A multicomponent secondary school health promotion intervention and adolescent health: An extension of the SEHER cluster randomised controlled trial in Bihar, India
A multicomponent secondary school health promotion intervention and adolescent health: An extension of the SEHER cluster randomised controlled trial in Bihar, India
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DOI：
10.1371/journal.pmed.1003021
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发表时间：
2020-02-01
期刊：
影响因子：
15.8
通讯作者：
Patel, Vikram
中科院分区：
文献类型：
--
作者：
Shinde, Sachin;Weiss, Helen A.;Patel, Vikram
研究背景加强基于学校的青少年健康促进干预的证据基础（SEHER）是由印度比哈尔邦公立中学的非专业辅导员或教师提供的多成分、全校健康促进干预。本研究的目的是检查干预的效果，经过两年的随访，并评估的一致性的结果观察随time.Methods和findingsWe进行了一个集群随机试验，其中75所学校随机（1：1：1）接受SEHER干预提供的外行辅导员（SEHER米特拉[SM]）或教师（教师SEHER米特拉[TSM]），分别，旁边的标准化，以课堂为基础的生活技能青少年教育计划（AEP），相比，AEP单独（对照组）。试验设计为重复横断面研究。九年级学生在2015 - 2016学年，13 - 15岁的学生接受了为期两年的干预，并在三个时间点进行了结果评估-2015年6月的基线; 2016年3月的8个月随访，当时学生仍在9年级;和2016年12月17个月随访时的终点（学生在10年级时），其结果见本文。主要结果，学校气氛，测量与超越蓝色学校气氛问卷（BBSCQ）。采用混合效应线性或逻辑回归估计干预效果，包括调整校内聚类、最小化变量、基线聚类水平结局评分和社会人口学特征的随机效应。共有15，232名学生参加了为期17个月的调查。与对照组相比，SM干预组的参与者报告学校气氛有所改善（校正的平均差异[aMD]= 7.33; 95% CI：6.60 - 8.06; p <0.001）和大多数次要结局（抑郁：aMD =-4.64; 95% CI：-5.83-3.45; p <0.001;性别平等态度：aMD = 1.02; 95% CI：0.65 - 1.40; p <0.001;欺负频率：aMD =-2.77; 95%可信区间：-3.40至-2.14; p <0.001;暴力行为：比值比[OR]= 0.08; 95% CI：0.04 - 0.14; p <0.001;暴力行为：OR = 0.16; 95% CI：0.09 - 0.29; p <0.001）。与对照组相比，没有证据表明TSM组具有干预效果。与8个月时相比，17个月随访时，非专业咨询师提供的干预措施对大多数结局的影响更大：学校氛围（效应量[ES; 95%CI]= 2.23 [1.97 - 2.50] vs 1.88 [1.44 - 2.32]，p <0.001）;抑郁（ES [95%CI]=-1.19 [-1.56至-0.82]对比-0.27 [-0.44至-0.11]，p <0.001）;对两性平等的态度（ES [95%CI]= 0.53 [0.27 - 0.79]对比0.23 [0.10 - 0.36]，p <0.001）;欺凌（ES [95%CI]=-2.22 [-2.84至-1.60]对比-0.47 [-0.61至-0.33]，p <0.001）;暴力受害（OR [95% CI]= 0.08 [0.04 - 0.14] vs 0.62 [0.46 - 0.84]，p <0.001）;和暴力犯罪（OR [95%CI]= 0.16 [0.09 - 0.29] vs 0.68 [0.48 - 0.96]，p <0.001），表明延长干预可增加获益。该研究的一个局限性是，27%的基线参与者没有完成17个月的结果assessment.ConclusionsThe试验表明，第二年的结果是类似的第一年的结果，没有影响的教师主导的干预和更大的好处，对学校的气氛和青少年的健康积累扩展外行辅导员提供的干预。
BackgroundStrengthening Evidence base on scHool-based intErventions for pRomoting adolescent health (SEHER) is a multicomponent, whole-school health promotion intervention delivered by a lay counsellor or a teacher in government-run secondary schools in Bihar, India. The objective of this study is to examine the effects of the intervention after two years of follow-up and to evaluate the consistency of the findings observed over time.Methods and findingsWe conducted a cluster randomised trial in which 75 schools were randomised (1:1:1) to receive the SEHER intervention delivered by a lay counsellor (SEHER Mitra [SM]) or a teacher (Teacher as SEHER Mitra [TSM]), respectively, alongside a standardised, classroom-based life skills Adolescence Education Program (AEP), compared to AEP alone (control group). The trial design was a repeat cross-sectional study. Students enrolled in grade 9 (aged 13-15 years) in the 2015-2016 academic year were exposed to the intervention for two years and the outcome assessment was conducted at three time points- at baseline in June 2015; 8-months follow-up in March 2016, when the students were still in grade 9; and endpoint at 17-months follow-up in December 2016 (when the students were in grade 10), the results of which are presented in this paper. The primary outcome, school climate, was measured with the Beyond Blue School Climate Questionnaire (BBSCQ). Intervention effects were estimated using mixed-effects linear or logistic regression, including a random effect to adjust for within-school clustering, minimisation variables, baseline cluster-level score of the outcome, and sociodemographic characteristics. In total, 15,232 students participated in the 17-month survey. Compared with the control group, the participants in the SM intervention group reported improvements in school climate (adjusted mean difference [aMD] = 7.33; 95% CI: 6.60-8.06; p < 0.001) and most secondary outcomes (depression: aMD = -4.64; 95% CI: -5.83-3.45; p < 0.001; attitude towards gender equity: aMD = 1.02; 95% CI: 0.65-1.40; p < 0.001; frequency of bullying: aMD = -2.77; 95% CI: -3.40 to -2.14; p < 0.001; violence victimisation: odds ratio [OR] = 0.08; 95% CI: 0.04-0.14; p < 0.001; and violence perpetration: OR = 0.16; 95% CI: 0.09-0.29; p < 0.001). There was no evidence of an intervention effect in the TSM group compared with control group. The effects of the lay counsellor-delivered intervention were larger for most outcomes at 17-months follow-up compared with those at 8 months: school climate (effect size [ES; 95% CI] = 2.23 [1.97-2.50] versus 1.88 [1.44-2.32], p < 0.001); depression (ES [95% CI] = -1.19 [-1.56 to -0.82] versus -0.27 [-0.44 to -0.11], p < 0.001); attitude towards gender equity (ES [95% CI] = 0.53 [0.27-0.79] versus 0.23 [0.10-0.36], p < 0.001); bullying (ES [95% CI] = -2.22 [-2.84 to -1.60] versus -0.47 [-0.61 to -0.33], p < 0.001); violence victimisation (OR [95% CI] = 0.08 [0.04-0.14] versus 0.62 [0.46-0.84], p < 0.001); and violence perpetration (OR [95% CI] = 0.16 [0.09-0.29] versus 0.68 [0.48-0.96], p < 0.001), suggesting incremental benefits with an extended intervention. A limitation of the study is that 27% of baseline participants did not complete the 17-month outcome assessment.ConclusionsThe trial showed that the second-year outcomes were similar to the first-year outcomes, with no effect of the teacher-led intervention and larger benefits on school climate and adolescent health accruing from extending lay counsellor-delivered intervention.