Climate Change Resilience Training for Adolescent Mental Health in India: Protocol for a Sequential, Explanatory Mixed Methods Cluster Randomized Controlled Trial Within the Ayushman Bharat School Health and Wellness Program.

Abstract

Climate change increasingly affects adolescent mental health, particularly in heat-vulnerable regions such as Odisha, India. Strengthening climate awareness, adaptive behaviors, and psychological resilience among adolescents is therefore essential. The goal of this study is to determine the effectiveness of the Climate Change Resilience Training (CCRT) intervention on adolescents' readiness for climate change. The main objectives are to assess climate change-related mental health outcomes among adolescents, explore adolescents' mental health perceptions and coping related to climate change, and evaluate the effectiveness of climate change resilience training on climate change readiness among adolescents. A sequential, explanatory mixed methods study will be conducted among adolescents in public schools in Khordha district, Odisha, India. Phase 1 will assess climate change-related mental health outcomes using standardized tools; phase 2 will explore adolescents' perceptions, emotional experiences, coping, and hopes through focus group discussions; and phase 3 will evaluate the Climate Change Resilience Training intervention using a superiority cluster randomized controlled trial with 1:1 allocation between intervention and control schools. The intervention will comprise 5 structured classroom sessions over 1 month and 1 booster session 2 months later under the Ayushman Bharat School Health and Wellness Program. The primary outcome will be the change in a climate change awareness score; secondary outcomes will include heat wave preventive practices, climate-protective behaviors, climate hope, and climate-related mental health outcomes. Ethics approval was obtained in December 2025. The study was funded in January 2026. As of manuscript submission, participant recruitment had not commenced. Recruitment is scheduled to commence in November 2026 following school permissions and facilitator training. Data collection is expected to continue through 2027, with data analysis planned immediately after completion of follow-up assessments. The findings may inform the integration of climate resilience and mental health promotion into existing school health programs and support policy development for adolescent health in India and other low- and middle-income countries. Clinical Trials Registry-India CTRI/2026/01/101299; https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2026/01/101299. PRR1-10.2196/104387.