Evidence map›Paper›PMID 30723088›Full record

Trial reportJournal of epidemiology and community health2019

Examining intervention mechanisms of action using mediation analysis within a randomised trial of a whole-school health intervention.

Chris Bonell, Elizabeth Allen, Charles Opondo, Emily Warren, Diana Ruth Elbourne, Joanna Sturgess, Leonardo Bevilacqua, Jennifer McGowan, Anne Mathiot, Russell M Viner

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of epidemiology and community health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Article
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Chris BonellDepartment of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK.ORCID 0000-0002-6253-6498
Elizabeth AllenDepartment of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
Charles OpondoDepartment of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
Emily WarrenDepartment of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK.
Diana Ruth ElbourneDepartment of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
Joanna SturgessDepartment of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
Leonardo BevilacquaDepartment of Social Science, UCL Institute of Child Health, London, UK.
Jennifer McGowanDepartment of Social Science, UCL Institute of Child Health, London, UK.
Anne MathiotDepartment of Social Science, UCL Institute of Child Health, London, UK.
Russell M VinerDepartment of Social Science, UCL Institute of Child Health, London, UK.ORCID 0000-0003-3047-2247

Funding

Department of Health 12/153/60
6 · The paper itself

Abstract

backgroundInterventions to modify school environments are effective in promoting young people's health across outcomes, but mechanisms are poorly understood. We assessed mediation in a trial of the Learning Together intervention, building on the recent publication of results of effectiveness for reducing bullying and benefits across secondary outcomes and generally good implementation fidelity.

methodsWithin a cluster-randomised trial involving 40 English schools, we examined student-reported and staff-reported school climate and student-reported involvement with delinquent peers at 24-month and 36-month follow-up, assessing the reliability of measures and whether these mediated health outcomes at a final follow-up.

resultsResponse rates and reliability were good for student-reported but not staff-reported measures. The intervention increased student-reported but not staff-reported-positive school climate but, like effects on student health outcomes, these manifested only at a final follow-up. The intervention reduced student-reported contact with delinquent peers at an interim follow-up. Student-reported potential mediators measured at the interim follow-up were associated with most health outcomes at the final follow-up. Adjustment for student-reported school climate and contact with delinquent peers at the interim follow-up did not reduce the associations between trial arm and our health outcomes.

conclusionDespite being constrained by imperfect measures and by the late manifestation of impacts on student-reported school climate undermining ability to assess mediation, our study for the first time provides tentative evidence that mediation of intervention effects via improved climate and disengagement from delinquent peers is plausible. Our study provides the first evidence from a trial that whole-school interventions may work by modifying school environments and student relationships. TRIAL REGISTRATION NUMBER: ISRCTN10751359.

Indexed as

SchoolsSocial EnvironmentAdolescentBullyingChildCluster AnalysisEnglandFemaleHealth PromotionHumansMaleSelf ReportStudentsadolescentbehaviourenvironmentschoolstrial

Identifiers

PMID30723088
PMCPMC6581112

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.