Sachin Shinde|Helen A. Weiss|Beena Varghese|Prachi Khandeparkar|Bernadette Pereira|Amit Sharma|Rajesh Gupta|David A. Ross|George C. Patton|Vikram Patel
Promoting school climate and health outcomes with the SEHER multi-component secondary school intervention in Bihar, India: a cluster-randomised controlled trial
London School of Hygiene & Tropical Medicine|Sangath|London School of Hygiene & Tropical Medicine|Public Health Foundation of India|Sangath|Sangath|Sangath|Sangath|London School of Hygiene & Tropical Medicine|Murdoch Children's Research Institute|University of Melbourne|Harvard Global Health Institute|Sangath|Harvard University
school environments affect health academic outcomes increasing secondary school retention lowincome middleincome countries promoting quality school social environments could offer scalable opportunity improve adolescent health wellbeingwe clusterrandomised trial assess effectiveness multicomponent wholeschool health promotion intervention seher integrated economic process evaluations grade 9 students aged 1314 years governmentrun secondary schools nalanda district bihar state india schools randomly assigned 111 three groups seher intervention delivered lay counsellor seher mitra sm group seher intervention delivered teacher teacher seher mitra tsm group control group standard governmentrun classroombased lifeskills adolescence education program implemented primary outcome school climate measured beyond blue school climate questionnaire bbscq students assessed start academic year june 2015 8 months later end academic year march 2016 via selfcompleted questionnaires study registered clinicaltrialsgov number nct02484014of 112 eligible schools nalanda district 75 randomly selected participate trial randomly assigned 25 schools three groups one school subsequently dropped tsm group leaving 24 schools group baseline survey included total 13 035 participants endpoint survey included 14 414 participants participants smdelivered intervention schools substantially higher school climate scores endpoint survey control group bbscq baselineadjusted mean difference amd 757 95 ci 611903 effect size 188 95 ci 144232 p00001 tsmdelivered intervention amd 757 95 ci 606908 effect size 188 95 ci 143234 p00001 effect tsmdelivered intervention compared control amd 0009 95 ci 153 151 effect size 000 95 ci 045 044 p099 compared control group participants smdelivered intervention schools moderate large improvements secondary outcomes depression amd 123 95 ci 189 057 bullying amd 091 95 ci 115 066 violence victimisation odds ratio 062 95 ci 046084 violence perpetration 068 95 ci 048096 attitude towards gender equity amd 041 95 ci 021061 knowledge reproductive sexual health amd 029 95 ci 006053 similar results secondary outcomes noted comparison smdelivered intervention schools tsmdelivered intervention schools depression amd 123 95 ci 191 055 bullying amd 083 95 ci 108 057 violence victimisation 049 95 ci 035067 violence perpetration 049 95 ci 034071 attitude towards gender equity amd 023 95 ci 002044 knowledge reproductive sexual health amd 022 95 ci 002 047 however effects secondary outcomes observed tsmdelivered intervention schools compared control group depression amd 003 95 ci 070 065 bullying amd 008 95 ci 034 018 violence victimisation 127 95 ci 093173 violence perpetration 137 95 ci 095195 attitude towards gender equity amd 017 95 ci 009 038 knowledge reproductive sexual health amd 006 95 ci 018 032the multicomponent wholeschool seher health promotion intervention substantial beneficial effects school climate healthrelated outcomes delivered lay counsellors effects delivered teachers future research focus evaluation scaling seher intervention diverse contexts delivery agentsjohn catherine macarthur foundation usa united nations population fund india office