Challenges in establishing positive mental health effects of a school-based intervention: a cluster-randomized controlled trial of a life skill program in ten public high schools in Norway

Abstract

Schools are well positioned for large scale promotion of mental health among young people. We tested the MindPower program delivered universally in the classroom to strengthen self-efficacy, self-esteem, and quality of life in high school students. We used a cluster randomized two-groups delayed intervention design. Participants where 1,673 out of 2,384 students, aged 15–16 years, in all the 110 first year high school classes in a county in Norway, randomized into two intervention groups, IG1 and IG2. IG1 started with MindPower. IG2 waited for four months to participate. Seven repeated measures were conducted with Rosenberg Self-esteem Scale (short version), General Perceived Self-Efficacy Scale (short version), and Warwick Edinburg Mental Wellbeing Scale. Self-efficacy level was compared to scores from a large comparable population study, locally and nationally (UngData). Mixed model analyses adjusted for cluster effects showed no significant increase in the three measures from start to five to nine months follow up. Self-efficacy level was approximately the same as the one found in UngData. The universal implementation in schools was a great challenge and attrition was comprehensive. MindPower did not strengthen students’ levels of self-efficacy, self-esteem, and quality of life, partly because the initial levels were already high (ceiling effect). In spite of careful preparations, fidelity was low and attrition high. Results should therefore be interpreted with caution. Learning points in implementing and conducting class based universal mental health programs in high school are discussed comprehensively. ClinicalTrials.gov: NCT03647826. The 27.08.2018. Retrospectively registered.