Perceived feasibility and acceptability of an innovative emotion regulation programme with physical activity elements for older South African adolescents from low-income settings: a qualitative study.

BACKGROUND: Adaptive emotion regulation and physical activity may protect against mental health conditions such as depression and anxiety in adolescents. However, contextually relevant psychosocial interventions remain scarce in South Africa, and limited research explores adolescents' lived experiences and perceived impacts of these interventions. This qualitative study examined the feasibility, acceptability, and perceived impact of a co-adapted, task-shared emotion regulation intervention incorporating physical activity. METHODS: The group-based programme was piloted in a single-arm feasibility study with 85 adolescents (aged 15-18) across four low-income schools in the Western Cape. Semi-structured interviews (40-60 min) were conducted with adolescents (n = 20), community stakeholders (n = 7), and facilitators (n = 4) to explore their perceptions of the intervention. RESULTS: Five key themes emerged: (1) Perceived programme acceptability, (2) Experiences with training and supervision, (3) Barriers and facilitators to delivery and retention, (4) Perceived impact on mental health and (5) Facilitators of learning. Participants found the intervention engaging and relevant, highlighting its role in strengthening emotion regulation skills. Adolescents reported improved mood and behaviour, with reductions in stress, anger, anxiety, and depressive symptoms, alongside enhanced academic engagement and social connectedness. Facilitators viewed the task-sharing model, supported by competency-based training and supervision, as comprehensive and valuable for successful implementation. Experiential learning, enjoyment, and the use of digital and hardcopy materials were found to be key facilitators of learning in the programme. CONCLUSIONS: The findings highlight the feasibility and acceptability of integrating emotion regulation skills with creative, movement-based strategies in adolescent mental health interventions. By combining emotion regulation training with physical activity in an engaging group setting, the programme promoted adaptive emotional coping strategies. This study emphasizes the potential of creative, experiential, evidence-based approaches to address adolescent mental health needs in low-resource settings. This feasibility study was registered retrospectively with the Pan African Clinical Trial Registry (PACTR202412659160564, registered 17/12/2024). This study can be accessed at:  https://pactr.samrc.ac.za/Search.aspx .