Mixed methods evaluation of mental health integration into SKILLZ Core, SKILLZ Girl, and SKILLZ Guyz among adolescents in Zambia

Brief Summary

Background

Adolescents in Zambia, particularly in rural Eastern Province, face overlapping sexual and reproductive health and mental health challenges, and mental health support is often limited within existing youth programs.

What Grassroot Soccer did

Grassroot Soccer Zambia integrated three mental health topics into its existing SKILLZ Guy, SKILLZ Girl, and SKILLZ Core programs for adolescents ages 10–19, delivered by 82 trained SKILLZ Coaches across three rural districts, and evaluated the integration with participants, Coaches, teachers, caregivers, and staff.

What the study found

Across the three programs, over 19,500 adolescents participated, with 83% graduating. Participants who completed the program reported increased knowledge of mental health and sexual and reproductive health, as well as more positive attitudes toward mental health and gender norms. Coaches and teachers found the mental health content relatable and easy to teach, though some recommended expanding topics and addressing community misconceptions about mental health.

Why this matters

Findings suggest that integrating mental health content into existing sexual and reproductive health programming is feasible and well received, offering a scalable way to address both sets of needs among adolescents in rural, underserved communities.

DETAILED SUMMARY

Importance

Due to limited mental health investment within existing sexual and reproductive health and rights (SRHR) interventions, GRS Zambia, under its Total Health Phase 2 strategy, integrated mental health concepts across three existing SRHR programs: SKILLZ Guy, SKILLZ Girl, and SKILLZ Core. This integration sought to address both sets of adolescent health needs within a single program model, rather than treating mental health as a separate, standalone service.

Objective

To explore the integration of mental health into existing SKILLZ programming from the perspectives of participants, Coaches, GRS staff, and teachers.

Study details

Study design: Mixed methods study (no control group)
Data collection tools: Attendance registers; pre/post questionnaires (20 items covering behavior, attitudes, and knowledge); service referral forms; qualitative interviews and focus group discussions with participants, Coaches, teachers, caregivers, and GRS staff
Participants: Adolescents ages 10–19 (SKILLZ Core: ages 10–14, mixed-sex; SKILLZ Girl and SKILLZ Guy: ages 15–19, single-sex); pre/post surveys completed by 1,919 participants; qualitative data collected from participants, 82 SKILLZ Coaches, 6 teachers, 4 caregivers, and 3 GRS staff
Implementation setting: Nyimba, Petauke, and Chipata districts, Eastern Province, Zambia (rural)
Study period: August 2024 to September 2025 (14 months)

Intervention

Integrated SKILLZ Core, SKILLZ Girl, and SKILLZ Guyz: 10–12 sport-based practices per curriculum, each incorporating three mental health topics (as standalone sessions or embedded within SRHR topics), delivered by trained near-peer SKILLZ Coaches in schools and communities.

Results

GRS reached 19,515 participants across SKILLZ Girl (8,788), SKILLZ Guy (6,263), and SKILLZ Core (4,464); 16,203 (83%) graduated by attending seven or more sessions.
Mental health session attendance ranged from 91% (SKILLZ Core) to 78–87% (SKILLZ Guy and SKILLZ Girl).
Pre/post results (n=1,919) showed an overall 26% increase in comprehensive knowledge of mental health, SRHR, and services (15% SKILLZ Core, 31% SKILLZ Guy, 33% SKILLZ Girl), and a 64% overall increase in positive attitudes and beliefs regarding mental health and gender norms (57% SKILLZ Core, 69% SKILLZ Guy, 65% SKILLZ Girl).
Participants also showed a 22% overall improvement in informed decision-making regarding sexual relationships, contraceptives, and reproductive health, and a 23% overall improvement in self-concept.
Qualitative findings indicated that participants, Coaches, and GRS staff found the mental health content relatable, well-summarized, and easy to deliver; recommendations included adding topics such as suicide, substance abuse, and counseling, and addressing community misconceptions that associate mental health with witchcraft.
Reported implementation barriers included limited parental and community buy-in, strict school schedules, translation challenges for mental health concepts, and long travel distances for Coaches.

Conclusions and implications

Integrating mental health content into existing SKILLZ SRHR programming appears feasible and well received, with early evidence of improved mental health and SRHR knowledge and attitudes among adolescents.
Expanding mental health content, strengthening community sensitization, and better aligning programming with school schedules may further improve outcomes and sustainability.