Title: A multicentre cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of KiVa to reduce bullying in primary schools: The UK KiVa Trial
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Bullying is an extremely important public mental health risk. Over 25% of UK children report being bullied at least weekly and are more likely to experience depression and anxiety, do less well academically, and be at heightened risk of health-related problems in adolescence and adulthood including smoking, drinking, drug abuse, and self-harm compared to children who do not experience bullying. The Finnish KiVa school–based antibullying programme was highly effective in reducing several types of bullying including cyberbullying and was consequently widely implemented. We want to test whether KiVa reduces the number of bullied children, improves child mental health school attendance and enjoyment, and increases UK teacher confidence in dealing with bullying. Family- and school-level deprivation in the UK is associated with an increased risk of experiencing bullying and we also want to see whether KiVa works as well in disadvantaged schools, as indicated by the percentage of pupils eligible for free school meals, and particularly for children from disadvantaged backgrounds. This is something that has not been evaluated to date in Finnish studies where disparity is not as marked._x000D_ KiVa has dedicated 45-minute fortnightly lessons for pupils in years 3-6 (ages 7-11), posters, on-line games to play at home and/or school, whole school assemblies, parent information, designated trained staff to deal with confirmed bullying incidents and set procedures for use when bullying occurs. Class lessons teach an understanding of children’s own and others’ emotions and how to stand up against bullying and support victims._x000D_ We will also report the cost of introducing KiVa and explore whether any gains achieved represent value for money._x000D_ We plan to work with 116 primary schools in four areas in a thirty-three month study; i) North Wales and Cheshire, ii) the West Midlands, iii) South East and iv) South West England. Half of the schools will be randomly allocated to use the KiVa programme, the remaining 58 schools continue with usual practice and will not access the programme during that school year. This study will follow and link data from pupils in school years 3-5 (ages 7-10 year at baseline in May with the same children providing data the following May in years 4-6), an anticipated 12,828 children. Schools allocated to intervention will deliver KiVa as part of the personal social curriculum. We will measure the levels of bullying (perpetrator and victim), children’s mental wellbeing, attendance and academic attainment at baseline and again 12 months later. We will compare results for children in KiVa schools with those not in KiVa schools. We will also ask teachers how effective they consider themselves to be at dealing with bullying. _x000D_ Data from two UK pilot studies show intervention acceptability. Two advisory groups will meet 6 times during the life of the project. One group will comprise teachers, head teachers, and parents; and the other children from different primary schools. These groups will advise on all aspects of the research with particular focus on study information, recruitment, retention and the methods of dissemination of results._x000D_ Trial findings will be disseminated through policy briefings, in press-releases, social media updates, and via the creation of short audio-visual clips for schools and children and published in peer-reviewed academic journals and conference presentations.

Lay abstract: Aim: To evaluate the effectiveness & cost-effectiveness of KiVa school-based anti-bullying programme in reducing bullying & victimisation._x000D_ _x000D_ Design: A two-arm pragmatic multicentre, cluster-randomised controlled trial, with process evaluation, in 116 UK primary schools._x000D_ _x000D_ Main research question: Is KiVa effective and cost-effective in reducing bullying among 7-11-year olds in UK schools?_x000D_ _x000D_ Intervention: Intervention schools will implement KiVa over one academic year. KiVa, is a whole-school programme, that has a Key Stage 2 (KS2) lesson curriculum, high visibility break time supervision vests, posters & a parent’s guide. All school staff learn about KiVa and its aims. Indicated actions address confirmed bullying incidents. KiVa has yet to be rigorously evaluated in the UK; two small pilot trial in Wales yielded positive findings, however with considerable variation across schools._x000D_ _x000D_ Delivery: North Wales & Cheshire, the West Midlands, South East & South West England. KS2 teachers will deliver KiVa class lessons. A trained school based KiVa team will address confirmed bullying. Schools are trained by a local KiVa trainer co-ordinated through the Children’s Early Intervention Trust Charity the UK licensed disseminator._x000D_ _x000D_ Participants: 116 primary schools (12,828 pupils) across England and Wales_x000D_ _x000D_ Comparator: Usual Practice (UP)_x000D_ _x000D_ Outcomes and measures (baseline & 12 month follow-up)_x000D_ _x000D_ Primary outcome: Pupil self-reported bullying and victimisation using the Olweus Bully Victim Questionnaire._x000D_ _x000D_ Secondary outcomes: Pupil and teaching staff measures. Pupil level:_x000D_ _x000D_ Pupil mental health: Teacher Strengths & Difficulties Questionnaire (SDQ)_x000D_ Child roles in bullying_x000D_ Child Health Utility 9D (CHU-9D)_x000D_ School well-being (HIFAMS)_x000D_ School attendance_x000D_ Academic attainment_x000D_ _x000D_ Teaching staff level:_x000D_ Self-efficacy in dealing with bullying_x000D_ Warwick-Edinburgh Mental Well-being Scale_x000D_ Maslach Burnout Inventory-Educators Survey_x000D_ _x000D_ Analysis: Intention to treat based on individual pupils, allowing for clustering between pupils within school using robust standard errors. Between-group comparisons will be presented with two-sided 95% CIs. All analyses will control for school level stratification variables & pupil characteristics. ICCs will be reported with 95% CIs. Primary sub-group analyses will investigate intervention by pupil gender & Free School Meal status. Appropriate imputation methods will be applied via sensitivity analyses._x000D_ _x000D_ Economic evaluation: Bullying incidence, Child Health Utility 9D, Client Service Receipt Inventory, asking for frequency of additional services used by children (e.g. through the school’s Special Educational Needs Co-ordinator/ team) and consultations with school staff regarding bullying; Intervention costs (e.g. staff training, supervision & resources) including data from routine sources._x000D_ _x000D_ Process evaluation: An integral process evaluation will assess implementation fidelity; identify influences on KiVa implementation including how it interacts with school context; examine intervention mechanisms, including intervention receipt by pupils and parents; describe control schools’ UP in relation to preventing and dealing with bullying._x000D_ _x000D_ Impact: A universal intervention that reduces bullying is likely to improve children’s mental health and, via improved school connectedness and peer and teacher relationships, reduce the high costs associated with antisocial behaviour, child mental health and inequalities.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: GENERIC HEALTH RELEVANCE