Adolescent Resilience-Building In Urban Slums-A Multifaceted Implementation Trial of Life Skills Education in India (ANUMATI 2.0) among older adolescents: a protocol for a double blind, three arm, cluster randomised controlled trial.

BACKGROUND: Adolescence is a period of rapid physical, psychological, and social change. Older adolescents (15-19 years) experience key transitions; successfully navigating these can reduce the risk of stress and may mitigate subsequent impacts in adulthood, given that stress and depression in young people are highly correlated with behavioural risk factors such as alcohol and substance use, physical inactivity, and poor dietary behaviours. The Adolescent Resilience-Building In Urban Slums-A Multifaceted Implementation Trial of Life Skills Education in India (ANUMATI 2.0) will be undertaken in 105 slums across New Delhi and Hyderabad/Secunderabad in India among older adolescents. The hypothesis is that life skills administered either in-person or through social media will improve wellbeing, depression symptoms, and lead to a reduction in other non-communicable disease risk factors (smoking, alcohol and substance use, physical inactivity) relative to enhanced usual care. A secondary hypothesis is that the social media-based programme will be more cost-effective than the in-person programme. METHODS: The Life Skills Education Programme (LSEP) was co-designed with adolescents from slums and comprises four modules delivered over 8 months, with refresher sessions being carried out in the remaining 4 months of the 12-month implementation period. It will be implemented and evaluated in a 3-arm, hybrid type 2 cluster randomised controlled trial with process and economic evaluations. Older adolescents will be screened for depression and suicide ideation using the Patient Health Questionnaire (PHQ-9). Adolescents with a PHQ-9 score ≥ 10 and/or a score ≥ 2 on the self-harm/suicide risk question of the PHQ-9 will be included in the trial. Arm 1 will receive the in-person LSEP, arm 2 will receive the LSEP delivered through social media platforms, and arm 3 will be provided with enhanced usual care. DISCUSSION: Life skills education is an evidence-based approach to enhance young people's resilience to stressors. It focusses on improved communication, assertiveness, self-awareness, decision-making, problem solving, and creative thinking. The findings from this study will generate evidence on scalable strategies to enhance resilience and reduce non-communicable disease risk factors for young people living in resource-limited settings both in India and elsewhere. TRIAL REGISTRATION: Clinical Trial Registry India, CTRI/2024/08/072338. Registered on August 12, 2024.