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Table 4 Thematic analysis of EASE workbook data and supervision notes of non-specialist facilitators on the use of EASE intervention strategies by adolescents

From: Feasibility and acceptability of a multicomponent, group psychological intervention for adolescents with psychosocial distress in public schools of Pakistan: a feasibility cluster randomized controlled trial (cRCT)

EASE Intervention strategies

Thematic analysis of EASE workbook on implementation of intervention strategies by adolescents

Thematic analysis of supervision notes of non-specialist facilitators

‘Understanding my feelings’ activity—identification of emotions

Identification of emotions

 1. Felt anxious and worried because of academic problems (n = 15)

 2. Sad, worried, angry and unhappy due to family problems/issues such as fights between parents, illness of caregiver and dispute with caregivers (n = 9)

 3. Happy and angry while playing with friends (n = 4)

Level of understanding: most participants clearly understood the activity, identified multiple feelings and filled the feelings pot along with the key (n = 22)

Difficulties: some participants faced difficulty in identifying their different feelings. Mostly they had only colored for sadness or happiness in their feeling pots (n = 2)

Some participants had not drawn the key properly and sometimes it was missing and few participants lost interest in the strategy towards the end of the session (n = 4)

A few participants completed home practice for the sake of completing it and could not relate to the activities (n = 3)

‘Calming my body’ activity—manage physical sensations while facing a difficult situation

Using managing physical sensations strategy

 1. At night before falling asleep (n = 8)

 2. While feeling angry, after having a fight with siblings and with friends (n = 3)

 3. When felt physically hurt (n = 2)

 4. When having physical sensations (increased heartbeat, palpitation, headache) while facing a difficult situation (n = 11)

 5. When faced with bulling in the school (n = 4)

Level of understanding: most participant understood breathing exercise; practiced it while experiencing difficult emotions and understood the link between emotions and associated physical changes (n = 19)

Difficulties: some participants faced difficulty in practicing slow breathing exercise initially (they reported dizziness and headache while practicing slow breathing exercise). (n = 4)

A few participants had drawn similar drawing in all the body maps and could not link the emotions with physical sensations. (n = 3)

‘Changing my Actions’ activity

Use of changing my actions activity by boys:

 1. Resuming playful activities (such as playing cricket, volley ball, football, marbles, badminton, carom board, kite flying) (n = 10)

 2. Helping others (friends in studies, neighbours for carrying their groceries, parents in looking after domestic animals, siblings) (n = 4)

 3. Hangouts with friends and cousins (n = 2)

Use of changing my actions activity by girls:

 1. Resuming playful activities (including hide and seek, reading storybooks, playing with sister, cousins and friends) (n = 4)

 2. Household chores, cooking, and creative art activities (n = 8)

Level of understanding: most participants grasped the concept and appeared to understand the strategy well during the session and selected suitable activity for the strategy and, completed all steps. (n = 14)

Difficulties: few participants were not able to think of any activities that they had stopped doing due to the big and difficult feelings. They only reported those activities that they had stopped doing due to lack of time and other external barriers (n = 9)

A few participants struggled to understand the strategy however, with extra effort they were able to complete the steps of the activity (n = 2)

‘Managing my Problems’ activity

Use of managing my problems activity

 1. To manage academic problems (getting late for school; procrastination, incomplete home work; poor hand writing; not preparing for test) (n = 9)

 2. To manage problems with peers such as bullying; arguments and to stop fighting with friends, accusation of stealing from friends (n = 9)

 3. To manage problems at home such as not doing home chores; conflict with siblings (n = 2)

 4. To manage personal problems such as unable to sleep; finding time to play; forgetting things (n = 8)

Level of understanding: most participants understood the strategy well and were able to use the strategy to solve their problems (n = 18)

Engagement: participants appeared interested and engaged particularly with this strategy. (n = 25)

Difficulties: some participants had mentioned in their workbook that instead of trying one best solution, they had tried four solutions to solve their problem. (n = 3)