Four Steps To My Future (4STMF): acceptability, feasibility and exploratory outcomes of a universal school‐based mental health and well‐being programme, delivered to young adolescents in South Africa in Child and Adolescent Mental Health

First published: 13 July 2023



Mental health disorders affect many children in South Africa, where vulnerability is high, and treatment is limited. We sought to determine the feasibility and acceptability of a universally delivered classroom-based programme for the promotion of mental health in young adolescents.


We pilot tested an 8 session, cognitive-behavioural therapy-based programme, 4 Steps To My Future (4STMF) in two schools. Participants were grade 5 learners (n = 222; Meanage = 10.62 (Standard deviation = 0.69)). 4STMF was delivered in class time by trained psychology postgraduates. Feasibility (rates of parental opt-out, child assent, assessment completion at baseline and follow-up, programme completion, session attendance and programme fidelity), acceptability (teacher feedback and focus groups with learners), as well as demographic data and data on a battery of a psychological measures were collected at baseline, postintervention and at one-month follow-up.


Most eligible learners at both schools agreed to participate (85% – school 1; 91% – school 2) with more than 80% completing postintervention measures. Learner session attendance and programme fidelity were high. Teachers rated facilitators highly on confidence, preparedness, enthusiasm and classroom management and observed children to be enjoying the programme. Focus group data suggest that learners liked the programme, could recall the content and had shared some of the content with their family. An exploratory analysis of outcomes showed significant pre–post differences on self-esteem at school 1 and on emotion regulation at school 1 and school 2, maintained at follow-up.


This pilot study has shown that 4STMF can acceptably and feasibly be delivered, at classroom level, as a universal school-based prevention programme to young adolescent learners in South African primary schools. The programme could fit in with school context, could be delivered by nonspecialists, showed significant improvements on self-esteem and emotion regulation and was liked by the learners.

Key Practitioner Message

What is known?

  • Common mental disorders like anxiety and depression are preventable through early intervention.
  • Universal school-based prevention interventions for mental health have been delivered to good effect in high-income settings, but comparatively less is known about this in low- and middle-income settings like South Africa.

What is new?

  • We have demonstrated that it is feasible and acceptable to deliver a universal school-based prevention programme at classroom level to young adolescents in an LMIC setting.
  • We have also shown that the programme can be flexibly delivered.

What is significant for clinical practice?

  • Delivery of programmes aimed at prevention of mental health conditions is possible and can be done at school level among young adolescents.
  • Delivery of these programmes can be done by nonspecialists, which may alleviate the burden of patient load on public health care facilities.