Barriers and facilitators to implementation of a community wellbeing service for black, Asian and minoritised young people

Adolescent, Mental Health, Ethnicity, Community setting, Qualitative Research, Complex health interventions ALL Metrics - Views Downloads How to cite this article Ijaz S, Salam S, Williams J et al. Barriers and facilitators to implementation of a community wellbeing service for black, Asian and minoritised young people [version 2; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2025, 5:46 (https://doi.org/10.3310/nihropenres.13912.2) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente Select a format first ▬ ✚ Research Article Revised Barriers and facilitators to implementation of a community wellbeing service for black, Asian and minoritised young people [version 2; peer review: 1 approved, 2 approved with reservations] Previously titled: Barriers and facilitators to implementation of a community wellbeing service for black, Asian and minoritised young people: mixed method evaluation Sharea Ijaz https://orcid.org/0000-0001-5727-1790 1, Shumona Salam1, Jo Williams1,2, Geraldine Smyth2, Deborah M Caldwell https://orcid.org/0000-0001-8014-7480 1, Katrina Turner1Sharea Ijaz https://orcid.org/0000-0001-5727-1790 1, Shumona Salam1, [...] Jo Williams1,2, Geraldine Smyth2, Deborah M Caldwell https://orcid.org/0000-0001-8014-7480 1, Katrina Turner1 PUBLISHED 23 Sep 2025 Author details Author details 1 University of Bristol Bristol Population Health Science Institute, Bristol, England, UK 2 Bristol City Council, Bristol, England, UK 2 Bristol City Council, Bristol, England, UK Sharea Ijaz Roles: Conceptualization, Funding Acquisition, Investigation, Methodology, Project Administration, Validation, Writing – Original Draft Preparation Roles: Conceptualization, Funding Acquisition, Investigation, Methodology, Project Administration, Validation, Writing – Original Draft Preparation Shumona Salam Roles: Data Curation, Formal Analysis, Investigation, Project Administration, Software, Writing – Original Draft Preparation Roles: Data Curation, Formal Analysis, Investigation, Project Administration, Software, Writing – Original Draft Preparation Jo Williams Roles: Conceptualization, Funding Acquisition, Methodology, Resources, Writing – Review & Editing Roles: Conceptualization, Funding Acquisition, Methodology, Resources, Writing – Review & Editing Geraldine Smyth Roles: Conceptualization, Funding Acquisition, Methodology, Resources, Writing – Review & Editing Roles: Conceptualization, Funding Acquisition, Methodology, Resources, Writing – Review & Editing Deborah M Caldwell Roles: Conceptualization, Formal Analysis, Funding Acquisition, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing Roles: Conceptualization, Formal Analysis, Funding Acquisition, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing Katrina Turner Roles: Conceptualization, Formal Analysis, Funding Acquisition, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing Roles: Conceptualization, Formal Analysis, Funding Acquisition, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing OPEN PEER REVIEW REVIEWER STATUS Young people from minoritised ethnic backgrounds experience greater mental health needs and face greater challenges when accessing mental health support. We evaluated implementation of a new mental wellbeing service for minoritised young people in an urban youth centre. We evaluated the service during its first 12 months of implementation. We held twelve interviews with four service practitioners and three paired interviews with six young people. Fieldnotes were taken and used to contextualise interview data. Practitioners recorded young people’s attendance. Qualitative data were analysed thematically. Attendance data were analysed descriptively. The service included Four components: a weekly two-hour session with mental health practitioners in the youth centre, opportunistic wellbeing conversations and activities, mentoring, and referrals to therapeutic support. It was developed iteratively to allow time for relationships between practitioners and with young people to develop and for intervention to be tailored to the setting. Implementation was facilitated by the setting’s positive influence, practitioners’ lived experience, iterative development of the service, and establishing trusting relationships. Barriers included the informal nature of activities, slow service implementation, and young people’s inconsistent attendance and reluctance to engage with the service. 94 young people attended at least one session. Successful implementation of wellbeing services in community settings for minoritised young people can be affected by the informal and relaxed nature of the setting and the activities delivered, and the extent to which young people are willing to engage. Additionally, it requires relationship building and flexibility in delivery and pace. Future development and evaluation of similar services should consider these requirements. Young people from ethnic minority backgrounds have greater need for mental health support. Yet they often face difficulties in finding this support. We evaluated a new mental health support service for these young people in a youth centre. Over 12 months, we interviewed service practitioners and young people, took fieldnotes, and recorded young people's attendance. We analysed all this information to identify what helped implementing such a service and what didn't. The new service had four components: weekly sessions with mental health practitioners, wellbeing conversations and activities, mentoring, and referrals to other services. It evolved over time as relationships were built and was tailored to the environment in the youth centre. What helped the implementation of the service was the supportive environment, providers' lived experience, service flexibility, and establishment of trust. Whereas slow service delivery, unstructured activities, irregular attendance of young people, and their reluctance to engage hindered the implementation. Relationship building and flexibility of a service are required for successful implementation of mental health support services for young people from minoritized ethnicities. Future service development should consider these factors. Adolescent, Mental Health, Ethnicity, Community setting, Qualitative Research, Complex health interventions Corresponding Author(s) Sharea Ijaz ([email protected]) Grant information: This project is funded by the National Institute for Health Research (NIHR) under its Three NIHR Research Schools Mental Health Programme Practitioner Evaluation Scheme (MH022). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Sharea Ijaz ’s time is supported by the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), NIHR Clinical Research Network West of England (PHLARP funding), and NIHR Research Support Service Specialist Centre for Public Health (LARP funding) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Ijaz S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Ijaz S, Salam S, Williams J et al. Barriers and facilitators to implementation of a community wellbeing service for black, Asian and minoritised young people [version 2; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2025, 5:46 (https://doi.org/10.3310/nihropenres.13912.2) First published: 15 May 2025, 5:46 (https://doi.org/10.3310/nihropenres.13912.1) Latest published: 23 Sep 2025, 5:46 (https://doi.org/10.3310/nihropenres.13912.2) Sharea Ijaz ’s time is supported by the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), NIHR Clinical Research Network West of England (PHLARP funding), and NIHR Research Support Service Specialist Centre for Public Health (LARP funding) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We have revised the text to elaborate on unclear points based on peer reviewer comments. They key changes are: More simplified plain language summary. More detail on how intervention was commissioned in the introduction section. More details on methods especially analysis, and moving some of the result section into methods as recommended. Addition of an introductory sentence for facilitators. Reflection on our definition of implementation in the discussion section. We have revised the text to elaborate on unclear points based on peer reviewer comments. They key changes are: More simplified plain language summary. More detail on how intervention was commissioned in the introduction section. More details on methods especially analysis, and moving some of the result section into methods as recommended. Addition of an introductory sentence for facilitators. Reflection on our definition of implementation in the discussion section. They key changes are: More simplified plain language summary. More detail on how intervention was commissioned in the introduction section. More details on methods especially analysis, and moving some of the result section into methods as recommended. Addition of an introductory sentence for facilitators. Reflection on our definition of implementation in the discussion section. See the authors' detailed response to the review by Gerard Leavey See the authors' detailed response to the review by Maria Loades and Sophie Dallison Children and young people (CYP) from Black, Asian, or minoritised ethnic backgrounds are underrepresented in NHS services despite higher rates of mental health conditions1–4. Reasons include CYP facing greater challenges in accessing mental health support5, not knowing about services or locations, language and culture differences between themselves and health professionals, and higher mental health stigma in minoritised communities1,5–8. Minoritised CYP are more likely to be referred to Child and Adolescent Mental Health Services through education, social services, or judicial pathways rather than the usual primary care route9,10. They often seek support from informal services, community organisations, or family and friends1,9–12. Providing culturally appropriate mental health services could address these barriers13–16. The UK mental health framework encourages the use of community assets, such as youth groups to support CYP wellbeing17. Community organisations can provide context-specific preventive mental health services, but evidence indicates gaps in evaluation of these services18–20. A new community-based mental wellbeing service was commissioned by Bristol’s local authority to improve wellbeing support and access to mental health services for CYP from Black and Asian minoritised ethnicities. To set up the service, the local authority organised a meeting with Black and Asian led CYP support organisations in the city to identify those willing to collaborate on service delivery in a community setting. The organisations in one locality who agreed were contracted to collaborate for developing and providing the service and supporting an evaluation. The key service aims were to support minoritised young people’s mental wellbeing and facilitate referrals to mental health services, where appropriate. The service was set in a youth club and intended to be both universal (through games and activities for all attendees) and targeted (through mentoring and/ or referral for at risk CYP). We evaluated this service in its first year to identify barriers and facilitators to implementation. This paper presents findings from the evaluation and highlights what should be considered when developing and evaluating similar future interventions. Eligible study participants were the four practitioners delivering the service and all the minoritised CYP aged 11–17 registered at the centre attending the service. We aimed to purposefully sample CYP of varying age and gender for interviews. A £10 shopping voucher was given to CYP who participated in interviews. 94 CYP attended at least one wellbeing session during the course of the study. All of them were shown study flyers and leaflets and approached for participation in the study. Six CYP and all four service providers from the centre were interviewed. Their characteristics are not described to avoid identification. The providers were a youth worker and a manager, and two mental health practitioners. They visited the centre weekly to deliver the service. All four were interviewed on three occasions between December 2022 and March 2024; at the start of service implementation, then after seven, and 12 months. Interviews lasted one hour on average (range 37–74 min). Five interviews were conducted face-to-face, at the youth centre or at the mental health organisation’s office, and seven were conducted by phone. CYP were reluctant to participate in the evaluation and only three paired interviews were conducted. The six young people interviewed were between 11 and 15 years (Median age 13 years), included both boys and girls and represented a range of minoritised ethnic backgrounds. These interviews lasted, on average, 30 minutes and were held in a private room at the centre between May and November 2023. The new service was set in a community youth centre located in a deprived urban area with a diverse population (30–35% ethnic minority)21. The ethnic makeup of the youth centre attendees was varied, including CYP with Black, Asian and mixed heritages in majority. The service hub was a 2-hour, weekly, youth activity session run for 11- to 17-year-old CYP in the youth centre where mental health practitioners were present. The aims of the new service were broad, so the specific design and professional activities of the service were not decided a priori and were developed as service was implemented. It was co-developed and facilitated by two youth practitioners from the community centre and two specialist mental health practitioners from the mental health organisation (the service ‘providers’). Majority of the youth and mental health practitioners were from the same community and of Black Asian or Mixed ethnicity. The practitioners discussed and agreed on what the service would comprise of and developed it together, based on their knowledge and experience of looking after minoritised CYP and their own lived experience of being from minoritised communities. They therefore understood the reluctance and sensitivity around mental health. We held in person and online conversations prior to and during the study with parents and guardians of children attending the youth centre to inform them about the study and enhance the reach. These conversations indicated that parents trusted the setting providers for looking after their children because of their longstanding presence in the community and shared values. One author (SS), a senior research associate experienced in qualitative methods and with a master’s in public health, visited the centre and met with practitioners prior to evaluation starting. She was from an ethnic minority background, as suggested by our Public and Patient Involvement work (see below in section titled Public and Patient Involvement). Participants were told that SS was the researcher employed on the study to conduct the qualitative work. She attended all the sessions where all providers (two centre staff and two mental health practitioners) were present, and when the centre was open to CYP aged 11 to 17. During these visits, SS took fieldnotes based on what she observed, such as physical description of the community centre and the activities carried out. These notes provided contextual data for the providers’ and young people’s accounts. Throughout the evaluation, SS invited providers and the CYP attending the activity session to interviews, to explore their views and experiences of the service. Individuals approached for interview were given an information sheet that described the aim of the study and what taking part would entail. Individuals could read this sheet at their leisure and ask questions about the study. SS secured written informed consent prior to interview and conducted all the interviews. When the participant was under 16 years of age, consent was obtained from the guardians or parents of the CYP, as well as the CYP themselves. For interviews with service providers, a topic guide was used to ensure consistency across the interviews. The same guide was used at each of the three time points. It was based on the purpose of the interviews and informed by relevant literature, knowledge of the planned intervention and discussions within the research team. It included open-ended questions to elicit details and description from the participants about the service, its implementation, and the barriers and facilitators to service delivery. The interviews were held at a private location in the centre or via phone, at a time convenient to the participant. For interviews with young people, a flexible and open-ended topic guide was designed to explore their awareness and experiences with the service. This guide was also refined in conjunction with our young people’s research advisory group (see under Patient and Public Involvement). The topic guide included open questions about their perception of mental health and of the new service. A guide was also developed for the interviews with CYP who were referred for mentoring or additional mental health support. It included questions about young person’s perceptions of the additional support and referral components, and processes and how it could be improved in future. (see Supplementary data for all topic guides22). The interviews were audio-recorded and fully transcribed professionally. All audio recordings were deleted within three months of interview. The transcripts will be kept securely for 10 years. All information is stored safely and securely by the University of Bristol – in line with the General Data Protection Regulations and the University of Bristol’s Data Protection policy. In terms of analysing the interview data, following the principles of grounded theory23, data collection and analysis proceeded in parallel, so that findings from earlier interviews informed the focus of later data collection. The interview transcripts were analysed thematically, using the approach suggested Braun and Clarke24. Data collection and analysis proceeded in parallel, so that findings from earlier interviews informed the focus of later data collection. This entailed a subsample of all transcripts being independently read and manually coded by SS and KT, who then met to discuss their coding and interpretation of the data, and to develop a coding frame which reflected themes identified in the data. Once the coding frame had been agreed, transcripts were uploaded into NVivo v1425 and electronically coded. As data collection progressed, new codes were added to the coding frame and transcripts that had previously been coded were re-coded where necessary. Finally, codes were grouped together to develop categories and collated into potential themes and sub-categories. This inductive approach to the analysis ensured findings were based on participants’ accounts and not coded according to the researchers’ pre-existing assumptions or priorities. Researcher bias was also controlled for through the double coding of transcripts and regular discussion between SS and KT about how findings related to the data set. In addition, during data collection, SS discussed interim findings with providers to check our interpretation of the data. Whilst it was felt SS’s ethnicity had facilitated access to the centre and the interviews with providers, it was also felt her gender had hindered the extent to which young men, particularly the 16- and 17-year-olds, using the centre were willing to take part in the research. In terms of analysing the quantitative data collected by the providers on CYP’s attendance at wellbeing sessions, and referrals to other services over the 12 months, these data were analysed descriptively using Excel. Ethical approval was granted by the University of Bristol Faculty of Health Sciences Research Ethics Committee on 30th Nov 2022 (application ID13984). We worked with the service providers and an independent young people’s research advisory group (YPAG) prior to evaluation and throughout the study. They helped us in developing participant information materials, choosing outcomes and interpreting the findings. A YPAG is a group of volunteer young people who advise on research concerning young people using their lived experience and age specific views. Members of the YPAG consulted were all from minoritised ethnic backgrounds. Fifty service sessions were held over 12 months and 94 of the CYP registered at the centre attended at least one of these sessions. The proportion of sessions attended ranged from 2% to 58% and only 19 CYP attended >=20% of the sessions. Five of the 94 CYP were offered 1:1 additional therapeutic support off-site. None had taken up the offer, during the evaluation period. We start by describing the centre and then detail the service content and implementation. Finally, we present facilitators and barriers to implementation, and the service impact. Quotes are used to illustrate findings and have been tagged with a participant’s unique identifier number indicating whether a provider or CYP is being quoted. Providers explained the centre had been offering community-based services for 40 years, serving multiple generations of local families, primarily from minoritised ethnic backgrounds. The centre already offered a variety of skill-building activities, such as sports, music production, games, movies, cooking, arts, and crafts. Activities were overseen by youth practitioners, most of whom were from minoritised ethnic backgrounds. The CYP interviewed recalled engaging in activities, and described them as soothing and as building their skills and confidence. Participation in activities was not mandatory and CYP could move freely within the space, using it predominantly to socialise with their peers and friends. CYP described how this meant the centre provided them with a space to relax and feel safe: “Maybe like how to cook for yourself and how to speak to people and just talk to people, anyone, and that it would be safe …safe space ...” (CYP02, paired interview) “… it doesn't feel like at school when it's like you don't really have a choice. I'm more relaxed here… the staff just let you know every time and then you can just choose what you want to do…” (CYP01, paired interview) The providers stated that the aim of the service was to ensure a referral pathway for CYP to access mental health services and to normalise mental health and wellbeing conversations among centre attendees. Providers explained the service was being developed iteratively, on-site, over several months, and included four components: (i) Weekly presence of mental health practitioners at the Centre. (ii) Identifying CYP in need of further support and referring them to appropriate services. (iii) Opportunistically embedding discussions and activities about mental health into conversations and centre activities (iv) Offering drop-in sessions for one-to-one or group mentoring. Service implementation was slow. Providers explained this was because it was a novel offering and that they had limited experience of such service implementation. They noted additional time was needed to build mutual understanding and trust between the youth workers and mental health practitioners, who had not previously worked together. They also felt the service needed to be developed naturally, through trial and error, so that it fitted within the constraints of the setting and was tailored to the CYP’s needs. Facilitators to implementation included building trust and relationships with service users and between organisations, and tailoring activities to context. Fostering trust and building relationships. Providers stated building trust and relationships was crucial to successful service implementation. They mentioned that their expertise and lived experience helped them recognise the stigma and apprehension surrounding mental health in minoritised communities, and be responsive to the needs of these communities: “We’re known as being a project that not only provides a service but connects with young people that we work with on a deeper level than most practitioners can because we understand the lived experience because we all are practitioners from the lived experience....” (SP3 Interview) Providers explained their approach transcended the traditional therapist-client dynamic, aiming to cultivate informal, youth-friendly relationships akin to youth workers, to mitigate power imbalances and cultivate meaningful connections with the CYP: “…I’m very much conversing and engaging with them in vernacular with a presentation that very much matches them. With the core principles of building slow trust…it’s not going in and rushing an engagement or rushing an interaction or connection.” (SP3 Interview) Initially, the mental health practitioners did not introduce themselves as such to the CYP, in case this label discouraged communication: “… I didn’t advertise that fact (that they were a mental health practitioner) because I don’t think, when you’re developing relationships, you want to be watched…going forward…I’d probably want to use language that would be more understood with children, to explain to them better because some don’t even know what mental health is, or have heard of it as a buzzword on TikTok. So, at the moment, I just like to be the friendly face that they can come to…” (SP1 Interview) Additionally, mental health practitioners mentioned their positive relationship with centre staff facilitated the process of them being accepted by the CYP. Trust building between the organisations. Ongoing engagement, knowledge-sharing, and training (of youth centre staff by the practitioners from mental health organisation) facilitated the development of a collaborative relationship between the two organisations. This fostered mutual understanding and trust, enabling staff at the centre to seek guidance in addressing specific challenges related to safeguarding, engaging disengaged young people, and responding to young people’s mental health needs. Tailoring activities to the context. Providers explained that centre activities were determined by CYP interests and participation was optional. This meant that while the providers wanted to implement structured educational activities, uptake depended on the CYP’s willingness to engage. ” I think the approach here is slightly different where it’s a bit more run by the children and things are quite relaxed and unstructured, which is its complete beauty, but does have difficulties when trying to implement a more structured…” (SP1 Interview) For this reason, providers opportunistically incorporated mental health conversations and activities into their usual interactions with CYP. Examples included regularly checking in with CYP about how they were feeling and encouraging them to discuss something positive or challenging that happened during their day. This was also reflected in the CYP interviews. Although CYP could not recall any specific mental health activities, they mentioned providers checking-in on them, having conversations about their emotions, and discussing positive and challenging events. It was also evident that they felt the providers genuinely cared. Barriers to implementation mentioned by providers included inconsistent attendance of CYP, the unstructured nature of activities delivered in the centre, slow intervention delivery, and the CYP’s reluctance to engage in wellbeing services or conversations. Inconsistent attendance. CYP’s inconsistent attendance hindered the development of trust and rapport with the providers, and also affected the continuity of service delivery. “…Young people’s attendance is quite inconsistent. So will show up for a week, two weeks. We’ll build a bond. They’ll disappear for a week. So, consistency is also a barrier that we’re facing, which is a fundamental pillar to our work as practitioners.” (SP3 interview) Informal and relaxed structure. Providers repeatedly highlighted a ‘tension’ between the formality of the service and the informality of the community setting. To engage effectively with CYP, providers had to navigate around the habitual actions and expectations of CYP attending the activities: “…the young people…have particular expectations of the space…So people are acting habitually in the space. They will go to the studio. They will hang out, stay on their phones, chat with each other, and disengage from people and professionals in the space because that’s their space and that’s their time. Working alongside established habitual actions within the space, and what young people themselves expect from that space…that’s also been a bit of a barrier for us in terms of being able to work our angle in the space.” (SP3 Interview) Slow pace of service delivery. All providers acknowledged that service implementation was slower than anticipated. This was partly due to the service being developed through trial and error. Implementation was also slow because the centre needed to develop the safety procedures required when providing a mental health service. It took 12 months for all four service components to become operational. This delay contributed to providers being unsure of their roles within the service. As all the CYP we interviewed were not aware of the new service, this operational delay likely contributed to a lack of service visibility to CYP. Hesitancy in engaging with service and providers. Providers mentioned that CYP did not want to discuss mental health or access further support when it was offered. They suggested that, in the early phases of the service, this might have been because they were not familiar with the mental health practitioners. They also commented that it could be due to the perception that participating could signal that CYP had problems, underscoring the need for practitioners to approach them with care and sensitivity. “……You’ve got to be more therapeutic with your approach or more mindful with your approach because we don’t want them to feel like oh, there’s something wrong with me why this mental health person keeps trying to talk to me…” (SP2 Interview) CYP accounts suggested that their reluctance to engage could also be because they were unsure what was meant by 'mental wellbeing' or 'emotions', and what service and activities were being offered. They also mentioned not seeing the service as relevant to them, as they considered their mental health was fine. CYP were also unsure how to discuss their mental health and explain how they felt. “I think it [activity with SP03] helped us understand our emotions a bit more because sometimes you just don't understand what you're feeling and like you just… Well, you can't understand it. …. Yeah. I think it helped me understand emotions because when you describe them [pause] like it helps you understand them because like people just say emotions, but they don't really understand what that actually means.” (CYP02, paired interview) During follow-up interviews, providers emphasised they had established relationships with CYP and between the two organisations, despite slow implementation. They had started offering mentoring sessions and had developed a clear referral pathway for CYP needing specialist mental health support. Although they recognised the process of trust building had been slow, it had led to CYP opening up and confiding in the providers: "One of the young girls became particularly close with our community mental health practitioner, and she’s been able to confide in things that have been upsetting her." (SP2 Interview) Providers noted that once a collaborative relationship had been established between the two organisations, they were able to respond very quickly to challenges. This was demonstrated by the provision of additional drop-in sessions and support for CYP affected by a violent incident that occurred in the local community, during the study period. Successful implementation of a community-based wellbeing service for minoritised CYP was facilitated by the positive regard of the setting, lived experience of service providers, iterative and tailored development of the service, and trust building between all those involved. Barriers included the informal or unstructured nature of centre activities, slow service implementation, CYP’s inconsistence attendance and reluctance to engage. Services implemented in community centres can positively impact CYP’s wellbeing, particularly for those from marginalised backgrounds26. Our findings describing building trust and relationships, following CYP’s preferences, and collaborative development, have been identified previously as facilitators to implementation of interventions for CYP’s mental health27. The profile of CYP attending community youth settings has shifted since the 1980s, from mostly marginalised backgrounds to now mostly children from well-off and safe neighbourhoods26. This may be due to long-standing funding limitations and the current cost of living crisis. Recognising these trends, this service, made possible through local authority funding and community organisations, aimed to embed local provision for minoritised CYP. Our study shows that preventative services for marginalised CYP are feasible in community settings if time is available for trust building and tailoring to children’s preferences. In-depth interviews with providers allowed them to describe their views and experiences in detail, raise issues that were important to them (e.g., trust building) and explain the rationale behind how the service was being implemented (e.g., the need to be child-led). A strength of our study was that all the providers participated throughout the evaluation, allowing their views and experiences of the service to be explored in real time as it was implemented. This was particularly important because implementation was slow, going through the phases of building trust and intervention development, to finally establishing activities and a referral pathway. Only six CYP were interviewed, so insight into their views and experiences of the service is limited. We had also aimed to interview CYP referred for additional therapeutic support, but no referral offers were taken up by the CYP during the time of the study so this could not be done. The fact that the service developed iteratively during our evaluation meant we identified barriers and facilitators to implementation that related to the characteristics of setting in which the service was delivered, and the relationships and exchanges that were needed for the service to be implemented. Our definition of implementation, therefore, was to what extent the service was being operationalised and not to what extent the service was being delivered as intended. This latter definition is the one that is often used when evaluating complex health interventions and is the definition used within the RE-AIM framework developed to guide this process28. This definition, however, assumes the intervention has been fully developed and is clearly defined and structured before being implemented, and that we have some measure or expectation against which to assess implementation. Thus, our paper raises questions about how implementation should be defined and suggests this should depend on to what extent the intervention has been defined prior to it being used in a real-world setting. Community settings offer valuable spaces for mental health services for minoritised CYP, ensuring easy access to trusted adults. Successful implementation of youth wellbeing services in community settings require understanding of the context, commitment to relationship building, and flexibility in delivery and pace of the intervention. Future development and evaluation of similar services should acknowledge these requirements. Ethical approval was granted by the University of Bristol Faculty of Health Sciences Research Ethics Committee on 30th Nov 2022 (application ID13984). The researcher secured written informed consent in advance and conducted all the interviews. Consent was obtained from the guardians or parents for children under 16 years and from CYP themselves if they were 16 years or older. Consent forms available in supplementary files. Please contact Professor Deborah Caldwell to request for data. Because of the very small sample and risk of identification, transcripts will not be made available alongside the manuscript. As very few providers were interviewed, and they were concerned about confidentiality and being identified, we did not ask them to consent to their data being stored and made available for future use. However, parents did consent to their children's data being anonymised, stored and made available to other researchers. These data are therefore available upon request from the lead author, for the purposes of research. Open Science Framework: Improving wellbeing and mental health support for young people from black, Asian and minoritised groups This project contains the following extended data: COREQ checklist Supplementary data files Open Science Framework: COREQ Checklist ‘Improving wellbeing and mental health support for young people from black, Asian and minoritised groups’ Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0) (https://creativecommons.org/licenses/by/4.0/). We are grateful to the providers for their contribution to data collection, setting up and recruitment, to the NIHR ARC West Young Person’s Advisory Group members for their advice, and to the CYP who participated in the evaluation. Faculty Opinions recommendedReferences - 1. 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Chui Z, Gazard B, MacCrimmon S, et al.: Inequalities in referral pathways for young people accessing secondary mental health services in South East London. Eur Child Adolesc Psychiatry. 2021; 30(7): 1113–1128. PubMed Abstract | Publisher Full Text | Free Full Text - 13. Forman-Hoffman VL, Middleton JC, McKeeman JL, et al.: Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review. Implement Sci. 2017; 12(1): 93. PubMed Abstract | Publisher Full Text | Free Full Text - 14. Kurtz Z, Street C: Mental health services for young people from black and minority ethnic backgrounds: the current challenge. J Child Serv. 2006; 1(3): 40–9. Publisher Full Text - 15. Street C, Stapelkamp C, Taylor E, et al.: Minority voices: research into the access and acceptability of services for the mental health of young people from black and minority ethnic groups. London: Young Minds, 2005. Report No.: ISBN: 0–9545123–7–5. Reference Source - 16. Troy D, Anderson J, Jessiman PE, et al.: What is the impact of structural and cultural factors and interventions within educational settings on promoting positive mental health and preventing poor mental health: a systematic review. BMC Public Health. 2022; 22(1): 524. PubMed Abstract | Publisher Full Text | Free Full Text - 17. Department of Health & Social Care: Improving the mental health of babies, Children and Young People: a framework of modifiable factors. 2024. Reference Source - 18. Thomson A, Harris E, Peters-Corbett A, et al.: Barriers and facilitators of community-based implementation of evidence-based interventions in the UK, for Children and Young People's mental health promotion, prevention and treatment: rapid scoping review. BJPsych Open. 2023; 9(4): e132. PubMed Abstract | Publisher Full Text | Free Full Text - 19. Baskin C, Zijlstra G, McGrath M, et al.: Community-centred interventions for improving public mental health among adults from ethnic minority populations in the UK: a scoping review. BMJ Open. 2021; 11(4): e041102. Publisher Full Text - 20. Duncan F, Baskin C, McGrath M, et al.: Community interventions for improving adult mental health: mapping local policy and practice in England. BMC Public Health. 2021; 21(1): 1691. PubMed Abstract | Publisher Full Text | Free Full Text - 21. Office for National Statistics (ONS): Ward-level population estimates. In: ONS, editor. Population Estimates. Reference Source - 22. Ijaz S: Improving wellbeing and mental health support for young people from black, Asian and minoritised groups. In: Open Science Framework. 2025. https://osf.io/x28mr/ - 23. Strauss A, Corbin JM: Basics of qualitative research: grounded theory procedures and techniques. Thousand Oaks, CA, US: Sage Publications, Inc, 1990. Reference Source - 24. Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psychol. 2006; 3(2): 77–101. Publisher Full Text - 25. Lumivero: NVivo (version 14). In.: Lumivero, 2023. - 26. SQW & University of Warwick: Youth provision and life outcomes: systematic literature review. In: Youth provision and life outcomes research. London: Department for Culture, Media and Sport; 2024; 142. Reference Source - 27. Reed J, Hunn L, Smith T, et al.: Barriers and facilitators in the implementation of youth and young adult models of mental health care. Early Interv Psychiatry. 2025; 19(1): e13555. PubMed Abstract | Publisher Full Text | Free Full Text - 28. Glasgow RE, Vogt TM, Boles SM: Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999; 89(9): 1322–1327. PubMed Abstract | Publisher Full Text | Free Full Text Author details Author details 1 University of Bristol Bristol Population Health Science Institute, Bristol, England, UK 2 Bristol City Council, Bristol, England, UK 2 Bristol City Council, Bristol, England, UK Sharea Ijaz Roles: Conceptualization, Funding Acquisition, Investigation, Methodology, Project Administration, Validation, Writing – Original Draft Preparation Roles: Conceptualization, Funding Acquisition, Investigation, Methodology, Project Administration, Validation, Writing – Original Draft Preparation Shumona Salam Roles: Data Curation, Formal Analysis, Investigation, Project Administration, Software, Writing – Original Draft Preparation Roles: Data Curation, Formal Analysis, Investigation, Project Administration, Software, Writing – Original Draft Preparation Jo Williams Roles: Conceptualization, Funding Acquisition, Methodology, Resources, Writing – Review & Editing Roles: Conceptualization, Funding Acquisition, Methodology, Resources, Writing – Review & Editing Geraldine Smyth Roles: Conceptualization, Funding Acquisition, Methodology, Resources, Writing – Review & Editing Roles: Conceptualization, Funding Acquisition, Methodology, Resources, Writing – Review & Editing Deborah M Caldwell Roles: Conceptualization, Formal Analysis, Funding Acquisition, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing Roles: Conceptualization, Formal Analysis, Funding Acquisition, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing Katrina Turner Roles: Conceptualization, Formal Analysis, Funding Acquisition, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing Roles: Conceptualization, Formal Analysis, Funding Acquisition, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing Competing interests SS, DC & KT declare no competing interests. SI is embedded part time in the Bristol City Council’s (BCC) Public Health team with a remit to increase their research activity and this project was developed in that role. JW is Consultant in Public Health (Healthy Children and Families), at BCC and the departmental academic lead. GS is the commissioner for this evaluated service, and the providers reported quarterly on the service to her. Grant information This project is funded by the National Institute for Health Research (NIHR) under its Three NIHR Research Schools Mental Health Programme Practitioner Evaluation Scheme (MH022). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Sharea Ijaz ’s time is supported by the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), NIHR Clinical Research Network West of England (PHLARP funding), and NIHR Research Support Service Specialist Centre for Public Health (LARP funding) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Sharea Ijaz ’s time is supported by the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), NIHR Clinical Research Network West of England (PHLARP funding), and NIHR Research Support Service Specialist Centre for Public Health (LARP funding) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (2) Copyright © 2025 Ijaz S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. metrics VIEWS $counts.viewCount downloads Citations CITE how to cite this article Ijaz S, Salam S, Williams J et al. Barriers and facilitators to implementation of a community wellbeing service for black, Asian and minoritised young people [version 2; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2025, 5:46 (https://doi.org/10.3310/nihropenres.13912.2) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. track receive updates on this article Track an article to receive email alerts on any updates to this article. Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 23 Sep 2025 Revised Views 0 How to cite this report: Chong MK. Reviewer Report For: Barriers and facilitators to implementation of a community wellbeing service for black, Asian and minoritised young people [version 2; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2025, 5:46 (https://doi.org/10.3310/nihropenres.15356.r38361) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/5-46/v2#referee-response-38361 https://openresearch.nihr.ac.uk/articles/5-46/v2#referee-response-38361 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 13 Jan 2026 Approved with Reservations VIEWS 0 This paper evaluates the implementation of a new mental wellbeing service for young people from minoritised ethnic backgrounds delivered within an urban youth centre in the UK. Using a mixed-methods implementation evaluation over the first 12 months, the study ... Continue reading I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close This paper evaluates the implementation of a new mental wellbeing service for young people from minoritised ethnic backgrounds delivered within an urban youth centre in the UK. Using a mixed-methods implementation evaluation over the first 12 months, the study draws on longitudinal qualitative interviews with four service practitioners, paired interviews with six young people, fieldnotes, and descriptive attendance data. Thematic analysis of collected data demonstrated that the implementation was facilitated by trust building between practitioners and child and young people, as well as between organisations, while barriers included the informal nature of activities, slow implementation, inconsistent attendance, and young people’s reluctance to engage. This is a clearly written and concise paper that addresses an important gap in the implementation literature relating to mental wellbeing services for minoritised young people in community settings. The focus on real-world service implementation, rather than intervention efficacy alone, is a notable strength and aligns well with current priorities in youth mental health research and practice. Overall, the paper demonstrates a novel and timely approach to embedding mental wellbeing support within community settings for marginalised young people, particularly those who may have limited access to and information about mental health services. The emphasis on flexibility, relationship building, and iterative service development offers valuable insights for future community-based service design. Further clarification on aspects of the service structure, analytic approach, and interpretation of findings would further strengthen the paper.

As thematic analysis also does not prescribe a fixed order of data collection and analysis, a clearer justification of the use of both grounded theory principles and thematic analysis would strengthen methodological clarity.

Discussion This is a clearly written and concise paper that addresses an important gap in the implementation literature relating to mental wellbeing services for minoritised young people in community settings. The focus on real-world service implementation, rather than intervention efficacy alone, is a notable strength and aligns well with current priorities in youth mental health research and practice. Overall, the paper demonstrates a novel and timely approach to embedding mental wellbeing support within community settings for marginalised young people, particularly those who may have limited access to and information about mental health services. The emphasis on flexibility, relationship building, and iterative service development offers valuable insights for future community-based service design. Further clarification on aspects of the service structure, analytic approach, and interpretation of findings would further strengthen the paper.

- The supplementary file referenced in the paper was not available for review, therefore was not able to review the guided questions. - The paper describes an iterative process of developing service aims and activities, noting that “the aims of the new service were broad, so the specific design and professional activities of the service were not decided a priori and were developed as the service was implemented.” However, further details on how the four components of the service were developed and why these components were deemed suitable for this demographic were not provided. Please consider adding this to the results or supplementary material. - It would be helpful to specify explicitly that the two-hour weekly sessions were group-based activities - The longitudinal interview design and inclusion of all service practitioners are key strengths of the study. In particular, the longitudinal format allows insight into whether practitioners’ perceived facilitators and barriers evolved over time. It would be useful to: - - Identify the timepoints at which participant quotes were collected. - Clarify whether practitioners’ views on service design or implementation strategies changed across interviews. - The interviewer’s existing relationship with interviewees may have limited the transparency of the data collected. It may be worth acknowledging that participants could have been hesitant to provide critical feedback due to their existing relationship with the researcher - The following description of data collection and analysis appears duplicative and potentially counterintuitive: As thematic analysis also does not prescribe a fixed order of data collection and analysis, a clearer justification of the use of both grounded theory principles and thematic analysis would strengthen methodological clarity. - Providing information on theme development over time (e.g. a thematic map or description of analytic iteration) would further demonstrate reflexivity.

- Leaving the service design broad is a strength, as co-development and iterative refinement can better meet young people’s needs. However, as previously stated, further explanation of how and why the four service components evolved (or remained the same) over time would be beneficial - The themes “Fostering trust and building relationships” and “Trust building between the organisations” appear conceptually similar. A clearer distinction between trust-building with child and young people versus trust-building between organisations would improve interpretability. - Minor clarification: in the quote “So will show up for a week, two weeks,” it is unclear whether “So” was intended to be “Some.”

- The opening sentence of the discussion states that implementation was facilitated by practitioners’ lived experience and iterative, tailored service development. However, the data presented do not clearly demonstrate how lived experience or iteration directly influenced implementation, and this claim may require further support or reframing. - The 5 young people referred for further care did not take the offer. This may provide insight into the challenges or limitations of this service design. Further exploration on this may be important. - Is the work clearly and accurately presented and does it cite the current literature? Yes - Is the study design appropriate and is the work technically sound? Yes - Are sufficient details of methods and analysis provided to allow replication by others? Yes - If applicable, is the statistical analysis and its interpretation appropriate? Not applicable - Are all the source data underlying the results available to ensure full reproducibility? Yes - Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Youth mental health, health services research CITE HOW TO CITE THIS REPORT Chong MK. Reviewer Report For: Barriers and facilitators to implementation of a community wellbeing service for black, Asian and minoritised young people [version 2; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2025, 5:46 (https://doi.org/10.3310/nihropenres.15356.r38361) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/5-46/v2#referee-response-38361 https://openresearch.nihr.ac.uk/articles/5-46/v2#referee-response-38361 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. Views 0 How to cite this report: Dallison S and Loades M. Reviewer Report For: Barriers and facilitators to implementation of a community wellbeing service for black, Asian and minoritised young people [version 2; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2025, 5:46 (https://doi.org/10.3310/nihropenres.15356.r37294) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/5-46/v2#referee-response-37294 https://openresearch.nihr.ac.uk/articles/5-46/v2#referee-response-37294 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 08 Oct 2025 Approved VIEWS 0 The authors have sufficiently addressed the initial ... Continue reading We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close The authors have sufficiently addressed the initial feedback given. No further comments to make. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Child and adolescent mental health provision; clinical psychology CITE HOW TO CITE THIS REPORT Dallison S and Loades M. Reviewer Report For: Barriers and facilitators to implementation of a community wellbeing service for black, Asian and minoritised young people [version 2; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2025, 5:46 (https://doi.org/10.3310/nihropenres.15356.r37294) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/5-46/v2#referee-response-37294 https://openresearch.nihr.ac.uk/articles/5-46/v2#referee-response-37294 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. Version 1 VERSION 1 PUBLISHED 15 May 2025 Views 0 How to cite this report: Leavey G. Reviewer Report For: Barriers and facilitators to implementation of a community wellbeing service for black, Asian and minoritised young people [version 2; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2025, 5:46 (https://doi.org/10.3310/nihropenres.15120.r35920) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/5-46/v1#referee-response-35920 https://openresearch.nihr.ac.uk/articles/5-46/v1#referee-response-35920 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 21 Jul 2025 Approved with Reservations VIEWS 0 The authors indicate that young people from black and minority ethnic backgrounds are underrepresented in CAMHS services, despite evidence that they may be more vulnerable to mental health problems than their white counterparts. They mention the need for more culturally ... Continue reading I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close The authors indicate that young people from black and minority ethnic backgrounds are underrepresented in CAMHS services, despite evidence that they may be more vulnerable to mental health problems than their white counterparts. They mention the need for more culturally appropriate services. The report provides information related to the evaluation of a new "wellbeing service" for minoritized young people in an urban youth center. There are some issues related to the impact of the service that are covered here but they are only sketchily presented. Although they have set up this new wellbeing service, there is no mention of the specific design, aims and professional activities of the service. (a) For whom specifically was the service intended and what processes were set up - was it a universal programmed or targeted at CYP thought to be at risk? (b) I note that it wasn't codeveloped with the CYP but rather the service providers - was this a problem or potentially a failure; (c) How many CYP used the service overall and how many were approached for the study; (d) what was the ethnic make-up of the youth center and the study participants - do the authors feel this is relevant, and if not, why not? and related (e) where does cultural appropriateness fit in this programmed? The conclusions in the abstract are somewhat banal (requirements for trust and flexibility) whereas the findings in the lay summary provided much more useful information. On these points - it would be useful to see the challenges elaborated more fully. For example, that CYP don't necessarily regard themselves as having a mental health problem and were wary of the 'wellbeing' label for the service. Again, sensitivity to stigma and terminology which may have emerged in a better co-design. This could be covered better. The report could provide more details on the topic guide and the analysis. The report provides information related to the evaluation of a new "wellbeing service" for minoritized young people in an urban youth center. There are some issues related to the impact of the service that are covered here but they are only sketchily presented. Although they have set up this new wellbeing service, there is no mention of the specific design, aims and professional activities of the service. (a) For whom specifically was the service intended and what processes were set up - was it a universal programmed or targeted at CYP thought to be at risk? (b) I note that it wasn't codeveloped with the CYP but rather the service providers - was this a problem or potentially a failure; (c) How many CYP used the service overall and how many were approached for the study; (d) what was the ethnic make-up of the youth center and the study participants - do the authors feel this is relevant, and if not, why not? and related (e) where does cultural appropriateness fit in this programmed? The conclusions in the abstract are somewhat banal (requirements for trust and flexibility) whereas the findings in the lay summary provided much more useful information. On these points - it would be useful to see the challenges elaborated more fully. For example, that CYP don't necessarily regard themselves as having a mental health problem and were wary of the 'wellbeing' label for the service. Again, sensitivity to stigma and terminology which may have emerged in a better co-design. This could be covered better. The report could provide more details on the topic guide and the analysis. - Is the work clearly and accurately presented and does it cite the current literature? Partly - Is the study design appropriate and is the work technically sound? Partly - Are sufficient details of methods and analysis provided to allow replication by others? Partly - If applicable, is the statistical analysis and its interpretation appropriate? Not applicable - Are all the source data underlying the results available to ensure full reproducibility? Partly - Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: mental illness, ethnicity and culture, Health services research, qualitative design CITE HOW TO CITE THIS REPORT Leavey G. Reviewer Report For: Barriers and facilitators to implementation of a community wellbeing service for black, Asian and minoritised young people [version 2; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2025, 5:46 (https://doi.org/10.3310/nihropenres.15120.r35920) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/5-46/v1#referee-response-35920 https://openresearch.nihr.ac.uk/articles/5-46/v1#referee-response-35920 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. - Author Response 23 Sep 2025Sharea Ijaz, University of Bristol Bristol Population Health Science Institute, Bristol, UK23 Sep 2025Author ResponseThank you for your comments that have helped us improve the clarity of our paper. We have addressed the comments by adding details in the manuscript for the points raised. ... Continue reading Thank you for your comments that have helped us improve the clarity of our paper. We have addressed the comments by adding details in the manuscript for the points raised. - The aims of the service, its design and activities were broad and developed as service was implemented. They key aims were to support attending minoritised young people’s mental wellbeing and facilitate appropriate referrals to mental health services. We have now added in the following text in the introduction section to elaborate on the aims and design process for the service as well as target population: - We have clarified on how many CYP attended the new service and were approached for interview. The text now reads: - We have added text describing ethnic makeup of the youth centre and the cultural context of the service providers who developed the service content as follows: The service hub was a 2-hour, weekly, youth activity session run for 11- to 17-year-old CYP in the youth centre where mental health practitioners were present. The aims of the new service were broad, so the specific design and professional activities of the service were not decided a priori and were developed as service was implemented. It was co-developed and facilitated by two youth practitioners from the community centre and two specialist mental health practitioners from the mental health organisation (the service ‘providers’). Majority of the youth and mental health practitioners were from the same community and of Black Asian or Mixed ethnicity. The practitioners discussed and agreed on what the service would comprise of and developed it together, based on their knowledge and experience of looking after minoritised CYPs and their own lived experience of being from minoritised communities. They therefore understood the reluctance and sensitivity around mental health. We held in person and online conversations prior to and during the study with parents and guardians whose children attended the youth centre to inform them about the study. These conversations indicated that parents trusted the setting providers for looking after their children because of their longstanding presence in the community and shared values.- We have added the challenges to the abstract conclusions. The text now reads: - We have added the following text to elaborate on our qualitative analysis methods and report the topic guides in full in supplementary files: Thank you for your comments that have helped us improve the clarity of our paper. We have addressed the comments by adding details in the manuscript for the points raised.Competing Interests: No competing interests were disclosed. Close- The aims of the service, its design and activities were broad and developed as service was implemented. They key aims were to support attending minoritised young people’s mental wellbeing and facilitate appropriate referrals to mental health services. We have now added in the following text in the introduction section to elaborate on the aims and design process for the service as well as target population: - We have clarified on how many CYP attended the new service and were approached for interview. The text now reads: - We have added text describing ethnic makeup of the youth centre and the cultural context of the service providers who developed the service content as follows: The service hub was a 2-hour, weekly, youth activity session run for 11- to 17-year-old CYP in the youth centre where mental health practitioners were present. The aims of the new service were broad, so the specific design and professional activities of the service were not decided a priori and were developed as service was implemented. It was co-developed and facilitated by two youth practitioners from the community centre and two specialist mental health practitioners from the mental health organisation (the service ‘providers’). Majority of the youth and mental health practitioners were from the same community and of Black Asian or Mixed ethnicity. The practitioners discussed and agreed on what the service would comprise of and developed it together, based on their knowledge and experience of looking after minoritised CYPs and their own lived experience of being from minoritised communities. They therefore understood the reluctance and sensitivity around mental health. We held in person and online conversations prior to and during the study with parents and guardians whose children attended the youth centre to inform them about the study. These conversations indicated that parents trusted the setting providers for looking after their children because of their longstanding presence in the community and shared values.- We have added the challenges to the abstract conclusions. The text now reads: - We have added the following text to elaborate on our qualitative analysis methods and report the topic guides in full in supplementary files: COMMENTS ON THIS REPORT - Author Response 23 Sep 2025Sharea Ijaz, University of Bristol Bristol Population Health Science Institute, Bristol, UK23 Sep 2025Author ResponseThank you for your comments that have helped us improve the clarity of our paper. We have addressed the comments by adding details in the manuscript for the points raised. ... Continue reading Thank you for your comments that have helped us improve the clarity of our paper. We have addressed the comments by adding details in the manuscript for the points raised. - The aims of the service, its design and activities were broad and developed as service was implemented. They key aims were to support attending minoritised young people’s mental wellbeing and facilitate appropriate referrals to mental health services. We have now added in the following text in the introduction section to elaborate on the aims and design process for the service as well as target population: - We have clarified on how many CYP attended the new service and were approached for interview. The text now reads: - We have added text describing ethnic makeup of the youth centre and the cultural context of the service providers who developed the service content as follows: The service hub was a 2-hour, weekly, youth activity session run for 11- to 17-year-old CYP in the youth centre where mental health practitioners were present. The aims of the new service were broad, so the specific design and professional activities of the service were not decided a priori and were developed as service was implemented. It was co-developed and facilitated by two youth practitioners from the community centre and two specialist mental health practitioners from the mental health organisation (the service ‘providers’). Majority of the youth and mental health practitioners were from the same community and of Black Asian or Mixed ethnicity. The practitioners discussed and agreed on what the service would comprise of and developed it together, based on their knowledge and experience of looking after minoritised CYPs and their own lived experience of being from minoritised communities. They therefore understood the reluctance and sensitivity around mental health. We held in person and online conversations prior to and during the study with parents and guardians whose children attended the youth centre to inform them about the study. These conversations indicated that parents trusted the setting providers for looking after their children because of their longstanding presence in the community and shared values.- We have added the challenges to the abstract conclusions. The text now reads: - We have added the following text to elaborate on our qualitative analysis methods and report the topic guides in full in supplementary files: Thank you for your comments that have helped us improve the clarity of our paper. We have addressed the comments by adding details in the manuscript for the points raised.Competing Interests: No competing interests were disclosed. Close- The aims of the service, its design and activities were broad and developed as service was implemented. They key aims were to support attending minoritised young people’s mental wellbeing and facilitate appropriate referrals to mental health services. We have now added in the following text in the introduction section to elaborate on the aims and design process for the service as well as target population: - We have clarified on how many CYP attended the new service and were approached for interview. The text now reads: - We have added text describing ethnic makeup of the youth centre and the cultural context of the service providers who developed the service content as follows: The service hub was a 2-hour, weekly, youth activity session run for 11- to 17-year-old CYP in the youth centre where mental health practitioners were present. The aims of the new service were broad, so the specific design and professional activities of the service were not decided a priori and were developed as service was implemented. It was co-developed and facilitated by two youth practitioners from the community centre and two specialist mental health practitioners from the mental health organisation (the service ‘providers’). Majority of the youth and mental health practitioners were from the same community and of Black Asian or Mixed ethnicity. The practitioners discussed and agreed on what the service would comprise of and developed it together, based on their knowledge and experience of looking after minoritised CYPs and their own lived experience of being from minoritised communities. They therefore understood the reluctance and sensitivity around mental health. We held in person and online conversations prior to and during the study with parents and guardians whose children attended the youth centre to inform them about the study. These conversations indicated that parents trusted the setting providers for looking after their children because of their longstanding presence in the community and shared values.- We have added the challenges to the abstract conclusions. The text now reads: - We have added the following text to elaborate on our qualitative analysis methods and report the topic guides in full in supplementary files: Views 0 How to cite this report: Loades M and Dallison S. Reviewer Report For: Barriers and facilitators to implementation of a community wellbeing service for black, Asian and minoritised young people [version 2; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2025, 5:46 (https://doi.org/10.3310/nihropenres.15120.r35819) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/5-46/v1#referee-response-35819 https://openresearch.nihr.ac.uk/articles/5-46/v1#referee-response-35819 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 17 Jun 2025 Approved with Reservations VIEWS 0 This article presents a valuable description of the implementation of a novel and innovative service designed specifically for minoritised young people. The authors have commendably embedded patient and public involvement throughout the research process and drawn on a rich variety ... Continue reading We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above. Close This article presents a valuable description of the implementation of a novel and innovative service designed specifically for minoritised young people. The authors have commendably embedded patient and public involvement throughout the research process and drawn on a rich variety of data sources—including field notes, interviews with both young people and service providers, and basic count data on service attendance. As such, this is a mixed methods study, though the data is primarily qualitative in nature. Overall, the paper makes a useful contribution to the existing literature, particularly by addressing an important gap in understanding how services can be better tailored to meet the needs of young people from minoritised backgrounds. That said, there are a few areas where the manuscript could be further strengthened. Most of these are relatively minor, but three stand out as more substantive. First, some content currently located in the results section might be better placed in the methods section. Moving this information would help readers more clearly understand the study context before engaging with the findings. In particular, restructuring the methods section using conventional subheadings—such as Participants, Procedure, Materials and Measures, Ethical Approval, and Data Analysis—could improve clarity and flow. For example, the description of participants that appears at the beginning of the results section could be moved to the newly created Participants subsection. While approaches can vary, presenting this information earlier would reduce repetition and better support the reader’s journey through the manuscript, reserving the results section for presentation of findings. Second, the description of the data analysis process is currently quite brief. Given the use of an inductive thematic analysis, we encourage the authors to provide a more detailed account of how the analysis was conducted. It would be helpful to reference the specific approach followed—for instance, whether it aligns with Braun and Clarke’s thematic analysis—and to describe the epistemological and ontological positioning that underpinned the analysis. A brief comment on reflexivity in relation to the analytic process would also strengthen the manuscript by helping readers contextualise the findings, or at a minimum a statement on each researchers’ positionality. Third, it doesn’t truly seem to be a mixed methods study as the quantitative data are very limited, please consider whether it is appropriate to call it such. In addition to these main points, we would also encourage the authors to consider the following more minor suggestions: Thank you for the opportunity to engage with this important and timely work. Overall, the paper makes a useful contribution to the existing literature, particularly by addressing an important gap in understanding how services can be better tailored to meet the needs of young people from minoritised backgrounds. That said, there are a few areas where the manuscript could be further strengthened. Most of these are relatively minor, but three stand out as more substantive. First, some content currently located in the results section might be better placed in the methods section. Moving this information would help readers more clearly understand the study context before engaging with the findings. In particular, restructuring the methods section using conventional subheadings—such as Participants, Procedure, Materials and Measures, Ethical Approval, and Data Analysis—could improve clarity and flow. For example, the description of participants that appears at the beginning of the results section could be moved to the newly created Participants subsection. While approaches can vary, presenting this information earlier would reduce repetition and better support the reader’s journey through the manuscript, reserving the results section for presentation of findings. Second, the description of the data analysis process is currently quite brief. Given the use of an inductive thematic analysis, we encourage the authors to provide a more detailed account of how the analysis was conducted. It would be helpful to reference the specific approach followed—for instance, whether it aligns with Braun and Clarke’s thematic analysis—and to describe the epistemological and ontological positioning that underpinned the analysis. A brief comment on reflexivity in relation to the analytic process would also strengthen the manuscript by helping readers contextualise the findings, or at a minimum a statement on each researchers’ positionality. Third, it doesn’t truly seem to be a mixed methods study as the quantitative data are very limited, please consider whether it is appropriate to call it such. In addition to these main points, we would also encourage the authors to consider the following more minor suggestions: - The plain English summary is still quite complex and would be hard to follow in places for a lay reader – we encourage the authors to review and simplify where possible. The NIHR has useful guidance around lay summaries. - It may be helpful to include the topic guides used for interviews as supplementary material, to support transparency and replicability. - While the importance of preserving participant anonymity is fully appreciated, including some basic demographic data—for instance, the mean or median age of participants alongside the age range (which we understand to be 11–15)—would provide valuable context without compromising confidentiality. Similarly, a summary indication of whether participants shared the same minoritised background or represented a range of minoritised groups would help readers consider the transferability of findings to other settings. - A brief definition of what a young people’s advisory group is needed for reader who are not familiar with these. - Results: it was a valuable inclusion to have a paragraph outlining the barriers before delving into each theme, however this was missing for the facilitators section, so it would be helpful to have a paragraph summarising the themes and for consistency. - Finally, it could strengthen the paper if the authors briefly referenced a relevant implementation framework—such as CFIR or RE-AIM—in either the introduction or, more pertinently, the discussion. This framing does not need to be extensive but could support interpretation of the findings and help to situate them within broader implementation science literature. It may also assist in further identifying and framing the directions for future research. In keeping with implementation, it is unclear what ‘implemented’ means here: “The new service was implemented during a 2-hour, weekly, youth activity session ….”, perhaps a different word would better explain this. - Consistency needed on US/UK spelling e.g. minoritised/minoritized - Check for full stops and missing words - Use of the phrase ‘de novo’ – unclear what this means/jargon - Use of ‘(see below)’ is unclear where the authors are directing the reader Thank you for the opportunity to engage with this important and timely work. - Is the work clearly and accurately presented and does it cite the current literature? Partly - Is the study design appropriate and is the work technically sound? Partly - Are sufficient details of methods and analysis provided to allow replication by others? Partly - If applicable, is the statistical analysis and its interpretation appropriate? Not applicable - Are all the source data underlying the results available to ensure full reproducibility? No source data required - Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Child and adolescent mental health provision; clinical psychology CITE HOW TO CITE THIS REPORT Loades M and Dallison S. Reviewer Report For: Barriers and facilitators to implementation of a community wellbeing service for black, Asian and minoritised young people [version 2; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2025, 5:46 (https://doi.org/10.3310/nihropenres.15120.r35819) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/5-46/v1#referee-response-35819 https://openresearch.nihr.ac.uk/articles/5-46/v1#referee-response-35819 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. - Author Response 23 Sep 2025Sharea Ijaz, University of Bristol Bristol Population Health Science Institute, Bristol, UK23 Sep 2025Author ResponseThank you for your feedback and suggestions which have helped improve the clarity of the paper. For the main points raised:- We have moved the details of participants For the main points raised:- We have moved the details of participants to methods section and added headings for different parts of the methods as suggested. - We have added more details on analysis as suggested along with references to underpinning frameworks and comments on reflexivity in the analysis process. The text now reads: In terms of analysing the interview data, following the principles of grounded theory[23], data collection and analysis proceeded in parallel, so that findings from earlier interviews informed the focus of later data collection. The interview transcripts were analysed thematically, using the approach suggested by Braun and Clarke [24].This inductive approach to the analysis ensured findings were based on participants’ accounts and not coded according to the researchers’ pre-existing assumptions or priorities. Researcher bias was also controlled for through the double coding of transcripts and regular discussion between SS and KT about how findings related to the data set. In addition, during data collection, SS discussed interim findings with providers to check our interpretation of the data. Whilst it was felt SS’s ethnicity had facilitated access to the centre and the interviews with providers, it was also felt her gender had hindered the extent to which young men, particularly the 16- and 17-year-olds, using the centre were willing to take part in the research. - We have revised the title to remove reference to a mixed method design. - We have revised the text of the plain language summary to make it simpler and can confirm the readability age to be at 8th grade now according to Flesch-Kincaid Grade Level. - All topic guides are available in supplementary files on Open Science Framework as per NIHR Open guidance: OSF | Improving wellbeing and mental health support for young people from black, Asian and minoritized groups and have been linked as a reference in the manuscript text: (see Supplementary data for topic guides[22]). - We have added the median age, and a reference to the range of ethnic background and for participants as advised on page 10. The text now reads: The six young people interviewed were between 11 and 15 years (Median 13 years). The young people included both boys and girls and represented a range of minoritized ethnic backgrounds. - We have added a definition of YPAG as suggested: A YPAG is a group of volunteer young people who advise on research concerning young people using their lived experience and age specific views. - We have added an introduction sentence to facilitators as suggested: Facilitators to implementation included building trust and relationships with service users and between organisations, and tailoring activities to context. - We appreciate this comment as it has led to us to think about how we were defining implementation during the study. We have now clarified this in the paper, within the discussion, by inserting the following text:The fact that the service developed iteratively during our evaluation meant we identified barriers and facilitators to implementation that related to the characteristics of setting in which the service was delivered, and the relationships and exchanges that were needed for the service to be implemented. Our definition of implementation, therefore, was to what extent the service was being operationalised and not to what extent the service was being delivered as intended. This latter definition is the one that is often used when evaluating complex health interventions and is the definition used within the RE-AIM framework developed to guide this process [28]. This definition, however, assumes the intervention has been fully developed and is clearly defined and structured before being implemented, and that we have some measure or expectation against which to assess implementation. Thus, our paper raises questions about how implementation should be defined and suggests this should depend on to what extent the intervention has been defined prior to it being used in a real-world setting. We have also done a thorough check and addressed the grammatical, jargon and proofing errors.Thank you for your feedback and suggestions which have helped improve the clarity of the paper.Competing Interests: No competing interests were disclosed. Close For the main points raised:- We have moved the details of participants to methods section and added headings for different parts of the methods as suggested. - We have added more details on analysis as suggested along with references to underpinning frameworks and comments on reflexivity in the analysis process. The text now reads: In terms of analysing the interview data, following the principles of grounded theory[23], data collection and analysis proceeded in parallel, so that findings from earlier interviews informed the focus of later data collection. The interview transcripts were analysed thematically, using the approach suggested by Braun and Clarke [24].This inductive approach to the analysis ensured findings were based on participants’ accounts and not coded according to the researchers’ pre-existing assumptions or priorities. Researcher bias was also controlled for through the double coding of transcripts and regular discussion between SS and KT about how findings related to the data set. In addition, during data collection, SS discussed interim findings with providers to check our interpretation of the data. Whilst it was felt SS’s ethnicity had facilitated access to the centre and the interviews with providers, it was also felt her gender had hindered the extent to which young men, particularly the 16- and 17-year-olds, using the centre were willing to take part in the research. - We have revised the title to remove reference to a mixed method design. - We have revised the text of the plain language summary to make it simpler and can confirm the readability age to be at 8th grade now according to Flesch-Kincaid Grade Level. - All topic guides are available in supplementary files on Open Science Framework as per NIHR Open guidance: OSF | Improving wellbeing and mental health support for young people from black, Asian and minoritized groups and have been linked as a reference in the manuscript text: (see Supplementary data for topic guides[22]). - We have added the median age, and a reference to the range of ethnic background and for participants as advised on page 10. The text now reads: The six young people interviewed were between 11 and 15 years (Median 13 years). The young people included both boys and girls and represented a range of minoritized ethnic backgrounds. - We have added a definition of YPAG as suggested: A YPAG is a group of volunteer young people who advise on research concerning young people using their lived experience and age specific views. - We have added an introduction sentence to facilitators as suggested: Facilitators to implementation included building trust and relationships with service users and between organisations, and tailoring activities to context. - We appreciate this comment as it has led to us to think about how we were defining implementation during the study. We have now clarified this in the paper, within the discussion, by inserting the following text:The fact that the service developed iteratively during our evaluation meant we identified barriers and facilitators to implementation that related to the characteristics of setting in which the service was delivered, and the relationships and exchanges that were needed for the service to be implemented. Our definition of implementation, therefore, was to what extent the service was being operationalised and not to what extent the service was being delivered as intended. This latter definition is the one that is often used when evaluating complex health interventions and is the definition used within the RE-AIM framework developed to guide this process [28]. This definition, however, assumes the intervention has been fully developed and is clearly defined and structured before being implemented, and that we have some measure or expectation against which to assess implementation. Thus, our paper raises questions about how implementation should be defined and suggests this should depend on to what extent the intervention has been defined prior to it being used in a real-world setting. We have also done a thorough check and addressed the grammatical, jargon and proofing errors. COMMENTS ON THIS REPORT - Author Response 23 Sep 2025Sharea Ijaz, University of Bristol Bristol Population Health Science Institute, Bristol, UK23 Sep 2025Author ResponseThank you for your feedback and suggestions which have helped improve the clarity of the paper. For the main points raised:- We have moved the details of participants For the main points raised:- We have moved the details of participants to methods section and added headings for different parts of the methods as suggested. - We have added more details on analysis as suggested along with references to underpinning frameworks and comments on reflexivity in the analysis process. The text now reads: In terms of analysing the interview data, following the principles of grounded theory[23], data collection and analysis proceeded in parallel, so that findings from earlier interviews informed the focus of later data collection. The interview transcripts were analysed thematically, using the approach suggested by Braun and Clarke [24].This inductive approach to the analysis ensured findings were based on participants’ accounts and not coded according to the researchers’ pre-existing assumptions or priorities. Researcher bias was also controlled for through the double coding of transcripts and regular discussion between SS and KT about how findings related to the data set. In addition, during data collection, SS discussed interim findings with providers to check our interpretation of the data. Whilst it was felt SS’s ethnicity had facilitated access to the centre and the interviews with providers, it was also felt her gender had hindered the extent to which young men, particularly the 16- and 17-year-olds, using the centre were willing to take part in the research. - We have revised the title to remove reference to a mixed method design. - We have revised the text of the plain language summary to make it simpler and can confirm the readability age to be at 8th grade now according to Flesch-Kincaid Grade Level. - All topic guides are available in supplementary files on Open Science Framework as per NIHR Open guidance: OSF | Improving wellbeing and mental health support for young people from black, Asian and minoritized groups and have been linked as a reference in the manuscript text: (see Supplementary data for topic guides[22]). - We have added the median age, and a reference to the range of ethnic background and for participants as advised on page 10. The text now reads: The six young people interviewed were between 11 and 15 years (Median 13 years). The young people included both boys and girls and represented a range of minoritized ethnic backgrounds. - We have added a definition of YPAG as suggested: A YPAG is a group of volunteer young people who advise on research concerning young people using their lived experience and age specific views. - We have added an introduction sentence to facilitators as suggested: Facilitators to implementation included building trust and relationships with service users and between organisations, and tailoring activities to context. - We appreciate this comment as it has led to us to think about how we were defining implementation during the study. We have now clarified this in the paper, within the discussion, by inserting the following text:The fact that the service developed iteratively during our evaluation meant we identified barriers and facilitators to implementation that related to the characteristics of setting in which the service was delivered, and the relationships and exchanges that were needed for the service to be implemented. Our definition of implementation, therefore, was to what extent the service was being operationalised and not to what extent the service was being delivered as intended. This latter definition is the one that is often used when evaluating complex health interventions and is the definition used within the RE-AIM framework developed to guide this process [28]. This definition, however, assumes the intervention has been fully developed and is clearly defined and structured before being implemented, and that we have some measure or expectation against which to assess implementation. Thus, our paper raises questions about how implementation should be defined and suggests this should depend on to what extent the intervention has been defined prior to it being used in a real-world setting. We have also done a thorough check and addressed the grammatical, jargon and proofing errors.Thank you for your feedback and suggestions which have helped improve the clarity of the paper.Competing Interests: No competing interests were disclosed. Close For the main points raised:- We have moved the details of participants to methods section and added headings for different parts of the methods as suggested. - We have added more details on analysis as suggested along with references to underpinning frameworks and comments on reflexivity in the analysis process. The text now reads: In terms of analysing the interview data, following the principles of grounded theory[23], data collection and analysis proceeded in parallel, so that findings from earlier interviews informed the focus of later data collection. The interview transcripts were analysed thematically, using the approach suggested by Braun and Clarke [24].This inductive approach to the analysis ensured findings were based on participants’ accounts and not coded according to the researchers’ pre-existing assumptions or priorities. Researcher bias was also controlled for through the double coding of transcripts and regular discussion between SS and KT about how findings related to the data set. In addition, during data collection, SS discussed interim findings with providers to check our interpretation of the data. Whilst it was felt SS’s ethnicity had facilitated access to the centre and the interviews with providers, it was also felt her gender had hindered the extent to which young men, particularly the 16- and 17-year-olds, using the centre were willing to take part in the research. - We have revised the title to remove reference to a mixed method design. - We have revised the text of the plain language summary to make it simpler and can confirm the readability age to be at 8th grade now according to Flesch-Kincaid Grade Level. - All topic guides are available in supplementary files on Open Science Framework as per NIHR Open guidance: OSF | Improving wellbeing and mental health support for young people from black, Asian and minoritized groups and have been linked as a reference in the manuscript text: (see Supplementary data for topic guides[22]). - We have added the median age, and a reference to the range of ethnic background and for participants as advised on page 10. The text now reads: The six young people interviewed were between 11 and 15 years (Median 13 years). The young people included both boys and girls and represented a range of minoritized ethnic backgrounds. - We have added a definition of YPAG as suggested: A YPAG is a group of volunteer young people who advise on research concerning young people using their lived experience and age specific views. - We have added an introduction sentence to facilitators as suggested: Facilitators to implementation included building trust and relationships with service users and between organisations, and tailoring activities to context. - We appreciate this comment as it has led to us to think about how we were defining implementation during the study. We have now clarified this in the paper, within the discussion, by inserting the following text:The fact that the service developed iteratively during our evaluation meant we identified barriers and facilitators to implementation that related to the characteristics of setting in which the service was delivered, and the relationships and exchanges that were needed for the service to be implemented. Our definition of implementation, therefore, was to what extent the service was being operationalised and not to what extent the service was being delivered as intended. This latter definition is the one that is often used when evaluating complex health interventions and is the definition used within the RE-AIM framework developed to guide this process [28]. This definition, however, assumes the intervention has been fully developed and is clearly defined and structured before being implemented, and that we have some measure or expectation against which to assess implementation. Thus, our paper raises questions about how implementation should be defined and suggests this should depend on to what extent the intervention has been defined prior to it being used in a real-world setting. We have also done a thorough check and addressed the grammatical, jargon and proofing errors. Alongside their report, reviewers assign a status to the article: - Approved - Approved with reservations - Not approved | Invited Reviewers | ||| |---|---|---|---| | 1 | 2 | 3 | | | Version 2 (revision) 23 Sep 25 | read | read | | | Version 1 15 May 25 | read | read | Sign up for content alerts You are now signed up to receive this alert Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' - Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. - You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. - You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). - You work at the same institute as any of the authors. - You hope/expect to benefit (e.g. favour or employment) as a result of your submission. - You are an Editor for the journal in which the article is published. 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