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Effective and scalable interventions are urgently needed to address these challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This protocol outlines a multicountry cluster randomised factorial trial, implemented according to the multiphase optimisation strategy (Phase 2), which evaluates the effectiveness and costs of three add-on components for the Parenting for Lifelong Health for Parents and Teens programme: adolescent mental health tools based on UNICEFs Helping Adolescents Thrive comics, adolescent peer support based on UNICEFs \u2018I Support My Friends\u2019 intervention and engagement booster designed to enhance attendance and programme completion through incentives. The study will recruit 720 families and involve 64 clusters in North Macedonia and Moldova. Primary outcomes will include adolescent internalising problems and social support, family functioning and attendance during the programme. Secondary outcomes will assess broader aspects of mental health among caregivers and adolescents, as well as implementation and cost outcomes. Data will be collected at baseline and postintervention, approximately, 8\u2009weeks later. Statistical analyses will include regression models to assess the main and interaction effects of the intervention components and cost analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study received ethical approval from the University of Klagenfurt in Austria (approval number: 2023\u2013013), the Medical Faculty at St. Cyril and Methodius University in North Macedonia (approval number: 03-2144\/4) and the National Committee of Ethical Expertise for Clinical Trials in Moldova (approval number: 1476). The results will be disseminated through peer-reviewed journals, conferences, webinars in multiple languages, regional forums, stakeholder meetings with policymakers and practitioners, public communication through media engagement and open access platforms, including data sharing and early release of findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration details<\/jats:title>\n                    <jats:p>\n                      Trial registration:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06562244\">NCT06562244<\/jats:ext-link>\n                      ; Project page:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.flourish-study.org\/about.html\">https:\/\/www.flourish-study.org\/about.html<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-094085","type":"journal-article","created":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T22:58:16Z","timestamp":1738969096000},"page":"e094085","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Family-focused intervention programme to foster adolescent mental health and well-being: protocol for a multicountry cluster randomised factorial trial (FLOURISH Phase 2)"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct06562244","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06562244","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0613-0696","authenticated-orcid":false,"given":"Antonio","family":"Piolanti","sequence":"first","affiliation":[{"name":"Department of Health Psychology, University of Klagenfurt, Klagenfurt, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5005-2218","authenticated-orcid":false,"given":"Janina","family":"Mueller","sequence":"additional","affiliation":[{"name":"Department of Health Psychology, University of Klagenfurt, Klagenfurt, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franziska","family":"Waller","sequence":"additional","affiliation":[{"name":"Department of Health Psychology, University of Klagenfurt, Klagenfurt, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8301-5798","authenticated-orcid":false,"given":"Nina","family":"Heinrichs","sequence":"additional","affiliation":[{"name":"Department of Psychology, Bielefeld University, Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9279-8627","authenticated-orcid":false,"given":"Judit","family":"Simon","sequence":"additional","affiliation":[{"name":"Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria"},{"name":"Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0254-3397","authenticated-orcid":false,"given":"Yulia","family":"Shenderovich","sequence":"additional","affiliation":[{"name":"Centre for Development, Evaluation, Complexity, and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK"},{"name":"Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6820-9183","authenticated-orcid":false,"given":"Swetha","family":"Sampathkumar","sequence":"additional","affiliation":[{"name":"Centre for Development, Evaluation, Complexity, and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5183-1352","authenticated-orcid":false,"given":"Dennis","family":"Wienand","sequence":"additional","affiliation":[{"name":"Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marija","family":"Raleva","sequence":"additional","affiliation":[{"name":"Institute for Marriage, Family, and Systemic Practice - 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