From leadership research to district action: Stakeholder perspectives on the development of a school based mental health programme in Bangladesh: a qualitative needs assessment

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Background Bangladesh, a South Asian country where approximately one-third of the population comprises children and adolescents, has an estimated prevalence of mental disorder of 13.6% among this age group, while the treatment gap remains as high as 94.5%. A whole-school approach, grounded in the Health Promoting Schools (HPS) framework, emphasises school–community partnerships, supportive environments, curriculum integration, and enabling policy support. This study conducted a multi-level needs assessment to identify systemic gaps and capacities to inform the development of a universal school-based mental health programme (SBMHP) for adolescents. Methods A qualitative needs assessment was undertaken over a two-month period using sixteen focus group discussions and six key informant interviews with students (n = 48), teachers (n = 24), parents (n = 24), and mental health professionals (n = 6). Data were transcribed verbatim and analysed in NVivo 14 using a hybrid thematic approach. Deductive coding was guided by the research questions and interview guides, while inductive coding captured emergent contextual insights. Triangulation across stakeholder groups enhanced analytic rigour. The HPS framework was applied post-analysis as an interpretive lens. Results A substantial mismatch emerged between adolescents’ mental health promotion needs and schools’ capacity to deliver coordinated preventive support. Despite stakeholder awareness, efforts were constrained by fragmented policies, limited institutional capacity, urban-centred tertiary services, and weak school–family–community collaboration. Mapping the findings onto the HPS framework indicated only partial alignment across the domains of governance, environment, curriculum, engagement, and service integration. Conclusions The study identifies structural and institutional determinants shaping adolescent mental health promotion in Bangladeshi schools and provides formative evidence to inform the future development of a culturally responsive and scalable school-based mental health promotion programme, contributing to the limited evidence base from low- and middle-income settings. Supplementary Information The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28560-1.

Study methods

This study adopted a qualitative design using focus group discussions (FGDs) and key informant interviews (KIIs) to conduct a needs assessment among adolescent students, parents, teachers, and mental health professionals in Bangladesh [14, 15]. Qualitative approaches are particularly appropriate in low- and middle-income country (LMIC) contexts, where mental health needs, help-seeking behaviours, and service pathways are strongly shaped by sociocultural norms, stigma, and resource and system constraints, which may not be adequately captured through quantitative measures alone [16, 17]. FGDs were used to explore shared meanings, collective experiences, and community norms related to adolescent mental health within school and family contexts, while KIIs enabled in-depth examination of structural, policy, and service-level perspectives from stakeholders occupying key professional and leadership roles [18, 19]. The combined use of FGDs and KIIs facilitated triangulation of perspectives and supported the identification of locally salient priorities, implementation barriers, and contextual strengths, which are essential for the design of feasible and culturally responsive SBMHP in resource-constrained settings [20–22].

Limitations

This study has several limitations. Participants were recruited using convenience sampling through school-based gatekeeping (e.g., head teacher notices), which may have introduced selection bias and limited representativeness. Although efforts were made to include diverse stakeholder groups across urban and rural settings and different school types, the sample may not fully capture the breadth of experiences across Bangladesh. No participants with lived experience of clinical-level mental health conditions were identified, limiting perspectives on treatment pathways. Mental health professionals were included in limited numbers, and no policy-level stakeholders (e.g., Ministry of Health or Education) were involved due to the scope and time constraints of this exploratory study. In addition, all data were collected online, which may have affected interaction depth and non-verbal communication, particularly in rural settings with intermittent connectivity. Finally, the lead researcher’s role as a psychiatrist may have influenced participant responses during FGDs with school stakeholders. Therefore, the findings should be interpreted as exploratory and context-specific, providing formative insights rather than broadly generalisable conclusions for national-level policy or programme development.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one school improvement question with teachers. Protect a short shared planning cycle, agree an instructional change and use a common rubric for examining student work. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Review implementation fidelity, teacher time and independently scored student work against a recorded baseline. Examine access differences and competing explanations before attributing changes to leadership. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Md Saleh Uddin; Ernesta Sofija; Fahad Bin Akhter; Tanny Barua; Paul Harris. Stakeholder perspectives on the development of a school based mental health programme in Bangladesh: a qualitative needs assessment. BMC Public Health (2026-08-04). https://doi.org/10.1186/s12889-026-28560-1

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.