BACKGROUND:Academic pressure could increase the risk of adolescent depression and self-harm. However, there are few longitudinal studies of this association, and those that exist have limitations. We aimed to investigate associations between perceived levels of academic pressure and subsequent depressive symptoms and self-harm from adolescence to early adulthood. Our hypothesis was that higher levels of academic pressure would be associated with higher levels of depressive symptoms and self-harm. METHODS:In this longitudinal study, we used data from the Avon Longitudinal Study of Parents and Children (Avon, UK) that includes adolescents born in 1991-92. Our primary exposure of interest was academic pressure measured at age 15 years, using items from a school experiences questionnaire (total scores 0-9). Outcomes were depressive symptoms assessed with the Short Mood and Feelings Questionnaire at five timepoints between age 16 years and 22 years (total scores 0-26), and a self-harm questionnaire at four timepoints between age 16 years and 24 years. Analyses were linear (depressive symptoms) and logistic (self-harm in the previous year) multilevel models in samples with multiply imputed data, before and after adjustments. FINDINGS:We included 4714 adolescents (2725 [57·8%] female, 1989 [42·2%] male). In fully adjusted models, a 1-point increase in academic pressure at age 15 years was associated with a 0·43 (95% CI 0·36-0·51) point increase in depressive symptoms. This association was largest when depressive symptoms were assessed at age 16 years (0·53, 0·42-0·64), but remained at age 22 years (0·35, 0·23-0·47). For self-harm, in fully adjusted models, each 1-point increase in academic pressure was associated with an 8% higher odds of self-harm (adjusted odds ratio 1·08, 1·01-1·16), with no differences over time. INTERPRETATION:Our findings support the hypothesis that academic pressure is a potential modifiable risk factor for adolescent depressive symptoms, and possibly self-harm. Interventions to reduce academic pressure could be developed and evaluated. FUNDING:Sir Henry Dale Fellowship, Wellcome Trust, and Royal Society.

School is an important setting for supporting young people's healthy development and positive mental wellbeing. Recent curriculum changes in Scotland and Wales reflect this, adopting a whole-school approach to health and wellbeing as a central pedagogical focus and responsibility of all working in the sector. Alongside education system reform, there is a growing recognition of the need for health improvement decision-making in schools to take a data-driven approach. Interactive data dashboards are data visualisation tools that can facilitate quick information processing and effective decision-making. The Schools Health and Wellbeing Improvement Research Network (SHINE) in Scotland and the School Health Research Network (SHRN) in Wales have been exploring interactive data dashboards as tools for sharing health and wellbeing data with teachers, pupils and parents. This paper explores the views of Local Authority staff, teachers and pupils on the potential application of interactive data dashboards within the school setting to inform health improvement planning. Findings suggest that these offer an accessible tool that could promote cross-curricular health and wellbeing learning, strengthen the link between home and school life, and engage education and community partners in data-informed health and wellbeing promotion. However, the needs of the school community must remain central in the dashboard design process. Implications for health and wellbeing data-related practices within the school community and future directions are discussed.

School is an important setting for supporting young people's healthy development and positive mental wellbeing. Recent curriculum changes in Scotland and Wales reflect this, adopting a whole-school approach to health and wellbeing as a central pedagogical focus and responsibility of all working in the sector. Alongside education system reform, there is a growing recognition of the need for health improvement decision-making in schools to take a data-driven approach. Interactive data dashboards are data visualisation tools that can facilitate quick information processing and effective decision-making. The Schools Health and Wellbeing Improvement Research Network (SHINE) in Scotland and the School Health Research Network (SHRN) in Wales have been exploring interactive data dashboards as tools for sharing health and wellbeing data with teachers, pupils and parents. This paper explores the views of Local Authority staff, teachers and pupils on the potential application of interactive data dashboards within the school setting to inform health improvement planning. Findings suggest that these offer an accessible tool that could promote cross-curricular health and wellbeing learning, strengthen the link between home and school life, and engage education and community partners in data-informed health and wellbeing promotion. However, the needs of the school community must remain central in the dashboard design process. Implications for health and wellbeing data-related practices within the school community and future directions are discussed.

Purpose There is evidence that academic pressure has been rising among adolescents in the UK. While this may be a modifiable risk factor for mental health problems, there are few validated measures of academic pressure and all have limitations. Methods With secondary-school students, we co-produced a student-reported measure of academic pressure, the 7-item Academic Pressure Questionnaire (APQ). This was included in the baseline survey of students aged 12-13 within the Positive Choices trial, a whole-school intervention to promote sexual health in English secondary schools. We ran factor analyses and assessed internal consistency, associations with sex and depressive symptoms, and variation in academic pressure between schools. Results We extracted one factor (Cronbach's alpha 0.76). Female students had higher APQ scores than males (mean difference = 2.18, 95% CI: 1.88 to 2.49). Higher APQ scores were associated with more depressive symptoms (coefficient = 0.51, 95% CI: 0.48 to 0.55) and associations were larger in female than male students (p value for interaction <0.001). School-level factors explained 2.6% of variation in APQ scores after adjusting for individual-level factors (ICC = 0.026, 95% CI: 0.01 to 0.06). Conclusion The APQ is a valid and reliable tool to investigate academic pressure in secondary-school adolescents.

Background:Emotional problems among adolescents have increased substantially in recent years, and there is evidence that schoolwork pressures have also increased globally. We examine trends in perceived schoolwork pressure and emotional problems in Wales between 2002 and 2021, and associations between the two over this period. Methods:Repeat cross-sectional data were used from surveys conducted in secondary schools in Wales. Participants were 11-16-year-olds (n = 318,554). Measures included self-reported perceived schoolwork pressure and emotional problems (HBSC-SCL). Results:The percentage of students reporting a lot of perceived schoolwork pressure increased from 21% in 2002, to 24% in 2004. Rates then declined until 2009, dropping to 13%, before increasing to nearly 26% by 2021. Students reporting the most pressure were females in older school years, with up to 57% of females in Year 11 reporting a lot of perceived pressure in 2021. Emotional problems followed a similar trend, decreasing between 2002 and 2009, and then increasing between 2009 and 2021. Between 2009 and 2019, estimates of the cohort difference in emotional problems reduced from 2.23 (95% CI = 2.12, 2.34) to 1.64 (95% CI = 1.54, 1.75) when adjusting for changes in schoolwork pressure. This is consistent with the hypothesis that schoolwork pressure may be driving some of the increase in emotional problems over time. Conclusions:Our findings showed a decline in perceived school pressure until 2009, followed by a rise until 2021. Increases were particularly apparent among female adolescents, mirroring trends in emotional problems. Although a range of competing causal explanations cannot be ruled out, overall increases in schoolwork pressure from the late 2000s may have contributed to the rise in adolescent emotional problems over this period.

Epidemiological evidence shows a substantial increase in adolescent emotional problems in many countries, but reasons for this increase remain poorly understood. We tested change in emotional problems in a national sample of young people in Wales in 2013, 2017 and 2019 using identical symptom screens, and examined whether trends were accounted for by changes in youth friendship quality and bullying. The present study of 230,735 11–16-year olds draws on repeat cross-sectional data obtained on three occasions (2013, 2017 and 2019) in national school-based surveys in Wales (conducted by the School Health Research Network). Emotional problems were assessed with a brief validated symptom screen (the SCL-4). There was a significant increase in emotional problem scores between 2013 and 2019 ( b [95% CI] = 1.573 [1.380, 1.765]). This increase was observed for all ages and was more pronounced for girls than boys (interaction b [95% CI] = 0.229 [0.004, 0.462]) and for young people from less affluent families (interaction b [95% CI] = −0.564[−0.809, −0.319]). Of the total sample, 14.2% and 5.7% reported frequent face-to-face and cyberbullying respectively. There were modest decreases in friendship quality and increases in rates of bullying between 2013 and 2019, but accounting for these changes did not attenuate estimates of the population-level increase in emotional problems. This study provides evidence of a substantial increase in emotional problems among young people in Wales, particularly for young people from less affluent backgrounds. Changes in bullying or friendship quality did not explain this increase.

Objectives: Community sites, including schools, are important settings for interventions to promote children and young people's mental health and wellbeing. A central provision to support mental health in the UK is school- and community-based counselling services. However, the evidence-base for school counselling services is limited by weak evaluation designs, lack of understanding of different counselling approaches in use, and a failure to conceptualise counselling services as part of a wider complex system. To address the last point, this article takes a complex system-focused perspective to explore how a 'system disruption', that is counselling service implementation, can be optimised in the Welsh education system.Design: The approach used in this study is a mixed-method qualitative design.Setting: Participants were recruited from school and community settings. They included children and young people, parents, carers, school staff, counsellors and stakeholders from health and education.Method: Consultations, key system stakeholder interviews and school case studies were conducted. All stakeholders were asked about their experiences of local authority-funded school- and community-based counselling services in Wales. Interview and consultation data were analysed using a thematic analysis approach.Results: Data converged into three main themes focusing on the specifics of counselling sessions, counselling services as part of universal mental health provision and a whole education system approach. These three themes are brought together into a complex systems-focused model of an optimised school- and community-based counselling service.Conclusion: The model offers an opportunity to address issues with current counselling services in Wales and improve outcomes and sustainability by increasing the likelihood they will become embedded in the whole education system.

Teachers as delivery agents within school-based mindset programmes is a potential intervention strategy for improving pupils’ outcomes. The Mindset Teams programme, utilises teachers as delivery agents, with an aim to improve learning resilience for health and attainment outcomes among schools in Scotland. This study examined the perceived impacts of the programme to develop a programme theory of change and refine an earlier co-produced logic model. Across six intervention schools, one-to-one interviews were conducted with teachers (N = 18) and focus groups were conducted with 23 pupils aged 8-11-years. Fourteen stakeholders involved in programme provision, secondary school delivery, funding decisions or policy-related areas also participated in a one-to-one interview. Qualitative data were analysed using thematic analysis with a combined deductive and inductive coding approach. Themes were identified in relation to impacts on teachers (five themes), pupils (eight themes), and broader outcomes (two themes), with most themes discussed by teachers and wider stakeholders. Across data, findings highlighted the proposed mechanisms by which the programme was intending to produce impacts, largely through increasing teacher knowledge and facilitating a positive school environment. Themes demonstrated the breadth of perceived programme impacts, highlighting both attainment and wellbeing outcomes among pupils. Findings provide support for Mindset programmes focusing on the development of teachers’ mindsets, highlighting the resultant perceived impacts this can have on both teachers and pupils alike. Future research should seek to capture health and wellbeing measures alongside attainment data to fully explore programme impacts.

IntroductionProvision of school- and community-based counselling services differs in terms of funding, implementation and eligibility criteria across the UK. The existing evidence of the effectiveness of counselling services is mixed, with little consideration of service context, implementation or acceptability. This rapid review seeks to address the gaps in the extant evidence syntheses by exploring the effectiveness, implementation and acceptability of school- and community-based counselling services in the UK. MethodsA systematic literature search was conducted in five electronic databases. Grey literature searches were conducted in 23 national government and third-sector organisational websites. The searches focussed on studies examining counselling interventions aimed at children aged 7-18 years that examined either effectiveness, implementation, acceptability or context. ResultsFifty-four studies were included in the review. The few RCT studies suggest that there is no clear evidence of effectiveness of the therapeutic approach, due to mixed findings. There is some tentative evidence for weaker study designs that counselling may have positive impacts across different settings. The service is highly valued by learners, teachers and parents and is believed to improve well-being; however, it is often seen as a discrete service that is not well-embedded within the education system. ConclusionsThere is mixed evidence for the effectiveness of school- and community-based counselling. However, this needs to be understood in the context of acceptability and implementation. Future work is needed to improve the implementation of services by considering the wider complexity of the systems in which these services are embedded.

This qualitative study explores the motivations, barriers, and facilitators underpinning the adoption of the Mindset Teams programme in primary schools across Scotland. Semi-structured interviews were conducted with 18 teachers across six Mindset Teams schools and 14 wider stakeholders working across local, regional, and national levels. Findings suggested underpinning factors across the socio-ecological model, with differential themes identified, including six supporting school motivations and ten spanning barriers and facilitators, across teacher and stakeholder data. Limitations, implications for school and educational psychology (EP) practice, and suggestions for future school-based mindset interventions are considered.

We evaluated the impact of a growth mindset intervention on pre-specified teacher outcomes and pupil academic attainment and attendance. Delivered over 12 months, the Mindset Teams intervention provides teachers with formal and self-directed online learning, and an opportunity to implement evidence-based growth mindset practice in the classroom setting. The intervention aims to influence teacher practices to improve pupil resilience for learning and bring about positive impacts on pupil attainment and health outcomes. Impacts on teachers were explored through pre- and post-intervention survey data (570 and 301 respectively). Pupil attainment and attendance data from 1220 schools, 72 of which received the intervention, across years 2017-2021 (minus 2020), were analyzed using weighted mixed effects models, using a Difference-in-differences framework. Bayes factors were calculated as a measure of strength of evidence. Results suggest positive impacts of the intervention on teacher outcomes and indicate a moderate effect (+3% (95%CI +1%, +6%)) of programme delivery on writing attainment, but no evidence of effect for other outcomes. Findings highlight important issues for further research, specifically the need to explore programme impacts using pupil or classroom level data.

BACKGROUND:Online communication has become an integral aspect of daily life for young people internationally. Very little research has examined whether the association between social media use and well-being depends on who young people engage with (i.e. real, or virtual friendships). METHODS:Data were drawn from a subsample of students (N = 38,736) who took part in the School Health Research Network (SHRN) 2019 Student Health and Well-being (SHW) survey. A series of multivariable regression models were used to assess the association between who adolescents were communicating with online and well-being, controlling for confounders: passive social media use; friendship quality; and cyberbullying. We also tested whether these associations were modified based on gender. RESULTS:Students are highly engaged on social networking sites, and these sites are used to communicate with existing friendship groups and develop virtual friendships. Frequent online communication with best friends (b = .340, p < .001) and bigger friendship groups (b = .397; p < .001) was associated with higher levels of well-being. However, the frequency of online contact with virtual friends made online was negatively and significantly associated with well-being (b = -.760; p < .001), with a larger negative association for girls than boys. CONCLUSIONS:Online communication with virtual friendship networks were associated with lower mental well-being, with stronger associations for girls than boys; however, frequent online communication with 'real' friends was associated with better well-being. Our results indicate the importance of considering the nature of adolescent online communication, rather than just its quantity, in developing interventions to improve adolescent well-being.

BACKGROUND:Epidemiological evidence shows a substantial increase in adolescent emotional problems in many countries, but reasons for this increase remain poorly understood. We tested change in emotional problems in a national sample of young people in Wales in 2013, 2017 and 2019 using identical symptom screens, and examined whether trends were accounted for by changes in youth friendship quality and bullying. METHODS:The present study of 230,735 11-16-year olds draws on repeat cross-sectional data obtained on three occasions (2013, 2017 and 2019) in national school-based surveys in Wales (conducted by the School Health Research Network). Emotional problems were assessed with a brief validated symptom screen (the SCL-4). RESULTS:There was a significant increase in emotional problem scores between 2013 and 2019 (b[95% CI] = 1.573 [1.380, 1.765]). This increase was observed for all ages and was more pronounced for girls than boys (interaction b [95% CI] = 0.229 [0.004, 0.462]) and for young people from less affluent families (interaction b [95% CI] = -0.564[-0.809, -0.319]). Of the total sample, 14.2% and 5.7% reported frequent face-to-face and cyberbullying respectively. There were modest decreases in friendship quality and increases in rates of bullying between 2013 and 2019, but accounting for these changes did not attenuate estimates of the population-level increase in emotional problems. CONCLUSIONS:This study provides evidence of a substantial increase in emotional problems among young people in Wales, particularly for young people from less affluent backgrounds. Changes in bullying or friendship quality did not explain this increase.

The education systems of the four UK nations are diverging, and the education system in Wales is undergoing major reform with substantially increased emphasis on health and wellbeing. Understanding the implementation of major policy and system reforms requires an understanding of system histories and starting points. This study aimed to explore the perceived roles of schools in contemporary society, and how this role has evolved over time; the aims of the reforms, with a particular focus on health and wellbeing; and perceived barriers and facilitators for implementation. Interviews were held with senior stakeholders in the Welsh education system who held a strategic role in shaping the reforms. These included senior members of government and schools with a remit in either design of the curriculum or educationalists’ professional learning, Wales's school regulatory body, and those with a multidisciplinary remit in health and education. Interviews were subjected to thematic analysis, which produced a number of themes related to each objective, including ‘a changing society and increasing expectations on schools’, ‘the perceived role of schools in supporting health and wellbeing’, ‘the aims of the reform’, ‘what will success look like?’, ‘national level barriers and facilitators’ and ‘community and school level barriers and facilitators’. Findings suggest that education system reform requires change at multiple levels of the education system. Consideration of each level, and the interactions between them, is necessary for achieving change.

INTRODUCTIONAlthough the evidence base on bullying victimization and self-harm in young people has been growing, most studies were cross-sectional, relied on self-reported non-validated measures of self-harm, and did not separate effects of in-person and cyberbullying. This study aimed to assess associations of self-harm following in-person bullying at school and cyberbullying victimization controlling for covariates.METHODSSchool survey data from 11 to 16 years pupils collected in 2017 from 39 Welsh secondary schools were linked to routinely collected data. Inverse probability weighting was performed to circumvent selection bias. Survival analyses for recurrent events were conducted to evaluate relative risks (adjusted hazard ratios [AHR]) of self-harm among bullying groups within 2 years following survey completion.RESULTSA total of 35.0% (weighted N = 6813) of pupils reported being bullied, with 18.1%, 6.4% and 10.5% being victims of in-person bullying at school only, cyberbullying only and both in-person bullying at school and cyberbullying respectively. Adjusting for covariates, effect sizes for self-harm were significant after being in-person bullied at school only (AHR = 2.2 [1.1-4.3]) and being both in-person bullied at school and cyberbullied (AHR = 2.2 [1.0-4.7]) but not being cyberbullied only (AHR = 1.2 [0.4-3.3]). Feeling lonely during recent summer holidays was also a robust predictor (AHR = 2.2 [1.2-4.0]).CONCLUSIONSWe reaffirm the role of in-person bullying victimization on self-harm. Pupils were twice as likely to self-harm following in-person bullying as their nonvictimised peers. Interventions for young people that minimize the potential impacts of bullying on self-harm should also include strategies to prevent loneliness.

Existing frameworks for developing public health interventions have limited guidance for researchers on how to work with stakeholders to co-produce context-specific interventions. To address this, a promising framework for the co-production of public health interventions was developed through a previous review of school-based co-production. The present study aimed to optimise this co-production framework through applying and testing it in real-world secondary school contexts. Within schools, Research Action Groups (RAGs) were established with multiple school stakeholders supported by an external facilitator to use school data to produce school-specific mental health and wellbeing interventions. A mixed method process evaluation of two contextually diverse case study secondary schools in the UK was used to optimise the co-production framework. The process evaluation sought the views of those involved (students, school staff, school Senior Management Team (SMT) members, and the external co-production facilitator/researcher) on the co-production functions they were involved in so they could be modified, if needed. Data collected for the process evaluation during co-production were a researcher diary ( n = 45 entries), and observations of student photography ( n = 21) and RAG meetings ( n = 8). Post co-production, interviews, and surveys with RAG students ( n = 18) and staff ( n = 8), and two school-specific SMT focus groups ( n = 10) were conducted. The study identified four recommendations to optimise and integrate co-production into real world practice. They include the need to: assess schools for their readiness to undertake co-production; more effectively communicate the necessity to have stakeholders from the whole system involved; work with SMTs throughout co-production functions; involve stakeholders outside the school to support producing solutions to change school mental health and wellbeing priorities. The framework is intended to be used by researchers to integrate stakeholders into a shared decision-making process to develop interventions that meet the needs and contexts of individual schools. It could be transferred to other settings to support the development of public health interventions for other health areas, and populations. Further evaluation to test its use in other settings is needed.

The education systems of the four UK nations are diverging, and the education system in Wales is undergoing major reform with substantially increased emphasis on health and wellbeing. Understanding the implementation of major policy and system reforms requires an understanding of system histories and starting points. This study aimed to explore the perceived roles of schools in contemporary society, and how this role has evolved over time; the aims of the reforms, with a particular focus on health and wellbeing; and perceived barriers and facilitators for implementation. Interviews were held with senior stakeholders in the Welsh education system who held a strategic role in shaping the reforms. These included senior members of government and schools with a remit in either design of the curriculum or educationalists’ professional learning, Wales's school regulatory body, and those with a multidisciplinary remit in health and education. Interviews were subjected to thematic analysis, which produced a number of themes related to each objective, including ‘a changing society and increasing expectations on schools’, ‘the perceived role of schools in supporting health and wellbeing’, ‘the aims of the reform’, ‘what will success look like?’, ‘national level barriers and facilitators’ and ‘community and school level barriers and facilitators’. Findings suggest that education system reform requires change at multiple levels of the education system. Consideration of each level, and the interactions between them, is necessary for achieving change.

ObjectivesThe Strengthening Families Programme 10–14 (SFP10-14) is a USA-developed universal group-based intervention aiming to prevent substance misuse by strengthening protective factors within the family. This study evaluated a proportionate universal implementation of the adapted UK version (SFP10-14UK) which brought together families identified as likely/not likely to experience/present challenges within a group setting.DesignPragmatic cluster-randomised controlled effectiveness trial, with families as the unit of randomisation and embedded process and economic evaluations.SettingThe study took place in seven counties of Wales, UK.Participants715 families (919 parents/carers, 931 young people) were randomised.InterventionsFamilies randomised to the intervention arm received the SFP10-14 comprising seven weekly sessions. Families in intervention and control arms received existing services as normal.Outcome measuresPrimary outcomes were the number of occasions young people reported drinking alcohol in the last 30 days; and drunkenness during the same period, dichotomised as ‘never’ and ‘1–2 times or more’. Secondary outcomes examined alcohol/tobacco/substance behaviours including: cannabis use; weekly smoking (validated by salivary cotinine measures); age of alcohol initiation; frequency of drinking >5 drinks in a row; frequency of different types of alcoholic drinks; alcohol-related problems. Retention: primary analysis included 746 young people (80.1%) (alcohol consumption) and 732 young people (78.6%) (drunkenness).ResultsThere was no evidence of statistically significant between-group differences 2 years after randomisation for primary outcomes (young people’s alcohol consumption in the last 30 days adjusted OR=1.11, 95% CI 0.72 to 1.71, p=0.646; drunkenness in the last 30 days adjusted OR=1.46, 95% CI 0.83 to 2.55, p=0.185). There were no statistically significant between-group differences for other substance use outcomes, or those relating to well-being/stress, and emotional/behavioural problems.ConclusionsPrevious evidence of effectiveness was not replicated. Findings highlight the importance of evaluating interventions when they are adapted for new settings.Trial registration numberISRCTN63550893.Cite Now

Background In many countries, including in the United Kingdom (UK), COVID-19 social distancing measures placed substantial restrictions on children’s lives in 2020 and 2021, including closure of schools and limitations on play. Many children faced milestones such as transition to secondary school having missed several months of face-to-face schooling in the previous academic years. Methods This paper examines change in mental health difficulties, life satisfaction, school connectedness, and feelings about transition to secondary school among 10–11-year-olds in Wales, UK, using data from repeat cross-sectional surveys before and after the onset of the COVID-19 pandemic. Participants were 4032 10–11-year-old schoolchildren. The first cohort completed a school-based survey in 2019 (prior to introduction of social distancing measures), and the second in 2021 (following full return to school after two rounds of school closure). Results The percentage of children reporting elevated emotional difficulties rose from 17% in 2019 to 27% in 2021 (Odds Ratio = 1.65; 95%CI = 1.23 to 2.20). There was no evidence of increased behavioural difficulties (OR = 1.04; 95%CI = 0.73 to 1.46). There was a tendency toward declines in life satisfaction in all analyses, but this intersected the null (OR = 0.86; 95%CI = 0.70 to 1.07). Children reported a high degree of school connectedness before and after the pandemic, with no evidence of change in ratings of teacher relationships, pupil relationships or pupil involvement in school life. There was no evidence of impacts of the pandemic on children’s feelings about the transition to secondary school, with feelings becoming more positive as transition neared. Most findings were robust to a range of sensitivity analyses. Conclusions Supporting children’s emotional recovery from the COVID-19 pandemic is a public health priority requiring urgent and effective action at multiple levels of society. Maintaining connectedness to school through the pandemic may have played a role in preventing a steeper increase in child mental health difficulties.

Objectives Research on the adaptation of population health interventions for implementation in new contexts is rapidly expanding. This has been accompanied by a recent increase in the number of frameworks and guidance to support adaptation processes. Nevertheless, there remains limited exploration of the real-world experiences of undertaking intervention adaptation, notably the challenges encountered by different groups of stakeholders, and how these are managed. Understanding experiences is imperative in ensuring that guidance to support adaptation has practical utility. This qualitative study examines researcher and stakeholder experiences of funding, conducting and reporting adaptation research. Setting Adaptation studies. Participants Participants/cases were purposefully sampled to represent a range of adapted interventions, types of evaluations, expertise and countries. Semistructured interviews were conducted with a sample of researchers (n=23), representatives from research funding panels (n=6), journal editors (n=5) and practitioners (n=3). Measures A case study research design was used. Data were analysed using the framework approach. Overarching themes were discussed within the study team, with further iterative refinement of subthemes. Results The results generated four central themes. The first three relate to the experience of intervention adaptation (1) involving stakeholders throughout the adaptation process and how to integrate the evidence base with experience; (2) selecting the intervention and negotiating the mismatch between the original and the new context; and (3) the complexity and uncertainty when deciding the re-evaluation process. The final theme (4) reflects on participants’ experiences of using adaptation frameworks in practice, considering recommendations for future guidance development and refinement. Conclusion This study highlights the range of complexities and challenges experienced in funding, conducting and reporting research on intervention adaptation. Moving forward, guidance can be helpful in systematising processes, provided that it remains responsive to local contexts and encourage innovative practice.