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Preventing Physical and Emotional Violence by Teachers in Public Schools in Pakistan (ICC-T_Pak)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT06001554
Recruitment Status : Recruiting
First Posted : August 21, 2023
Last Update Posted : April 9, 2024
Sponsor:
Collaborators:
Shifa Foundation
Shifa International Hospital
Mclean Hospital
University of Konstanz
Information provided by (Responsible Party):
Bielefeld University

Study Description
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Brief Summary:

Violence has severe and long-lasting negative consequences for children and adolescents' well-being and psychosocial functioning, thereby also hampering communities and societies' economic growth. Studies show high prevalence rates of violence by teachers against children in Pakistan. In addition to legal and structural factors (e. g. stressful working conditions for teachers), attitudes favoring violence against children as an effective and acceptable discipline method and the lack of access to alternative non-violent strategies are likely to contribute to teachers' ongoing use of violence against children.

Notwithstanding, there are currently very few school-level interventions to reduce violence by teachers that a) have been scientifically evaluated and b) that focus both on changing attitudes towards violence and on equipping teachers with non-violent discipline strategies.

Thus, the present study tests the effectiveness of the preventative intervention Interaction Competencies with Children - for Teachers (ICC-T) in secondary schools in Pakistan. Previous studies have provided initial evidence on the feasibility to implement teacher violence interventions in secondary schools in Pakistan. This study aims to provide first evidence for the effectiveness of ICC-T to reduce violence and to improve children's functioning (i.e. mental health, well-being, academic performance) in Pakistan.


Condition or disease Intervention/treatment Phase
Violence Behavioral: Interaction Competencies with Children - for Teachers (ICC-T) Not Applicable

Detailed Description:

The study is a multi-site cluster randomized controlled trial with schools (clusters) as level of randomization. Three districts in each site of the four sites (Khyber Pakhtunkhwa province, Sindh province, the State of Azad Jammu & Kashmir, and the federal capital Islamabad+Punjab province) will be purposely selected to ensure diversity of schools in terms of geographical, economical, social, and politically background. In each site, 12 public schools will be randomly selected, resulting in a total number of 48 schools (12 per sites). Schools will be stratified based on school type (girls or boys school). In each site, 6 schools (3 girls and 3 boys schools) will be randomly allocated to the intervention group (that will receive the ICC-T intervention) and the control group (that will receive no intervention).

At each school, 30 students in the first year of secondary and all teachers (expected average number: 15) will be recruited. Thus the final sample will comprise 1440 students and at least 720 teachers at baseline.

The study will have three data assessment points: baseline assessment prior to the intervention, the first follow-up assessment six months after the intervention and the second follow-up assessment 18 months after the intervention. In addition, feasibility data will be assessed in the intervention group at the beginning and the end of the intervention.

Primary outcome measures are student- and teacher-reported physical and emotional violence by teachers in the past week. Secondary outcome measures include children's emotional and behavioral problems, quality of life, cognitive functioning, academic performance, and school attendance.

Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 2100 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary Purpose: Prevention
Official Title: Improving Adolescent Student Mental Health and Quality of Life Through a Reduction in Physical and Emotional Violence by Teachers in Pakistan: A Cluster Randomized Controlled Trial
Actual Study Start Date : September 15, 2023
Estimated Primary Completion Date : July 2026
Estimated Study Completion Date : December 2026

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Health Checkup

Arms and Interventions
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Arm Intervention/treatment
Experimental: ICC-T
5 days with 8 hours of training for teachers. Core training components include teacher-student interaction, maltreatment prevention, effective discipline strategies, identifying and supporting burdened students and implementation of the training materials into the school setting
 Behavioral: Interaction Competencies with Children - for Teachers (ICC-T)
Core training components include teacher-student interaction, maltreatment prevention, effective discipline strategies, identifying and supporting burdened students and implementation of the training materials into the school setting
No Intervention: monitoring condition
No intervention


Outcome Measures
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Primary Outcome Measures :
  1. Change of students' exposure to emotional and physical violence by teachers [ Time Frame: The CTS will be used at T0 (baseline, prior to intervention), T1 (first follow-up, 6 months after intervention) and T2 (second follow-up, 18 months after intervention) ]
    The Conflict Tactics Scale (CTS) will be used to assess students' self-reported experiences of emotional and physical violence by teachers at school in the past week. Higher scores indicate higher levels of violence that is used by teachers. We hypothesize a stronger reduction of exposure to violence in the intervention group compared to the control group.

  2. Change of teachers' use of emotional and physical violence [ Time Frame: The CTS will be used at T0 (baseline, prior to intervention), T1 (first follow-up, 6 months after intervention) and T2 (second follow-up, 18 months after intervention) ]
    The Conflict Tactics Scale (CTS) will be used to assess teachers' use of emotional and physical violent discipline measures against students in the past week. Higher scores indicate higher levels of violence that is used by teachers. We hypothesize a stronger reduction of the use of violence in the intervention group compared to the control group.


Secondary Outcome Measures :
  1. Change of teachers' positive attitudes towards emotional and physical violence [ Time Frame: The adapted version of CTS will be used at T0 (baseline, prior to intervention), T1 (first follow-up, 6 months after intervention) and T2 (second follow-up, 18 months after the intervention) ]
    Teacher's attitudes towards emotional and physical violence will be assessed with an adapted version of the Conflict Tactic Scale (CTS). Higher scores indicate higher levels of positive attitudes towards violence. We hypothesize a stronger decrease of positive attitudes towards violence in the intervention group compared to the control group.

  2. Change of student's mental health [ Time Frame: The PSC-Y will be used at T0 (baseline, prior to intervention), T1 (first follow-up, 6 months after intervention) and T2 (second follow-up, 18 months after intervention) ]

    The Pediatric Symptom Checklist - Youth Report (PSC-Y) will assess students' emotional and behavioral problems.

    Higher scores indicate higher levels of students' mental health problems. We hypothesize a stronger reduction of mental health problems in the intervention group compared to the control group.


  3. Change of students' quality of life [ Time Frame: The KIDSCREEN-10 will be used at T0 (baseline, prior to intervention), T1 (first follow-up, 6 months after intervention) and T2 (second follow-up, 18 months after intervention) ]

    The KIDSCREEN-10 will assess students' quality of life. Higher scores indicate higher levels of students' quality of life.

    We hypothesize an overall improvement of in the quality of life in the intervention group compared to the control group.


  4. Change of students' cognitive functioning [ Time Frame: The app-based tasks will be used at T0 (baseline, prior to intervention), T1 (first follow-up, 6 months after intervention) and T2 (second follow-up, 18 months after intervention) ]
    Five tasks from the tablet application Inquisit will be used to assess children's cognitive abilities including selective attention (Letter Cancellation Task), working memory (Corsi Block Tapping Backwards), response inhibition (Arrow Flanker Task), planning and problem solving (Tower of London) and cognitive flexibility (Wisconsin Card Sorting Test). The test results in each test will be z-standardized and then combined to one compound score. Higher scores indicate higher levels of students' cognitive abilities. We hypothesize higher levels of cognitive functioning in the intervention group compared to the control group.


Other Outcome Measures:
  1. Change of students' academic performance [ Time Frame: Students' grades will be collected at T0 (baseline, prior to intervention), T1 (first follow-up, 6 months after intervention) and T2 (second follow-up, 18 months after intervention). ]
    Students' grades in the previous term's exams will be obtained from the school administration. An improvement in academic performance in the intervention group is hypothesized.

  2. Change of peer violence [ Time Frame: he Multidimensional Peer Victimization Scale will be used at T0 (baseline, prior to intervention), T1 (first follow-up, 6 months after intervention) and T2 (second follow-up, 18 months after intervention) ]
    The Multidimensional Peer Victimization Scale will be used assess students' experiences of violence by peers. Higher scores indicate higher levels of students' experiences of peer violence. We hypothesize a stronger decrease of peer violence in the intervention group compared to the control group.


Eligibility Criteria
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Ages Eligible for Study:   11 Years to 62 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

General:

Inclusion Criteria:

All: Written informed consent (if underaged by parents (written) & minors themselves (written) Students: Enrollment in selected secondary school Teachers: All teachers employed at the selected schools

Schools:

Public secondary schools Day schools At least 30 students in selected class/stream

Exclusion criteria:

Students and teachers:

Acute drug or alcohol intoxication Acute psychotic disorder

Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT06001554


Contacts
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Contact: Tobias Hecker, PhD +49 521 106 3105 tobias.hecker@uni-bielefeld.de
Contact: Alaptagin Khan, MBBS +1 617 855 2096 AKHAN@MCLEAN.HARVARD.EDU

Locations
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Pakistan
Shifa International Hospitals Recruiting
Islamabad, Pakistan
Contact: Abdul Wahab Yousafzai, MBBS       wahab.yousafzai@gmail.com   
Sponsors and Collaborators
Bielefeld University
Shifa Foundation
Shifa International Hospital
Mclean Hospital
University of Konstanz
Investigators
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Principal Investigator: Alaptagin Khan, MBBS McLean Hopstial
More Information
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Responsible Party: Bielefeld University
ClinicalTrials.gov Identifier: NCT06001554    
Other Study ID Numbers: ICC-T CRCT Pakistan
First Posted: August 21, 2023    Key Record Dates
Last Update Posted: April 9, 2024
Last Verified: July 2023
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description:

The ICC-T intervention is being tested in various other countries including Haiti, Ghana, Tanzania and Uganda. We will share anonymized data with project partners from the different countries for combined and/or comparative analyses. In addition, we will share anonymized data with other researchers working on prevention of violence against children in school settings for the purpose of conducting synthesizing analyses such as meta-analyses.

Finally, the anonymized data collected in the study will be made publicly available in a data repository.
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Clinical Study Report (CSR)
Analytic Code
Time Frame: The anonymized data will be made publicly available after completion of the project in 2027
Access Criteria: During the project, anonymized data will be shared only with partners working in other ICC-T projects and other researchers working in prevention of violence against children upon request. After the completion of the project, the anonymized data will be available to the public.

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Bielefeld University:
school violence
teacher violence
teachers
intervention
 students
public schools
secondary schools