Using the NASSS-Complexity Assessment Tool to Evaluate the Implementation of "Cadê O Kauê?": Chat-Story Intervention for Youth Participation in Mental Health Promotion in Brazil

Clinical Snapshot

Key Findings

• P Value: Not applicable for qualitative study

• Effect Size: Not applicable for qualitative study

• Primary Outcome: Implementation complexities identified across technology, organization, and wider system domains

• Nnt Or Sensitivity: Thematic analysis revealed interdependencies, unintended consequences, and uncertainties as key complexity characteristics

• Confidence Interval: Not applicable for qualitative study

Clinical Application

Moderate - requires organizational readiness assessment and infrastructure considerations before implementation Relevant for Australian digital mental health initiatives, particularly in rural/remote schools with infrastructure limitations. Aligns with National Mental Health Commission priorities for youth mental health Healthcare organizations implementing digital mental health interventions for adolescents, particularly in resource-constrained settings

Abstract

BACKGROUND: The global public health challenge of young people's mental health is particularly evident in Brazil, which is considered the most anxious and the fifth most depressed country globally. In response to this, a digital intervention, that takes the form of a storytelling chatbot named "Cadê o Kauê?" (translation: "Where is Kauê?"), was coproduced by an interdisciplinary team of researchers, young people, and narrative designers as part of a project titled Engajadamente. The intervention was designed to strengthen Brazilian adolescents' skills in promoting their peers' mental health through direct support and collective action for mental health. The intervention was rolled out in select schools in Brazil and online via social media, but it encountered challenges during the initial implementation phase in school settings. OBJECTIVE: This project's primary objective is to evaluate the implementation of "Cadê o Kauê" in school settings in Brazil, assess current and potential complexities, and formulate recommendations to reduce or manage these complexities. The secondary objective of this project is to understand the current and potential sociotechnical change resulting from the implementation of the "Cadê o Kauê" in a real-world setting. METHODS: The Non-adoption, Abandonment, Scale-up, Spread, Sustainability (NASSS) framework was selected as the theoretical framework to identify different areas of complexity across domains and further thinking of ways to reduce or manage these complexities. Data were gathered by conducting semistructured online interviews with the Engajadamente team members based in the United Kingdom and Brazil. The NASSS-Complexity Assessment Tool was used as a sensemaking device to facilitate a collective understanding of the implementation, and narratives were mapped onto specific NASSS domains. Key themes were identified across overarching domains using thematic analysis to meet the objectives of this evaluation. RESULTS: The results mapped onto the NASSS domains generated a narrative about the initial implementation of "Cadê o Kauê?" in schools. Existing and potential complexities across technology, organization, and wider system domains were characterized by interdependencies, unintended consequences, and uncertainties. The implementation of "Cadê o Kauê?" highlighted challenges related to internet dependency, infrastructure limitations, and varying levels of organizational readiness, teacher preparedness, and school culture. Addressing these through offline solutions, additional teacher training, whole-school engagement strategies, and a value-informed complexity approach can enhance accessibility, alignment with school priorities, and adaptability within Brazil's dynamic sociopolitical context. CONCLUSIONS: Using the NASSS framework, the evaluation captured both current and emerging complexities in implementing "Cadê o Kauê?" in schools. By engaging with theory-informed approaches to technology implementation projects and deep-diving into discursive dynamic interactions between technology and its "context" of implementation, we have explored ways to manage these complexities and developed suitable recommendations to guide the Engadajamente team and support similar projects in the future.

References

1. 1.Setia, S., Pavarini, G., Koshkouei, M., & Giardini Murta, S. (2026). Using the NASSS-Complexity Assessment Tool to Evaluate the Implementation of "Cadê O Kauê?": Chat-Story Intervention for Youth Participation in Mental Health Promotion in Brazil. Journal of Medical Internet Research. https://doi.org/10.2196/79106