NIHR Public Health Review Team

First Episode Psychosis (FEP) is a term used to describe the first time a person experiences symptoms like hallucinations or delusions severe enough to affect how they think, see reality, and cope with everyday life.

Although FEP is most common in late adolescence and early adulthood, it can occur at any age. Despite advances in detection and early intervention, the evidence base for prevention remains fragmented. As it stands, most reviews have focused on clinical high-risk samples only, with interventions aimed at youth who already show early warning signs prior to the onset of FEP.

Longitudinal research (studies that follow participants over time) has identified multiple modifiable factors, including trauma, substance use, discrimination, and social disadvantage. However, these have not been brought together systematically.

We will address these evidence gaps by examining preventive interventions and modifiable risk factors (things that can be changed via interventions such as substance misuse) for FEP.

Review questions

The protocol for this work is available at: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261309356

Background

Young people face increased health risks, including substance misuse, mental ill-health, and sexual health concerns. These can and often do co-occur. Having depression or anxiety may affect sexual health decision making and lead to sexually transmitted infections (STIs) or make substance misuse more likely. In turn, factors such as peer pressure, stress and lack of support are also influential.

Such challenges tend to be more pronounced for sexual and ethnic minoritised, cared for and care experienced, disabled and disadvantaged young people.

Digital public health interventions are seen as a promising solution to address these challenges by improving accessibility, efficiency, and personalisation of care. However, robust evidence on their effectiveness for underserved populations remains limited.

We set out to systematically review the evidence on digital public health interventions tailored to young people, particularly those from underserved groups, focusing on mental health, sexual health, and substance use outcomes. We looked specifically at interventions delivered through digital technologies such as text messages, mobile phone apps and websites.

What we did

We wanted to find out:

• What is the quantity, quality, and strength of evidence for digital public health interventions tailored to underserved groups?
• How are digital public health interventions tailored to underserved groups? And what is the evidence of effectiveness for them?
• Is there evidence for differential effectiveness of digital public health interventions by underserved groups?

We wrote three corresponding papers:

• Digital public health interventions targeting young people's mental health, substance use and sexual health: systematic review of reviews and equity analysis.
• Inclusion of underserved young people in digital public health interventions for mental health, sexual health and substance use. A systematic review and intervention component analysis.
• Inclusion of underserved young people in digital public health interventions for mental health, sexual health and substance use: Systematic review and equity synthesis of moderation analyses.

What we found

We found mixed evidence for the effectiveness of digital interventions, and inconsistent consideration of equity impacts across diverse groups of young people. As a result, the promise of digital approaches is constrained by uncertainty about their ability to support underserved populations and address needs equitably. Further research is needed to understand their impact more fully and to ensure they do not inadvertently widen existing health inequalities.

Further details about each review:

• The first review included 75 reviews. It found that digital public health interventions were effective for mental health outcomes, most substance use outcomes, but evidence was mixed for sexual health outcomes. Findings were limited by review quality, variation across the reviews (heterogeneity) that limited direct comparison, and inconsistent reporting of equity characteristics.
• In the second review, we identified twelve intervention components that were consistent to tailored mental health, substance use and sexual health interventions. Four related to how young people were involved in the design of interventions. Six related to how interventions worked to engage young people and to turn knowledge into action. Evidence of effectiveness was strongest for substance use interventions, was mixed for sexual heath and limited for mental health.
• In our third review analysis, we found that digital public health interventions generally produced inconsistent and non-significant moderation effects, and that evidence is lacking for many important equity-relevant characteristics (such as socioeconomic status, education, sexual orientation, and disability). Therefore, it remains uncertain how well these interventions are able to equitably address mental health, substance use, and sexual health challenges in young people.

Sharing our findings

• Protocols for the reviews are hosted on PROSPERO: CRD42025641364
• Digital public health interventions targeting young people's mental health, substance use and sexual health: systematic review of reviews and equity analysis. (forthcoming)
• Inclusion of underserved young people in digital public health interventions for mental health, sexual health and substance use. A systematic review and intervention component analysis. (forthcoming)
• Inclusion of underserved young people in digital public health interventions for mental health, sexual health and substance use: Systematic review and equity synthesis of moderation analyses. (forthcoming)

Background

The UK has low breastfeeding rates with substantial variation both regionally and socio-demographically. Whilst some women make an informed decision not to breastfeed, many stop before they intended. 

Pain and latching problems are key reasons, but there are other factors. These include mothers’ psychological adjustment and systemic barriers.

Breastfeeding support offered in the community can potentially help women navigate these. This includes support delivered by women with similar social or cultural backgrounds (peer support) as well as non-hospital-based healthcare professionals, for example health visitors.

However, existing evidence suggests that some women may benefit more from this type of support than others.

For this project we looked at research evidence to help understand how peer and community support services could be delivered to make sure that more women have a positive breastfeeding experience and are encouraged and supported to breastfeed if they want to.

What we did

We conducted two reviews:

1. Peer support and community interventions targeting breastfeeding in the UK: systematic review and equity synthesis of qualitative evidence

This drew together qualitative evidence from the UK to understand how the characteristics of mothers shaped their experiences of peer and community support.

2. Equity-focused peer support and community interventions for breastfeeding in high-income countries: Systematic review and intervention component analysis

This looked at studies of peer and community support in higher-income countries to understand what activities (components) are delivered during breastfeeding peer support, and if they prevent inequities in breastfeeding rates.

What we found

Peer support and community interventions targeting breastfeeding in the UK: systematic review and equity synthesis of qualitative evidence

Fifty-five studies were included in this review. Mothers from lower socio-economic backgrounds and black and minority ethnic communities tend to have poorer experiences of support.

There were different experiences across the different phases of receiving support, which may lead to inequities in breastfeeding rates, these include:

• Inadequate consideration of mothers’ social, economic and cultural background, and how this might shape their needs (e.g. not comfortable breastfeeding in public spaces).
• Lack of consideration of different physical characteristics (e.g. body type, disability).
• Structural barriers (e.g. lack of community acceptance, unsupportive workplace policies) that might discourage breastfeeding

Equity-focused peer support and community interventions for breastfeeding in high-income countries: Systematic review and intervention component analysis

Thirty-one studies were included in this review. It found that peer and community support tend to use four different types of principles when working with underserved communities to prevent inequities:

• Crosscutting principles: Support underpinned by principle of continued availability throughout key parenting transitions, while keeping a holistic focus on mothers’ health and wellbeing.
• Contextual fit: Support providers with similar cultural, social and economic background to mothers; support to be delivered in a suitable place (e.g. home), through appropriate mode (e.g. face-to-face or video call); and include people from the target population in intervention design.
• Delivery: Information and materials accessible to varying cultural and language needs; support providers build relationships with mothers; and offer practical breastfeeding resources (e.g. practical devices such as nipple shields, breast pump, nipple cream, nursing bras).
• Wayfinding: Support for mothers throughout the breastfeeding journey by strengthening support in existing social network (e.g. family involvement and support); creating new networks of breastfeeding support through a community asset approach; offering activities and resources to support breastfeeding in conjunction with returning to work or education (e.g. addressing concerns about breastfeeding in public).

Whilst mothers who received interventions were around 10% less likely to stop breastfeeding up to one year, there was no conclusive evidence that any intervention components were more effective than others in targeting breastfeeding rates among underserved communities.

Sharing our findings

• Protocols for the reviews are hosted on PROSPERO: CRD42024537108 and  CRD42024589555

The academic papers are available at:

• Peer support and community interventions targeting breastfeeding in the UK: systematic review and equity synthesis of qualitative evidence
• Equity-focused peer support and community interventions for breastfeeding in high-income countries: Systematic review and intervention component analysis (forthcoming)
• Blog posts discussing this work is available here and here.
• A briefing paper which can be found here.