Adaptation and feasibility assessment of a school-based Suicide Prevention Intervention for Adolescents (SPREAD Study) in Nigeria: protocol for a cluster randomised controlled feasibility trial
Abiodun O Adewuya,, Olushola Olibamoyo,, Olabisi E Oladipo, Olayinka Atilola, Adesegun Fatusi, Ife O Abodunrin, Kemi AkejuIntroduction
Adolescent suicide constitutes a critical public health challenge in low-income and middle-income countries (LMICs), where structural deficits in mental health infrastructure compound an already substantial burden. In Nigeria, where suicidal ideation among secondary school students has been documented at a lifetime prevalence of 22.9%, curative clinic-based responses are neither scalable nor sustainable. School-based universal interventions offer a pragmatic upstream alternative. The Youth Aware of Mental Health (YAM) programme has demonstrated robust efficacy in European contexts, reducing incident suicide attempts by approximately 50%; however, its transferability to the West African educational and cultural environment remains untested. This protocol describes a study designed to culturally adapt YAM for Nigerian secondary schools and assess the feasibility of conducting a definitive cluster randomised controlled trial in Lagos State.
Methods and analysis
This study employs a hybrid type 1 effectiveness–implementation design, structured as a two-arm parallel-group cluster randomised feasibility trial across 10 public secondary schools in Lagos State. Approximately 600 adolescents aged 13–17 years will be recruited. Prior to the trial, YAM will be systematically adapted using the Method for Programme Adaptation through Community Engagement framework, producing the YAM-Nigeria curriculum. Schools will be randomised to receive either the culturally adapted YAM-Nigeria programme (five sessions of 45–60 min each delivered by trained external facilitators) or enhanced usual practice (standard health education curriculum supplemented with suicide awareness materials). Primary feasibility outcomes include school recruitment rates (target ≥60%), student consent rates (target ≥70%), retention at the 3-month follow-up (target ≥75%), implementation fidelity (target ≥80% adherence) and acceptability (target ≥70% student satisfaction). Secondary exploratory outcomes include suicidal ideation, depression, mental health literacy, stigma and help-seeking behaviour, measured to estimate the SD and intraclass correlation coefficient required to power a future definitive trial. Progression to a definitive phase III trial will be governed by pre-specified traffic light criteria.
Ethics and dissemination
Ethical approval has been granted by the Lagos State University Teaching Hospital Health Research Ethics Committee (Ref: LREC/06/10/2656) and the Liverpool School of Tropical Medicine Research Ethics Committee (Ref: RGETEM045). A two-stage consent process requiring written parental consent and adolescent assent will be implemented. Findings will be disseminated through open-access peer-reviewed publications, policy briefs for the Lagos State Ministries of Health and Education and plain-language summaries for participating communities.
Trial registration number
ISRCTN registry,