Strengths and limitations
HOLIDAYS, SECONDARY
This study has numerous strengths. The study had strong statistical power provided by a large sample size and the protocol was preregistered and published ahead of data collection [Despite the positive outcomes in improving pupils’ mental health literacy, this study is not without limitations. Follow-up of the Guide Cymru’s impact was taken only two weeks after the programme's completion, which is insufficient to evaluate whether the positive impact of the interventions was maintained over time. Unfortunately, the restrictions imposed due to the COVID-19 pandemic did not allow us to complete our intended longer-term repeat follow-up of our cohort in order to evaluate the degree to which positive changes in mental health literacy was sustained. Future research should replicate and extend the findings with longer follow-up periods. Future research may also consider reflecting upon pupil feedback in a process evaluation in their response to the programme. This may also be a consideration for looking at the sustainability of the Guide programme to see if further training is needed. Future research may also consider observing the potential impact on inequalities to assess generalisability and sustainability of the research going forward. It may also be beneficial to gather feedback from teachers on their perceptions of the training and the approaches they took to delivering the programme within their schools. This would be useful for understanding what mechanisms worked well and the sustainability of the programme.The take-up rate of implementing the Guide Cymru from secondary schools was low (at 26.83%) despite the programme being offered without direct cost to the school. All secondary schools across Wales were invited to participate in the research, and several schools expressed interest. However, given the time restraints of the randomised controlled trial and the inability to release staff for training, many schools did not feel that they could implement the Guide. This particularly highlights how capacity of teachers to undertake the training of mental health literacy remains as an important barrier to these types of interventions. Both direct and indirect costs (e.g., staff time) need to be factored into research programmes attempting to intervene with child and adolescent mental health, and that funding streams should consider providing financial support for supply teachers and/or provide additional payments to teaching staff to undertake training during the weekends or school holidays. Further, the onset of the Covid-19 pandemic meant that many schools that were interested in implementing the Guide could not do so due to the restrictions imposed and school closures due to the Covid pandemic.Finally, while many significant improvement in mental health literacy are demonstrated in this study, the magnitude of these changes were “small” in terms of effect sizes, though comparable with those found by Milin et al., [