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School-based mental health and wellbeing interventions demonstrate mixed and sometimes limited effectiveness, partially attributed to a lack of fit with school needs and contexts. Increased support for stakeholder co-production to address these issues has led to a growing number of school-based health co-production intervention studies. Whilst there is an emergent effectiveness literature about these, our understanding of the different co-production types, their intervention theories and properties, and stakeholders’ experiences of them is lacking. This thesis aimed to address this through developing programme theory for the co-production of school-based health interventions. To achieve this, a mixed methods intervention development study with two sequential phases was undertaken. Phase 1 aimed to build promising intervention theory, predominantly through a systematic review of co-production studies. Subsequently, phase 2 aimed to refine this theory by delivering in two schools the co-production intervention, focusing on mental health and wellbeing; and assessing it through a process evaluation. The phase 1 systematic review described three co-production types, with the system-level capacity-building type chosen for phase 2. This type involved the establishment of Research Action Groups (RAGs) with multiple school and external stakeholders that developed school-specific wellbeing plans. It was chosen because it provided a strong evidence base to develop theory from and was found to more likely lead to stakeholders’ health ideas being delivered than other types. Theoretical gaps were addressed through stakeholder involvement, and a pilot of participatory methods to elicit students’ understandings of wellbeing. Phase 2 involved two contextually diverse case study secondary schools developing RAGs with researcher support. The process evaluation assessed implementation, context, mechanisms of change, and social validity between cases and across stakeholders. Successful

School-based mental health and wellbeing interventions demonstrate mixed and sometimes limited effectiveness, partially attributed to a lack of fit with school needs and contexts. Increased support for stakeholder co-production to address these issues has led to a growing number of school-based health co-production intervention studies. Whilst there is an emergent effectiveness literature about these, our understanding of the different co-production types, their intervention theories and properties, and stakeholders’ experiences of them is lacking. This thesis aimed to address this through developing programme theory for the co-production of school-based health interventions. To achieve this, a mixed methods intervention development study with two sequential phases was undertaken. Phase 1 aimed to build promising intervention theory, predominantly through a systematic review of co-production studies. Subsequently, phase 2 aimed to refine this theory by delivering in two schools the co-production intervention, focusing on mental health and wellbeing; and assessing it through a process evaluation. The phase 1 systematic review described three co-production types, with the system-level capacity-building type chosen for phase 2. This type involved the establishment of Research Action Groups (RAGs) with multiple school and external stakeholders that developed school-specific wellbeing plans. It was chosen because it provided a strong evidence base to develop theory from and was found to more likely lead to stakeholders’ health ideas being delivered than other types. Theoretical gaps were addressed through stakeholder involvement, and a pilot of participatory methods to elicit students’ understandings of wellbeing. Phase 2 involved two contextually diverse case study secondary schools developing RAGs with researcher support. The process evaluation assessed implementation, context, mechanisms of change, and social validity between cases and across stakeholders. Successful

The negative impact of mental health illness on families is well known. Although the high incidence of mental health problems, especially PTSD, amongst military Veterans is recognised there is little systematic support for their families. TGP are a Welsh Charity which supports vulnerable and marginalised children, young people and families in Wales. TGP are closely associated with use of a Restorative Approach: a philosophy and practice drawn from Restorative Justice that is based on the shared set of democratic values such as honesty, trust, fairness, inclusion and collaboration. A Restorative Approach has been adopted in varied service settings including education and welfare, with encouraging signs of improved relationships and reduction in problems such as aggression and bullying. Recent research exploring use of a Restorative Approach in family support systems has found signs of better, more effective service provision and higher levels of family communication and reduced family conflict. TGP are seeking to provide a family support service for the families of Veterans with PTSD. To do so they are working with Veterans NHS Wales, a NHS service providing support for Welsh veterans with PTSD. The ‘Restorative Approach for Veteran Families Service’ seeks to work with families and Veterans alongside the VNHSW service with the intent of improving family relationships and dynamics and so benefitting the mental health of all family members including the Veteran. This research is evaluating the project over the first three years of development and implementation with the aim of identifying and addressing project facilitators and barriers and thereby producing the best model of service implementation.

The effectiveness of school-based wellbeing interventions has been limited, primarily due to their lack of contextual fit and omission of stakeholders in intervention development. Mitigating these issues necessitates the coproduction of interventions, with this study aiming to assess the suitability of three participatory methods for involving secondary school students in the coproduction process. The study entailed two research phases. Phase 1 involved conducting guided walks (n=6), photography (n=6) and mapping (n=2) with students. Assessment methods included researcher observations (n=14) and semi-structured participant interviews (n=14). Phase 2 involved member checking wellbeing data from Phase 1 with students in method specific focus groups (n=3) and collecting further participant reflections. An Assessment Framework was applied to assess: method acceptability; feasibility of use in secondary schools; the distribution of power; and the internal validity of data generated. The study found photography and mapping could have a balanced distribution of power, be acceptable, feasible, and internally valid, however, guided walks were problematic in the manner they were enacted. A model was developed to support use of photography and mapping in intervention coproduction.

DECIPHer have developed a research advisory group of young people aged 14-21 called ALPHA (Advice Leading to Public Health Advancement). The group of 20 young people live in South Wales, and were recruited through youth centres and projects. Their role is to advise researchers by discussing and debating their views on public health topics and the research the Centre plans to carry out. We would like to show the film (only the first minute) that the young people have made about the group. This will show how the group is run. After the film, the researcher would like to discuss the important factors that help to support young people to be involved which may be different to involving adults. These include: researchers coming into young people’s meetings rather than young people sitting on steering group of adults; pre-paid transport as young people cannot pay in advance and get reimbursed; accrediting their time as they are in the stage of life where they need for the first time to prove to potential employers or educational establishments that they have skills and experience. DECIPHer has involved younger children in research in a one-off consultation but would like to share with the audience expanding in the future to an on-going mechanism of involving primary school aged children in research.

OBJECTIVE: The nature and topics of adolescent health research is determined by the research interests of adults, be they research funders or do-ers. The relevance of this research to the interests of young people themselves is not widely considered. The aim of this ongoing work is to create a collaborative adolescent health research charter between young people, funders, researchers and policymakers. METHODS: A collaborative session at the 2012 AYPH conference in Cardiff engaged 19 young people in a series of peer-led activities relating to both the content and infrastructure of adolescent health research in the UK. This included the young people interviewing a senior researcher and a senior health policymaker who were keynote speakers at the conference. Reflection points included: ♣ How can we make sure research about young people’s health is relevant, useful and helps improve their health? ♣ What five key areas of young people’s health do you want to see improved and why? RESULTS: The young people at the conference emphasised the importance of meaningful participation of young people in the design and development of research. They expressed concern about the research cycle, particularly how long it takes to get to dissemination work. As a group, we acknowledged that young research participants may well be adults by the time the research is published. Pre-session discussion with ALPHA revealed content areas of interest including Alcohol and substance abuse, Obesity, Teenage Pregnancy, Stress, and Sexual health. A short film summarising the day’s outputs is available at http://www. youtube.com/watch?v=nB6rDYLPf0A. CONCLUSIONS: We have made a promising start in generating infrastructure and content issues for adolescent health research that will go forward for agreement and prioritisation using online consensus methods with a snowball sample of young people in the UK for future dissemination as a charter to the adolescent health research community, including funders

Public involvement has been considered a complex intervention which would benefit from a clearer evidence base of ‘what works, for whom, in what circumstances and why’ (Staniszewska et al 2011). Some of the key issues with current evidence include a focus on the process of public involvement over a clear and consistent measurement of outcomes, a tendency to evaluate public involvement from a user perspective neglecting the impacts to the researchers and the research projects, as well as an emphasis on short term outcomes with a paucity of long term impact data. The poster will set out the research centre context, the approach taken including the employment of an involvement researcher and establishment of a young people’s advisory group and the programme of work undertaken to increase public involvement. Furthermore it will outline a monitoring and evaluation framework developed by DECIPHer, that defines for researchers, what public involvement data is collected, when and how. It is hoped the data will contribute to the evidence base for public involvement particularly in the shortcoming areas noted. It is hoped delegates will learn about and discuss the complex nature of measuring public involvement and the attempts of one research centre to do this.