Working on mental health stigma in education: a multicenter community-based clinical trial
| ISRCTN | ISRCTN63945853 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN63945853 |
| Secondary identifying numbers | PI06072022 |
- Submission date
- 20/08/2024
- Registration date
- 20/08/2024
- Last edited
- 20/08/2024
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Mental and Behavioural Disorders
Plain English Summary
Background and study aims
According to the World Health Organization (WHO), one in seven adolescents worldwide aged 10-19 has a mental health problem; emotional disorders, eating disorders and psychosis are the most prevalent. In Spain, the percentage of adolescents with a diagnosed psychopathological disorder is 20.8% (21.4% girls and 20.4% boys), which places it at the top of the European countries with the highest prevalence of mental health disorders in this type of population. This increase in prevalence from previous years may be related to the context and restrictive protective measures that were put in place in the COVID-19 pandemic years. In this regard, evidence has shown that such restrictions appeared to predispose people to anxiety, social isolation and depressive symptoms, among others, facilitating the emergence of new cases of adolescents with mental health problems, aggravating the situation of those most vulnerable and leading to negative consequences that could persist in the long term.
This is why national and international institutions such as the Spanish Ministry of Health and the WHO, through the publication of action plans, have emphasised the need to carry out community interventions related to the prevention and promotion of mental health in the adolescent population from all areas, highlighting the school context and the role of teachers. This approach is supported by the scientific literature, which shows that the educational setting is an ideal context for reaching a large number of adolescents and is also conceived as a safe environment for mental health promotion, since the school year involves contact with students for a long period of time, and teachers accompany them throughout the school day. In addition, at present, among the different competencies of teachers is that of acquiring knowledge and attitudes about mental health so that they can be agents of reference for the adolescent population in the classroom, encouraging active help-seeking and accompanying adolescents during their period of growth and in any kind of need related to mental health.
However, in order to become support agents, teachers have to be given appropriate training in mental health. In this regard, recent research has not only shown that teachers’ knowledge and training in mental health is low, but they also have other limitations related to skills shortages, such as a lack of confidence in their performance and a lack of engagement with their students. Stigma is also a major barrier to addressing mental health problems in general and, in school settings, contributes to social isolation, minimisation of symptoms and poorer management of the consequences of mental health disorders.
It is also important to take into account that in Spain, teachers do not include in their curricula systematic training in mental health that includes the recognition and early detection of the most prevalent mental disorders in adolescence, the identification and management of risk and protective factors for mental health in the classroom, active help-seeking or anti-stigma interventions.
Therefore, given the evident need for mental health training programmes for high school teachers, including the reduction of stigmatising attitudes and beliefs, and taking into account that the current curricula do not contemplate this content, researchers propose carrying out a teacher training programme led by a mental health nurse, as this group of health professionals plays an essential role in health education and promotion, including mental health, both for the general population and for the specific population through preventive measures and community approach strategies.
The main goal of this research is therefore to evaluate the effectiveness of a training programme in the prevention and promotion of mental health, delivered by a mental health nurse, in order to reduce stigmatising attitudes (Anti-stigma Training Programme) among teachers from different high schools in the self-governing region of Valencia, Spain.
Who can participate?
High school teachers working full-time at participating schools
What does the study involve?
The anti-stigma training programme was delivered by a mental health nurse, in a face-to-face format over four different sessions (each lasting 2 hours) in consecutive weeks. All the sessions were held at the schools themselves during teachers’ working hours in July 2023, as the school term was over and teachers had more time available. There were no financial incentives or incentives of any kind for the teachers taking part, and there were no adverse effects during the programme or after it finished.
What are the possible benefits and risks of participating?
First, teachers should increase knowledge related to health prevention and promotion while reducing stigmatizing attitudes related to it. Secondly, this will make it possible to reduce erroneous beliefs and be a support figure for adolescents if necessary. It will also allow them to work on mental health in the classroom at any time, as well as acquire skills in crisis care. There is no risk in participating.
Where is the study run from?
Jaume I University (Spain)
When is the study starting and how long is it expected to run for?
September 2021 to December 2023
Who is funding the study?
1. General Council of Nursing of Spain
2. College of Nursing of Valencia (Spain)
3. Jaume I University (Spain)
Who is the main contact?
Lucía Santonja Ayuso, Al400276@uji.es
Contact information
Public, Scientific, Principal Investigator
C/enguera 9
Piso 1 Pta 5
La Eliana
46183
Spain
 ORCID ID |
0000-0002-8269-5787 |
|---|---|
| Phone | +34 (0)695432143 |
| al400276@uji.es |
Study information
| Study design | Multicentre community-based non-randomized clinical trial |
|---|---|
| Primary study design | Interventional |
| Secondary study design | Non randomised study |
| Study setting(s) | School |
| Study type | Other, Prevention |
| Participant information sheet | Not available in web format, please use contact details to request a participant information sheet |
| Scientific title | Prevention and promotion of mental health through an anti-stigma intervention led by psychiatric nursing and aimed at high school teachers in Spain: a non-randomized multicenter community clinical trial |
| Study hypothesis | The main goal of this research is therefore to evaluate the effectiveness of a training programme in the prevention and promotion of mental health, delivered by a mental health nurse, in order to reduce stigmatising attitudes (Anti-stigma Training Programme) among teachers from different high schools in the self-governing region of Valencia, Spain. |
| Ethics approval(s) |
Approved 13/05/2022, Research Ethics Committee - Research Commission of the Department of Health of La Ribera of the Valencian Community, University Hospital of La Ribera de Alzira (km 1, Ctra. Corbera, 46600 Alzira, Valencia, Alzira, 46600, Spain; +34 (0)962542800; broch_marcas@gva.es), ref: PI06072022 |
| Condition | Mental health |
| Intervention | The anti-stigma training programme was developed based on the available scientific evidence and the content of guides, manuals and recommendations of both experts and prestigious national and international entities in the field of mental health. The content of the programme focused on training on the risk and protective factors present in the adolescent period, the reduction of stigmatising beliefs, the definition of the role that teachers should play in this area, and training on the algorithm of action and the social and health resources available in the region. The anti-stigma programme was evaluated by professionals in the field of psychiatry and university lecturers and its usefulness was assessed in a previous pilot study, reporting favourable results. The intervention was thus composed of four different thematic blocks and divided into four different sessions (prevention and promotion of mental health in adolescence; stigma and psychoeducation in psychosis; emotions and healthy emotional regulation; and algorithm of action and referral to the health system). In each session, the contents were shown by means of a digital presentation and were complemented with methods and techniques of group education. The anti-stigma training programme was delivered by a mental health nurse, in a face-to-face format over four different sessions (each lasting 2 hours) in consecutive weeks. All the sessions were held at the schools themselves during teachers’ working hours in July 2023, as the school term was over and teachers had more time available. There were no financial incentives or incentives of any kind for the teachers taking part, and there were no adverse effects during the programme or after it finished. |
| Intervention type | Behavioural |
| Primary outcome measure | Level of stigma measured using the Attribution Questionnaire-27 (AQ-27) scale. In both the experimental and control groups, the participating teachers answered the AQ-27 scale before the training programme (T0). Subsequently, the experimental group answered the AQ-27 after the end of the programme (T1) and at the 3-month follow-up (T2). The control group were not given the training programme, and so only answered the AQ-27 scale at T2. |
| Secondary outcome measures | An ad hoc questionnaire was drawn up to collect the socio-demographic data of the participating teachers (gender, age, number of children, work experience, place of residence, level of studies), and a set of variables to determine their experience with students with mental health problems (tutoring students, familiarity with mental health services, familiarity with self-harm and/or suicidal behaviour, crisis care and perceived feelings during care). Completed before the training programme (T0). |
| Overall study start date | 25/09/2021 |
| Overall study end date | 18/12/2023 |
Eligibility
| Participant type(s) | Employee |
|---|---|
| Age group | Adult |
| Lower age limit | 18 Years |
| Upper age limit | 70 Years |
| Sex | Both |
| Target number of participants | 80 in the experimental group |
| Total final enrolment | 169 |
| Participant inclusion criteria | Participants: 1. Working full-time at the school at the time of submission of the programme 2. Spanish as native language or official accreditation of a high level of Spanish (C1ⴕ) 3. Willingness to attend 100% of the sessions 4. Signing the informed consent form Educational establishments 1. Public or private 2. Compulsory Secondary Education and/or Baccalaureate (from the age of 12 years) |
| Participant exclusion criteria | Participants: 1. Working part-time and/or being on leave of absence and/or sick leave 2. Showing conditions that make it impossible to answer the questionnaire (motor, hearing, visual or speech functional diversity) 3. Previous participation in a similar programme Educational establishments: 1. Special education schools 2. Schools whose official language is not Spanish/Valencian |
| Recruitment start date | 15/05/2023 |
| Recruitment end date | 14/06/2023 |
Locations
Countries of recruitment
- Spain
Study participating centres
Alzira
46600
Spain
Albalat de la Riebra
46687
Spain
Sponsor information
University/education
Avinguda de Vicent Sos Baynat, s/n, 12006 Castelló de la Plana, Castelló
Castellon
12006
Spain
| Phone | +34 (0)964728000 |
|---|---|
| pejo@uji.es | |
| Website | https://www.uji.es |
"ROR" |
https://ror.org/02ws1xc11 |
Funders
Funder type
University/education
Private sector organisation / Universities (academic only)
- Alternative name(s)
- Universitat Jaume I de Castelló, Universitat Jaume I de Castellón, UJI
- Location
- Spain
No information available
No information available
Results and Publications
| Intention to publish date | 20/08/2024 |
|---|---|
| Individual participant data (IPD) Intention to share | Yes |
| IPD sharing plan summary | Stored in non-publicly available repository, Available on request |
| Publication and dissemination plan | Planned publication in a peer-reviewed journal |
| IPD sharing plan | The datasets generated during and/or analysed during the current study will be stored in a non-publicly available repository (Department of Health of La Ribera of the Valencian Community, University Hospital of La Ribera de Alzira). At the schools in the study, the programme protocol was explained. Both the school management and the teachers who took part did so voluntarily. The privacy and confidentiality of both their personal data and the answers to the questionnaires were guaranteed. |
Editorial Notes
20/08/2024: Study's existence confirmed by Jaume I University and the General Nursing Council.
