Effects of two community-based multimodal exercise programs on physical activity, performance, fall prevention, and quality of life in older adults: a randomized clinical trial.

The consequences of violence and compounded adversity among youth in conflict‐affected countries in sub‐Saharan Africa contribute to high rates of depression, anxiety, and posttraumatic stress reactions (Betancourt, Thomson, & VanderWeele, ), alongside reduced labor participation and quality of life (Patel et al., ). However, access to mental health services remains limited, with most low‐ and middle‐income countries allocating <2% of their health budgets to mental health (Moitra et al., ). In fragile, conflict‐affected settings, the treatment gap often exceeds 75% (Vos et al., ). In Sierra Leone, multiple crises—including an 11‐year civil war, the Ebola outbreak, climate‐related disasters, and the COVID‐19 pandemic—have strained the country's health, social, and mental health systems, severely limiting service capacity (Amnesty International, ; Richards, ). A shortage of trained mental health professionals (Betancourt, Meyers‐Ohki, Charrow, & Tol, ) exacerbates the treatment gap in Sierra Leone (Bond et al., ). To address this, as a part of National Institutes of Mental Health (NIMH) global implementation science research hubs (Collins, Price, & Pringle, ), the Youth Functioning and Organizational Success for West African Regional Development (Youth FORWARD) initiative was launched in 2017 to integrate the Youth Readiness Intervention (YRI) into entrepreneurship programs in Sierra Leone (Betancourt et al., ). The YRI is a transdiagnostic, evidence‐based group mental health intervention consisting of 12 modules. It uses common practice therapeutic components drawn from cognitive‐behavioral, interpersonal therapy, and mindfulness techniques delivered by nonspecialists and integrated into alternative delivery platforms. The Youth FORWARD initiative in partnership with the Sierra Leone Ministry of Youth Affairs and the German development agency (GIZ) tested a Collaborative Team Approach (CTA) as a strategy to enhance quality of delivery of the YRI by nonspecialists who also led entrepreneurship training to youth ages 18–30 across three rural districts. .Guided by the EPIS (Exploration, Preparation, Implementation, Sustainment) framework (Aarons, Hurlburt, & Horwitz, ), phased integration under the CTA strategy adapted the YRI to rural contexts, while also setting up Plan–Do–Study–Act (PDSA) problem‐solving cycles (Taylor et al., ). PDSA is an iterative, data‐driven approach that involves planning changes, implementing them on a small scale, studying the outcomes, and acting on the results to refine and improve an intervention. This ensures that any implementation barriers (such as poor attendance) are overcome promptly and that feedback loops of testing strategies to overcome implementation barriers are initiated. Youth FORWARD effectiveness data under this delivery strategy was conceptualized as a Hybrid Type II implementation‐effectiveness study, which examined the impact of the CTA on fidelity and competence while an embedded cluster‐randomized trial examined mental health and functioning outcomes to assess the intervention's effectiveness.