Building connections in health and wellbeing education: Qualitative findings of a study with New Zealand agricultural students

Background: As the burden of mental health challenges increases globally, delivering mental health education programmes to at-risk groups is critical. Important factors governing the success of health and wellbeing education include the relationships and connections formed between students and those delivering the education. This article reports on the qualitative findings from a mixed-methods study evaluating a mental health wellbeing programme delivered to first-year agricultural students across two universities in New Zealand. Design: The qualitative data that formed the basis of this article involved an exploratory approach utilising semi-structured interviews with participants who had attended a mental health wellbeing programme. Findings: The study found that feelings of connectedness in relation to the programme and the educators, as well as the material provided, improved engagement. In particular, connection was improved through the use of peer educators from within the target community, alongside considerations of timing, promotion and incentives in the delivery of programmes. Conclusions: Relationships and building connections are crucial when delivering health and wellbeing education. These findings have implications for those developing and delivering educational mental health interventions at tertiary institutions in terms of the mechanisms used to support engagement, learning and integration of knowledge.


Introduction
Finding ways to improve mental wellbeing in rural communities is vitally important.The agricultural sector in New Zealand faces a myriad of financial, environmental, social and cultural challenges, which affect the mental health and wellbeing of those working and living in farms (Knook et al., 2022a).Suicide rates in rural communities are higher than national rates, which is true not only in New Zealand but also in Ireland, the UK and France (Rose et al., 2023).Given this situation, it is important to build resilience in mental health and wellbeing in rural communities (Rose et al., 2023).
One way of building wellbeing resilience is by introducing those working and living in farms to aspects of wellbeing via extension and education programmes (Knook et al., 2022b).These programmes can be helpful in conveying mental health concepts to those who come from rural communities, such as university students (Stallman and Shochet, 2009).Current rural intervention programmes are predominantly targeted towards older farm owners on the assumption that they carry the stress of adverse financial, weather and general farm events.Little is known about how to support the delivery of mental health messages for young people studying agriculture.Of the 185 people who died by suicide on farms in New Zealand between 2007 and 2015, 25% were farm labourers younger than 25 years (Beautrais, 2018).Concerningly, few of these young people had had contact with a doctor in the period prior to their death, suggesting that interventions need to be delivered in settings other than primary care (Stanley-Clarke, 2019).
Previous research recommends incorporating programmes to increase mental health literacy and create empathy into education programmes (Wynaden et al., 2014).There is consequently an increasing focus on mental health within education, with previous research showing that schools and universities play a crucial role in promoting positive mental health and wellbeing (O'Reilly et al., 2018;Reavley et al., 2012).Understanding the factors that best support the effective delivery of educational mental health interventions is important for tertiary institutions delivering to at-risk groups to improve mental health and reduce lives lost by suicide including students studying agriculture.
Student connection and engagement with wellbeing programmes supports wellbeing knowledge integration and application (Winder et al., in press).This article reports on qualitative findings from a mixed-methods evaluation of WellMates, a university educational mental health programme in New Zealand targeted towards first-year students of agriculture.The development and delivery of this wellbeing programme was prompted by a concern from academic staff at one of the universities in reaction to suicide deaths of rurally based alumni; the high rates of suicide attached to rural communities in New Zealand and an identified gap in terms of wellbeing programmes for agricultural university students (Beautrais, 2018;Knook et al., 2022b;Stanley-Clarke, 2019).
The focus of the educational mental health programme was on improving the mental health literacy of first-year agricultural students through peer-to-peer discussions, knowledge about wellbeing challenges and signs of poor mental health in themselves and others.As stated by Jorm (2012Jorm ( , 2015)), it is these various skills, among others, that can be imparted in educational mental health interventions that can improve the mental health literacy of communities, empowering people to take preventive actions to support themselves and others.
The study sought to explore agricultural students' experiences of the wellbeing programme to understand the aspects that worked well and the elements that could be improved to support student engagement and learning.Examining how to improve connection between students and the programme, the educators and the material provided is important for improving mental health awareness, knowledge and outcomes.This article discusses the importance of relationships in education and the efficacy of peer-led approaches in engaging students in health and wellbeing programmes and interventions at tertiary institutions.It offers insight into strategies that can be employed to improve the engagement of populations and groups that are often reluctant to engage with wellbeing messages and mental health supports such as agricultural students, addressing an identified gap in the literature.
There is scant research on engaging agricultural university students in wellbeing education.Hence, this article provides an overview of the wider literature in relation to mental health wellbeing education including the value of mental health interventions, the importance of connection and the role of peer-led approaches.

Mental health education interventions
The delivery of mental health education to young people can have long-term benefits for individuals, increasing their resilience, improving mental health literacy and developing healthy social behaviours (Ashwood et al., 2015;Ferris et al., 2019;Winzer et al., 2018;Young et al., 2022).
There is an increasing emphasis on the delivery of key mental health messages within education systems (Atkins et al., 2010;Young et al., 2022).Schools and universities have a fundamental role in improving mental health awareness and knowledge (Daniele et al., 2022;Huang et al., 2018;Jorm, 2015;O'Reilly et al., 2018;Reavley et al., 2012).Guest speakers, workshops and special classes on mental health are becoming more frequent in these settings with varying degrees of success (Huang et al., 2018;O'Reilly et al., 2018).To address the inconsistencies in intervention success, research calls for a clearer and more strategically informed approach to respond to the worsening mental health of young people (Fleming et al., 2020;Ministry of Health, 2022;United Nations Children's Fund, 2021;World Health Organization, 2022) and to provide a stronger foundation for educational mental health interventions (Barkham et al., 2019;O'Reilly et al., 2018).
Critical to maximising the effectiveness of mental health educational and promotional programmes are effective relationships and building connections (Bulanda et al., 2014;Johnson et al., 2021;Wynters et al., 2021).Wynters et al. (2021) conducted a qualitative assessment of a sportsbased mental health literacy programme targeted at young men.They found that relating the educational content to the participants' context and developing personal connections between educators and participants increased the perceived efficacy of the programme.Similarly, evaluation of a mental health promotion programme focusing on coping and resilience in high-school students by McAllister et al. (2018) found that the students benefited from the collaboration between health and education sectors in delivering the programme, highlighting the crucial role that relationships and connections play in student engagement and educational outcomes.This type of intentional curriculum design is supported by a growing body of studies (Slavin et al., 2014;Tang and Ferguson, 2014;Young et al., 2022).For example, a review of a university wellbeing programme by Young et al. (2022) found its implementation through classes helped students connect the learning to their studies, reduced stress and stigma for students and positively impacted their time and personal resources for managing wellbeing.Accordingly, it is important that consideration is given to planning and providing time in the delivery of mental health education programmes for building connections with students to enhance student engagement and support learning (Cole et al., 2004;Craft et al., 2014;Wessels, 2015).

Connecting through curriculum
Finding ways to make programme content interesting and relevant to students is another way to engage students in learning (Cole et al., 2004;Craft et al., 2014).The higher education literature emphasises the importance of educators providing a positive connection to the material and knowledge being imparted, linking it to students' personal interests, to their studies, and illustrating its applicability to their everyday lives (Bati et al., 2013;Cole et al., 2004;Wynters et al., 2021).Creating this relevance and meaning for students by contextualising content is critical in the effective delivery of material triggering both extrinsic and intrinsic drivers positively impacting student engagement and outcomes (Bati et al., 2013;Cole et al., 2004;Craft et al., 2014;Mearman et al., 2014).In addition, ensuring interactive and practical content improves student engagement and connection to material (Burke, 2011;Johnson et al., 2014;Wynters et al., 2021).Research highlights that with interactive learning using real-life examples, connections may be made between the course content and a relevant context for the students attending, supporting engagement and learning by enabling them to see the applicability of it to their everyday lives (Cole et al., 2004;Craft et al., 2014;Wynters et al., 2021).

Peer-led approaches
Research has shown the efficacy of peer-led approaches in improving educational outcomes (Avci et al., 2023;Maticka-Tyndale and Barnett, 2010).The use of peers in the delivery of educational health programmes has been shown to break down communication barriers (Bulanda et al., 2014).Peer-led approaches to health education involve those of a similar age or status as those attending the programme, as well as individuals from the target community (Maticka-Tyndale and Barnett, 2010).Bulanda et al. ( 2014) evaluated a youth-led programme designed to reduce mental health stigma in high-school students.They found that youth-led approaches to mental health education had a positive effect on student engagement and knowledge retention.In a similar vein, Avci et al. (2023) found that a peer-education model was effective in reducing smartphone dependency in adolescents.Alongside other mechanisms such as the interactive and practical delivery of content that supports student learning and engagement, studies such as these illustrate that creating a peer connection can assist in providing an environment that is effective and engaging.

Methodology and methods
The findings reported here come from a mixed-methods study that involved both quantitative and qualitative data collection (Winder et al., in press).The wider study evaluated WellMates, a mental health education programme, for first-year students at Lincoln University (University A) and Massey University (University B) in New Zealand.The programme was the first formal wellbeing education programme delivered to agricultural students at these universities.It was designed to reduce lives lost by suicide in rural communities and address the social costs associated with such loss for individuals, families, the local community and the economy (Beautrais, 2018;Menzies et al., 2020;OECD, 2018;Paterson et al., 2018).
The mental health programme was co-designed by agricultural academic staff, wellbeing staff and students at one of the universities in this study.The programme also received expert input from those working in suicide prevention and rural wellbeing.It involved teaching first-year agricultural students the skills to stay mentally well and strategies for returning to positive wellbeing after challenging times.The programme did this by covering topics on strengthening students' mental health and wellbeing, recognising signs related to when to seek mental health support, providing advice on how to recognise signs of mental unwellness in others and knowing what to do to support others.It consisted of a 2-hour workshop, facilitated by students in their second or third year of study.A range of delivery methods were utilised, including a PowerPoint presentation, group work, activities, scenarios and videos.The programme was delivered at University A in May 2022 and at University B in August 2022.
The qualitative data were derived from semi-structured interviews with participants attending the programme (Cresswell, 2014).The interviews sought data on participants' experience of the programme and contextual knowledge about mental health issues for this student cohort.Purposive sampling focused on participants who had completed the programme.The participants were volunteers who responded to invitations to an interview made by facilitators immediately following programme delivery and distributed through student learning platforms.As volunteers, they were not paid for their time but were provided with a meal voucher to thank them for their contribution.All those who volunteered for the interviews were selected and included as part of the research.
Participants included four programme participants from University A with interviews conducted online using Zoom and face-to-face interviews with three participants from University B. There were two male and five female participants: All were first-year university students.No other demographic information was collected due to the small number of potential interview participants and the need to ensure confidentiality for the participants.Interviews were undertaken by AH and NS-C.Interviews were approximately 1 hour long and occurred between July and November 2022.Both researchers had prior experience in undertaking qualitative interviews and clinical experience working in mental health and education settings.Topics covered during the interviews included general questions about wellness and student wellbeing, their experience of the programme, lessons learned from it and the impact on their wellbeing.Examples of questions included: Has completing the WellMates programme changed how you think about your mental health and wellbeing?(If so, please explain) Is there anything else you think we should know about to support students like yourself in managing their mental health and wellbeing?
Ethical approval for the study was received from the ethical review bodies at each university (Lincoln University Reference: HEC2022-04 and Massey University Reference: SOA 22-08; SOB 22-28).Ethical principles informing the study included beneficence, informed consent, confidentiality and avoidance of conflict of interest.These principles were important given the nature of the research dealing with aspects of mental health and suicide and that participants were students at the universities where both the authors and educators were employed.
Researchers were intentionally uninvolved in any course teaching.Prior to the interviews, participants were provided with an information sheet about the research process.They were given an informed consent form to sign, which included consent for the interview to be recorded.The participants were also provided with details of mental health support services for their information.
The nature of the semi-structured interview enabled the interviewer to use open-ended questions and ask follow-ups.To maintain confidentiality, all participants have been allocated pseudonyms, and any identifiable information was anonymised or removed.A professional transcriber transcribed the interviews.Participants were sent their transcripts for checking prior to analysis to ensure the trustworthiness of the data.
The interviews were analysed thematically by both AH and NS-C to ensure inter-coder reliability.Thematic analysis involves the process of identifying patterns and/or themes within data, ascribing meaning to the themes and then reporting on the key findings (Braun and Clarke, 2022).The qualitative component of the study was inductive, meaning there were no pre-existing frameworks that shaped the identification of themes; however, the authors were interested in participants' experiences of the programme, including what worked well and what could be learned in terms of improving engagement and learning in future deliveries (Braun and Clarke, 2022).

Results and discussion
Understanding the factors that build connection and engage agricultural students with mental health education is key to building resilience within these populations.Findings from the interviews conducted in this study emphasised the importance of the relationships built between students and educators, the value given to attending the workshops and connection to the material being delivered and the methods used.

Enhancing student/educator relationships
The efficacy of peer-led mental health programmes is established within the literature (Bulanda et al., 2014;Maticka-Tyndale and Barnett, 2010;Wynters et al., 2021).Stigma, including embarrassment and shame, has been cited as a barrier to young people recognising and addressing the signs and symptoms of mental illness as well as their engagement in health promotion activities (Aguirre Velasco et al., 2020;Batten and Dutton, 2011;Moss et al., 2022).Peers can break down communication barriers through their connection with participants contributing positive peer pressure to support learning (Bulanda et al., 2014).
For mental health interventions and wellbeing messages to be integrated into day-to-day lives, they need to be normalised as part of wider education programmes.Having conversations with peers can help normalise the conversation about mental wellbeing and reduce stigma.The use of peer educators from within the same community supports continuity and connection in terms of mental health messaging and may support the normalising of conversation about mental health outside of a formal learning environment.Young people are more likely to hear and absorb mental health advice and knowledge from others they see as similar to themselves, which is key to delivering messages to populations such as young agricultural students (Azizi et al., 2017;Goetz et al., 2011;Sloane and Zimmer, 1993).
The workshops at both universities were peer-led by student facilitators engaged in agricultural programmes at University A. As authors, we saw this peer connection as an important part of creating an engaging and comfortable environment (Winder et al., in press).Four participants across both universities commented on the benefits of a peer connection in supporting their learning.John from University A commented: 'It was like talking to a mate', with peer connection increasing his engagement with the programme.Sam from University A concurred saying that the connection meant people felt comfortable to share on what could have been a tricky topic: 'By the end of it, it was sort of like competing for time to talk and time to shine, and just showing it's actually a comfortable environment'.
The importance of building connections was further evident in the experiences reported by students who attended the workshops at University B. The workshops they attended were delivered by the same people as at University A, so were outsiders to University B. Rose talked to her lecturer in advance about the workshop and was told, 'There were people coming from [University A] especially for it'.This information about the educators coming from outside the university may have resulted in the low attendance numbers at University B, as well as the fact that the workshop was optional.As Sarah also from University B explained, 'It was advertised as an optional, people are coming up from [University A]'.The lack of peer connection to the educators felt by students at University B even prior to the delivery of the workshop highlights the importance of involving educators from within the community it is desired to reach (Maticka-Tyndale and Barnett, 2010).
Improving connection at University B may better have been achieved by one of the programme educators attending student classes at that university prior to the workshop.For students at University B, it was important that the connection went beyond studying the same subject.In line with Maticka-Tyndale and Barnett (2010), the results suggest that involving community groups with a shared interest to the students might have supported greater connectedness, thereby enhancing students' sense of engagement.Sarah suggested that: 'Maybe in the future, the Young Farmers Club.That's quite influential . . .You would get a lot more people listening if it was people from [. . .you could] look up to in a way'.(Sarah).
Participants' experiences at both universities show it was important for them to feel connected to the educators, while for the students at University A, having a peer connection enhanced this connectedness and made the workshops more engaging while the disconnection for students at University B showed that these peer connections should be from within the local community to provide a relevant context.

Valuing attendance
The connection between students and educators was not the only factor influencing engagement and learning.Participants needed to see value in attending.Both extrinsic and intrinsic factors can engage students in this respect (Bati et al., 2013;Cole et al., 2004;Mearman et al., 2014).Extrinsic factors include drivers such as whether a lecture or workshop is compulsory or not, and whether it links to assessment (Bati et al., 2013).This was a factor for students at University A, where attendance was high.Here, the workshops were delivered as a compulsory part of their course that was incentivised through marks and prizes awarded to students who attended the workshop.John explained, '. . .we all got 5% marks . . .no one really complained about it all . . .they were going to come along . . .they [also] had prizes there'.
In comparison, at University B, the programme did not hold the same importance as their other classes because of the way it was promoted by academic staff, its lack of perceived connection to their agricultural courses, the fact that educators came from a different university and the lack of any course-mark allocation.The workshop was not compulsory, and only seven students attended.Interview participants from University B discussed the ambiguity surrounding the workshop.Rose's view was reflective of other participants stating that, 'No one really knew what it was and what it was going to be about and stuff'.Sarah explained that the information received about the programme prior to its delivery did not promote its value: 'We started getting emails [about it] a couple of weeks prior, but it wasn't pushed as much as an important lecture would be . . .I think if it was pushed as more of a lecture, then people would have come'.(Sarah).In line with the higher education literature, reflections of Rose and Sarah highlight the importance of educators stressing the value of an activity to students by stressing the connection between the material and its relevance to their studies (Bati et al., 2013;Cole et al., 2004;Wynters et al., 2021).These extrinsic factors can increase the likelihood of students feeling a connection to the programme -a view affirmed by the interview participants in this study.Bati et al. (2013) explain how other factors such as timing can impact student attendance and engagement.In University B, the workshop was held immediately before the mid-semester break, at a time when assignments are typically due and on a day when students received multiple lectures back to back.Kate explained that many of her peers did not prioritise attendance at the programme because of this, saying: 'timing was a big one [reason for not attending] when I talked to people about it'.Rose explained: '. . . it was [right] at the end of the day and we had a pretty long day, we had already had four lectures . . .It was just before the [mid semester] break, so probably not the best timing'.(Rose).
In comparison to the extrinsic factors that primarily motivated students at University A, for the few University B students who did attend the programme, their main motivations were derived from intrinsic factors such as personal connection or an interest in the topic.Sarah explained how her interest arose from her concern for others and her wish to learn as much as possible: 'I'm quite passionate about mental health . . .I had a friend in high school who wasn't very well [mentally]'.(Sarah).This connection provided relevance for Sarah by connecting the material to a personal interest (Cole et al., 2004;Wynters et al., 2021).
Crucial to the success of wellbeing education is students' attendance at the programme.Learning how best to do this with agricultural students is an important factor to consider if resilience is to be built within rural communities.It was evident in this study that both extrinsic and intrinsic factors influenced participant attendance and engagement with the workshops, their content and the educators.The difference in factors motivating student attendance across the two universities illustrates the need to provide a value for attendance to ensure student engagement and connection to the programme in all delivery settings (Bati et al., 2013;Cole et al., 2004;Wynters et al., 2021).

Contextualising the content
An additional factor that participants discussed was their engagement with the workshop content.Including interactive and practical content improves student connection and engagement (Burke, 2011;Johnson et al., 2014;Wynters et al., 2021).Interview participants agreed that the content offered during the workshops made them feel more engaged and supported a sense of connection.Sam from University A explained, '. . .Like we had group activities, and then we had to say, basically blurt out your answers sort of thing . . .For such a big group they did well to sort of encompass everything and everyone'.Beth also from University A appreciated the inclusive style of the educators and the fact that it involved movement: 'The [educator] actually got us up and moving and put us at different tables, and stuff.So we had to collaborate with other people, which was quite good'.
Another aspect of the workshops that was valued was the use of videos of people in farming contexts.Harry from University A shared that this enabled him to relate the course content to real life: 'I really liked . . . the video about that guy on his cropping farm and how he struggled with mental health . . .It was very good to relate back to the outside world'.Participants felt that by connecting the course content to a context they were familiar with, they were able to see its applicability to the outside world and its relevance to their own lives (Cole et al., 2004;Craft et al., 2014;Wynters et al., 2021).
Improving the mental health literacy of agriculture students is crucial for building not only their resilience but also the future of vulnerable farming communities.The skills covered in educational mental health programmes not only improve mental health literacy but also empower young people to take preventive action to support themselves and others (Jorm, 2012(Jorm, , 2015)).To do this effectively, thought needs to be given to the planning and delivery of educational programmes to ensure the material presented is relevant and engaging and is delivered in a way that provides connection for the target group (Azizi et al., 2017;Sloane and Zimmer, 1993).
The use of both peer educators and a range of delivery methods including activities and videos relevant to the everyday lives of first-year agricultural students enhanced their engagement and learning.In line with the published literature (see Bulanda et al., 2014;Johnson et al., 2021;Wynters et al., 2021), our findings show it was important for students to feel connected to the educators so as to make the workshops more engaging.In addition, connecting the course content to contexts the students were familiar with, in this case, a rural setting, enabled them to see its applicability to their lives and studies.

Conclusion
This paper has discussed factors that influenced the connection between agricultural students and educators in relation to a mental health wellbeing programme delivered at two universities in New Zealand.The goal of the programme was to address mental health issues and reduce lives lost by suicide in rural communities.Through the programme, agricultural students were taught the skills to stay well mentally and strategies to return to positive wellbeing after a challenging time.
Findings highlight the critical role of relationships and building connections in improving engagement in the programme.To facilitate this, consideration should be given to timing, promotion and incentives for attendance, as students often need to balance attending alongside competing demands.The use of peers as educators was welcomed, but peer connection should be from the local community (be this within the university or further afield) where the programme is to be delivered.Furthermore, contextualising the programme content to real-life experience is important.
The study adds to the limited literature on the connection between educators and students in mental health workshops in a rural context (Knook et al., 2022b;Stanley-Clarke, 2019).While the findings cannot be generalised due to sample selection and size, they add to learning and are relevant to the delivery of mental health wellbeing programmes to agricultural students by stressing the importance of relationships and building connection.Future research could consider which factors are more important in terms of student participation and engagement with mental health programmes including the provision of incentives or the use of peer facilitators.Additional research could look at hypothesis testing some of the factors suggested by the qualitative research in terms of workshop effectiveness.