Feasibility of co-creating and delivering a youth-led noncommunicable diseases risk reduction intervention in schools of slums in Karachi, Pakistan: protocol for a mixed-methods, pre- and post-intervention study

Background: Adolescents are more susceptible to the shared risk factors of noncommunicable diseases (NCDs), including physical inactivity, tobacco use (smoking and smokeless), and unhealthy diets. However, there is limited literature from Pakistan that involves school-going adolescents in developing and delivering NCD risk-reduction interventions among their younger peers. Objective: This study aims to assess the feasibility of co-creating and delivering a youth-led NCD risk reduction intervention in schools of slums in Karachi, Pakistan. Methods: Using a mixed-methods, pre- and post-intervention design approach, we will conduct the study in 10 randomly selected schools (5 government and 5 private) in Azam Basti and Mehmoodabad, the urban slums in Karachi. The study comprises five sequential phases: Phase I involves identifying shared risk factors of NCDs among younger peers aged 9 to 12 (grades 5 and 6 students) (n = 100) using structured diaries, which will also serve as a pre-intervention assessment. Phase II entails conducting qualitative interviews with youth aged 14 to 16 (grades 9 and 10 students) (n = 40), their parents, school head teachers, class teachers, and canteen staff to discuss intervention components, materials, and delivery methods. In Phase III, workshops will be held to co-create the intervention with the help of youth. Phase IV will involve 3 days of comprehensive youth training by a qualified nutritionist on delivering the intervention to their younger peers. Finally, in Phase V, youth will deliver the intervention among all grades 5 and 6 students in their schools, followed by a post-intervention assessment, in which the younger peers will complete the structured diaries for the shared risk factors. Two independent data collectors will also perform fidelity checks of the intervention delivery using a checklist. The expected outcomes will include the feasibility of developing and implementing a culturally relevant youth-led NCD risk reduction intervention and youth training manual. The feasibility of the intervention will be assessed using the recruitment and retention rates for schools, youth, and younger peers, youth attendance at workshops and training sessions, structured diaries completion rates at pre- and post-intervention, the fidelity of delivering the intervention, and the preliminary change in the risk factors at post-intervention compared to the baseline. Ethics and dissemination: The study was approved by the Ethical Review Committee of the Aga Khan University (ref.: 2024–9763-29,256). If the intervention proves feasible, we will disseminate our findings to both academic and nonacademic audiences. Additionally, we will implement a definitive trial across various slum settings in Karachi, Pakistan. Trial registration: ClinicalTrials.gov, NCT06465771. Registered 20 June 2024—prospectively registered, https://clinicaltrials.gov/study/NCT06465771.