RESUMO
BACKGROUND: Schools have a major role in promoting children's physical and psychological health and well-being and the mental health literacy of all key stakeholders, especially teachers, is critical to achieving this goal. Teachers' knowledge and beliefs about psychological problems influence the way they deal with their students' mental health issues. This study is a preliminary investigation evaluating the effectiveness and feasibility of a School Mental Health Programme (SMHP) developed by the World Health Organization's Eastern Mediterranean Regional Office (WHO-EMRO) in improving mental health literacy and self-efficacy among school teachers in an inner-city area of urban Lahore. METHODS: Teachers were randomly assigned to 3 days standardized WHO-EMRO School Mental Health Manual based Intervention (n = 118) or to a wait list delayed intervention control group (n = 113). Teachers were assessed pre and post training and at 3 months follow up using measures for mental health literacy (Primary outcome) and self-efficacy. School Heads completed the WHO School Psychosocial Profile and students reported socioemotional skills and psychological problems using Strengths and Difficulties questionnaire at baseline and 3 months post intervention. RESULTS: Compared with waitlist group, teachers in intervention group presented a significant increase in mental health literacy (F2,181 = 8.92; P < 0.001), as well as better teacher's self-efficacy in classroom management and student engagement (F2,181 = 16.45; P ≤ 0.000 and F2,181 = 4.65; P ≤ 0.011, respectively). Increase confidence in helping students with mental health problems was also noted in the intervention arm (F2,181 = 15.96 P ≤ 0.000). Improvement in overall school environment was also found. No statistical difference in the emotional and behavioural difficulties in students was noticed at 3 months. CONCLUSION: This study is one of the first preliminary investigation of WHO-EMRO school mental health intervention in Pakistan. The study showed that intervention led to significant improvement in mental health literacy and self-efficacy among teachers, which was largely sustained over time. Despite a major limitation of lack of clustering and likely contamination affecting follow up outcomes, the study showed promising results in the context of mental health promotion, prevention and early intervention in schools in Lahore, Pakistan. A larger cluster randomised trial is justified, given the level of participant engagement and acceptability by schools. TRAIL REGISTRATION: ClinicalTrials.gov registry (NCT02937714) Registered 13th October 2016, https://register. CLINICALTRIALS: gov .
RESUMO
BACKGROUND: We aimed to explore inner city school teachers' perceptions of problems faced in schools, it causes and role of schools and teachers in promoting child social and emotional well-being, using qualitative approach. METHODS: Following ethical approval and informed consent, In-depth interviews were conducted in 2017 with twenty teachers belonging to four private schools in inner city area of Provincial capital, Lahore, Pakistan. Inclusion criteria were at least 12 years of formal education and minimum of 5 years' experience in teaching profession. Framework Analysis was used to analyze data. RESULTS: Teachers identified learning problems, inattention, disobedience, aggression, lying & disrespect as the most commonly encountered problems of children, with very few teachers mentioning emotional difficulties. Teachers view the family, parenting practices and home environment alongside media (in particular social media) as being the main causes of child behavioral problems. With prompts, however, they did identify various school and teacher-related factors having negative impact on children. Fair conceptualization of good school and good teacher was observed. Need for teacher awareness and training for strategies promoting child emotional and social wellbeing was highlighted. CONCLUSION: As perceived by teachers, children studying in inner city schools have several behaviour problems. Study results and the gaps identified will help in ensuring that teachers receive training targeted towards their needs. Findings of the study also substantiate the need for targeting whole school-wide preventive approach as efforts begin to implement school mental health initiative in Pakistan.
RESUMO
BACKGROUND: The teacher's role in school mental health initiatives cannot be overemphasized. Despite global evidence of educational interventions in improving teachers' knowledge and attitudes regarding mental health, this area remains under researched in Pakistan. This paper presents a study protocol of a pilot randomized controlled trial to examine the effectiveness of a teacher training intervention for improving mental health literacy and self-efficacy among school teachers in urban Lahore, Pakistan. METHODS: The randomized controlled trial will follow the CONSORT guidelines. Participants will be allocated to the Intervention group (receiving the World Health Organization, Eastern Mediterranean Region (WHO-EMRO) School Mental Health Manual-based intervention in three 6-h, face-to-face sessions) or a waitlist control group (not receiving training during the study period). Participants will be teachers of private schools with similar broad demographic characteristics in an inner city area of Lahore. The primary outcome measures for the trial is teachers' mental health literacy. It will be assessed by using the previously applied (during WHO training of Master Trainers) self-administered questionnaire in both groups pre and post training and at 3 months' follow-up. Secondary outcomes include: for teachers: Teachers' self-efficacy (assessed by the Teachers' Sense of Self Efficacy Scale (TSES) short form.); for students (11-16 years): socio-emotional skills and psychological problems measured by the Strengths and Difficulties Questionnaire (assessed at baseline and 3 months post intervention); for schools: the WHO School Psychosocial Profile Questionnaire (baseline and 3 months post intervention). DISCUSSION: Given the high prevalence of child mental health problems, stigma and lack of services, it is important to consider alternate avenues for promoting positive mental health among youth. This pilot study should establish the effectiveness of the WHO-EMRO School Mental Health Manual-based Intervention improving teacher's mental health literacy and helping them to learn practical steps that can be implemented at low cost in school settings. It will also provide information regarding intervention implementation and sustainability. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02937714 . Registered on 18 October 2016.