Call centres are a fast-growing industry in the Philippines. Although well-paid, call centre employees have little control over their work, must deal regularly with angry clients, and must meet high demands under time pressure. These stressful conditions can lead to mental ill-health which can affect their performance at work as well as whether they take risks with their health, and whether they have positive social relationships. Poor mental health can also affect how well the organisation performs; it can lead to lower productivity, increased sickness absence and higher staff turnover rates. At the same time, the Philippines has the fastest growing HIV epidemic in the world and call centre employees are believed to be at risk due to high levels of unprotected sexual activity. High-stress and high disposable income in this young workforce, combined with a relatively high proportion of men who have sex with men (MSM), are also thought to contribute to increased HIV risk. Stigma and discrimination around sexual identity, behaviour and HIV status are both contributors to poor mental ill health. Previous research has shown that poor mental health and HIV risk often exist together and each makes the other worse, particularly where people also experience things like stigma and discrimination. For this reason, researchers have urged that the two health issues should be tacked together. There are lots of effective ways to address mental health and reduce HIV in workplace settings but little work has been done to bring these together, and little has been done to address issues specific to call centres in LMIC. The aim of this project is to understand how the workplace setting (or system) shapes both mental health and HIV risk. We will work with call centre employees and their managers to understand their priorities and identify aspects of the workplace that they think could provide potential solutions. Having agreed on these solutions we will try them out in the workplace and ask managers and employers for their views on how well they address the issues, how easy they are to implement and whether they represent value for money. The solutions will need to consider the physical environment, working culture and wider social influences to ensure it is acceptable, and easy to deliver in the long-term. The project will involve workshops with employees and managers, as well as interviews with employees and outside experts. Our aim will be to come up with a final design that call centres and stakeholders in industry and government think would be worth evaluating on a wider scale. We will also share lessons with other researchers on methods for designing interventions in corporate settings.

AIM: To develop a systems-informed workplace intervention to promote mental health and reduce HIV risk among call centre workers in the Philippines Objectives (summary): 1. In collaboration with key actors, map how call centres in Manila operate as a system shaping employee mental health and HIV risk 2. Identify the role, priorities and perspectives of key actors in the system 3. With key actors, co-design an intervention addressing mental health and HIV/STI risk 4. Articulate and refine an overarching programme theory, including wider changes and impacts. 5. Over several cycles, test and refine individual components 6. Assess whether criteria for progression to feasibility trial stage are met 7. Build capacity among both research teams. Objectives in detail: 1. In workshops with key actors, we will co-create a system map (actors, concepts and relationships) of mental health and HIV risk in Filippino call centres and decide where to draw the boundary of the system for the purpose of intervention design. This work will consider what is likely to be within and outside of the control of an intervention and will seek to identify positive and negative feedback loops. It will also include mapping of venues for alcohol consumption and mental/sexual health services close to workplaces to inform discussion of where to draw the boundary. 2. Through the mapping workshops with call centre employees we will seek to identify the priorities and perspectives of key actors in the system, and map them in a coherent way. Where these conflict, we will work with key actors to identify ways of resolving this within the intervention design. 3. With key actors, we will develop consensus on desired mechanisms of change, and co-design an intervention that responds to identified priorities and system leverage points, by selecting and refining candidate components or creating novel ones. We have identified several candidate intervention approaches and further scoping work will enable us to choose and tailor the components to issues and leverage points identified in objective one. 4.We will articulate and refine an overarching programme theory, including wider changes and impacts. We will investigate novel ways to visualise the programme theory to reflect the dynamics of system and intervention mechanisms of change. 5. Over several cycles, we will test and refine individual components, focusing on: how they alter relationships between concepts, activities and actors within the system; how the system adapts and whether is indication of positive (and negative) feedback; how resources are being distributed; whether any activities are being displaced; key actors' perspectives on the extent to which the intervention components are coherent, feasible to implement, have value for money and likely to lead to systemic change in the longer term. 6. The progression criteria will focus on: whether we are able to achieve a workable consensus on a system map that accounts for the diversity in the environment; whether the intervention meets criteria indicative of feasibility and sustainability in the longer term; whether there is support for the intervention from stakeholders in the broader system (e.g. Department of Labour and Employment; Business Processing Association of the Philippines); whether important outcomes of the intervention can be measured; whether any important undesirable effects are identified; evidence of positive and productive partnership between research teams in Manila and Glasgow. 7. Through partnership working, we seek to build capacity among both research teams: Manila team on systems thinking; and Glasgow team on workplace interventions in LMIC