Our approach to addressing the five objectives involves a range of methods and work streams. The first two objectives will be addressed primarily through quantitative (statistical) analyses of data on recipients of CTPs. Important concepts emerging from the qualitative analysis, i.e., interviews and focus groups with providers and recipients of CTPs (objective 4), as well as from stakeholder consultations (objective 5) and the scientific literature will inform the interpretation of findings from quantitative analyses. This includes knowledge about contextual factors and programme features likely to explain differences in findings on impacts. Findings from the qualitative analysis will inform interpretation of results from the quantitative analysis. The economic analysis conducted (objective 3) will be informed by both the quantitative and qualitative analyses, as well as stakeholder consultation. Figure 1 provides an overview of the approach. This study will follow a triangulation design , in which quantitative and qualitative parts are conducted mainly in parallel and we use and analyse multiple sources of data together to more comprehensively address our research question and to increase validity of findings. The main interaction and integration between the quantitative and qualitative methods will take place in the analysis and interpretation of the quantitative findings. However, there are additional interaction points as triangulation follows a flexible approach that allows findings to emerge at different stages and from the different parts of the research to address interconnected questions of the role of contextual factors, mechanisms and impacts.
Investigating the impact of CTPs (Objective 1)
In quantitative (statistical) analyses, we will explore effects of the CTPs on mental health and on life chances outcomes by first examining impacts overall and then by mental health status, adjusting for all relevant covariates. We will first conduct country-specific analysis on each CTP, and then conduct analysis based on data that are harmonised across all countries. The primary data sources for the quantitative analysis will be data from intervention and population panel studies in each of the six countries (Table 1). Table 4 presents the socio-demographic characteristics of young people and their households from the population panel studies in Brazilian, Colombian and South African, including a comparison of characteristics of young people with and without mental health problems.
All studies have used validated measures of poverty, mental health and life chances variables from well-established datasets. Based on these secondary datasets, we will investigate the impact of CTPs on mental health, and on life chances variables for young people. Different age ranges will be considered depending on eligibility criteria for the CTP and study design (Table 1). As much as this is possible mental health variables that indicate conditions will be analysed on a continuum “from mild, time-limited distress to chronic, progressive and severely disabling conditions” . In addition to assessing mental health conditions, variables which focus on related positive aspects of mental health such as life satisfaction, self-esteem, self-efficacy, and resilience will be analysed. With regard to life chances, a range of variables are measured in studies that provide indicators of the present situation and future of young person participants. These include educational achievements, employment status, income, substance misuse, living arrangements and relationship status (Table 1). In terms of poverty, relevant variables exist in each of the datasets, which allows us to adopt a multi-dimensional approach to poverty.
Our data analysis strategies will be based on quasi-experimental evaluation techniques  and other epidemiological approaches. As examples of quasi-experimental techniques we will identify so-called ‘discontinuities’ in the eligibility criteria for CTPs (often based, in parts, on an income or poverty threshold) and use a regression discontinuity design . For some programmes, we will use a difference-in-differences design, incorporating propensity score matching when appropriate. As for other epidemiological approaches, we will use different ways of estimating associations and causal effects of programs with cross-sectional and longitudinal data. The analytic method will be selected based on: (a) presence (or not) of necessary information/variables as well as number of observations for applying each quasi-experimental method and (b) verification of main identification assumptions underlying each method. Where the data meet the criteria of more than one method, we will compare results of all available methods.
Data harmonisation will include identifying commonalities and differences in mental health, life chances and poverty measures, and harmonising them across datasets, for example, using standardised percentile scores. Since datasets refer to different time periods, collected at different waves, and covering different age ranges, a selection will be made for the harmonised dataset, choosing data for time periods and age ranges most closely aligned with each other. The harmonisation process will involve collating shared variables (regarding the CTPs, mental health, life chances, poverty and socioeconomic status) and using the differences between programmes to answer key questions about their effect on mental health. This will allow comparisons across cultures and across CTPs (e.g., conditionality, age at receipt, length of receipt) to determine which features of the CTP are associated with better improvements in mental health and life chances. Online resource 2 provides an example of how data might be harmonised, by demonstrating this for selected datasets and indicators.
Delineating pathways and identifying mechanisms (Objective 2)
We will conceptualise and assess pathways that explain relationships between poverty, mental health and future life chances, and the influence CTPs have on them. This will be done primarily using quantitative analyses of datasets mentioned above (Table 1). As with the analysis of impact, parameters will be informed by qualitative findings, as well as scientific literature and stakeholder consultation. In addition, qualitative data could provide a broader conceptualisation of pathways and mechanisms, including those that cannot be tested quantitatively through our analyses (but that might inform future data collection and analyses).
First, we will carry out a systematic review of the literature on the impact of CTPs on mental health outcomes of young people, focusing on LMICs. We will then develop a conceptual framework of hypothesised pathways and mechanisms based on those contextual factors, conditionalities and features of CTPs identified as important in previous evaluations of CTPs and mental health programmes, other relevant scientific literature and views and experiences from young people and professionals involved in or knowledgeable of CTPs.
Overlaps between data gathered from the reviewed literature and our own knowledge (including knowledge based on data collected by that time) will be used to confirm the importance of pathways. Where data from different sources diverge, this will be also highlighted.
Next, where possible, we will test some of the mechanisms linking mental health and poverty to improved life chances. Potential variables to consider as having a role in those pathways include:
Contextual factors: e.g., unemployment, social cohesion, family functioning;
Conditionalities: e.g., school attendance and child health visits; and
Other programme features: e.g., amount of money; length of time receiving the cash transfer; ways of monitoring compliance
We will develop statistical models using recommended methods for mediation and moderation . For example, we will examine whether CTPs are associated with improvements in mental health and if these improvements mediate any improvement in future life chances.
Simulating cost-effectiveness of CTPs and mental health interventions (Objective 3)
Decision analytical modelling will be conducted to estimate the return-on-investment to the public purse from investing in country specific CTPs given any potential association we identify with mental health outcomes and life chances. This will be compared with expected outcomes and public purse costs associated with no intervention. In addition, the return-on-investment from investing in CTPs will be compared with alternative or complementary investment in selected effective mental health interventions in LMIC contexts. Such interventions will be identified in published systematic reviews and meta-analyses.
Effect sizes identified in the statistical analysis in Objective 2 will be combined with longitudinal trajectories of mental health and life chances identified in each of the longitudinal data sources (Table 1) to estimate potential long-term outcomes. Long-term monetary values will be attached to different life chances outcomes where possible. An example would be to estimate the value of higher rates of school completion for wealth accumulation and income through to adulthood. We will draw on published literature, e.g., costs reported in previous economic analyses of CTPs , as well as statistical reports relating to CTPs in the six countries, to estimate their administrative costs. The specific time frame for the modelling will depend on data availability. Costs and outcomes beyond 1 year will be discounted and all monetary values will be reported in purchasing power parity adjusted international dollars.
Modelling will also take account of implementation and scale-up costs in line with previous work . We will also vary underlying assumptions using both deterministic and probabilistic sensitivity analysis to reflect uncertainty on both effectiveness estimates and cost distributions. To increase policy relevance, and after engagement with stakeholders (Objective 5) we will also model specific conservative and optimistic scenarios. This could include varying assumptions on uptake rates to reflect themes in qualitative analysis with young people, families and professionals set out in Objective 4.
Understanding young people’s, families’ and professionals’ experiences (Objective 4)
We will conduct semi-structured interviews and focus groups with young people, families and professionals who use or deliver CTPs in the three countries in which our partners are based (Brazil, Colombia and South Africa). The aim of this qualitative research is to elicit information about:
Young people’s experiences and meaning of poverty and mental health in these diverse cultures and settings;
Personal experiences of being involved in the CTP,
Implementation barriers and facilitators of current programmes; and
Ideas for future combined CTP and mental health interventions.
The interviews will allow us to gain an in-depth understanding of young people’s experiences with CTPs, how they experience mental health and poverty more generally, and how they view their future, whereas in focus groups we seek to get an understanding of the family and community context in which programmes operate. We will elicit views from young people, families and professionals about the local context and about how programmes operate, the role of programme features and how programmes can be improved to better support young people.
We plan to conduct between 15 and 20 interviews and 3 and 4 focus groups in each of the 3 countries. Sampling and recruitment strategies for interviews and focus group will be tailored to the country setting. Partners will build rapport with the community and potential participants beforehand, through community visits and meetings utilising relationships with community organisations, youth groups and non-government organisations.
For the interviews, we will invite young people who are past or current users of CTPs, and who received or applied for the cash transfer themselves or who received this via their parents. For the focus groups, we will recruit parents who receive cash transfers, practitioners involved in the delivery of programmes and youth leaders from youth organisations.
Focus groups and interviews will be conducted in the local language, audio-recorded, transcribed and translated into English. First, country-specific analysis will be conducted using the complete data (in the mother language where possible). Next, data (in English) will be harmonised across countries by identifying commonalities. We will apply a constant comparative approach towards the coding [48, 52], thus allowing for repeated explorations and reflections with colleagues across countries. Data will be analysed primarily using inductive methods in the form of a framework approach to thematic analysis.
Details on how data for interviews and focus groups will be gathered and analysed following COREQ recommended standards are presented in online resource 1 .
Engaging stakeholders and young people (Objective 5)
A key element of CHANCES-6 is to work in partnership with policy makers and influencers, and other national or local stakeholders. This includes various representatives in governmental and non-governmental organisations (NGOs) who have responsibilities for health and welfare funding, planning and delivery. We will organise high-level policy workshops in each of the countries where our partners are based (i.e., Brazil, Colombia and South Africa), one in the first and one in the last year of the project. In the first round of stakeholder workshops, we will raise awareness of the research aims, seek feedback on methods and approach, and understand interests and capacities in utilising and implementing findings from the research. In addition, we will gather information that will help us understand implementation barriers and facilitators of current programmes, and opportunities for combined provision of CTPs and mental health programmes. The main aim of the second stakeholder workshop will be to discuss implications of the CHANCES-6 findings for policies and programme development, implementation and evaluation. We will plan activities to stay engaged with stakeholders between workshops and identify new stakeholders throughout the project. Partners in each of the countries will facilitate an ongoing dialogue with stakeholders, so we can incorporate their feedback as the research develops based, for example, on policy changes (including in relation to COVID-19), and in the interpretation and presentation of findings.
Additionally, we will develop and use various (social) media channels, outputs and tools to create opportunities for engaging with stakeholders and influence policies in all six countries of the project and beyond. Information and updates on the project, including research findings as they become available during the project, will be provided on the project website (https://www.lse.ac.uk/cpec/chances-6). We will also engage with representatives from international development agencies such as the World Bank, World Health Organisation and UNICEF and with relevant international communities.
Our ultimate beneficiaries are young people living in poverty. Overall, we plan to work with young people throughout the project, by engaging with youth leaders and representatives of organisations which advocate for the rights of young people, locally or nationally. The approach towards engaging with youth will be context-specific, and build on existing partnerships. Young people will be invited to become involved in telling their stories through social media, and by participating in a short films. Young people will become involved in the project, for example in the roles of advisors, advocates, and research staff. This will include involving students from universities, and involving youth in the interpretation of findings of the research.