JMIR Publications

ABSTRACT

Background:

The global public health challenge of young people's mental health is particularly evident in Brazil, which is considered the most anxious country and fifth most depressed globally. In response to this, a digital intervention that takes the form of a storytelling chatbot named “Cadê o Kauê?” (translation: “Where is Kauê?”) was co-produced by an interdisciplinary team of researchers, young people and narrative designers as part of a project titled Engajadamente (www.engajadamente.org). The intervention was designed to strengthen Brazilian adolescents’ skills in promoting their peers' mental health through peer support and collective action. The tool's implementation commenced in select schools in Brazil and online via social media, but it encountered challenges during the initial adoption phase in school settings.

Objective:

This project aims to evaluate the implementation of the chat-story intervention in school settings and address the complexities in its adoption. The NASSS (Non-adoption, Abandonment, Scale-up, Spread, Sustainability) framework is selected as the theoretical framework to identify different areas of complexity across domains and further thinking of ways to reduce or manage these.

Methods:

Data was gathered by conducting structured online interviews with Engajadamente team members based in the UK and Brazil. The NASSS-CAT tool was employed as a sensemaking device to facilitate a collective understanding of the implementation, and narratives were mapped onto specific domains. Key sub-themes were identified across overarching domains of NASSS using thematic analysis to meet the aims and objectives of this service evaluation.

Results:

The results mapped onto the NASSS domains generated a narrative about the initial implementation of “Cadê o Kauê?” in schools. Existing and potential complexities across technology, organisation, and wider system domains were characterised by interdependencies, unintended consequences, and uncertainties. The implementation of “Cadê o Kauê?” highlighted challenges related to internet dependency, infrastructure limitations, and varying levels of organisational readiness, teacher preparedness, and school culture -- factors that influence its successful integration and scalability. Addressing these through offline solutions, additional teacher training, whole-school engagement strategies, and a value-informed complexity approach can enhance accessibility, alignment with school priorities, and adaptability within Brazil’s dynamic socio-political context.

Conclusions:

Using the NASSS framework, this evaluation captured both past and emerging complexities in implementing “Cadê o Kauê?” in schools. By engaging with theory-informed approaches to technology implementation projects and deep-diving into discursive dynamic interactions between technology and its ‘context’ of implementation, we have explored ways to manage these complexities and developed suitable recommendations to guide the Engadajamente team and support similar projects in the future.