Promoting school climate and health outcomes with the SEHER multi-component secondary school intervention in Bihar, India: a cluster-randomised controlled trial

Shinde, Sachin; Weiss, Helen A.; Varghese, Beena; Khandeparkar, Prachi; Pereira, Bernadette; Sharma, Amit; Gupta, Rajesh; Ross, David A.; Patton, George C.; Patel, Vikram

doi:10.1016/s0140-6736(18)31615-5

Cited by 135 publications

(204 citation statements)

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“…Sufficient coordination and communication at the school level, the availability of external PE, team cohesion, and feedback loops among all actors involved enhanced the implementation of the changes. These findings of the current study, in which we used a systems approach, are consistent with and add to the findings and recommendations of previous studies which also point to the importance of feedback, external support, clear coordination and communication, and bottom-up involvement for sufficient adoption and implementation of school health promotion programmes [20,95,96,101]. The current study further extends the knowledge by, among other things, insight on creating disruption in the schools.…”

Section: Discussionsupporting

confidence: 91%

“…Even though this favourable effect on children's BMI zscore seems promising, the effect can be indicated as a small effect, according to Lipsey's guidelines [100], and therefore raises the question regarding its clinical relevance. Previous studies have explored the minimal differences in BMI-z scores in overweight children to ensure clinically relevant health benefits [101]. As yet, little is known about when population-level public health interventions achieve clinical relevance [165].…”

Section: Clinical Relevance Of the Effects Of Hpsf On Children's Healmentioning

confidence: 99%

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Evaluating health promotion in complex adaptive school systems

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Section: Discussionsupporting

confidence: 91%

Section: Clinical Relevance Of the Effects Of Hpsf On Children's Healmentioning

confidence: 99%

Evaluating health promotion in complex adaptive school systems

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“…We previously reported strong effects of the SEHER intervention on school climate, violence and bullying, depression and attitude towards gender norms after one academic year of exposure, and dose-response effects after two years, in the SM arm of the trial. On the other hand, there was no evidence of an intervention effect on any outcome either after one or two years of intervention in the TSM arm [9][10].…”

Section: Box 1: Overview Of the Seher Trialmentioning

confidence: 70%

“…Comparison schools received the Adolescence Education Program (AEP), a classroom-delivered life-skills curriculum, which was conducted in all schools in all arms. Full details of the intervention and the evaluation have been reported elsewhere [8][9][10]. Box 1 provides an overview of the SEHER interventions and trial.…”

mentioning

confidence: 99%

What makes multicomponent school-based health promotion interventions work? A qualitative study nested in the SEHER trial in Bihar, India.

Shinde

Khandeparkar

Pereira

et al. 2020

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Background A cluster-randomized controlled trial in secondary schools in Bihar, India, reported the effectiveness of a multi-component, school health promotion intervention (SEHER) when delivered by lay counsellors (“SEHER Mitra” (SM); meaning “friend” in the local language), but not when delivered by a teacher (“Teacher as SEHER Mitra” (TSM)) compared with the government-run Adolescence Education Program (AEP). This nested qualitative study explored what key factors determined the effectiveness of the intervention and the difference in effectiveness by the delivery agent. Methods We purposively selected 12 intervention schools (6 each from the two intervention arms) based on the size of school. In these schools, we conducted semi-structured interviews with 12 principals, 12 AEP teachers, 12 other teachers, and 11 students who participated in SEHER counselling services. We conducted focus group discussions with girl students (n = 14), boy students (n = 12) SMs (n = 2), TSMs (n = 2), and supervisors (n = 1). Data analysis followed a framework approach to thematic analysis. Results Three overarching themes were identified – i.e. stakeholders’ understanding of SEHER; SEHER intervention planning and implementation, and other issues in the implementation process. All the stakeholders from both the arms strongly believed that the SEHER program was important in imparting health knowledge and life skills to secondary school students. The following factors facilitated the successful implementation of SEHER in SM-arm schools: a shared understanding of the SEHER program by the whole school community, influential school-level leadership, engagement of, and collaboration with, all stakeholders including students in program activities, the trust of the school community in the SMs, full-time availability of SMs for program activities, and prompt actions on students’ concerns by the SMs. Barriers to effective implementation of SEHER in TSM-arm schools included: lack of communication and poor relationship-building between the TSMs, principals and other teachers, TSMs’ perceptions that they were overburdened with academic and non-academic responsibilities, students’ lack of clarity about the TSM’s role, concerns about confidentiality, inaction on students’ concerns, and lack of support from other teachers and the department of education. Conclusions The embedded qualitative study identified important facilitators and barriers to the effective implementation of the intervention when delivered by two different delivery agents. Trial registration: www.clinicaltrials.gov/ NCT02484014

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“…A trial of a multi-level, structural and norms-based intervention in Karnataka found no evidence of a reduction in school drop-out and child marriage among girls aged 12-13 [34]. The whole-school SEHER (Strengthening Evidence base on scHool-based in-tErventions for pRomoting adolescent health programme) intervention delivered by lay counsellors in Bihar improved school climate and health-related outcomes among secondary school students (including depression, bullying and violence victimisation) [35].…”

Section: Discussionmentioning

confidence: 99%

Community youth teams facilitating participatory adolescent groups, youth leadership activities and livelihood promotion to improve school attendance, dietary diversity and mental health among adolescent girls in rural eastern India: protocol for a cluster-randomised controlled trial

Prost

Samal

Pradhan

et al. 2020

Trials

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Background: Improving the health and development of adolescents aged 10-19 years is a global health priority. One in five adolescents globally live in India. The Rashtriya Kishor Swasthya Karyakram (RKSK), India's national adolescent health strategy, recommends supporting community-based peer educators to conduct group meetings with boys and girls. Groups aim to give adolescents a space to discuss the social and health issues affecting them and build their capacity to become active community members and leaders. There have been no evaluations of the community component of RKSK to date. In this protocol, we describe the evaluation of the Jharkhand Initiative for Adolescent Health (JIAH), a community intervention aligned with RKSK and designed to improve school attendance, dietary diversity and mental health among adolescent girls aged 10-19 years in rural Jharkhand, eastern India.

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Promoting school climate and health outcomes with the SEHER multi-component secondary school intervention in Bihar, India: a cluster-randomised controlled trial

Abstract: Promoting school climate and health-related outcomes: a cluster randomised controlled trial of the SEHER multi-component secondary school intervention in Bihar, India.

Cited by 135 publications

References 39 publications

Evaluating health promotion in complex adaptive school systems

Evaluating health promotion in complex adaptive school systems

What makes multicomponent school-based health promotion interventions work? A qualitative study nested in the SEHER trial in Bihar, India.

Community youth teams facilitating participatory adolescent groups, youth leadership activities and livelihood promotion to improve school attendance, dietary diversity and mental health among adolescent girls in rural eastern India: protocol for a cluster-randomised controlled trial

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