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Effectiveness of School Based Intervention for Promoting Mental Health Literacy Among Teachers

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. Read our disclaimer for details. Identifier: NCT02937714
Recruitment Status : Completed
First Posted : October 19, 2016
Last Update Posted : March 26, 2020
Information provided by (Responsible Party):
King Edward Medical University

Brief Summary:

Significantly higher prevalence of emotional and behavioural problems have been reported from Pakistan.This higher prevalence along with stigma of psychiatric problems and limited child & adolescent mental health services in Pakistan means that it is important to consider alternate methods for promoting psychological and emotional well-being of our youth. Schools can thus act as a natural platform for mental health promotion as schools context has almost as much impact on students' emotional health as the family context.

Teachers' role in the school mental health initiatives cannot be overemphasized. Teachers own knowledge and beliefs regarding mental health influence the way they respond to students mental health crisis. Recognizing the need for wider implementation of evidence based school mental health interventions in the region and to help in addressing the mental health literacy of educators in resource constrained settings, World Health Organization, Eastern Mediterranean Region (WHO-EMRO) has developed a concise and practical manual of school mental health in December 2014. In the absence of any "whole school approach" study from Pakistan focusing on teachers training and addressing all the various evidence based components of promotion of positive mental health, Investigators aim to conduct a pilot randomized controlled trial to assess effectiveness of training based on WHO-EMRO manual, in addition to its feasibility & acceptability in improving teachers' mental health literacy and self-efficacy in dealing with students mental health issues.


For teachers:

  • School mental health training intervention will significantly improve teacher's mental health literacy & self-efficacy compared to wait list control group.
  • At 3 months follow-up, control group teachers' mental health literacy will also improve compared to baseline due to contamination of information provided, across groups within the same school.

All hypothesis pertains to individual level.

For students:

Mental health training of teachers would lead to an overall improvement in student's outcome measure (student's emotional and behavioural difficulties) at 3 months follow-up.

Condition or disease Intervention/treatment Phase
School Mental Health Training of Teachers Other: School Mental Health training Not Applicable

Detailed Description:

Pakistan is the 6th most populous country of the world with population over 188 million; Almost 35% of population is under the age of 14. Country cannot afford to ignore mental health of this large group. School experiences are important for children emotional, psychological and social development World Health Organization (WHO) also identifies promotion of emotional health and well- being as a core feature of their Health promoting school initiative. Schools can play an important role in promoting positive mental health, reducing stigma, raising awareness among teachers, parents and children about mental health issues as well as identifying and supporting youth experiencing mental health difficulties. Furthermore, mental health initiatives in schools help teachers to feel less stressed and be more satisfied with their role and save costs. Educational interventions involving teachers have shown significant improvement in teachers knowledge and attitudes regarding mental health & better accuracy of teacher identification of children and adolescents with mental health problems. Although importance of schools for mental health promotion and early identification for mental health problems has been evident for quite some time, it is almost nonexistent in developing countries including Pakistan with only a handful of studies focusing one aspect of health promoting school or on one disorder. World Health Organization, Eastern Mediterranean Region (WHO-EMRO) has developed a concise and practical manual of school mental health in December 2014.This manual is primarily intended for all stakeholders involved in the educational process including teachers. It aims for helping educators to take practical steps that can be implemented at low costs in school settings.


To assess the effectiveness of locally adapted WHO school mental health Manual based intervention in improving mental health literacy among school teachers through a randomized controlled trial.

Secondary objectives include

  1. To assess whether school mental health Manual based intervention leads to better self- efficacy among school teachers.
  2. To determine if mental health training of teachers would lead to an indirect improvement in students outcome measure (emotional and behavioural difficulties) and school psychosocial environment.

STUDY PHASE 1: Interaction with key stakeholders to do a current situational analysis / identify priority using WHO Questionnaires & in depth Interviews.

STUDY PHASE 2: Randomized controlled trial to assess effectiveness, feasibility & acceptability of the adapted manual delivery in school settings.

STUDY PHASE 3: Process Evaluation by feedback from Teachers.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 231 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Health Services Research
Official Title: Effectiveness of School Based Intervention for Promoting Mental Health Literacy Among Teachers: A Randomized Controlled Trial
Actual Study Start Date : September 10, 2017
Actual Primary Completion Date : November 30, 2018
Actual Study Completion Date : November 30, 2018

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: School mental health training
Teachers Training workshop Workshop based on local adaptation of WHO-EMRO school mental health manual will be conducted in school. The duration of the workshop will be 3 days. Teachers can decline to participate or withdraw at any stage.
Other: School Mental Health training
School based intervention (Teacher training intervention) is the teachers training program based on World Health Organization, Eastern Mediterranean Region (WHO-EMRO) School mental health manual draft (December 2014). Topics to be covered in training workshop include normal childhood development, behaviour management strategies for schools, life skills training, essential components for healthy schools, recognizing warning signs for common psychiatric and developmental disorders common to children and adolescents & school based interventions for various psychiatric problems
Other Name: WHO-EMRO School Mental Health Manual Based Training

No Intervention: Wait list control group
Wait list control group of teachers in same schools. Half of teachers in the same school will be the wait list control group.

Primary Outcome Measures :
  1. Teachers' knowledge [ Time Frame: At the end of 3 days workshop ]
    Mental health literacy refers to a person's knowledge and beliefs about mental disorders, which in turn increases their ability to recognize, manage, or prevent the development or exacerbation of mental health problems. It has various elements including: 1) enhancing capacity to obtain and maintain good mental health; 2) enhancing understanding of mental disorders and their treatments; 3) decreasing stigma related to mental illness; 4) enhancing help-seeking efficacy. It will be assessed in the study using a self-administered questionnaire based on literature review and addressing various mental health literacy elements. Although main outcome time frame is post workshop but it will be reevaluated at 3 months time to see if change from baseline is seen.

Secondary Outcome Measures :
  1. Teachers' Sense of Self Efficacy [ Time Frame: At the end of 3 days workshop ]
    Teachers sense of efficacy scale(TSES) measures teachers assessment of their self-efficacy for teaching tasks as well as their other responsibilities. Efficacy in Student Engagement & Efficacy in Classroom Management subscales will be used to assess self efficacy of teachers. There are 8 statements & each statement is rated on 9 point Likert scale. It will also be reassessed at 3 months after the training workshop to assess if change from baseline is seen.

  2. Students behavioural and emotional Problems [ Time Frame: 3 months after the teachers training ]
    Self- reported Strengths and Difficulties questionnaire{SDQ} (11-16 years) will be used to assess students behavioural and emotional problems. SDQ measures 25 attributes, which are grouped in subscales of five items each, generating scores for conduct, hyperactivity, emotional, peer problems and prosocial behaviour. Statements are rated on a three point likert scale:0(not tue), 1(somewhat true) and 2(certainly true). All scales excluding the last are added to generate a total difficulties score (0-40). Total difficulties and categories scores can be coded in normal, borderline and abnormal categories.

Other Outcome Measures:
  1. The School psycho-Social Profile [ Time Frame: 3 months after the teachers training ]
    The School psycho-Social Profile Questionnaire (PSE ; WHO tools)will be completed by principals before and 3 months after the teacher training.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • All the teachers in the participating schools.
  • Teachers of Grade 1-10 will be approached.
  • Both Genders.

Exclusion Criteria:

  • Lack of informed consent.
  • Teachers who are leaving/ not planning to be in the school in 3 months' time.
  • Teachers who have not been involved in active teaching in last 6 months.

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 identifier (NCT number): NCT02937714

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King Edward Medical University
Lahore, Punjab, Pakistan, 54000
Sponsors and Collaborators
King Edward Medical University
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Principal Investigator: Nazish Imran, MRCPsych King Edward Medical University
Weist, MD & Murray M. Advancing school mental health promotion globally. Advances in School Mental Health Promotion 2007; 1(1): 2-12.
Kutcher S, Wei Y, McLuckie A, Bullock L. Educator mental health literacy: a programme evaluation of the teacher training education on the mental health & high school curriculum guide. Advances in School Mental Health Promotion 2013;6(2):83-93 DOI: 10.1080/1754730X.2013.784615

Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: King Edward Medical University Identifier: NCT02937714    
Other Study ID Numbers: KingEdwardMU
First Posted: October 19, 2016    Key Record Dates
Last Update Posted: March 26, 2020
Last Verified: March 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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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 King Edward Medical University:
mental health literacy
school mental health promotion