Experts’ consensus on using social capital in interventions to promote adolescents’ mental health: A qualitative Delphi Study

Experts’ consensus on using social capital in interventions to promote adolescents’ mental health: A qualitative Delphi Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Experts’ consensus on using social capital in interventions to promote adolescents’ mental health: A qualitative Delphi Study Kennedy Sigodo, Kerri McPherson, Jens Nygren, Antony Morgan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6479008/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract There is convincing evidence for the positive links that exist between social capital and adolescent mental health. However, utilisation of social capital in interventions to promote adolescent mental health remains complex. This study aims to fill this gap by identifying the areas of agreement and contention on utilising social capital in interventions to promote adolescents' mental health. A two-round qualitative e-Delphi study built on a scoping review from a larger research project is used to collect experts' perceptions on social capital and its application in interventions seeking to promote the mental health of adolescents. The findings show three main overlapping actions characterising social capital interventions: Initiating or creating connections, enhancing existing connections and creating awareness of the benefits of social capital. Structural social capital is perceived by most experts as easier to simulate in interventions than cognitive social capital. However, cognitive social capital is more proximal to mental health outcomes than structural social capital in the pathway linking social capital actions to adolescent mental health. The study finds the view of social capital as a property of individuals to be of greater theoretical and practical advantage in adolescent mental health interventions than the perception of social capital as a public good. Myriads of contextual factors determine the need, type, and success of social capital interventions within different settings. The findings of this study support the application of social capital in practice by identifying the actions, processes and prerequisites for developing social capital interventions to promote adolescents’ mental health. Preventive Medicine Sociology Psychology Social Work Social capital adolescent mental health health promotion e-Delphi study social capital intervention Figures Figure 1 Figure 2 Figure 3 1. Introduction Social capital, an idea that social connections are valuable resources to individuals and society, is an important determinant of health (Moore and Kawachi, 2017 ). Social capital’s relationship to health has led to its expansion from its founding disciplines of sociology, economics and political science to form a central construct in health and wellbeing (Moore and Kawachi, 2017 ; Campbell, 2020 ). For this study, the extant evidence has shown a general acknowledgement of the concept’s potential in promoting adolescent mental health (McPherson et al., 2014 ; Morgan et al., 2021 ). However, despite the increase in the understanding and acknowledgement of social capital as a powerful and vital tool in changing individual and community health outcomes, its utilisation in interventions to promote adolescents’ mental health remains complex (Knorst, Vettore and Ardenghi, 2022 ). The complexity results from unresolved conflicts that negatively affect its use in public health interventions (Moore and Kawachi, 2017 ). Firstly, there is a deficiency in understanding the association between various dimensions and constructs of social capital and their determinants and consequences (Li, 2015 ). Secondly, the increase and fragmented nature of social capital research has further exacerbated this problem by focusing on one or a combination of constructs. For instance, studies have deliberately focused on constructs such as trust (Moore et al., 2011 ; Carpiano and Fitterer, 2014 ), sense of belonging (Ahn and Davis, 2020 ), and social networks (Moore et al., 2011 ). The rationales for privileging selected aspects are far from consistent. For example, while sense of belonging is overlooked by some researchers, such as Schaefer-McDaniel ( 2004 ), several other researchers have considered it a vital element in the building of social capital through influencing participation (Wellman et al., 2001 ), understanding inclusion and exclusion (Morrow, 2001 ), and reciprocity within the neighbourhood (Mata and Pandekur, 2014). This fragmentation of social capital, while intended to enhance the concept's comprehensibility and conceptualisation, has aroused more questions than answers. This avalanche of perspectives further casts doubts on the theoretical readiness of social capital to be used in designing public health interventions and makes operationalisation of the concept problematic. Arguably, getting a systemic understanding of social capital from the multiple fragmented studies has proved challenging. Rostila ( 2011 ) suggests that the solution is to agree on the crucial dimensions of the concept and distinguish the core dimensions of social capital from other structural and cognitive dimensions of social relationships. This study aimed to build on the previous works on social capital interventions designed to promote adolescents’ mental health (Wu, Tsang and Ming, 2012; Ogden, Morrison, and Hardee, 2014 ; Wu, 2017 ), and extends the extant knowledge by determining the areas of agreement and contention on the best ways to utilise social capital in interventions aiming to promote adolescents’ mental health. It sought to achieve this aim through the following objectives structured using a generic theory of change framework: 1. To determine the nature of actions required to obtain social capital outcomes. 2. To explore the relationship between intervention’s actions and outcomes and between various outcomes in the process linking social capital and mental health. 3. To identify indicators that enable assessment and evaluation of progress and measuring change during and after implementation of a social capital intervention. 4. To explore the contexts in which a social capital theory of change will work in interventions to promote the mental health of adolescents. 2. Methods 2.1 Preliminary scoping review A preliminary scoping review undertaken in the larger study enabled the identification of the nature and scope of literature on social capital and adolescents’ mental health. It identified gaps and contentions in the existing literature that created the foundation for this Delphi study by partly informing the development of the first-round questionnaire. Scoping reviews are useful for identifying the scope of literature on a given concept, gaps in the extant literature, clarifying concepts, and exploring the conduct of research around a concept (Peters et al., 2015 ; Munn et al., 2018 ). 2.2 Delphi process 2.2.1 Survey development A two round qualitative e-Delphi study was used to access experts’ perceptions on social capital and its application in interventions seeking to promote adolescents’ mental health. The unique characteristics of the Delphi technique are associated with its strengths that include making clear the plurality of opinions over a subject matter, enabling structured debate, minimising influence by dominant experts, and establishing agreements and disagreements on subjects (Landeta and Barrutia, 2011 ). Delphi approach enabled capturing most recent views of authors, some of whom may have changed stances after their publications. Also, Delphi approach’s iterative process through controlled feedback enabled experts to re-examine their perspectives leading to offering additional supporting critiques or changing their views in light of differing opinions from other experts. First-round questionnaire comprised a mixture of closed and open-ended questions structured using a generic theory of change model. Hence, the questionnaire comprised questions on pathways, interventions, indicators, and assumptions as per the objectives. Unlike, in the traditional Delphi where initial questions or preselected items are generated in the exploratory first round, the preliminary scoping review enabled this study to go directly into the main questions of concern without the exploratory round. The approach used in this study improved the initial response rate and provided a firm grounding in the existing literature. The questions in the second-round questionnaire were developed from the round-one findings. Specifically, the round-two questions sought clarifications on the contentious issues identified from analysing the data collected in the first round. Following completion of each of the two rounds, feedback comprising a summary of combined findings, anonymised justifications and experts’ own responses was shared with them. This step was referred to as analysis and dissemination in Fig. 1 below. The controlled feedback feature of the Delphi technique gives it an advantage over other consensus methods such as focus groups. However, controlled feedback has been associated with bias emanating from the ‘bandwagon effect’ (Winkler and Moser, 2016 ). This is where some panellists may change their responses to comply with what they perceive as the majority view. This effect was reduced in this study by ensuring anonymity. According to Tsikerdekis ( 2013 ), anonymity limits conformity by ensuring that panellists do not side with the renowned names on given subjects. 2.2.2 Selecting members of the panel This study adapted the guideline by Okoli and Pawlowski ( 2004 ) to select the panel of experts. This approach of selecting participants ensured that a purposeful mix of experts was included in this study. The selection process is summarised in the table below. Table 1 Process of selecting panel members Step 1 Identified suitable categories of experts. Experts were divided into three main categories: academics, practitioners, and practising academics. Step 2 Each of the three categories was populated with names. Academics and practicing academics were recruited based on authorship of articles included in the preliminary scoping review of literature on social capital and adolescent mental health and corroborated by publicly available institutional staff profiles detailing research interests. Practitioners were selected using snowballing technique through referrals from study contacts working with adolescents in programmes. Step 3 Experts were contacted via email and asked to nominate other experts. Step 4 Due to not meeting the target size of 25 all participants who met the eligibility criteria were invited to take part in the study. 2.2.3 Survey distribution An email with the link to the online survey was sent to all participants for each round. This study utilised a commercially available online survey tool ‘Jisc online surveys’ to collect data through sharing a link to the questionnaire with the panel members. A deviation or ineffectiveness of the survey questionnaire, the mode of delivery or the participants could introduce errors or bias (Wells, Bailey, and Link, 2014 ). This study ensured the three components worked together for the success of this Delphi study by ensuring a suitable panel and an online questionnaire accessible via any device with internet connection. Despite some finding no significant variations between smartphone and personal computer delivery modes (Wells et al., 2014 ), others argue that delivery modes can potentially affect the responses obtained through a questionnaire by causing differences in approximations, social desirability bias, and recall order effects (Bowling, 2005). 2.3 Data analysis Qualitative data analysis from each of the two rounds was informed by Boyatzis’s ( 1998 ) and Braun and Clarke’s ( 2006 ) guidelines and occurred in the following stages using NVivo version 12: Stage 1 Involved familiarising with the responses through repeated reading and development of initial codes. Stage 2 Data was re-read and the initial codes were rearranged into sub-themes. Stage 3 The sub-themes were categorised under specific themes based on similar patterns and meaning. Stage 4 For round one, the specific themes were categorised under the four predetermined themes summarised in Table 2 with those that did not fall under the categories presented as independent themes. In contrast, round 2 findings were organised under the contentions emerging from round-one. Stage 5 Excerpts from the raw data were extracted to support the themes within each of the four categories. Quantitative data analysis using Microsoft excel generated descriptive statistics for participants’ characteristics and findings from closed ended questions. Table 2 Description of predetermined themes from the four components of a theory of change framework Theory of change framework component Predetermined themes Interventions The actions embedded in social capital interventions Pathways Stepwise process through which interventions’ actions lead to mental health outcomes Assumptions Circumstances under which the social capital interventions work Indicators How to track progress and measure changes in social interactions 2.4 Ethical clearance Ethical clearance to undertake this study was obtained from Glasgow Caledonian University (Ref no: GSBS EC013). All ethical considerations when working with human participants such as confidentiality, privacy, informed consent and voluntary participation were ensured throughout this study. 3 Results 3.1 Participant characteristics Following recruitment, 19 participants were included in the study. Five pilot participants were added to the main study increasing the sample size to 24 participants. The average years of work experience of the recruited participants was 11.14 years across the two rounds. 17 out of the 24 participants were female. Sixteen identified themselves as academics, four as practitioners, and the other four as practising academics. Tables 2 and 3 show a summary of the characteristics of the participants involved in the study. Most participants were from Europe (10), followed by North America (5). A similar number of participants were from Australasia (4) and Africa (4), whereas one participant identified as global. Out of the 24 participants who took part in the round one of the Delphi, 21 advanced to the second round. This accounted for 12.5% attrition as shown in the Table 3 below. Table 3 Characteristics of participants and attrition percentage Participant characteristics Round-one Round-two Years of experience Average: 10.99 11.29 Gender Male (%) Female (%) 7 (29%) 17 (71%) 5 (24%) 16 (76%) Professional background Academic 16 (66.7%) 14 (66.7%) Practitioner 4 (16.7%) 3 (14.3%) Practising academic 4 (16.7%) 4 (19%) Region of work Africa 4 (16.6%) 3 (14.3%) North America 5 (20.8%) 4 (19.0%) Europe 10 (41.7%) 9 (42.9%) Australasia 4 (16.6%) 4 (19.0%) Global 1(4.2%) 1 (4.8%) Participation Participated in the round 24 21 Attrition 3 (12.5%) 3.2 Round one results The findings of first round were organised under the predetermined thematic areas constituting the key components of a generic theory of change framework summarised in Table 2 . 3.2.1 Interventions: Actions required to obtain social capital outcomes Social capital interventions suggested by the panellists comprised of the following three actions: initiating or creating connections, enhancing existing connections and creating awareness of the benefits of social capital. Sample interventions cited by the panellists included awareness campaigns and educational interventions aimed at adolescents, parents, teachers, and community members. One expert mentioned: Interventions providing financial support to families can help family spend more time socialising with their children hence building social capital for them…Education programmes can also educate parents on building positive parent-child relationship…educate teachers on promoting positive teacher-student relationship thereby promoting building of school social capital. (P01) There was no clear-cut distinction due to the overlap of actions constituting these interventions. For instance, an intervention meant to initiate networks could also lead to the strengthening of existing bonds. Overall, the panellists described desirable interventions as diverse, open, accessible, acceptable, repeated, interactive and supportive. Contentions The panellists showed divergent opinions on whether social capital could be built or created using interventions. Participants who argued that social capital could not be created explained that people could benefit from social capital without necessarily participating in any network. For instance, being in a neighbourhood where others take care of their local area and information easily spreads could enable a person to enjoy clean surroundings and obtain information passively. 3.2.2 Pathways: The relationship between the intervention’s actions and outcomes and between various outcomes that lead to an impact The panellists mentioned different pathways through which social capital led to mental health outcomes for adolescents. For instance, Degree of trust, knowledge and strength of networks an individual has, contributes to their degree of belonging, which is core to mental wellbeing. (P04) …through social interaction and engagement with people at the centre, the patients can feel less isolated which can create a sense of belonging/connectedness resulting in positive emotions, prevent depression and result in happiness and positive mental health of the patients. (P01) Relate to social identity and feelings of belonging, including feelings of social support and solidarity. This has a clear relationship to mental health and general wellbeing. (P22) Social connection validates oneself and contribute to build their identity which is key to maintaining and developing mental well-being. (P20) The panellists’ responses, such as those shown above, were synthesised by being broken down into individual steps to map the perceived stepwise process. The pathways linking the interventions and the mental health impact revealed immediate and intermediate outcomes. Immediate outcomes from interventions led to intermediate outcomes that were proximal to mental health impact as shown in Fig. 2 below. Contentions Some panellists advocated using other theories such as the attachment theories of Bowlby and the theory of human action to explain mechanisms linking social capital and mental health. This group of panellists partly associated the use of the term ‘social capital’ with the contentions surrounding the concept and its utilisation in interventions. Further, they suggested terms such as community development and social cohesion as more feasible and acceptable than social capital. 3.2.3 Indicators: Variables for tracking progress and measuring changes in social interactions Participants cited a broad range of potential indicators that could be used in social capital interventions. The choice of an indicator depended on multiple parameters including: Conceptualisation of social capital and its elements Intended health outcome/s Level of intervention – Individual level, family level, community level, school level Whilst there was consensus on the choice, the use of indicators in evaluation varied. Some panellists considered evaluation as a great hindrance to social capital. They explained that there were not enough ways of undertaking a complete assessment. …assess not just the number of ties, but the nature of these ties and the resource value of them. (P06) There was a variation in the perceived need to clarify the theoretical basis of social capital informing an intervention. For instance, other panellists indicated a crucial requirement for a clear understanding of constructs such as trust and social cohesion as used in a given intervention. Also, panellists differed in their preferences for Coleman’s, Putnam’s, Bourdieu’s, and other social capital authors’ conceptualisations as they relate to adolescents. Some panellists thought some conceptualisations were better developed to inform interventions involving adolescents’ mental health. One panellist explained: The Colemanesque, individual-level approach to social capital seems better suited to interventions to promote mental health, but many policy-based interventions will seek to work at more aggregated or abstracted units of analysis and may be less effective. (P12) I prefer to use Bourdieu's definition - social networks and connections and sociability - interlinked with other forms of capital - cultural, economic etc - over Putnam's. (P24) Some panellists stated that certain elements such as sense of belonging could be both an outcome and a construct of social capital. All these extraneous variables could potentially be seen as part of social capital itself. (P19) Methods such as questionnaires, interviews, social network analysis, use of existing measures, survey methods were mentioned as used to measure social capital. 3.2.4 Assumptions: Circumstances under which social capital interventions will work Experts explained that contextual factors were necessary to identify intervention design, implementation, and adaptation. The contextual variables were classified into seven categories, including time, community factors, intrapersonal characteristics, family factors, economic factors, environmental factors, and intervention factors. The assumptions are summarised in the Table 4 below. Table 4 Assumptions for successful social capital interventions Factor Impact on success of intervention Time Contact time or duration needed to be considered as some social capital elements can only be changed over a long duration Community factors According to the experts, social stability, social cohesion, homogeneity of the community, intergenerational closure, suitability of social spaces and social connections, political goodwill, positive peer pressure and influence, and presence of neighbourhood social capital were necessary for successful interventions Intrapersonal characteristics Most of the experts alluded that the sociability of adolescents, education level, ethnicity, marital status, health status, school bullying, and school residency (school social capital), and stage in life, gender, age, and social behaviour patterns determined the success of any social capital intervention. Family factors Family resources, family connections, and family structure; the quality of the parent-child relationship; adult interest in the child (e.g., involvement with school); parental monitoring, and extended family support were crucial for meaningful use and gains from social capital interventions Economic Factors Participants mentioned this in the forms of poverty and socioeconomic inequalities and their effects on social capital elements. Socioeconomic status was generally deemed crucial in determining the different impacts on the process of linking social capital with mental health outcomes Environmental factors Structural and institutional factors, social infrastructure, community assets, and geographical location were stated as enablers or inhibitors depending on the impact they had on social capital Intervention factors Programme leaders’ level of understanding about social capital theory and its application in practice, sufficient funds to start up and sustain an intervention to the required level, presence of incentives, intervention staff’s morale, and level of participation of the target population were explained to be significant determinants of interventions’ success The existing variations in the factors named above explain how social capital’s and its association with health outcomes differ among individuals and communities. Contentions Due to the many confounding factors influencing the association of social capital and mental health outcomes, attributing impacts and outcomes solely to social capital interventions but not to other social determinants of health was seen by some experts as contentious. 3.3 Round two results The round-two results were obtained by eliciting further discussions on the contentions from round-one of data collection. These were organised under the contentions emerging from round-one. 3.3.1 Variations in perceived amenability of social capital to interventions One of the first round’s contentions was the significant variation in panellists’ perceptions of whether the processes linking social capital to mental health outcomes could be simulated in interventions. Exploring the cause of the varied perceptions during round-two, experts explained that the differences in their individual experiences caused the disparities in the previous round. The experts had notions of what works from the interventions they had previously undertaken. One of the experts stated: Level of experience in real world interventions probably differs btwn respondents on the degree to which public health interventions are successful in dealing with young people's mental health at all. (P23) In addition to their experience, the experts’ perceptions of the amenability of social capital’s constructs to interventions depended on their knowledge and belief in what works or does not. Some experts explained that the contextual nature of social capital made it difficult to replicate interventions in different environments. The experts cited the complexity of the society, the multiplicity of confounding factors, and differences among the sub-segments of the population as reasons why it was difficult to simulate social capital processes in interventions. Among the panellists who did not agree with the amenability of social capital processes to interventions were those who, despite agreeing that social capital could neither be commanded nor overly controlled, expressed optimism that social capital could be nurtured by providing conditions for growth. 3.3.2 Ease and difficulty of using specific constructs of social capital in interventions Those who agreed that social capital could be created explained that simulation in intervention was a matter of ease and difficulty rather than possibility and impossibility. They identified some constructs of social capital as easy and others as difficult to create or influence in interventions. To determine which constructs were easy or difficult to simulate in practice, social capital constructs were extracted from the pathways linking social capital to mental health outcomes emerging from participants’ responses in the first round. For instance, an excerpt such as “…relate to social identity and feelings of belonging, including feelings of social support and solidarity… this has a clear relationship to mental health and general wellbeing” yielded the following constructs: social identity, sense of belonging, social support and solidarity. These constructs were listed in the round-two questionnaire, and experts were asked to identify the ease or difficulty of using them in interventions involving adolescents. The findings showed that there is variation in the perceived ease and difficulty of simulating social capital constructs in interventions. Figure 3 shows that constructs such as social engagement, social interaction, awareness, role modelling, social ties and participation were deemed as easy to influence by interventions. In contrast, constructs such as solidarity, emotional support, social approval, trust, reciprocity, sense of belonging, social norms and empowerment were seen as difficult to influence in interventions. Having identified the ease or difficulty, a follow-up question sought to get the criteria or rationale used by the panellists to decide whether a social capital construct was easy or difficult to simulate in intervention. The experts explained that their decision to categorise a construct as easy or difficult to simulate in interventions depended on the conceptualisation and dimension of construct, the level and nature of actions needed to influence the construct in interventions and the applicability of the given constructs to adolescents. Constructs such as social norms were perceived to have more stable characteristics grounded in culture and institutions. The stability of the construct was associated with a reduced predilection to change and a longer time to realise change, if any. Others argued that approaches that include norms were based on social constructivism that would inevitably require a change in the nature of subjective human experience, making them difficult to develop using an intervention. One of the panellists stated that ease and difficulty were a matter of conceptualisation of the construct and noted that more abstract constructs would be more challenging to influence. Also, a few other practitioners in the panel used experiential knowledge to inform their sense of ease or difficulty. Still, belief was also cited as a criterion among the practitioner participants. One of the participants stated: …whether I believed I, or others, could design an intervention to increase the specific aspect. (P08) It was generally agreed that it is easier to simulate structural constructs of social capital in interventions compared to cognitive constructs. Regarding nature and level of actions to be carried out. Constructs deemed to require sustained engagement or longer durations and broader changes to the social, cultural, belief, and value systems for successful intervention were considered difficult to influence in interventions. The perceived level of control of practitioners when undertaking interventions was also cited as a determinant of the ease or difficulty of creating or using a given construct in intervention. Aspects of constructs that could be highly controlled by intervention personnel were deemed to be easy and vice versa, as stated by a participant: Aspects that can be controlled by third parties were deemed easy. For instance, not sure how interventions can improve trust among two parties. Same as reciprocity and others tagged as difficult. (P21) The level of action, whether interventions were at the individual or community level, was also seen as a factor influencing perceived ease or difficulty in application. One expert wrote: …some aspects are interpersonal or at the family level (social ties and engagement), but others are more structural and contextual, which take much longer to change (i.e. social norms). (P13) The types of actions needed to influence the constructs were cited as a determinant of ease or difficulty. For instance, the ability to easily control a construct through education, sensitization, and regulation qualified a construct as easy to simulate in intervention. …as a collective resource, social capital may appear difficult to develop in what are very often individually delivered public health interventions. (P02). Overall, most panellists’ view was that social capital interventions are best targeted at the individual level in adolescent mental health interventions. Panellists stated that a construct’s applicability to adolescents determined their perception of its ease or difficulty to utilise in adolescents’ interventions. The second round showed that the experts agreed that adolescents’ social lives differed from adults’. Hence, there was a need to define and conceptualise social capital constructs to suit adolescents’ social lives. For instance, one participant who declined to comment on the ease and difficulty of the listed social capital constructs mentioned the need for such to be explained in relevance to adolescents. Suggesting that the meaning of these concepts varied with age. The participant stated: I can't really answer these questions, as they represent copious ill-defined concepts that need deconstructing and explaining before they can be acted upon. E.g. what is meant by 'trust'? 'Empowerment' etc. for 14-19-year olds? (P03) 3.3.3 Overcoming evaluation challenges The participants reiterated that social capital interventions were context specific, and so were the outcomes of interest. Hence, panellists stated the importance of accounting for contextual variations to overcome evaluation challenges. They explained the need for holistic assessment of contexts, not solely focusing on the social but also considering the cultural and biological contexts. This was presented as useful for mapping all factors that may influence interventions’ processes and actual impact. According to one of the panellists, resolving evaluation issues requires assumptions underlying social capital be based on a solid action-theoretical foundation that is explicit. Another suggestion from a panellist was to utilise complexity theory when undertaking an evaluation of social capital. The experts compared the challenges facing the evaluation of social capital to those facing the evaluation of complex interventions. Despite the difficulty of evaluating social capital, panellists explained that the challenges could be overcome by clearly conceptualising and defining social capital and the selected constructs at the beginning of the intervention and applying the most appropriate evaluation method. Most panellists agreed that overcoming evaluation challenges was a matter of overcoming paradigm challenges. They explained that limiting the evaluation of social capital to quantitative approaches was inadequate. Hence, adding qualitative methods to the predominant quantitative methods was presented by some panellists as a way to improve the evaluation challenges: …qualitative research might better capture social capital outcomes and effects of interventions since it may not be easily quantifiable. (P13) The addition of qualitative methods was explained to account for the variation in contexts and thereby aid in contextualising the evaluation of social capital interventions. …social capital is very difficult to measure in a general sense, but most scholars agree that it can be qualified in a specific context. (P22) Some of the methods suggested included longitudinal qualitative interviews. The expert panellists also suggested the use of advanced quantitative approaches to mitigate the influence of context on evaluating social capital. …maybe more complex measures, such as latent variable measures that look at underlying constructs, and indices could be useful. (P13) There was a general agreement that contextualising the evaluation of social capital could be resolved with the appropriate use of mixed qualitative and quantitative methods. Participation was cited as another way of overcoming evaluation challenges. This was deemed essential for two main reasons. Firstly, working with adolescents offered an opportunity to develop a deeper understanding of processes that matter to them. Secondly, involving adolescents enabled exploring effective evaluation solutions. Other participants explained that evaluation should be included right from the implementation or development stage. Measures of social capital should be properly defined at the start of the intervention. (P21) 4. Discussion The findings summarise the actions in social capital interventions as initiating or enhancing connections, or building awareness of benefits of social networks. The decision to create or strengthen networks or create awareness of social capital can be compared to Lin’s ( 2001 ) dichotomy of expressive or instrumental actions depending on whether an individual has networks or not or whether they are aware or not. According to this study’s findings, instrumental actions enable adolescents to create networks or relationships they do not have. In contrast, expressive actions are those taken to enhance the networks or relationships the adolescents already possess. Lin ( 2001 ) argued that these actions are mutually reinforcing. That is, an intervention may create awareness about the benefits of social capital and strengthen adolescents’ extant social networks while enabling the creation of new networks. This study shows experts’ preference for using network approaches over communitarian approaches in social capital interventions. Network approaches focus on social relationships and access to resources, whereas communitarian approaches view social capital as social features such as civic participation and trust (Moore, Salsberg, and Leroux, 2013 ; Moore and Kawachi, 2017 ). Moore et al. ( 2005 ) previously supported the preference for network over communitarian approaches in public health interventions by arguing that the former reorients focus on the structure of relationships and underscores the effects of non-spatial contexts on individuals and public health which dispels the dilemma of defining a ‘community’ that is faced when using the social cohesion approach. Conceptual differences among the experts were an important cause of the variations in their perspectives on whether social capital could be simulated in interventions and the ease and difficulty to operationalise its constructs. Similar sentiments have been conveyed by Pendley, Mock, and Theall ( 2020 ), who explain that how one defines social capital influences how one operationalises and measures the concept. Moore, Salsberg, and Leroux ( 2013 ) similarly found that conceptualisation has implications for the intervention. Hence, there is an imperative need to clearly define concepts, unearth assumptions underlying conceptual approaches to social capital and establish working concepts specifically for adolescents when designing social capital interventions. This study found a preference for the individual rather than communal concept of social capital in interventions targeting adolescents. That is, the view of social capital as an individual property that they can use to access personal benefits presented more clarity for adolescent mental health interventions compared to the view of social capital as a property of communities that enable collective action. Indeed, Portes ( 1998 ) argued that social capital at the individual level, not the communal or aggregate level, possesses the greatest theoretical value. Similarly, Rostila ( 2011 ) reiterates that the individual approach to social capital has a better theoretical advantage due to the clarity, unlike collective definitions. On pathway or mechanisms linking social capital to mental health impact, the study found that immediate outcomes of social capital interventions are of a structural dimension and precede the constructs of the cognitive dimension of social capital, which are closer to mental health impact. This temporal sequence of structural and cognitive dimensions is corroborated by numerous studies. For instance, a prospective study conducted in the United States of America (USA) by Fujiwara and Kawachi ( 2008 ) found that higher levels of cognitive social capital were linked to lower risk of developing major depression. In contrast, there was no association between structural dimensions and major depression. Reviews by De Silva et al. ( 2005 ) and Ehsan and De Silva ( 2015 ) found more substantial evidence linking cognitive social capital to mental health compared to structural social capital. Wong et al. ( 2019 ), found that structural social capital positively influenced cognitive social capital, which then alleviated depression. Also, they found an indirect link between structural social capital and mental health but not a direct one. This shows that the effect of structural social capital on mental health is mediated by cognitive social capital (Wong et al., 2019 ). While other studies argue that the formation of a cognitive construct such as trust precedes the creation and extension of networks (Dufur et al., 2019 ; Ahlborg, 2022 ), this study’s findings evidence that structural social capital in the form of networks forms the structures through which trust, reciprocity, sense of belonging, social support and many other constructs of cognitive social capital dimension develop and influence mental health outcomes. The pathway explaining the link between action, structural social capital, cognitive social capital and mental health impact is subject to a range of contextual factors. This finding reiterates Shiell, Hawe, and Kavanagh’s ( 2020 ) assertion that social capital interventions are some of the most sensitive to context. Nonetheless, considering the confounding factors increases the explanatory power and measurement of social capital (Kim et al., 2008 ). 4.1 Strengths and limitations of the study The panel of experts included academics adept with theory and practitioners with a variety of experiences about what works in real-life. The constitution of the panel enabled co-creation of intervention knowledge between academics and practitioners which is key to linking theory and practice and reducing the implementation gap in interventions applying social capital. However, two-thirds of the panel comprised experts working in academia, the remaining split evenly between practising academics and practitioners. This could have led to findings that were more representative of the majority group in the panel, especially in the case of this study where the responses were analysed together. Analysing the findings from the three main groups separately could have enabled a comparison of the responses to identify any similarities and differences. Despite the data presented in this publication being a few years old, the prevailing debates and complexities in understanding the mechanisms between social capital and adolescent mental health and the application of the former in interventions persist (Bosqui et al., 2024 ). 5. Conclusion This study aimed to establish general agreements on using social capital to promote mental health of adolescents in public health interventions. It achieved this aim by clarifying some of the contentions that have long hindered the utilisation of social capital interventions seeking to promote adolescent mental health. The study shows the ease of modifying networks in interventions over changing cognitive constructs of social capital. The study confirms that the view that individuals stand to gain from resources inherent in social groups presents itself as a more practical conceptualisation of social capital for adolescent mental health interventions than the perception of social capital being an enabler of community action. The findings of this study reveal proximal nature of cognitive social capital to mental health, hence, showing the temporal sequence from structural to cognitive social capital constructs in the pathway leading to mental health changes in adolescents. The findings of this study provide the rationale for using specific constructs and conceptualisation of social capital, thereby, enabling evidence informed decision making when developing social capital interventions. Future works should seek to empirically test the emergent pathways through quantitative studies to further bolster the evidence for recommendations made in this study. Declarations The authors declare that there is no conflict of interest regarding the publication of this paper. Acknowledgements This research was supported by the Glasgow Caledonian University PhD Studentship [GCUL2018002Morgan]. The authors acknowledge the support of Dr Eufrasiah Mero in reviewing the final manuscript and offering insightful comments. Data Availability The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. References Ahlborg, M. (2022). Social capital and inequalities in mental health among young adolescents in Sweden (Doctoral dissertation, Halmstad University Press). Available at:http://hh.diva-portal.org/smash/get/diva2:1636492/FULLTEXT01.pdf (Accessed: 02/1/2025) Ahn, M.Y. and Davis, H.H. (2020). Sense of belonging as an indicator of social capital. International Journal of Sociology and Social Policy . https://doi.org/10.1108/IJSSP-12-2019-0258 Bosqui, T., Mayya, A., Farah, S., Shaito, Z., Jordans, M.J., Pedersen, G., Betancourt, T.S., Carr, A., Donnelly, M. and Brown, F.L., 2024. Parenting and family interventions in lower and middle-income countries for child and adolescent mental health: A systematic review. Comprehensive psychiatry , p.152483 https://doi.org/10.1016/j.comppsych.2024.152483 Bowling, A. (2014). Research methods in health: investigating health and health services . McGraw-hill education (UK). Boyatzis, R.E. (1998). Transforming qualitative information: Thematic analysis and code development . sage. Braun, V., Clarke, V. (2006). Using thematic analysis in psychology. Qual. Res. Psychol. 3(2), 77–101 https://doi.org/10.1191/1478088706qp063oa Campbell, C. (2020). Social capital, social movements and global public health: Fighting for health-enabling contexts in marginalised settings. Social Science & Medicine , 257 , p.112153. https://doi.org/10.1016/j.socscimed.2019.02.004 Carpiano, R.M. and Fitterer, L.M. (2014). Questions of trust in health research on social capital: what aspects of personal network social capital do they measure?. Social science & medicine , 116 , pp.225-234. https://doi.org/10.1016/j.socscimed.2014.03.017 De Silva, M.J., McKenzie, K., Harpham, T. and Huttly, S.R. (2005). Social capital and mental illness: a systematic review. Journal of epidemiology & community health , 59 (8), pp.619-627. http://dx.doi.org/10.1136/jech.2004.029678 Dufur, M.J., Thorpe, J.D., Barton, H.S., Hoffmann, J.P. and Parcel, T.L. (2019). Can social capital protect adolescents from delinquent behavior, antisocial attitudes, and mental health problems?. Archives of Psychology , 3 (6). Available at: https://scholarsarchive.byu.edu/facpub/3818 (Accessed on 5th April 2025) Ehsan, A.M. and De Silva, M.J. (2015). Social capital and common mental disorder: a systematic review. J Epidemiol Community Health , 69 (10), pp.1021-1028. https://doi.org/10.1136/jech-2015-205868 Fujiwara, T. and Kawachi, I. (2008). A prospective study of individual-level social capital and major depression in the United States. Journal of Epidemiology & Community Health , 62 (7), pp.627-633. https://doi.org/10.1136/jech.2007.064261 Kim, D., Subramanian, S.V. and Kawachi, I. (2008). Social capital and physical health. Social capital and health , pp.139-190. https://doi.org/10.1007/978-0-387-71311-3_8 Knorst, J.K., Vettore, M.V. and Ardenghi, T.M. (2022). Social capital and oral health promotion: Past, present, and future challenges. Frontiers in Oral Health , 3 . https://doi.org/10.3389/froh.2022.1075576 Landeta, J. and Barrutia, J. (2011). People consultation to construct the future: a Delphi application. International Journal of Forecasting , 27 (1), pp.134-151. https://doi.org/10.1016/j.ijforecast.2010.04.001 Li, Y. ed., (2015). Handbook of research methods and applications in social capital. Edward Elgar Publishing. Lin, N. (2001). Social capital. A theory of social action and structure . https://doi.org/10.1017/CBO9780511815447 Mata, F. and Pendakur, R. (2014). Social capital, diversity and giving or receiving help among neighbours. Social Indicators Research , 118 (1), pp.329-347. https://doi.org/10.1007/s11205-013-0419-3 McPherson, K. E., Kerr, S., McGee, E., Morgan, A., Cheater, F. M., McLean, J., & Egan, J. (2014). The association between social capital and mental health and behavioural problems in children and adolescents: an integrative systematic review. BMC psychology , 2 (1), 1-16. https://doi.org/10.1186/2050-7283-2-7 Moore, S. and Kawachi, I. (2017). Twenty years of social capital and health research: a glossary. J Epidemiol Community Health , 71 (5), pp.513-517. http://dx.doi.org/10.1136/jech-2016-208313 Moore, S., Bockenholt, U., Daniel, M., Frohlich, K., Kestens, Y. and Richard, L. (2011). Social capital and core network ties: a validation study of individual-level social capital measures and their association with extra-and intra-neighborhood ties, and self-rated health. Health & place , 17 (2), pp.536-544. https://doi.org/10.1016/j.healthplace.2010.12.010 Moore, S., Salsberg, J. and Leroux, J. (2013). Advancing social capital interventions from a network and population health perspective. In Global perspectives on social capital and health (pp. 189-203). Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7464-7_8 Moore, S., Shiell, A., Hawe, P. and Haines, V.A. (2005). The privileging of communitarian ideas: citation practices and the translation of social capital into public health research. American journal of public health , 95 (8), pp.1330-1337. https://doi.org/10.2105%2FAJPH.2004.046094 Morgan, A., Svedberg, P., Nyholm, M. and Nygren, J. (2021). Advancing knowledge on social capital for young people’s mental health. Health promotion international , 36 (2), pp.535-547. https://doi.org/10.1093/heapro/daaa055 Morrow, V. (2001), "Young people’s explanations and experiences of social exclusion: retrieving Bourdieu’s concept of social capital", International Journal of Sociology and Social Policy , Vol. 21 No. 4/5/6, pp. 37-63. https://doi.org/10.1108/01443330110789439 Munn, Z., Peters, M.D., Stern, C., Tufanaru, C., McArthur, A. and Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC medical research methodology, 18 , pp.1-7. https://doi.org/10.1186/s12874-018-0611-x Ogden, J., Morrison, K. and Hardee, K. (2014). Social capital to strengthen health policy and health systems. Health policy and planning , 29 (8), pp.1075-1085. https://doi.org/10.1093/heapol/czt087 Okoli, C. and Pawlowski, S.D. (2004). The Delphi method as a research tool: an example, design considerations and applications. Information & management , 42(1), pp.15-29. https://doi.org/10.1016/j.im.2003.11.002 Pendley, S.C., Mock, N.B. and Theall, K.P. (2020). How you measure matters; defining social capital in drought-prone areas. International Journal of Disaster Risk Reduction, 50 , p.1017 https://doi.org/10.1016/j.ijdrr.2020.101715 Peters, M.D., Godfrey, C.M., Khalil, H., McInerney, P., Parker, D. and Soares, C.B. (2015). Guidance for conducting systematic scoping reviews. JBI Evidence Implementation, 13 (3), pp.141-146. 10.1097/XEB.0000000000000050 Portes, A. (1998). Social capital: Its origins and applications in modern sociology. Annual review of sociology , 24 (1), pp.1-24. https://www.annualreviews.org/doi/full/10.1146/annurev.soc.24.1.1 Rostila, M. (2011). The facets of social capital. Journal for the theory of social behaviour , 41 (3), pp.308-326. https://doi.org/10.1111/j.1468-5914.2010.00454.x Schaefer-McDaniel, N.J. (2004). Conceptualizing social capital among young people: Towards a new theory. Children youth and environments , 14 (1), pp.153-172. https://www.jstor.org/stable/10.7721/chilyoutenvi.14.1.0153 (05/April/2025) Shiell, A., Hawe, P. and Kavanagh, S. (2020). Evidence suggests a need to rethink social capital and social capital interventions. Social science & medicine , 257 , p.111930. https://doi.org/10.1016/j.socscimed.2018.09.006 Tsikerdekis, M. (2013). The effects of perceived anonymity and anonymity states on conformity and groupthink in online communities: AW ikipedia study. Journal of the American Society for Information Science and Technology , 64 (5), pp.1001-1015. https://doi.org/10.1002/asi.22795 Wellman, B., Haase, A.Q., Witte, J. and Hampton, K. (2001). Does the Internet increase, decrease, or supplement social capital? Social networks, participation, and community commitment. American behavioral scientist , 45 (3), pp.436-455. https://doi.org/10.1177%2F00027640121957286 Wells, T., Bailey, J.T. and Link, M.W. (2014). Comparison of smartphone and online computer survey administration. Social Science Computer Review , 32 (2), pp.238-255. https://doi.org/10.1177/0894439313505829 Winkler, J. and Moser, R. (2016). Biases in future-oriented Delphi studies: A cognitive perspective. Technological forecasting and social change , 105 , pp.63-76. https://doi.org/10.1016/j.techfore.2016.01.021 Wong, H., Huang, Y., Fu, Y. and Zhang, Y. (2019). Impacts of structural social capital and cognitive social capital on the psychological status of survivors of the Yaan earthquake. Applied Research in Quality of Life , 14 (5), pp.1411-1433. https://doi.org/10.1007/s11482-018-9661-9 Wu, Q. (2017). Effects of social capital in multiple contexts on the psychosocial adjustment of Chinese migrant children. Youth & Society , 49 (2), pp.150-179. https://psycnet.apa.org/doi/10.1177/0044118X14530133 Wu, Q., Tsang, B. And Ming, H. (2012). Contributions of family and neighbourhood factors to the mental health of migrant children in China: implications for policy and services. International Journal of Adolescence and Youth, 17 (2-3), pp.113-129 https://doi.org/10.1080/02673843.2012.656194 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6479008","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":444835715,"identity":"4a64a081-b0d0-4052-8371-c680e337ffd7","order_by":0,"name":"Kennedy Sigodo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABD0lEQVRIiWNgGAWjYBACgwMgko2BQb4ZSPMw2CBkcGkxbIBqMTgM1pJGWIsxA0wLA1jLYcJazNh7jz34UHaYwYCd/eKDNxXn7fpnJDB++MFw2BiXFhuec+mGM84dBvqFp9hwzpnbyTNuJDBL9jAcNsOpRSLHTJq3DeiewzxpQMbtZAOJBAZpINcGlxYz+Tdm0n8RWs6BtDD/xqfFWILHTJoRrIX9GFDLATugFjaQLTgdZtiTYybZcy6dx+AwDzPQL8kJEmcetln2GKTj9L7B8TNmEj/KrOXk+48/BIaYnT1/e/LhGz8qrCExhhs08wAjBRwTiQ0MjA14YgUO6oCY/QGIZU9Q7SgYBaNgFIw4AACFiVKMSMVR4wAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-0486-8312","institution":"Glasgow Caledonian University","correspondingAuthor":true,"prefix":"","firstName":"Kennedy","middleName":"","lastName":"Sigodo","suffix":""},{"id":444835716,"identity":"d18a32b7-4a9d-47ca-9dbf-6971775ade13","order_by":1,"name":"Kerri McPherson","email":"","orcid":"https://orcid.org/0000-0002-8356-9838","institution":"Glasgow Caledonian University","correspondingAuthor":false,"prefix":"","firstName":"Kerri","middleName":"","lastName":"McPherson","suffix":""},{"id":444835717,"identity":"f0b57280-0baa-4a2f-ae09-e6571f29c0e2","order_by":2,"name":"Jens Nygren","email":"","orcid":"https://orcid.org/0000-0002-3576-2393","institution":"Halmstad University","correspondingAuthor":false,"prefix":"","firstName":"Jens","middleName":"","lastName":"Nygren","suffix":""},{"id":444835718,"identity":"813082e2-4ac6-4c9b-b128-a9ff41e69309","order_by":3,"name":"Antony Morgan","email":"","orcid":"https://orcid.org/0000-0002-6055-4772","institution":"Glasgow Caledonian University","correspondingAuthor":false,"prefix":"","firstName":"Antony","middleName":"","lastName":"Morgan","suffix":""}],"badges":[],"createdAt":"2025-04-18 12:33:21","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6479008/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6479008/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80997462,"identity":"50568643-5fda-49d8-a3eb-c418a5155749","added_by":"auto","created_at":"2025-04-21 05:35:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22935,"visible":true,"origin":"","legend":"\u003cp\u003eA summary of the Delphi process used in this study\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6479008/v1/2239059a9ba71a5591410302.png"},{"id":80997464,"identity":"d6e3cd7e-8b9c-4a5a-afe6-b963b6701c26","added_by":"auto","created_at":"2025-04-21 05:35:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":91133,"visible":true,"origin":"","legend":"\u003cp\u003eThe pathways linking social capital action to mental health impact\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6479008/v1/63bf8ad58cc839e05332b71a.png"},{"id":80997466,"identity":"fef6cb5e-1071-4fb5-a9ed-3e1b9295e97e","added_by":"auto","created_at":"2025-04-21 05:35:22","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":36951,"visible":true,"origin":"","legend":"\u003cp\u003eEase and difficulty of simulating constructs of social capital in interventions\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6479008/v1/f5f4eba2c9dc52dd7f3cc33d.png"},{"id":80998473,"identity":"9e58b513-b1c4-44b6-98be-7f0a30b1111c","added_by":"auto","created_at":"2025-04-21 05:43:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1174860,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6479008/v1/035c1501-27d7-4ce8-a56d-a0115605d539.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eExperts’ consensus on using social capital in interventions to promote adolescents’ mental health: A qualitative Delphi Study\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSocial capital, an idea that social connections are valuable resources to individuals and society, is an important determinant of health (Moore and Kawachi, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Social capital\u0026rsquo;s relationship to health has led to its expansion from its founding disciplines of sociology, economics and political science to form a central construct in health and wellbeing (Moore and Kawachi, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Campbell, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). For this study, the extant evidence has shown a general acknowledgement of the concept\u0026rsquo;s potential in promoting adolescent mental health (McPherson et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Morgan et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). However, despite the increase in the understanding and acknowledgement of social capital as a powerful and vital tool in changing individual and community health outcomes, its utilisation in interventions to promote adolescents\u0026rsquo; mental health remains complex (Knorst, Vettore and Ardenghi, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe complexity results from unresolved conflicts that negatively affect its use in public health interventions (Moore and Kawachi, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Firstly, there is a deficiency in understanding the association between various dimensions and constructs of social capital and their determinants and consequences (Li, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Secondly, the increase and fragmented nature of social capital research has further exacerbated this problem by focusing on one or a combination of constructs. For instance, studies have deliberately focused on constructs such as trust (Moore et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Carpiano and Fitterer, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), sense of belonging (Ahn and Davis, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), and social networks (Moore et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). The rationales for privileging selected aspects are far from consistent. For example, while sense of belonging is overlooked by some researchers, such as Schaefer-McDaniel (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2004\u003c/span\u003e), several other researchers have considered it a vital element in the building of social capital through influencing participation (Wellman et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2001\u003c/span\u003e), understanding inclusion and exclusion (Morrow, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2001\u003c/span\u003e), and reciprocity within the neighbourhood (Mata and Pandekur, 2014). This fragmentation of social capital, while intended to enhance the concept's comprehensibility and conceptualisation, has aroused more questions than answers. This avalanche of perspectives further casts doubts on the theoretical readiness of social capital to be used in designing public health interventions and makes operationalisation of the concept problematic. Arguably, getting a systemic understanding of social capital from the multiple fragmented studies has proved challenging.\u003c/p\u003e \u003cp\u003eRostila (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) suggests that the solution is to agree on the crucial dimensions of the concept and distinguish the core dimensions of social capital from other structural and cognitive dimensions of social relationships. This study aimed to build on the previous works on social capital interventions designed to promote adolescents\u0026rsquo; mental health (Wu, Tsang and Ming, 2012; Ogden, Morrison, and Hardee, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Wu, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), and extends the extant knowledge by determining the areas of agreement and contention on the best ways to utilise social capital in interventions aiming to promote adolescents\u0026rsquo; mental health. It sought to achieve this aim through the following objectives structured using a generic theory of change framework:\u003c/p\u003e \u003cp\u003e1. To determine the nature of actions required to obtain social capital outcomes.\u003c/p\u003e\u003cp\u003e2. To explore the relationship between intervention\u0026rsquo;s actions and outcomes and between various outcomes in the process linking social capital and mental health.\u003c/p\u003e \u003cp\u003e3. To identify indicators that enable assessment and evaluation of progress and measuring change during and after implementation of a social capital intervention.\u003c/p\u003e \u003cp\u003e4. To explore the contexts in which a social capital theory of change will work in interventions to promote the mental health of adolescents.\u003c/p\u003e "},{"header":"2. Methods","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Preliminary scoping review\u003c/h2\u003e \u003cp\u003eA preliminary scoping review undertaken in the larger study enabled the identification of the nature and scope of literature on social capital and adolescents\u0026rsquo; mental health. It identified gaps and contentions in the existing literature that created the foundation for this Delphi study by partly informing the development of the first-round questionnaire. Scoping reviews are useful for identifying the scope of literature on a given concept, gaps in the extant literature, clarifying concepts, and exploring the conduct of research around a concept (Peters et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Munn et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Delphi process\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Survey development\u003c/h2\u003e \u003cp\u003eA two round qualitative e-Delphi study was used to access experts\u0026rsquo; perceptions on social capital and its application in interventions seeking to promote adolescents\u0026rsquo; mental health. The unique characteristics of the Delphi technique are associated with its strengths that include making clear the plurality of opinions over a subject matter, enabling structured debate, minimising influence by dominant experts, and establishing agreements and disagreements on subjects (Landeta and Barrutia, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Delphi approach enabled capturing most recent views of authors, some of whom may have changed stances after their publications. Also, Delphi approach\u0026rsquo;s iterative process through controlled feedback enabled experts to re-examine their perspectives leading to offering additional supporting critiques or changing their views in light of differing opinions from other experts.\u003c/p\u003e \u003cp\u003eFirst-round questionnaire comprised a mixture of closed and open-ended questions structured using a generic theory of change model. Hence, the questionnaire comprised questions on pathways, interventions, indicators, and assumptions as per the objectives. Unlike, in the traditional Delphi where initial questions or preselected items are generated in the exploratory first round, the preliminary scoping review enabled this study to go directly into the main questions of concern without the exploratory round. The approach used in this study improved the initial response rate and provided a firm grounding in the existing literature. The questions in the second-round questionnaire were developed from the round-one findings. Specifically, the round-two questions sought clarifications on the contentious issues identified from analysing the data collected in the first round.\u003c/p\u003e \u003cp\u003eFollowing completion of each of the two rounds, feedback comprising a summary of combined findings, anonymised justifications and experts\u0026rsquo; own responses was shared with them. This step was referred to as analysis and dissemination in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below. The controlled feedback feature of the Delphi technique gives it an advantage over other consensus methods such as focus groups. However, controlled feedback has been associated with bias emanating from the \u0026lsquo;bandwagon effect\u0026rsquo; (Winkler and Moser, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). This is where some panellists may change their responses to comply with what they perceive as the majority view. This effect was reduced in this study by ensuring anonymity. According to Tsikerdekis (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), anonymity limits conformity by ensuring that panellists do not side with the renowned names on given subjects.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Selecting members of the panel\u003c/h2\u003e \u003cp\u003eThis study adapted the guideline by Okoli and Pawlowski (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2004\u003c/span\u003e) to select the panel of experts. This approach of selecting participants ensured that a purposeful mix of experts was included in this study. The selection process is summarised in the table below.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eProcess of selecting panel members\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStep 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIdentified suitable categories of experts. Experts were divided into three main categories: academics, practitioners, and practising academics.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStep 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEach of the three categories was populated with names. Academics and practicing academics were recruited based on authorship of articles included in the preliminary scoping review of literature on social capital and adolescent mental health and corroborated by publicly available institutional staff profiles detailing research interests. Practitioners were selected using snowballing technique through referrals from study contacts working with adolescents in programmes.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStep 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExperts were contacted via email and asked to nominate other experts.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStep 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDue to not meeting the target size of 25 all participants who met the eligibility criteria were invited to take part in the study.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3 Survey distribution\u003c/h2\u003e \u003cp\u003eAn email with the link to the online survey was sent to all participants for each round. This study utilised a commercially available online survey tool \u0026lsquo;Jisc online surveys\u0026rsquo; to collect data through sharing a link to the questionnaire with the panel members. A deviation or ineffectiveness of the survey questionnaire, the mode of delivery or the participants could introduce errors or bias (Wells, Bailey, and Link, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). This study ensured the three components worked together for the success of this Delphi study by ensuring a suitable panel and an online questionnaire accessible via any device with internet connection. Despite some finding no significant variations between smartphone and personal computer delivery modes (Wells et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), others argue that delivery modes can potentially affect the responses obtained through a questionnaire by causing differences in approximations, social desirability bias, and recall order effects (Bowling, 2005).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Data analysis\u003c/h2\u003e \u003cp\u003eQualitative data analysis from each of the two rounds was informed by Boyatzis\u0026rsquo;s (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e1998\u003c/span\u003e) and Braun and Clarke\u0026rsquo;s (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2006\u003c/span\u003e) guidelines and occurred in the following stages using NVivo version 12:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStage 1\u003c/strong\u003e \u003cp\u003eInvolved familiarising with the responses through repeated reading and development of initial codes.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStage 2\u003c/strong\u003e \u003cp\u003eData was re-read and the initial codes were rearranged into sub-themes.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStage 3\u003c/strong\u003e \u003cp\u003eThe sub-themes were categorised under specific themes based on similar patterns and meaning.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStage 4\u003c/strong\u003e \u003cp\u003eFor round one, the specific themes were categorised under the four predetermined themes summarised in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e with those that did not fall under the categories presented as independent themes. In contrast, round 2 findings were organised under the contentions emerging from round-one.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStage 5\u003c/strong\u003e \u003cp\u003eExcerpts from the raw data were extracted to support the themes within each of the four categories.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eQuantitative data analysis using Microsoft excel generated descriptive statistics for participants\u0026rsquo; characteristics and findings from closed ended questions.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of predetermined themes from the four components of a theory of change framework\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheory of change framework component\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePredetermined themes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterventions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe actions embedded in social capital interventions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStepwise process through which interventions\u0026rsquo; actions lead to mental health outcomes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssumptions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCircumstances under which the social capital interventions work\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndicators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow to track progress and measure changes in social interactions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Ethical clearance\u003c/h2\u003e \u003cp\u003e Ethical clearance to undertake this study was obtained from Glasgow Caledonian University (Ref no: GSBS EC013). All ethical considerations when working with human participants such as confidentiality, privacy, informed consent and voluntary participation were ensured throughout this study.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Participant characteristics\u003c/h2\u003e \u003cp\u003eFollowing recruitment, 19 participants were included in the study. Five pilot participants were added to the main study increasing the sample size to 24 participants. The average years of work experience of the recruited participants was 11.14 years across the two rounds. 17 out of the 24 participants were female. Sixteen identified themselves as academics, four as practitioners, and the other four as practising academics. Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e show a summary of the characteristics of the participants involved in the study. Most participants were from Europe (10), followed by North America (5). A similar number of participants were from Australasia (4) and Africa (4), whereas one participant identified as global.\u003c/p\u003e \u003cp\u003eOut of the 24 participants who took part in the round one of the Delphi, 21 advanced to the second round. This accounted for 12.5% attrition as shown in the Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e below.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of participants and attrition percentage\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRound-one\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRound-two\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of experience\u003c/p\u003e \u003cp\u003eAverage:\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.99\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.29\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003cp\u003eMale (%)\u003c/p\u003e \u003cp\u003eFemale (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (29%)\u003c/p\u003e \u003cp\u003e17 (71%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (24%)\u003c/p\u003e \u003cp\u003e16 (76%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProfessional background\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAcademic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractising academic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (19%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRegion of work\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfrica\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (16.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorth America\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (19.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEurope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAustralasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (16.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (19.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlobal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParticipation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipated in the round\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAttrition\u003c/b\u003e 3 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Round one results\u003c/h2\u003e \u003cp\u003eThe findings of first round were organised under the predetermined thematic areas constituting the key components of a generic theory of change framework summarised in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Interventions: Actions required to obtain social capital outcomes\u003c/h2\u003e \u003cp\u003eSocial capital interventions suggested by the panellists comprised of the following three actions: initiating or creating connections, enhancing existing connections and creating awareness of the benefits of social capital. Sample interventions cited by the panellists included awareness campaigns and educational interventions aimed at adolescents, parents, teachers, and community members. One expert mentioned:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eInterventions providing financial support to families can help family spend more time socialising with their children hence building social capital for them\u0026hellip;Education programmes can also educate parents on building positive parent-child relationship\u0026hellip;educate teachers on promoting positive teacher-student relationship thereby promoting building of school social capital. (P01)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThere was no clear-cut distinction due to the overlap of actions constituting these interventions. For instance, an intervention meant to initiate networks could also lead to the strengthening of existing bonds. Overall, the panellists described desirable interventions as diverse, open, accessible, acceptable, repeated, interactive and supportive.\u003c/p\u003e \u003cp\u003e \u003cb\u003eContentions\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe panellists showed divergent opinions on whether social capital could be built or created using interventions. Participants who argued that social capital could not be created explained that people could benefit from social capital without necessarily participating in any network. For instance, being in a neighbourhood where others take care of their local area and information easily spreads could enable a person to enjoy clean surroundings and obtain information passively.\u003c/p\u003e \u003cp\u003e3.2.2 Pathways: The relationship between the intervention\u0026rsquo;s actions and outcomes and between various outcomes that lead to an impact\u003c/p\u003e \u003cp\u003eThe panellists mentioned different pathways through which social capital led to mental health outcomes for adolescents. For instance,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eDegree of trust, knowledge and strength of networks an individual has, contributes to their degree of belonging, which is core to mental wellbeing. (P04)\u003c/p\u003e\u003cp\u003e\u0026hellip;through social interaction and engagement with people at the centre, the patients can feel less isolated which can create a sense of belonging/connectedness resulting in positive emotions, prevent depression and result in happiness and positive mental health of the patients. (P01)\u003c/p\u003e\u003cp\u003eRelate to social identity and feelings of belonging, including feelings of social support and solidarity. This has a clear relationship to mental health and general wellbeing. (P22)\u003c/p\u003e\u003cp\u003eSocial connection validates oneself and contribute to build their identity which is key to maintaining and developing mental well-being. (P20)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe panellists\u0026rsquo; responses, such as those shown above, were synthesised by being broken down into individual steps to map the perceived stepwise process. The pathways linking the interventions and the mental health impact revealed immediate and intermediate outcomes. Immediate outcomes from interventions led to intermediate outcomes that were proximal to mental health impact as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e below.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eContentions\u003c/b\u003e \u003c/p\u003e \u003cp\u003eSome panellists advocated using other theories such as the attachment theories of Bowlby and the theory of human action to explain mechanisms linking social capital and mental health. This group of panellists partly associated the use of the term \u0026lsquo;social capital\u0026rsquo; with the contentions surrounding the concept and its utilisation in interventions. Further, they suggested terms such as community development and social cohesion as more feasible and acceptable than social capital.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e3.2.3 Indicators: Variables for tracking progress and measuring changes in social interactions\u003c/h2\u003e \u003cp\u003eParticipants cited a broad range of potential indicators that could be used in social capital interventions. The choice of an indicator depended on multiple parameters including:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eConceptualisation of social capital and its elements\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIntended health outcome/s\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eLevel of intervention \u0026ndash; Individual level, family level, community level, school level\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eWhilst there was consensus on the choice, the use of indicators in evaluation varied. Some panellists considered evaluation as a great hindrance to social capital. They explained that there were not enough ways of undertaking a complete assessment.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026hellip;assess not just the number of ties, but the nature of these ties and the resource value of them. (P06)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThere was a variation in the perceived need to clarify the theoretical basis of social capital informing an intervention. For instance, other panellists indicated a crucial requirement for a clear understanding of constructs such as trust and social cohesion as used in a given intervention. Also, panellists differed in their preferences for Coleman\u0026rsquo;s, Putnam\u0026rsquo;s, Bourdieu\u0026rsquo;s, and other social capital authors\u0026rsquo; conceptualisations as they relate to adolescents. Some panellists thought some conceptualisations were better developed to inform interventions involving adolescents\u0026rsquo; mental health. One panellist explained:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe Colemanesque, individual-level approach to social capital seems better suited to interventions to promote mental health, but many policy-based interventions will seek to work at more aggregated or abstracted units of analysis and may be less effective. (P12)\u003c/p\u003e\u003cp\u003eI prefer to use Bourdieu's definition - social networks and connections and sociability - interlinked with other forms of capital - cultural, economic etc - over Putnam's. (P24)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSome panellists stated that certain elements such as sense of belonging could be both an outcome and a construct of social capital.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAll these extraneous variables could potentially be seen as part of social capital itself. (P19)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eMethods such as questionnaires, interviews, social network analysis, use of existing measures, survey methods were mentioned as used to measure social capital.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e3.2.4 Assumptions: Circumstances under which social capital interventions will work\u003c/h2\u003e \u003cp\u003eExperts explained that contextual factors were necessary to identify intervention design, implementation, and adaptation. The contextual variables were classified into seven categories, including time, community factors, intrapersonal characteristics, family factors, economic factors, environmental factors, and intervention factors. The assumptions are summarised in the Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e below.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssumptions for successful social capital interventions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImpact on success of intervention\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContact time or duration needed to be considered as some social capital elements can only be changed over a long duration\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAccording to the experts, social stability, social cohesion, homogeneity of the community, intergenerational closure, suitability of social spaces and social connections, political goodwill, positive peer pressure and influence, and presence of neighbourhood social capital were necessary for successful interventions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrapersonal characteristics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMost of the experts alluded that the sociability of adolescents, education level, ethnicity, marital status, health status, school bullying, and school residency (school social capital), and stage in life, gender, age, and social behaviour patterns determined the success of any social capital intervention.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily resources, family connections, and family structure; the quality of the parent-child relationship; adult interest in the child (e.g., involvement with school); parental monitoring, and extended family support were crucial for meaningful use and gains from social capital interventions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEconomic Factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParticipants mentioned this in the forms of poverty and socioeconomic inequalities and their effects on social capital elements. Socioeconomic status was generally deemed crucial in determining the different impacts on the process of linking social capital with mental health outcomes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnvironmental factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStructural and institutional factors, social infrastructure, community assets, and geographical location were stated as enablers or inhibitors depending on the impact they had on social capital\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProgramme leaders\u0026rsquo; level of understanding about social capital theory and its application in practice, sufficient funds to start up and sustain an intervention to the required level, presence of incentives, intervention staff\u0026rsquo;s morale, and level of participation of the target population were explained to be significant determinants of interventions\u0026rsquo; success\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe existing variations in the factors named above explain how social capital\u0026rsquo;s and its association with health outcomes differ among individuals and communities.\u003c/p\u003e \u003cp\u003eContentions\u003c/p\u003e \u003cp\u003eDue to the many confounding factors influencing the association of social capital and mental health outcomes, attributing impacts and outcomes solely to social capital interventions but not to other social determinants of health was seen by some experts as contentious.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Round two results\u003c/h2\u003e \u003cp\u003eThe round-two results were obtained by eliciting further discussions on the contentions from round-one of data collection. These were organised under the contentions emerging from round-one.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.3.1 Variations in perceived amenability of social capital to interventions\u003c/h2\u003e \u003cp\u003eOne of the first round\u0026rsquo;s contentions was the significant variation in panellists\u0026rsquo; perceptions of whether the processes linking social capital to mental health outcomes could be simulated in interventions. Exploring the cause of the varied perceptions during round-two, experts explained that the differences in their individual experiences caused the disparities in the previous round. The experts had notions of what works from the interventions they had previously undertaken. One of the experts stated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eLevel of experience in real world interventions probably differs \u003cem\u003ebtwn\u003c/em\u003e respondents on the degree to which public health interventions are successful in dealing with young people's mental health at all. (P23)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIn addition to their experience, the experts\u0026rsquo; perceptions of the amenability of social capital\u0026rsquo;s constructs to interventions depended on their knowledge and belief in what works or does not. Some experts explained that the contextual nature of social capital made it difficult to replicate interventions in different environments. The experts cited the complexity of the society, the multiplicity of confounding factors, and differences among the sub-segments of the population as reasons why it was difficult to simulate social capital processes in interventions. Among the panellists who did not agree with the amenability of social capital processes to interventions were those who, despite agreeing that social capital could neither be commanded nor overly controlled, expressed optimism that social capital could be nurtured by providing conditions for growth.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.3.2 Ease and difficulty of using specific constructs of social capital in interventions\u003c/h2\u003e \u003cp\u003eThose who agreed that social capital could be created explained that simulation in intervention was a matter of ease and difficulty rather than possibility and impossibility. They identified some constructs of social capital as easy and others as difficult to create or influence in interventions.\u003c/p\u003e \u003cp\u003eTo determine which constructs were easy or difficult to simulate in practice, social capital constructs were extracted from the pathways linking social capital to mental health outcomes emerging from participants\u0026rsquo; responses in the first round. For instance, an excerpt such as \u0026ldquo;\u0026hellip;relate to social identity and feelings of belonging, including feelings of social support and solidarity\u0026hellip; this has a clear relationship to mental health and general wellbeing\u0026rdquo; yielded the following constructs: social identity, sense of belonging, social support and solidarity. These constructs were listed in the round-two questionnaire, and experts were asked to identify the ease or difficulty of using them in interventions involving adolescents. The findings showed that there is variation in the perceived ease and difficulty of simulating social capital constructs in interventions. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that constructs such as social engagement, social interaction, awareness, role modelling, social ties and participation were deemed as easy to influence by interventions. In contrast, constructs such as solidarity, emotional support, social approval, trust, reciprocity, sense of belonging, social norms and empowerment were seen as difficult to influence in interventions.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eHaving identified the ease or difficulty, a follow-up question sought to get the criteria or rationale used by the panellists to decide whether a social capital construct was easy or difficult to simulate in intervention. The experts explained that their decision to categorise a construct as easy or difficult to simulate in interventions depended on the conceptualisation and dimension of construct, the level and nature of actions needed to influence the construct in interventions and the applicability of the given constructs to adolescents.\u003c/p\u003e \u003cp\u003eConstructs such as social norms were perceived to have more stable characteristics grounded in culture and institutions. The stability of the construct was associated with a reduced predilection to change and a longer time to realise change, if any. Others argued that approaches that include norms were based on social constructivism that would inevitably require a change in the nature of subjective human experience, making them difficult to develop using an intervention.\u003c/p\u003e \u003cp\u003eOne of the panellists stated that ease and difficulty were a matter of conceptualisation of the construct and noted that more abstract constructs would be more challenging to influence. Also, a few other practitioners in the panel used experiential knowledge to inform their sense of ease or difficulty. Still, belief was also cited as a criterion among the practitioner participants. One of the participants stated:\u003c/p\u003e \u003cp\u003e\u0026hellip;whether I believed I, or others, could design an intervention to increase the specific aspect. (P08)\u003c/p\u003e \u003cp\u003eIt was generally agreed that it is easier to simulate structural constructs of social capital in interventions compared to cognitive constructs.\u003c/p\u003e \u003cp\u003eRegarding nature and level of actions to be carried out. Constructs deemed to require sustained engagement or longer durations and broader changes to the social, cultural, belief, and value systems for successful intervention were considered difficult to influence in interventions.\u003c/p\u003e \u003cp\u003eThe perceived level of control of practitioners when undertaking interventions was also cited as a determinant of the ease or difficulty of creating or using a given construct in intervention. Aspects of constructs that could be highly controlled by intervention personnel were deemed to be easy and vice versa, as stated by a participant:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAspects that can be controlled by third parties were deemed easy. For instance, not sure how interventions can improve trust among two parties. Same as reciprocity and others tagged as difficult. (P21)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe level of action, whether interventions were at the individual or community level, was also seen as a factor influencing perceived ease or difficulty in application. One expert wrote:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026hellip;some aspects are interpersonal or at the family level (social ties and engagement), but others are more structural and contextual, which take much longer to change (i.e. social norms). (P13)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe types of actions needed to influence the constructs were cited as a determinant of ease or difficulty. For instance, the ability to easily control a construct through education, sensitization, and regulation qualified a construct as easy to simulate in intervention.\u003c/p\u003e \u003cp\u003e\u0026hellip;as a collective resource, social capital may appear difficult to develop in what are very often individually delivered public health interventions. (P02).\u003c/p\u003e \u003cp\u003eOverall, most panellists\u0026rsquo; view was that social capital interventions are best targeted at the individual level in adolescent mental health interventions.\u003c/p\u003e \u003cp\u003ePanellists stated that a construct\u0026rsquo;s applicability to adolescents determined their perception of its ease or difficulty to utilise in adolescents\u0026rsquo; interventions. The second round showed that the experts agreed that adolescents\u0026rsquo; social lives differed from adults\u0026rsquo;. Hence, there was a need to define and conceptualise social capital constructs to suit adolescents\u0026rsquo; social lives. For instance, one participant who declined to comment on the ease and difficulty of the listed social capital constructs mentioned the need for such to be explained in relevance to adolescents. Suggesting that the meaning of these concepts varied with age. The participant stated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI can't really answer these questions, as they represent copious ill-defined concepts that need deconstructing and explaining before they can be acted upon. E.g. what is meant by 'trust'? 'Empowerment' etc. for 14-19-year olds? (P03)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003e3.3.3 Overcoming evaluation challenges\u003c/h2\u003e \u003cp\u003eThe participants reiterated that social capital interventions were context specific, and so were the outcomes of interest. Hence, panellists stated the importance of accounting for contextual variations to overcome evaluation challenges. They explained the need for holistic assessment of contexts, not solely focusing on the social but also considering the cultural and biological contexts. This was presented as useful for mapping all factors that may influence interventions\u0026rsquo; processes and actual impact.\u003c/p\u003e \u003cp\u003eAccording to one of the panellists, resolving evaluation issues requires assumptions underlying social capital be based on a solid action-theoretical foundation that is explicit. Another suggestion from a panellist was to utilise complexity theory when undertaking an evaluation of social capital.\u003c/p\u003e \u003cp\u003eThe experts compared the challenges facing the evaluation of social capital to those facing the evaluation of complex interventions. Despite the difficulty of evaluating social capital, panellists explained that the challenges could be overcome by clearly conceptualising and defining social capital and the selected constructs at the beginning of the intervention and applying the most appropriate evaluation method.\u003c/p\u003e \u003cp\u003eMost panellists agreed that overcoming evaluation challenges was a matter of overcoming paradigm challenges. They explained that limiting the evaluation of social capital to quantitative approaches was inadequate. Hence, adding qualitative methods to the predominant quantitative methods was presented by some panellists as a way to improve the evaluation challenges:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026hellip;qualitative research might better capture social capital outcomes and effects of interventions since it may not be easily quantifiable. (P13)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe addition of qualitative methods was explained to account for the variation in contexts and thereby aid in contextualising the evaluation of social capital interventions.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026hellip;social capital is very difficult to measure in a general sense, but most scholars agree that it can be qualified in a specific context. (P22)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSome of the methods suggested included longitudinal qualitative interviews.\u003c/p\u003e \u003cp\u003eThe expert panellists also suggested the use of advanced quantitative approaches to mitigate the influence of context on evaluating social capital.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026hellip;maybe more complex measures, such as latent variable measures that look at underlying constructs, and indices could be useful. (P13)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e There was a general agreement that contextualising the evaluation of social capital could be resolved with the appropriate use of mixed qualitative and quantitative methods.\u003c/p\u003e \u003cp\u003eParticipation was cited as another way of overcoming evaluation challenges. This was deemed essential for two main reasons. Firstly, working with adolescents offered an opportunity to develop a deeper understanding of processes that matter to them. Secondly, involving adolescents enabled exploring effective evaluation solutions. Other participants explained that evaluation should be included right from the implementation or development stage.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eMeasures of social capital should be properly defined at the start of the intervention. (P21)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe findings summarise the actions in social capital interventions as initiating or enhancing connections, or building awareness of benefits of social networks. The decision to create or strengthen networks or create awareness of social capital can be compared to Lin\u0026rsquo;s (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2001\u003c/span\u003e) dichotomy of expressive or instrumental actions depending on whether an individual has networks or not or whether they are aware or not. According to this study\u0026rsquo;s findings, instrumental actions enable adolescents to create networks or relationships they do not have. In contrast, expressive actions are those taken to enhance the networks or relationships the adolescents already possess. Lin (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2001\u003c/span\u003e) argued that these actions are mutually reinforcing. That is, an intervention may create awareness about the benefits of social capital and strengthen adolescents\u0026rsquo; extant social networks while enabling the creation of new networks.\u003c/p\u003e \u003cp\u003eThis study shows experts\u0026rsquo; preference for using network approaches over communitarian approaches in social capital interventions. Network approaches focus on social relationships and access to resources, whereas communitarian approaches view social capital as social features such as civic participation and trust (Moore, Salsberg, and Leroux, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Moore and Kawachi, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Moore et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2005\u003c/span\u003e) previously supported the preference for network over communitarian approaches in public health interventions by arguing that the former reorients focus on the structure of relationships and underscores the effects of non-spatial contexts on individuals and public health which dispels the dilemma of defining a \u0026lsquo;community\u0026rsquo; that is faced when using the social cohesion approach.\u003c/p\u003e \u003cp\u003eConceptual differences among the experts were an important cause of the variations in their perspectives on whether social capital could be simulated in interventions and the ease and difficulty to operationalise its constructs. Similar sentiments have been conveyed by Pendley, Mock, and Theall (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), who explain that how one defines social capital influences how one operationalises and measures the concept. Moore, Salsberg, and Leroux (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) similarly found that conceptualisation has implications for the intervention. Hence, there is an imperative need to clearly define concepts, unearth assumptions underlying conceptual approaches to social capital and establish working concepts specifically for adolescents when designing social capital interventions.\u003c/p\u003e \u003cp\u003eThis study found a preference for the individual rather than communal concept of social capital in interventions targeting adolescents. That is, the view of social capital as an individual property that they can use to access personal benefits presented more clarity for adolescent mental health interventions compared to the view of social capital as a property of communities that enable collective action. Indeed, Portes (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e1998\u003c/span\u003e) argued that social capital at the individual level, not the communal or aggregate level, possesses the greatest theoretical value. Similarly, Rostila (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) reiterates that the individual approach to social capital has a better theoretical advantage due to the clarity, unlike collective definitions.\u003c/p\u003e \u003cp\u003eOn pathway or mechanisms linking social capital to mental health impact, the study found that immediate outcomes of social capital interventions are of a structural dimension and precede the constructs of the cognitive dimension of social capital, which are closer to mental health impact. This temporal sequence of structural and cognitive dimensions is corroborated by numerous studies. For instance, a prospective study conducted in the United States of America (USA) by Fujiwara and Kawachi (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) found that higher levels of cognitive social capital were linked to lower risk of developing major depression. In contrast, there was no association between structural dimensions and major depression. Reviews by De Silva et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2005\u003c/span\u003e) and Ehsan and De Silva (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) found more substantial evidence linking cognitive social capital to mental health compared to structural social capital. Wong et al. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), found that structural social capital positively influenced cognitive social capital, which then alleviated depression. Also, they found an indirect link between structural social capital and mental health but not a direct one. This shows that the effect of structural social capital on mental health is mediated by cognitive social capital (Wong et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). While other studies argue that the formation of a cognitive construct such as trust precedes the creation and extension of networks (Dufur et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Ahlborg, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), this study\u0026rsquo;s findings evidence that structural social capital in the form of networks forms the structures through which trust, reciprocity, sense of belonging, social support and many other constructs of cognitive social capital dimension develop and influence mental health outcomes.\u003c/p\u003e \u003cp\u003eThe pathway explaining the link between action, structural social capital, cognitive social capital and mental health impact is subject to a range of contextual factors. This finding reiterates Shiell, Hawe, and Kavanagh\u0026rsquo;s (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) assertion that social capital interventions are some of the most sensitive to context. Nonetheless, considering the confounding factors increases the explanatory power and measurement of social capital (Kim et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Strengths and limitations of the study\u003c/h2\u003e \u003cp\u003eThe panel of experts included academics adept with theory and practitioners with a variety of experiences about what works in real-life. The constitution of the panel enabled co-creation of intervention knowledge between academics and practitioners which is key to linking theory and practice and reducing the implementation gap in interventions applying social capital. However, two-thirds of the panel comprised experts working in academia, the remaining split evenly between practising academics and practitioners. This could have led to findings that were more representative of the majority group in the panel, especially in the case of this study where the responses were analysed together. Analysing the findings from the three main groups separately could have enabled a comparison of the responses to identify any similarities and differences. Despite the data presented in this publication being a few years old, the prevailing debates and complexities in understanding the mechanisms between social capital and adolescent mental health and the application of the former in interventions persist (Bosqui et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study aimed to establish general agreements on using social capital to promote mental health of adolescents in public health interventions. It achieved this aim by clarifying some of the contentions that have long hindered the utilisation of social capital interventions seeking to promote adolescent mental health. The study shows the ease of modifying networks in interventions over changing cognitive constructs of social capital. The study confirms that the view that individuals stand to gain from resources inherent in social groups presents itself as a more practical conceptualisation of social capital for adolescent mental health interventions than the perception of social capital being an enabler of community action. The findings of this study reveal proximal nature of cognitive social capital to mental health, hence, showing the temporal sequence from structural to cognitive social capital constructs in the pathway leading to mental health changes in adolescents. The findings of this study provide the rationale for using specific constructs and conceptualisation of social capital, thereby, enabling evidence informed decision making when developing social capital interventions. Future works should seek to empirically test the emergent pathways through quantitative studies to further bolster the evidence for recommendations made in this study.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe authors declare that there is no conflict of interest regarding the publication of this paper.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThis research was supported by the Glasgow Caledonian University PhD Studentship [GCUL2018002Morgan]. The authors acknowledge the support of Dr Eufrasiah Mero in reviewing the final manuscript and offering insightful comments.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e \u003cp\u003eThe data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAhlborg, M. (2022). \u003cem\u003eSocial capital and inequalities in mental health among young adolescents in Sweden\u003c/em\u003e (Doctoral dissertation, Halmstad University Press). Available at:http://hh.diva-portal.org/smash/get/diva2:1636492/FULLTEXT01.pdf (Accessed: 02/1/2025)\u003c/li\u003e\n \u003cli\u003eAhn, M.Y. and Davis, H.H. (2020). 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Contributions of family and neighbourhood factors to the mental health of migrant children in China: implications for policy and services. \u003cem\u003eInternational Journal of Adolescence and Youth, 17\u003c/em\u003e(2-3), pp.113-129 https://doi.org/10.1080/02673843.2012.656194\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Glasgow Caledonian University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Social capital, adolescent, mental health, health promotion, e-Delphi study, social capital intervention","lastPublishedDoi":"10.21203/rs.3.rs-6479008/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6479008/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThere is convincing evidence for the positive links that exist between social capital and adolescent mental health. However, utilisation of social capital in interventions to promote adolescent mental health remains complex. This study aims to fill this gap by identifying the areas of agreement and contention on utilising social capital in interventions to promote adolescents' mental health. A two-round qualitative e-Delphi study built on a scoping review from a larger research project is used to collect experts' perceptions on social capital and its application in interventions seeking to promote the mental health of adolescents. The findings show three main overlapping actions characterising social capital interventions: Initiating or creating connections, enhancing existing connections and creating awareness of the benefits of social capital. Structural social capital is perceived by most experts as easier to simulate in interventions than cognitive social capital. However, cognitive social capital is more proximal to mental health outcomes than structural social capital in the pathway linking social capital actions to adolescent mental health. The study finds the view of social capital as a property of individuals to be of greater theoretical and practical advantage in adolescent mental health interventions than the perception of social capital as a public good. Myriads of contextual factors determine the need, type, and success of social capital interventions within different settings. The findings of this study support the application of social capital in practice by identifying the actions, processes and prerequisites for developing social capital interventions to promote adolescents\u0026rsquo; mental health.\u003c/p\u003e","manuscriptTitle":"Experts’ consensus on using social capital in interventions to promote adolescents’ mental health: A qualitative Delphi Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-21 05:35:18","doi":"10.21203/rs.3.rs-6479008/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b5009327-b643-4a15-9fc4-e3cbec03e394","owner":[],"postedDate":"April 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":47364249,"name":"Preventive Medicine"},{"id":47364250,"name":"Sociology"},{"id":47364251,"name":"Psychology"},{"id":47364252,"name":"Social Work"}],"tags":[],"updatedAt":"2025-04-21T05:35:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-21 05:35:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6479008","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6479008","identity":"rs-6479008","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}