Could an intervention on occupational stress reduce stress among secondary school teachers in Sinhala medium government schools in the District of Colombo?

Study setting – Type 1AB or 1C schools in the Colombo district. A cluster was defined as a Type 1AB or 1C school in the Colombo district where at least 40 secondary school teachers in grades 6 to 13 would be teaching. 10 secondary schools will receive the intervention while other 10 will remain as control. Secondary schools (clusters) will be selected to each arm by simple randomization. The draft design of the frequency and duration of intervention is as follows.

Intervention types - Cognitive-behavioural intervention & relaxation intervention activities targeted at the teachers and organizational intervention activities targeted at the school.

Intervention frequency and duration

(1) Cognitive-behavioural interventions - Includes eight 40 min sessions 2 weekly for 3 months, and monthly for 3 months.

(2) Relaxation interventions - One 80 min session Teachers will also be required to practice relaxation 15 to 20 minutes per day for 6 months and to maintain a mindful emotion diary for one week (They will note their emotions, time, duration, action taken).

(3) Organizational interventions - 6 months

Description of interventions

(1) Cognitive behavioral interventions – • Introducing stress, common causes, consequences, and symptoms of stress and how to identify stress with group activity • Adopting healthy lifestyles (reducing obesity, drinking and smoking) through nutrition advice and exercise • Problem solving skills • Commutation skills • Coping skills • Managing conflict • Time management • Negotiation • Assertiveness life style • Letting go of resentments • Making aware of support systems

(2) Relaxation interventions- • Deep muscle relaxation exercises • Breathing exercises • Cue controlled relaxation • Imagery

(3) Organizational modifications – Organizational modifications will be implemented through the support of the school principals. Advocacy meetings will be held with Principal/Deputy/Assistant Principals. A skill development session including below mentioned topics will be conducted to improve the relevant skills of Principal/Deputy/Assistant Principals and counselling teachers. Follow up meetings will be held to monitor the progress when the other sessions are conducted in each school.

• Redesigning the task Through defining their roles and responsibilities, promote taking on increased responsibilities through using appraisal, providing career development appraisal and involving workers in decision making

• Procedure for redesigning tasks
Defining their roles and responsibilities will be done according to their work load. (If the task (work load) of the teacher is high (>35/40 periods per week), the Principal/Sectional head will not give a class teacher/ other responsibility and redistribute the work among trainee teachers and other teachers at school, marking of the examination papers of the extra subjects they teach will be done with the help of another teacher)

• Promote responsibilities Promote taking on increased responsibilities through using appraisal, (Principal will compliment and appreciate teachers who take extra responsibilities. It will be included to the Agenda of the staff meetings)

• Establishing flexible work schedules Arranging free periods

• Redesigning the work environment Through policy modifications and work environment improvements, teachers and school principal using collaborative problem-solving approach for resolving stress-related issues in staff meetings, building a culture which encourages staff to be more supportive of each other and providing suitable conditions in which the employee can relax from the demands of the job which include facilities for leisure activities

• Establish coworker support group

Intervention for controlled groups Routine services provided by the Ministry of Health through preventive and curative services (Hospitals have psychiatric clinics and they can meet MOH (Medical Officer of Health) in the SMI (School Medical Inspection) if needed)

Research assistant / principal investigator (PI) will assess the psycosocial environment of the schools using a check list. Activities will be conducted by the PI and a research assistant.

Eligibility criteria for clusters

• Type 1AB or 1C school in the Colombo district where at least 40 secondary school teachers in grades 6 to 13 would be teaching

Eligibility criteria for secondary teachers

• Secondary school teachers employed by Types 1AB and 1C Sinhala medium government schools in Colombo district

• Secondary school teachers who will not transfer out for 6 months

• Secondary school teachers who do not plan on long leave within 6 months

Exclusion criteria for the secondary teachers

• Teachers diagnosed as having psychiatric disorders

• Teachers who score “high” OS (Occupational Stress) level in the TSI (Teacher Stress Inventory) (>2.88) and who are subsequently found to be having stress associated psychiatric disorders