Examining youth mental health promotion at scale: an exploration of the implementation of three initiatives in a national programme

There is well-established evidence regarding the positive impact of mental health promotion with young people. Despite this, we know less about the implementation of youth mental health promotion (YMHP) programmes delivered at scale, in part due to a lack of published evaluations. This study used the RE-AIM framework to examine cross-cutting and diverging implementation components of three different YMHP initiatives delivered as part of a national programme, with the aim of informing future YMHP implementation and evaluation. Drawing on programme materials, this study applied framework analysis to explore similarities and differences in implementation across initiatives in schools, higher education, and community settings. The RE-AIM implementation framework was used to examine findings and data quality for reach, effectiveness, adoption, implementation, and maintenance for each initiative. Adoption was facilitated by strong relationships, reputation, and incentives, with partnerships playing an important role. Two initiatives achieved extensive reach but were less successful in expanding beyond direct participants. Implementation success depended on flexibility, teamwork, support from Removed for Peer Review staff, fidelity, and incentives. Findings relating to the effectiveness were limited by recruitment challenges and small sample sizes. There was strong satisfaction with programme content, but measurement of impact was a challenge across initiatives. Data limitations in some areas, particularly effectiveness and maintenance, highlighted challenges faced by resource-constrained organisations in self-evaluating YMHP programmes. This study provides rich insights into the complexities involved in implementation and evaluation of YMHP initiatives at scale. The findings underscore the critical importances of evaluation strategies that are workable for on-the-ground implementers, ensuring measurable and sustainable improvements in youth mental health literacy and wellbeing across diverse settings. Funding: this research was funded by the Health Service Executive (Ire).