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P P, A R, E B, Z M, Z D, M H, R H, C F. Initiatives for promoting educator wellbeing: a Delphi study. BMC Psychol 2024; 12:220. [PMID: 38649952 PMCID: PMC11036615 DOI: 10.1186/s40359-024-01724-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Growing demands on educators have resulted in increased levels of burnout and stress and decreasing wellbeing. This study aimed to establish expert consensus on the key characteristics required in prospective educator wellbeing initiatives. METHODS The Delphi approach is a process of forecasting that is based on the aggregated opinion of panel members (or experts) within a field of study. Using a Delphi approach, academic and practitioner expertise were sought over a two-rounds, with 17 and 14 participants in each round respectively. The study aimed to identify how systemic factors (e.g., leadership) could be utilised to promote educator wellbeing. The study also sought expert consensus on enablers and barriers for engagement in educator wellbeing initiatives. RESULTS Findings highlighted the importance of fostering positive relationships with colleagues, communities and families, and the active role of wellbeing teams to promote wellbeing initiatives. The need for leaders to address their own wellbeing and build trust within teams was also identified. Panel members identified the need for prospective funding to prioritise wellbeing initiatives. There was also a preference for ongoing initiatives rather than stand-alone wellbeing events that conveyed the ongoing importance of managing one's wellbeing. CONCLUSIONS This paper presents practical recommendations that can be used to inform the development and evaluation of future initiatives and policy. Applying the consensus derived from this study is likely to make wellbeing initiatives more viable and facilitate uptake amongst educators.
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Affiliation(s)
- Patrick P
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo, VIC 3800, Clayton, Australia.
| | - Reupert A
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo, VIC 3800, Clayton, Australia
| | - Berger E
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo, VIC 3800, Clayton, Australia
- Monash Rural Health, Monash University, Warragul, Australia
| | - Morris Z
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo, VIC 3800, Clayton, Australia
| | - Diamond Z
- School of Education, Culture & Society, Faculty of Education, Monash University, Clayton, Australia
| | - Hammer M
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo, VIC 3800, Clayton, Australia
| | - Hine R
- Monash Rural Health, Monash University, Warragul, Australia
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Samfira EM, Sava FA. The effectiveness of a rational-emotive intervention on teachers' unconditional self-acceptance, perfectionism, and pupil control ideology. Front Psychol 2023; 14:1240269. [PMID: 38155692 PMCID: PMC10753790 DOI: 10.3389/fpsyg.2023.1240269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction The present research aimed to investigate the effectiveness of a Rational Emotive Behavior Therapy (REBT) intervention on in-service teachers. Methods A quasi-experimental 2-group (intervention vs. control) × 3-time (pre, post-test, follow-up) design was applied to explore to what extent the REBT interventions help teachers increase their level of unconditional self-acceptance as the primary outcome and decrease their perfectionism tendencies and pupil control ideology as secondary outcomes. The sample consisted of 100 in-service teachers assigned to either the intervention group (n = 50) or the control group (n = 50). The experimental group received a 6-week intervention program. Every session was held weekly and lasted 90-120 min. The Unconditional Self-Acceptance Questionnaire (USAQ), Pupil Control Ideology Scale (PCI), and Perfectionism Inventory Scale (PI) were used to collect data. This study used a mixed model ANOVA 2 × 3 for data analysis. Results The results indicated that in the experimental group, there was a statistically significant increase in unconditional self-acceptance level from pre-test to post-test, which remains significant at the 6-month follow-up. Likewise, there were no statistically significant differences in unconditional self-acceptance levels between the post-test and 6-month follow-up in the intervention group. Discussion These findings prove that REBT interventions are effective in increasing teachers' unconditional self-acceptance.
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Affiliation(s)
- Elena Mirela Samfira
- Teacher Training Department, University of Life Sciences from Timisoara, Timisoara, Romania
- Department of Psychology, West University of Timisoara, Timisoara, Romania
| | - Florin Alin Sava
- Department of Psychology, West University of Timisoara, Timisoara, Romania
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Richardson R, Dale HE, Robertson L, Meader N, Wellby G, McMillan D, Churchill R. Mental Health First Aid as a tool for improving mental health and well-being. Cochrane Database Syst Rev 2023; 8:CD013127. [PMID: 37606172 PMCID: PMC10444982 DOI: 10.1002/14651858.cd013127.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND The prevalence of mental health problems is high, and they have a wide-ranging and deleterious effect on many sectors in society. As well as the impact on individuals and families, mental health problems in the workplace negatively affect productivity. One of the factors that may exacerbate the impact of mental health problems is a lack of 'mental health literacy' in the general population. This has been defined as 'knowledge and beliefs about mental disorders, which aid their recognition, management, or prevention'. Mental Health First Aid (MHFA) is a brief training programme developed in Australia in 2000; its aim is to improve mental health literacy and teach mental health first aid strategies. The course has been adapted for various contexts, but essentially covers the symptoms of various mental health disorders, along with associated mental health crisis situations. The programmes also teach trainees how to provide immediate help to people experiencing mental health difficulties, as well as how to signpost to professional services. It is theorised that improved knowledge will encourage the trainees to provide support, and encourage people to actively seek help, thereby leading to improvements in mental health. This review focuses on the effects of MHFA on the mental health and mental well-being of individuals and communities in which MHFA training has been provided. We also examine the impact on mental health literacy. This information is essential for decision-makers considering the role of MHFA training in their organisations. OBJECTIVES To examine mental health and well-being, mental health service usage, and adverse effects of MHFA training on individuals in the communities in which MHFA training is delivered. SEARCH METHODS We developed a sensitive search strategy to identify randomised controlled trials (RCTs) of MHFA training. This approach used bibliographic databases searching, using a search strategy developed for Ovid MEDLINE (1946 -), and translated across to Ovid Embase (1974 -), Ovid PsycINFO (1967 -), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Common Mental Disorders Group's Specialised Register (CCMDCTR). We also searched online clinical trial registries (ClinicalTrials.gov and WHO ICTRP), grey literature and reference lists of included studies, and contacted researchers in the field to identify additional and ongoing studies. Searches are current to 13th June 2023. SELECTION CRITERIA We included RCTs and cluster-RCTs comparing any type of MHFA-trademarked course to no intervention, active or attention control (such as first aid courses), waiting list control, or alternative mental health literacy interventions. Participants were individuals in the communities in which MHFA training is delivered and MHFA trainees. Primary outcomes included mental health and well-being of individuals, mental health service usage and adverse effects of MHFA training. Secondary outcomes related to individuals, MHFA trainees, and communities or organisations in which MHFA training has been delivered DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. We analysed categorical outcomes as risk ratios (RRs) and odds ratios (ORs), and continuous outcomes as mean differences (MDs) or standardised mean differences (SMDs), with 95% confidence intervals (CIs). We pooled data using a random-effects model. Two review authors independently assessed the key results using the Risk of Bias 2 tool and applied the GRADE criteria to assess the certainty of evidence MAIN RESULTS: Twenty-one studies involving a total of 22,604 participants were included in the review. Fifteen studies compared MHFA training with no intervention/waiting list, two studies compared MHFA training with an alternative mental health literacy intervention, and four studies compared MHFA training with an active or an attention control intervention. Our primary time point was between six and 12 months. When MHFA training was compared with no intervention, it may have little to no effect on the mental health of individuals at six to 12 months, but the evidence is very uncertain (OR 0.88, 95% CI 0.61 to 1.28; 3 studies; 3939 participants). We judged all the results that contributed to this outcome as being at high risk of bias. No study measured mental health service usage at six to 12 months. We did not find published data on adverse effects. Only one study with usable data compared MHFA training with an alternative mental health literacy intervention. The study did not measure outcomes in individuals in the community. It also did not measure outcomes at our primary time point of six to 12 months. Four studies with usable data compared MHFA training to an active or attention control. None of the studies measured outcomes at our primary time point of six to 12 months. AUTHORS' CONCLUSIONS We cannot draw conclusions about the effects of MHFA training on our primary outcomes due to the lack of good quality evidence. This is the case whether it is compared to no intervention, to an alternative mental health literacy intervention, or to an active control. Studies are at high risk of bias and often not sufficiently large to be able to detect differences.
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Affiliation(s)
| | - Holly Eve Dale
- Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
| | | | | | - George Wellby
- Department of Psychiatry, West London Mental Health NHS Trust, London, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
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Kuyken W, Blakemore SJ, Byford S, Dalgleish T, Ford T, Hinze V, Mansfield K, Montero-Marin J, Ukoumunne OC, Viner RM. Mental health in adolescence: the role of schools-based social emotional teaching. J Ment Health 2023; 32:537-540. [PMID: 37226816 DOI: 10.1080/09638237.2023.2210668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/23/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Willem Kuyken
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Sarah-Jayne Blakemore
- Department of Psychology, University of Cambridge, Cambridge, UK
- UCL Institute of Cognitive Neuroscience, London, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, King's Health Economics, London, UK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Cambridge, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Verena Hinze
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Karen Mansfield
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Jesus Montero-Marin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiology and Public Health - CIBERESP), Madrid, Spain
| | - Obioha C Ukoumunne
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, NIHR Applied Research Collaboration South-West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Russell M Viner
- Population, Policy & Practice Research Programme, UCL Great Ormond St. Institute of Child Health, London, UK
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Zhang L, Chen J, Li X, Zhan Y. A Scope Review of the Teacher Well-being Research Between 1968 and 2021. THE ASIA-PACIFIC EDUCATION RESEARCHER 2023. [PMCID: PMC10009359 DOI: 10.1007/s40299-023-00717-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 12/10/2023]
Abstract
This review aimed at portraying a nuanced picture of the trajectory of teacher well-being research during 54 years from 1968 to 2021. This review used descriptive quantitative analysis with a dataset of 774 journal articles. The developmental trend demonstrates a considerable change in the volume of publications conducted during the most recent 14 years. Findings of the current review identify that research foci have covered the antecedents, nature, and effects of teacher well-being in a descending manner. Quantitative methods were observed as the most frequently used method in research studies. Moreover, the use of qualitative and mixed research methods increased in recent times. However, due to the considerable absence of mixed methods, longitudinal, and experimental research designs in this review’s corpus, our interpretation has been restricted to the ways in which teacher well-being can affect as well as be affected by associated constructs. Research on teacher well-being positions itself at the intermediate stage focusing on fusion relations combining new and recognized structures and adopting qualitative as well as quantitative practices. This review supports the evolution of the teacher well-being literature and poses recommendations for future research.
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Affiliation(s)
- Lutong Zhang
- Department of Education Policy and Leadership, Education University of Hong Kong, 10 Lo Ping Road, Tai Po, NT, Hong Kong SAR, China
| | - Junjun Chen
- Department of Education Policy and Leadership, Education University of Hong Kong, 10 Lo Ping Road, Tai Po, NT, Hong Kong SAR, China
| | - Xinlin Li
- Department of Education Policy and Leadership, Education University of Hong Kong, 10 Lo Ping Road, Tai Po, NT, Hong Kong SAR, China
| | - Ying Zhan
- Department of Curriculum and Instruction, Education University of Hong Kong, Hong Kong SAR, China
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Assessing the Feasibility of a Peer Education Project to Improve Mental Health Literacy in Adolescents in the UK. Community Ment Health J 2023; 59:784-796. [PMID: 36645608 PMCID: PMC9841483 DOI: 10.1007/s10597-022-01059-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/17/2022] [Indexed: 01/17/2023]
Abstract
Many mental health problems begin in adolescence and occur on a spectrum of severity: early recognition and intervention is important. This study is a quantitative feasibility study of the Mental Health Foundation's Peer Education Project (PEP). Attrition, psychometric properties of questionnaires, indications of improvement on a range of outcomes, and sample size required for a powered trial of effectiveness were assessed. 203 students completed the survey both pre and post-intervention. It was found that existing previously-validated measures had good psychometric properties, with two new questionnaires demonstrating reasonable reliability (self-help confidence alpha = 0.78, mental health knowledge alpha = 0.59). There were indications of improvement in help-seeking intentions, the number of sources likely to seek help from, and mental health knowledge from pre- to post-intervention. A future trial of PEP with a sample of approximately 36 schools, researcher-led data collections, and help-seeking intentions or sources as a primary outcome appears to be feasible.
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Blodgett JM, Birch JM, Musella M, Harkness F, Kaushal A. What Works to Improve Wellbeing? A Rapid Systematic Review of 223 Interventions Evaluated with the Warwick-Edinburgh Mental Well-Being Scales. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15845. [PMID: 36497919 PMCID: PMC9737992 DOI: 10.3390/ijerph192315845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) is a commonly used scale of mental wellbeing focusing entirely on the positive aspect of mental health. It has been widely used in a broad range of clinical and research settings, including to evaluate if interventions, programmes or pilots improve wellbeing. We aimed to systematically review all interventions that used WEMWBS and evaluate which interventions are the most effective at improving wellbeing. METHODS Eligible populations included children and adults, with no health or age restrictions. Any intervention study was eligible if the wellbeing outcome was measured using the 7 or 14-item WEMWBS scale assessed both pre- and post-intervention. We identified eligible intervention studies using three approaches: a database search (Medline, EMBASE, CINAHL, PyschInfo and Web of Science from January 2007 to present), grey literature search, and by issuing a call for evidence. Narrative synthesis and random-effects meta-analysis of standardised mean differences in the intervention group were used to summarise intervention effects on WEMWBS score. RESULTS We identified 223 interventions across 209 studies, with a total of 53,834 participants across all studies. Five main themes of interventions were synthesised: psychological (n = 80); social (n = 54); arts, culture and environment (n = 29); physical health promotion (n = 18); and other (n = 28). Psychological interventions based on resilience, wellbeing or self-management techniques had the strongest effect on wellbeing. A broad range of other interventions were effective at improving mental wellbeing, including other psychological interventions such as cognitive behavioural therapy, psychoeducation and mindfulness. Medium to strong effects were also seen for person-centred support/advice (social), arts-based, parenting (social) and social prescribing interventions. However, a major limitation of the evidence was that only 75 (36%) of studies included a control group. CONCLUSIONS WEMWBS has been widely used to assess wellbeing across a diverse range of interventions, settings and samples. Despite substantial heterogeneity in individual intervention design, delivery and groups targeted, results indicate that a broad range of intervention types can successfully improve wellbeing. Methodological changes, such as greater use of control groups in intervention evaluation, can help future researchers and policy makers further understand what works for mental wellbeing.
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Affiliation(s)
- Joanna M. Blodgett
- Kohlrabi Consulting, Manchester SK4 3HJ, UK
- Institute of Sport Exercise & Health, Division of Surgery & Interventional Science, University College London, London W1T 7HA, UK
| | - Jack M. Birch
- Kohlrabi Consulting, Manchester SK4 3HJ, UK
- Homerton College, University of Cambridge, Cambridge CB2 8PH, UK
| | | | | | - Aradhna Kaushal
- Kohlrabi Consulting, Manchester SK4 3HJ, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
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Li CR. Promoting positive mental health in children through the empowerment of teachers in delivery and resilience. Perspect Public Health 2022; 142:251-252. [PMID: 36120922 DOI: 10.1177/17579139221119016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Evans R, Bell S, Brockman R, Campbell R, Copeland L, Fisher H, Ford T, Harding S, Powell J, Turner N, Kidger J. Wellbeing in Secondary Education (WISE) Study to Improve the Mental Health and Wellbeing of Teachers: A Complex System Approach to Understanding Intervention Acceptability. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:922-933. [PMID: 35305231 PMCID: PMC9343291 DOI: 10.1007/s11121-022-01351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 11/27/2022]
Abstract
Teaching staff report poorer mental health and wellbeing than the general working population. Intervention to address this issue is imperative, as poor wellbeing is associated with burnout, presenteeism, and adverse student mental health outcomes. The Wellbeing in Secondary Education (WISE) intervention is a secondary school-based programme aimed at improving the mental health and wellbeing of teachers and students. There are three components: awareness-raising for staff; a peer support service delivered by staff trained in Mental Health First Aid (MHFA); and Schools and Colleges Mental Health First Aid (MHFA) training for teachers. A cluster randomised controlled trial with integrated process and economic evaluation was conducted with 25 secondary schools in the UK (2016-2018). The intervention was largely ineffective in improving teacher mental health and wellbeing. This paper reports process evaluation data on acceptability to help understand this outcome. It adopts a complex systems perspective, exploring how acceptability is a dynamic and contextually contingent concept. Data sources were as follows: interviews with funders (n = 3); interviews with MHFA trainers (n = 6); focus groups with peer supporters (n = 8); interviews with headteachers (n = 12); and focus groups with teachers trained in Schools and Colleges MHFA (n = 7). Results indicated that WISE intervention components were largely acceptable. Initially, the school system was responsive, as it had reached a 'tipping point' and was prepared to address teacher mental health. However, as the intervention interacted with the complexities of the school context, acceptability became more ambiguous. The intervention was seen to be largely inadequate in addressing the structural determinants of teacher mental health and wellbeing (e.g. complex student and staff needs, workload, and system culture). Future teacher mental health interventions need to focus on coupling skills training and support with whole school elements that tackle the systemic drivers of the problem.
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Affiliation(s)
- Rhiannon Evans
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, Wales.
| | - Sarah Bell
- Bristol Medical School, University of Bristol, Bristol, England
| | - Rowan Brockman
- Bristol Medical School, University of Bristol, Bristol, England
| | - Rona Campbell
- Department of Population Health Sciences, University of Bristol, Bristol, England
| | - Lauren Copeland
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, Wales
| | - Harriet Fisher
- Bristol Medical School, University of Bristol, Bristol, England
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, England
| | - Sarah Harding
- School for Policy Studies, University of Bristol, Bristol, England
| | - Jillian Powell
- School for Policy Studies, University of Bristol, Bristol, England
| | - Nicholas Turner
- Bristol Medical School, University of Bristol, Bristol, England
| | - Judi Kidger
- Bristol Medical School, University of Bristol, Bristol, England
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Kidger J, Evans R, Bell S, Fisher H, Turner N, Hollingworth W, Harding S, Powell J, Brockman R, Copeland L, Araya R, Campbell R, Ford T, Gunnell D, Morris R, Murphy S. Mental health support and training to improve secondary school teachers’ well-being: the WISE cluster RCT. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Health and Safety Executive data show that teachers are at heightened risk of mental health difficulties, yet few studies have attempted to address this. Poor teacher mental health may impact on the quality of support provided to young people, who also report increased mental health difficulties themselves.
Objective
To test the effectiveness of an intervention aiming to improve secondary school teachers’ well-being through mental health support and training.
Design
A cluster randomised controlled trial with embedded process and economic evaluations.
Setting
Twenty-five mainstream, non-fee-paying secondary schools in the south-west of England and South Wales, stratified by geographical area and free school meal entitlement, randomly allocated to intervention or control groups following collection of baseline measures (n = 12, intervention; n = 13, control) between May and July 2016.
Participants
All teachers in the study schools at any data collection. All students in year 8 (baseline) and year 10 (final follow-up).
Intervention
Each intervention school received three elements: (1) a 1-day mental health first aid for schools and colleges training session delivered to 8% of all teachers; (2) a 1-hour mental health session delivered to all teachers; and (3) 8% of staff trained in the 2-day standard mental health first aid training course set up a confidential peer support service for colleagues. Control schools continued with usual practice.
Main outcome measures
The primary outcome was teacher well-being (using the Warwick–Edinburgh Mental Wellbeing Scale). Secondary outcomes were teacher depression, absence and presenteeism, and student well-being, mental health difficulties, attendance and attainment. Follow-up was at 12 and 24 months. Data were analysed using intention-to-treat mixed-effects repeated-measures models.
Economic evaluation
A cost–consequence analysis to compare the incremental cost of the intervention against the outcomes measured in the main analysis.
Process evaluation
A mixed-methods study (i.e. qualitative focus groups and interviews, quantitative surveys, checklists and logs) to examine intervention implementation, activation of the mechanisms of change outlined in the logic model, intervention acceptability and the wider context.
Results
All 25 schools remained in the study. A total of 1722 teachers were included in the primary analysis. We found no difference in mean teacher well-being between study arms over the course of follow-up (adjusted mean difference –0.90, 95% confidence interval –2.07 to 0.27). There was also no difference in any of the secondary outcomes (p-values 0.203–0.964 in the fully adjusted models). The average cost of the intervention was £9103 (range £5378.97–12,026.73) per intervention school, with the average cost to Welsh schools being higher because of a different delivery model. The training components were delivered with high fidelity, although target dosage was sometimes missed. The peer support service was delivered with variable fidelity, and reported usage by teachers was low (5.9–6.1%). The intervention had high acceptability, but participants reported low support from senior leadership, and minimal impact on school culture.
Limitations
Participants and the study team were unblinded, self-report for the main outcome measures and inaccurate measurement of peer support service usage.
Conclusions
The Wellbeing in Secondary Education (WISE) intervention was not effective at improving teacher or student well-being, or reducing mental health difficulties, possibly because of contextual barriers preventing it becoming embedded in school life.
Future work
Identification of ways in which to achieve system-level change and sustained support from senior leaders is important for future school-based mental health interventions.
Trial registration
Current Controlled Trials ISRCTN95909211.
Funding
This project was funded by the National Institute for Health Research Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 12. See the NIHR Journals Library website for further project information. Intervention costs were met by Public Health Wales, Public Health England and Bristol City Council.
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Affiliation(s)
- Judi Kidger
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Rhiannon Evans
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Sarah Bell
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Harriet Fisher
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Nicholas Turner
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Randomised Trials Unit, University of Bristol, Bristol, UK
| | | | - Sarah Harding
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Jillian Powell
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Rowan Brockman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Lauren Copeland
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Ricardo Araya
- Centre for Population Neuroscience and Precision Medicine, King’s College London, London, UK
| | - Rona Campbell
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - David Gunnell
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Richard Morris
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Simon Murphy
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
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