Calm, Connection, or Just Compensation: A Qualitative Investigation of Subjective Adolescent Experiences with Behavioral Health Interventions within a Clinical Trial

Adolescent mental health and cardiometabolic concerns are at an all-time high, necessitating the development of acceptable, feasible, and effective interventions. Investigations of behavioral health interventions with teenagers must incorporate a means of understanding how adolescents perceive and engage with an intervention, and the relevance and meaning they ascribe to its therapeutic goals, as these potentially modifiable factors may ultimately influence future uptake, sustainability, and effectiveness of the interventions. Qualitative research methods provide well-established, rigorous frameworks for addressing these questions, but are underutilized in pediatric research. This qualitative study is part of a multisite, pilot, and feasibility randomized controlled trial of three 6-week behavioral group intervention arms: an experimental mindfulness-based intervention (MBI), standard-of-care cognitive-behavioral therapy (CBT), a didactic health education control group (HealthEd), for adolescents ages 12-17 years with elevated depression symptoms and body mass index. Data were collected through 24 semi-structured, 6-week/post-intervention focus groups with adolescents (N=77) and three post-enrollment study staff focus groups (n=12).  A two-pronged team-based approach to analysis involved an ongoing rapid qualitative analysis and a summative practical thematic analysis. Three overarching themes were identified: (a) group activities and peer-to-peer dynamics shape adolescent acceptability and perceived impact, (b) interventionist skills and qualities differentially influence adolescent acceptability across interventions, and (c) barriers unique to each intervention modality hinder group acceptability. Results highlight the distinct value of including qualitative methods within adolescent behavioral health intervention research, especially at the pilot and feasibility phase, as it provides a rich opportunity to optimize intervention delivery within future efficacy testing.