Community health

Addressing an unrecognised public health problem in Vietnam: A clustered randomised controlled trial of the culturally adapted Resourceful Adolescent Program (RAP-V) to improve adolescent mental health

Thach Tran; Huong Nguyen; Ian Shochet; Nga Nguyen; Nga La; Astrid Wurfl; Jayne Orr; Hau Nguyen; Ruby Stocker; Jane Fisher.

Dr Thach Tran and Professor Jane Fisher, leading a multidisciplinary team from Monash, Queensland University of Technology and Hanoi University of Public Health, conducted a school-based, two-arm, parallel, controlled trial to evaluate the effectiveness of the Resourceful Adolescent Program (RAP). The RAP was developed in Australia aiming to build psychological resilience and enhance the coping resources among adolescents, to prevent depression and promote positive mental health. The trial involved the recruitment of 1,084 students from eight schools located in urban and rural areas of Hanoi. Half of the schools received the intervention in the form of six weekly 90-minute sessions conducted with whole-class groups. Data was collected at three timepoints (at recruitment, and 2 weeks, and 6 months post intervention).

The data from this study demonstrates that an adapted version of the RAP program was effective in reducing depressive symptoms and promoting psychological wellbeing among adolescents at the post-intervention stage. In Vietnam and other low- and middle-income countries, mental health problems during adolescence are increasingly recognised. This study provides robust evidence on the effectiveness of a program that has significant potential to be integrated into the existing school curriculum, with the aim of reducing the prevalence of mental health problems and promoting positive mental health among adolescents in Vietnam. Scaling up this program in every high school in Vietnam could prevent up to 3,000 cases of depressive disorders among seven million high school adolescents (as a 5% reduction as observed in this study).

The findings of this study have been published in six international peer-reviewed papers and nine Vietnamese peer-reviewed papers. Two PhD candidates and five master's students have been supervised by the research team using data from this study.

Project papers

Tran TD, Nguyen H, Shochet I, Nguyen N, La N, Wurfl A, Orr J, Nguyen H, Stocker R, Fisher J. School-based universal mental health promotion intervention for adolescents in Vietnam: Two-arm, parallel, controlled trial. Global Mental Health (Cambridge Prisms). 2023 Oct 23;10:e69. doi: 10.1017/gmh.2023.66.

Tran TD, Nguyen H, Shochet I, Nguyen N, La N, Wurfl A, Orr J, Nguyen H, Stocker R, Fisher J. Psychometric properties of the Centre for Epidemiologic Studies Depression Scale Revised – Vietnamese Version (CESDR-V) among adolescents. Psychiatry Research Communications. 2024;4(2):100165. doi: 10.1016/j.psycom.2024.100165.

Tran T, Nguyen H, Shochet I, Nguyen N, La N, Wurfl A, Orr J, Nguyen H, Stocker R, Fisher J. Coping self-efficacy and thoughts of self-harm among adolescents in Vietnam: A longitudinal study. Archives of Suicide Research. 2023 Oct 14:1-13. doi: 10.1080/13811118.2023.2265444.

Shochet I, Orr J, Cockshaw W, Tran T, La N, Nguyen H, Nguyen N, Wurfl A, Nguyen H, Stocker R, Fisher J. Validation of the Behavioral Anger Response Questionnaire for Children (BARQ-C) in a large community sample of Vietnamese middle adolescents in Hanoi. BMC Psychology. 2022 Aug 12;10(1):199. doi: 10.1186/s40359-022-00907-4.

La NL, Shochet I, Tran T, Fisher J, Wurfl A, Nguyen N, Orr J, Stocker R, Nguyen H. Adaptation of a school-based mental health program for adolescents in Vietnam. PLoS One. 2022 Aug 4;17(8):e0271959. doi: 10.1371/journal.pone.0271959.

Tran T, La N, Nguyen H, Shochet I, Nguyen N, Wurfl A, Orr J, Nguyen H, Stocker R, Fisher J. Validation of the coping self-efficacy scale: Vietnamese version for adolescents. BMC Psychology. 2022 Mar 9;10(1):59. doi: 10.1186/s40359-022-00770-3.

Thanh HK, Ha DT, Nga NT, Tran T, Fisher J, Shochet I, Wurfl A, Orr J, Stocker R, Huong NT. Association between school connectedness and mental health among female students grade 10th: A Path analysis. Vietnam Journal of Preventive Medicine. 2021;31(9), 312–320. doi: 10.51403/0868-2836/2021/469.

Thanh HK, Ha DT, Nga NT, Tran TD, Fisher J, Shochet I, Wurfl A, Orr J, Stocker R, Huong NT. School connectedness and mental health among students grade 10th: Results from a survey of 8 high schools in Hanoi in 2020. Vietnam Journal of Preventive Medicine. 2021;31(7), 72–81. doi: 10.51403/0868-2836/2021/401.

Tran T, Nguyen HT, Shochet I, Wurfl A, Orr J, Nguyen N, La N, Nguyen H, Stocker R, Nguyen T, Le M, Fisher J. School-based, two-arm, parallel, controlled trial of a culturally adapted resilience intervention to improve adolescent mental health in Vietnam: study protocol. BMJ Open. 2020 Oct 16;10(10):e039343. doi: 10.1136/bmjopen-2020-039343.

Impact on men's attitudes and behaviours of a multi-component, gender-informed, father-inclusive intervention for early child development in Vietnam

Fisher J, Tran T, Nguyen T, Tran H.

Gender-based violence is prevalent in rural Vietnam, a country in which traditional gender norms are still widely adhered to. Overall, 27.3% of women who are pregnant have experienced at least one form of violence perpetrated by an intimate partner. In addition, during pregnancy, 32% of women report food insecurity, 20% have a BMI < 18.5, 80% are iodine deficient, 17% have iron deficiency anaemia and a third have clinically significant symptoms of the common mental disorders of depression and anxiety. Women in rural Vietnam are poor with average annual per capita incomes of USD2,800. These biological, psychological and social risks interact and lead to adverse maternal outcomes and compromised foetal and infant health and development.

The overall aim of this project is to ascertain whether participation in Learning Clubs, a multicomponent, gender-informed, father-inclusive program to improve early childhood development is associated with men having more equitable attitudes towards infant care and household work, and whether there are lower rates of gender-based violence perpetrated by men against their wives during pregnancy and in the first two postpartum years. This study is nested in the cRCT of the Learning Clubs program which aims to improve the health, growth and development of toddlers and the health of their mothers. The partners of women who are participating in the cRCT are being recruited for the sub-study.

Professor Fisher and colleagues received a World Bank Group’s Development Innovation Marketplace Award, via a competitive process from a global field of 240 applicants.

Experiences of heart and lung transplantation in Australia: creating a pre- and post-transplant resource

Kirkman M, Stubber C.

People who need a lung, heart, or heart and lung transplant not only have life-threatening conditions but are also aware that their only chance of survival depends on a fellow human’s death. These are highly emotionally-arousing circumstances. Access to accounts of the experiences of transplant recipients can reduce distress and improve the mental health and wellbeing of potential and recent recipients, but there is little opportunity in Australia to learn from those who are living with transplanted organs. The known benefits of learning from peers include feeling less alone, being better informed, knowing what to ask clinicians, and insight into managing such difficult procedures.

We have developed an online resource as an outcome of our video-recorded research with organ recipients. We have found that this resource to be of benefit to people contemplating organ transplantation, organ recipients, their families and friends, and professionals working with recipients and prospective recipients. This project was funded by the Grenet Foundation.

Latrobe Valley early parenting – What Were We Thinking

Fisher J, Rowe H.

What Were We Thinking (WWWT) is a carefully researched, evidence-based set of materials and activities designed to promote confidence and reduce distress in parents with a first baby.

WWWT is a two-session program, designed to be offered at local health centres, appropriately constructed as safe environments for parents and infants. It is intended to be conducted four to six weeks postpartum, at a time that is convenient to parents, and facilitated by an experienced maternal and child health or early childhood nurse.

This project involved the provision of course materials, face-to-face training, implementation and post-training support for 30 maternal and child health (MCH) nurses in the Latrobe Valley and the delivery of WWWT to parents attending all first-time parenting groups (FTPG) in the Latrobe Valley.

We partnered with the Victorian Government Department of Education and Training, City of Latrobe, Shire of Baw Baw, and the Shire of Wellington for this project, which was funded by Department of Education and Training.

Clinician-level Quality Indicator Reports: A qualitative research project to understand views of clinicians receiving and not receiving these reports

Kirkman M, Evans S, Heathcote P, Fisher J, Millar J, Mark S, Currow D, Frydenberg M, Khadra M.

The Prostate Cancer Outcome Registry-Australia and New Zealand (PCOR-ANZ) was established to monitor the quality of care provided by contributing hospitals and clinicians to patients with prostate cancer. Quality indicators were developed through a consensus process as tools to measure quality of care and, since 2012, the Prostate Cancer Outcome Registry-Victoria (PCOR-Vic) has provided Quality Indicator Reports six-monthly to clinicians and hospitals. These reports provide to contributing sites and clinicians a summary of the patterns of care of patients they are managing and specifies their individual performance relative to others. The PCOR-Vic and the PCOR-ANZ Steering Committees have sought guidance on how best to manage those who fall outside the ‘normal’ range of quality indicators (defined as two standard deviations below the mean). Given the many reasons why a hospital or clinician might register outside the normal range, management needs to be sensitive and responsible. The aim of this research is to understand how urologists respond to reports of the quality of care and how potential ‘outlier’ activity could be best be communicated. Urologists in Australia and New Zealand will be consulted to ascertain their views and advice.

Report

Kirkman M, Fisher J. Clinician-level Quality Indicator Reports: A qualitative research project to understand the views of clinicians receiving and not receiving these reports. Final report. December 2021.

Fatherhood aspirations, expectations and outcomes: an interdisciplinary investigation

Hammarberg K, Mills C, Holton S.

The aim of this project was to develop and pilot test a survey investigating the associations between structural (policy governed) and individual factors and contemporary men’s fatherhood desires, expectations and outcomes, and establish comprehensive theoretical explanations of fertility decision-making which include men’s perspectives and experiences.

This project was funded by Faculty of Arts and Faculty of Medicine, Nursing and Health Sciences Interdisciplinary Research Funding Scheme Monash University.

Reported in:

Hammarberg K, Mills C, Holton S. Development and pilot testing of a survey to explore men’s fatherhood aspirations and reproductive decision-making. Journal of Reproductive and Infant Psychology. Under review.

Further evaluation of the MyTime program

Fisher J, Hammarberg K.

The aim of this project was to investigate the feasibility of using brief, online surveys for monitoring and evaluating peer support groups for caregivers of children with disabilities. Responses revealed both positive and negative aspects of group participation. In general, expectations of benefits and support were met or exceeded. The surveys were found to be meaningful and acceptable and therefore to have face validity. Brief online surveys appear to be a feasible, sensitive method of monitoring and evaluating peer support group programs for caregivers of children with disabilities. This project was funded by the Parenting Research Centre (PRC).

Reported in:

Wynter K, Hammarberg K, Sartore GM, Cann W, Fisher J. Brief online surveys to monitor and evaluate facilitated peer support groups for caregivers of children with special needs. Evaluation and Program Planning. 2015 Apr;49:70-5. doi: 10.1016/j.evalprogplan.2014.12.019.

Bilateral Primary Care Professional Exchange to Build Health Promotion Capacity

Honda T, Fisher J, Rowe H.

This project, supported by the Australia-Japan Foundation in the Department of Foreign Affairs and Trade, aimed to exchange health professional education for postpartum mental health promotion between Australia and Japan. Japanese governments and health professionals recognise the urgent need to address the high prevalence of postnatal depression. Monash University has developed and tested What Were We Thinking (WWWT), an innovative gender-informed psychoeducational program for parents of first babies, which has been proven to reduce postnatal mental health problems among women.

Monash has a long collaboration with academics and midwives from Juntendo University School of Nursing. We have been working together to adapt WWWT for use in Japan. This project consisted of a 3-day visit of the Japanese professionals to Melbourne for learning Australia's experience, a 2-day workshop to enhance knowledge and practice of WWWT and to disseminate it in Japan, and a one-day symposium to discuss how best to establish the program's cultural authenticity and utility for Japan. This became the basis for future scientific testing of WWWT’s effectiveness and potential for scalability in Japan.

Knowledge, attitudes and social norms about healthy lifestyle behaviours among disadvantaged communities in Victoria: Findings of the Adult and Child Preventive Health Surveys

Wynter K, Tran TD, Fisher J, Nguyen H, Gualano R, and DHHS staff.

This project was to analyse, interpret and describe in several formats, data collected in the Victorian Department of Health Preventive Health Survey - Child (PHS - Child). The data for this survey was collected in 2012 by structured computer assisted telephone interviews with 2500 parents of Victorian children aged 5-17 years. They were recruited from 23 Local Government Areas (LGAs), including twelve Healthy Together Communities (HTC) and eleven matched comparator areas. The PHS-Child is a key source of data on which assessment of the impact data for the Healthy Together Victoria (HTV) strategy is to be based. The PHS-Child survey instrument comprises structured survey-specific items assessing health and lifestyle factors including nutrition (fruit and vegetable intake), physical activity, and anthropometric indices. Social circumstances were also collected such as age, gender, language and parents’ demographic characteristics.

Firstly, we conducted data cleaning to provide a clean database ready for the analysis phase. Secondly, we performed descriptive analyses to describe child nutrition status using childrens’ Body Mass Index (BMI) scores and the converted z scores according to the three international reference populations: the International Obesity Taskforce (IOTF), Center for Disease Control (CDC), and World Health Organisation (WHO). Thirdly, we undertook comparative analyses of children’s BMI classifications by the IOTF, CDC, and WHO methods. Three reports were submitted to the Victorian Department of Health and Human Services, who was the funder and our partner organisation for the project.

Centre of Research Excellence in childhood adversity and associated depression and anxiety

Hiscock H, Jorm A, Goldfeld S, Fisher J, Eastwood J, Reupert A, Sanci L, Yap M, Dalziel K, Eapen V.

Through this Centre of Research Excellence, we aimed to prevent depression, anxiety problems, and suicidality by reducing the occurrence of adverse childhood experiences. With our multi-disciplinary, multi-site team, we developed practitioner and policy maker documents showing which experiences were associated with depression, anxiety problems, and suicidality and how best to manage them. We then used this evidence to develop and test new ways of helping families facing these experiences.

This project was led by the Centre for Community Child Health at the Royal Children's Hospital Melbourne, and project partners included Monash University, the University of Melbourne, South Western Sydney Local Health District, and the University of New South Wales. The project was funded by the National Health and Medical Research Council (NHMRC).