series 2. Facilitator's Guide to the Magnificent Mei & Friends Comic Series. The comics represent life scenarios and situations young adolescents face in their daily lives. With the help of the comics, the facilitator teaches social and emotional skills to adolescents.
No Intervention: Enhanced Treatment-as-usual; Mental health services are not available in public schools of Pakistan to promote mental health and wellbeing of children and adolescents; therefore, the treatment as usual across both arms will be enhanced by conducting a 40 minutes awareness raising seminar on promoting mental health among adolescents through schools. In these seminars the teachers and adolescents will receive mental health awareness information from the study lead.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Social Emotional Abilities and Learning (SEAL)	It is 36 items tool designed to measure socioemotional abilities of adolescents. The items are rated on three-point Likert scale, where yes has the highest score (2), No has the score of (1) and maybe has the lowest score of (0) (UNICEF, 2021).Higher scores indicate stronger socio-emotional knowledge, skills, and positive practices, while lower scores indicate poorer socio-emotional competencies and awareness.	From baseline to one day post-intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pediatric Symptoms Checklist	It is a well established 35 items scale. It consists of three subscales: internalizing, externalizing and attention problems (Jellinek et al., 1988). The Urdu version has been previously adapted and used in Pakistan, showing satisfactory reliability and validity (Hamdani et al., 2024; 2022). Higher scores reflect greater levels of emotional and behavioral problems (internalizing, externalizing, and attention difficulties), while lower scores indicate fewer psychosocial problems.	from baseline to one day post-intervention
Revised Children's Anxiety and Depression Scale (RCADS)	RCADS is a 25-item instrument (on a 4-point Likert scale; transformed scores range 0-100) to measure levels of anxiety and low mood. It has two subscales (anxiety & depression). This tool has also been translated into the Urdu language previously and used successfully in Pakistan (Hamdani et al., 2024). Higher scores indicate higher levels of anxiety and depressive symptoms, whereas lower scores indicate fewer symptoms of anxiety and low mood.	From baseline to one day post-intervention
Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWS)	it is a 7-item scale and assesses the mental wellbeing by evaluating the functioning of thoughts and feelings in the past two weeks. Items are rated on Likert scale that ranges from "none of the time" to "all of the time". The total score is calculated by summing the responses on all the items (Tennant et al., 2007). This tool has also been translated into the Urdu language and validated previously (Hamdani et al., 2022). Higher scores indicate better mental wellbeing and more positive functioning of thoughts and feelings, while lower scores indicate poorer mental wellbeing.	from baseline to one day post-intervention
Bullying Victimization Questionnaire	Experience of bullying in the past 30 days will be measured through the contextualized version of the Bullying Victimization Questionnaire. The total score can range from 0 to 12. Higher scores indicate more frequent experiences of bullying victimization, while lower scores indicate fewer or no experiences of being bullied by peers.	from baseline to one day post-intervention
Study Specific Feasibility Assessment Questionnaire	Quantitatively Feasibility assessment will be done in terms of rate of recruitment, number of sessions delivered to the study participants, number of participants in the sessions who received the intervention, duration of sessions delivered, and retention at follow-up assessment. Qualitatively feasibility assessment will be done to explore the extent to which it was feasible to train non-specialist facilitators and delivery of the intervention in the school settings.	one day post intervention
Qualitative Evaluation of Intervention Acceptability	Acceptability will be assessed through qualitative assessments with the stakeholders in Semi Structured Interviews to assess acceptability, feasibility, facilitators, and barriers of the intervention strategies implemented, and challenges faced by the intervention facilitators during intervention delivery. The Focus Group Discussions with adolescents will explore the intervention strategies applied by the participants in the sessions, challenges faced in the application of the intervention strategies by the participants in real life, perceived usefulness, ease of use, comprehensibility for most/least helpful components, suggestions for improvement, and intent to continue behaviors/engagement with the intervention. The perception of the implementation in school settings will also be explored in terms of non-specialist as delivery agents, their training and supervision, the experience or perception of delivering the intervention.	one day post intervention

Collaborators and Investigators

• Sponsor: National University of Science and Technology, Pakistan
• Investigators: Study Chair: Sitwat Usman Langrial, National University of Sciences and Technology, Pakistan; Study Director: Joanna Lai, United Nations International Children's Emergency Fund

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2026
• Primary Completion (Estimated): April 20, 2026
• Study Completion (Estimated): April 20, 2026

Study Registration Dates

• First Submitted: February 8, 2026
• First Submitted That Met QC Criteria: February 20, 2026
• First Posted (Actual): February 25, 2026

Study Record Updates

• Last Update Posted (Actual): April 6, 2026
• Last Update Submitted That Met QC Criteria: April 3, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: randomized controlled trial; feasibility; acceptability; adolescent mental health; socioemotional skills; helping adolescent thrive
• Additional Relevant MeSH Terms: Behavior; Personal Satisfaction; Psychological Well-Being
• Other Study ID Numbers: 0839/Ethic/07S3H/87/DBS

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No