Feasibility and Acceptability of a School-Based Emotion Regulation Prevention Intervention (READY-Nepal) for Secondary School Students in Post-Earthquake Nepal
Abstract
:1. Introduction
2. Objective and Methods
2.1. Objective
2.2. Methods
2.2.1. Setting
2.2.2. Design
2.2.3. Quantitative Outcome Measures
2.2.4. Primary Outcome
2.2.5. Secondary Outcomes
2.3. Qualitative Measurement
2.4. Data Collection
2.5. Quantitative Analyses
2.6. Qualitative Analyses
3. Results
3.1. Description of Participants
3.2. Dropout & Session Attendance
3.3. Quantitative Clinical Outcomes
3.4. Qualitative Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Time | Topics Covered |
---|---|
Session One | Diary Card Program Orientation Group Guidelines Transactional Model of Stress Mindfulness * Defining mindfulness |
Session Two | Mindfulness * “What” skills “How” skills |
Session Three | Emotion Regulation * Awareness of emotions |
Session Four | Emotion Regulation * Changing emotions (crisis survival skills) |
Session Five | Emotion Regulation * Changing emotions (opposite action) |
Session Six | Interpersonal Effectiveness * Balancing priorities in relationships Relationship effectiveness |
Session Seven | Interpersonal Effectiveness * Objective effectiveness |
Session Eight | Program Recap & Review Closing |
(2) | (3) | (4) | (5) | (6) | (7) | (8) | |
(1) Emotion Regulation | 0.633 ** | 0.564 ** | 0.629 ** | 0.358 ** | 0.274 ** | 0.399 ** | 0.181 |
(2) Anxiety | -- | 0.624 ** | 0.660 ** | 0.332 ** | 0.384 ** | 0.273 ** | 0.109 |
(3) Post-Traumatic Stress | -- | -- | 0.593 | 0.254 ** | 0.273 ** | 0.326 ** | 0.182 |
(4) Functional Impairment | -- | -- | -- | 0.131 | 0.214 * | 0.297 ** | 0.250 * |
(5) Resilience | -- | -- | -- | -- | 0.479 ** | 0.333 ** | 0.186 |
(6) Functional Coping | -- | -- | -- | -- | -- | 0.493 ** | −0.172 |
(7) Dysfunctional Coping | -- | -- | -- | -- | -- | -- | 0.194 |
(8) Suicidal Ideation | -- | -- | -- | -- | -- | -- | -- |
Control (n = 60) | READY-Nepal (n = 42) | χ2, t | |
---|---|---|---|
Age, mean (SD) | 14.25 (1.40) | 14.38 (1.13) | −0.50 |
Female, n (%) | 28 (46.7) | 23 (54.8) | 0.65 |
Caste, n (%) | 13.48 ** | ||
Traditionally high-caste groups (Brahman, Chhetri) | 14 (23.3) | 3 (7.1) | |
Traditionally low-caste groups (Dalit) | 3 (5.0) | 1 (2.4) | |
Ethnic groups | 35 (58.3) | 38 (90.5) | |
Other | 8 (13.3) | 0 (0.0) | |
Clinical distress | |||
Emotion regulation, mean (SD) | 20.68 (7.60) | 19.69 (7.43) | 0.66 |
Anxiety, mean (SD) | 5.45 (3.11) | 5.05 (2.62) | 0.69 |
Post-traumatic stress, mean (SD) | 5.35 (3.15) | 5.21 (2.75) | 0.23 |
Functional impairment | 20.87 (5.28) | 18.52 (4.42) | 2.36 * |
Resilience | 10.02 (3.75) | 10.19 (4.15) | −0.22 |
Functional Coping | 23.50 (8.91) | 23.79 (8.30) | 2.32 |
Dysfunctional Coping | 3.54 (2.19) | 3.41 (1.80) | −0.50 |
Prior two weeks’ suicidal ideation, n (%) | 12 (20.0) | 7 (16.7) | 0.18 |
Pre-Intervention | Follow-Up | ||||||
---|---|---|---|---|---|---|---|
Measure | Control M (SD) | READY-Nepal M (SD) | Control M (SD) | READY-Nepal M (SD) | df | F | Partial η2 |
Emotion Regulation | 20.68 (7.60) | 19.69 (7.43) | 19.64 (6.32) | 19.44 (5.71) | |||
Time | 1, 92 | 2.08 | 0.022 | ||||
Time*Gender | 2, 92 | 0.22 | 0.002 | ||||
Time*Condition | 2, 92 | 0.78 | 0.008 | ||||
Anxiety | 5.45 (3.11) | 5.05 (2.62) | 5.52 (2.83) | 5.38 (2.83) | |||
Time | 1, 92 | 0.15 | 0.002 | ||||
Time*Gender | 2, 92 | 6.74 * | 0.068 | ||||
Time*Condition | 2, 92 | 0.59 | 0.006 | ||||
Trauma Distress | 5.35 (3.15) | 5.21 (2.75) | 4.95 (2.68) | 4.54 (2.27) | |||
Time | 1, 92 | 3.65 | 0.038 | ||||
Time*Gender | 2, 92 | 1.41 | 0.015 | ||||
Time*Condition | 2, 92 | 0.00 | 0.000 | ||||
Functional Impairment | 20.87 (5.28) | 18.52 (4.42) | 18.79 (5.17) | 18.05 (4.62) | |||
Time | 1, 92 | 8.67 ** | 0.086 | ||||
Time*Gender | 2, 92 | 1.54 | 0.017 | ||||
Time*Condition | 2, 92 | 3.00 | 0.032 | ||||
Resilience | 10.02 (3.75) | 10.19 (4.15) | 9.78 (4.43) | 9.82 (3.44) | |||
Time | 1, 92 | 0.95 | 0.010 | ||||
Time*Gender | 2, 92 | 0.25 | 0.003 | ||||
Time*Condition | 2, 92 | 0.09 | 0.001 | ||||
Functional Coping | 23.52 (8.65) | 23.55 (8.09) | 22.63 (7.85) | 23.49 (9.04) | |||
Time | 1, 92 | 0.49 | 0.005 | ||||
Time*Gender | 2, 92 | 0.08 | 0.001 | ||||
Time*Condition | 2, 92 | 0.13 | 0.001 | ||||
Dysfunctional Coping | 3.60 (2.14) | 3.45 (1.95) | 3.52 (2.12) | 3.25 (1.86) | |||
Time | 1, 92 | 0.26 | 0.003 | ||||
Time*Gender | 2, 92 | 0.62 | 0.007 | ||||
Time*Condition | 2, 92 | 0.13 | 0.001 |
Pre-Intervention (n) | Follow-Up (n) | Direction | |
---|---|---|---|
Control | 15 | 15 | - |
Female | 7 | 10 | ↑ |
Male | 8 | 5 | ↓ |
READY-Nepal | 13 | 10 | ↓ |
Female | 9 | 7 | ↓ |
Male | 4 | 3 | ↓ |
Theme | Subtheme | Illustrative Quotations (Female Students) | Illustrative Quotations (Male Students) | Endorsement |
---|---|---|---|---|
Student Feedback on READY-Nepal Intervention | ||||
Perceived Benefits (Intervention Group) | “These skills are useful whenever I am angry with friends, or whenever family members shout at you, or whenever you feel alone.” (Grade 7) “In a group [of girls] is better…it is fun being with friends and doing things with friends.” (Grade 7) | “I used to feel angry before the program. Now, only sometimes I feel angry. I felt angry in a school last time. I controlled my anger and played with friends. I didn’t focus on the thing that made me angry.” (Grade 9) “Separate group of boys and girls is good. I always feel shame in front of girls but not in front of boys.” (Grade 9) |
| |
Suggested Improvements (Intervention Group) | “I didn’t understand anything about sadness...The [facilitators] should explain in a clearer way so it is easy. And with more sessions.” (Grade 8) “Writing poems, narrating stories…or having some plays would be better.” (Grade 7) “Prizes.. would help me stay in the sessions.” (Grade 9) | “We should learn more about how to help others, how to respect elders, love youngers.” (Grade 9) “18–20 year olds would be better.. because they can understand better and can solve hard questions easily. (Grade 9) “Parents… should receive the program also.” (Grade 7) |
| |
Skills Use (Intervention Group) |
| “I was very angry. I did opposite actions but that didn’t calm me much. Then I thought of calming my sense organs and taking some cold water in a steel glass and stretching my body.” (Grade 7) “I don’t want to follow the shame part... because whenever we fight with friends or when we fall down while walking we feel shame and I don’t want to get into the situation that makes me feel shame.” (Grade 8) “Wise mind was the least helpful…It was difficult to understand.” (Grade 7) | “I remember the opposite actions for anger. Now I try to control my anger.” (Grade 9) |
|
Student Perceptions (Control Group) |
| “I just heard…that when we are angry we should go to an open space where nobody comes and sit there and we feel better… Whenever I feel angry, I go and stay in the open space in jungle for a while….By doing so, I don’t feel angry.” (Grade 9) | “My friends didn’t tell about… any activities they did.” (Grade 7) |
|
Teacher and Caregiver Feedback on READY-Nepal Intervention | ||||
Teacher Perceptions |
| “I’ve noticed that these days while doing some work they…interact very openly with each other.” | “From my perspective, honestly, I haven’t seen any changes. I feel it is the same at it used to be.” “School teachers… should get more administration about who [READY-Nepal program facilitators] are, what they do, what benefit adolescents get. I don’t know if administration told all of us this or not.” |
|
Caregiver Perceptions |
| “I’ve seen some changes in her and she’s also showing some interest in her studies within last 10–12 days… she was… talking about the singing bowl…to have a peaceful mind. So maybe this sound helped her to feel relieved.” (Biological Mother of Grade 7 Participant) “She said there was a program. But I don’t know about what the program is… She cooks food when I go to work, she cleans house, rooms, kitchen as before. I don’t know if she has stress in her mind.” (Biological Mother of Class 8 Participant) | “I haven’t seen [any changes]. He just said that program was to prevent worry and showed me the singing bell. I also didn’t ask much about the program as I was busy in my works.” (Grandparent of Class 8 Participant) |
|
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Ramaiya, M.K.; McLean, C.L.; Pokharel, M.; Thapa, K.; Schmidt, M.A.; Berg, M.; Simoni, J.M.; Rao, D.; Kohrt, B.A. Feasibility and Acceptability of a School-Based Emotion Regulation Prevention Intervention (READY-Nepal) for Secondary School Students in Post-Earthquake Nepal. Int. J. Environ. Res. Public Health 2022, 19, 14497. https://doi.org/10.3390/ijerph192114497
Ramaiya MK, McLean CL, Pokharel M, Thapa K, Schmidt MA, Berg M, Simoni JM, Rao D, Kohrt BA. Feasibility and Acceptability of a School-Based Emotion Regulation Prevention Intervention (READY-Nepal) for Secondary School Students in Post-Earthquake Nepal. International Journal of Environmental Research and Public Health. 2022; 19(21):14497. https://doi.org/10.3390/ijerph192114497
Chicago/Turabian StyleRamaiya, Megan K., Caitlin L. McLean, Manjila Pokharel, Kiran Thapa, M. Andi Schmidt, Martha Berg, Jane M. Simoni, Deepa Rao, and Brandon A. Kohrt. 2022. "Feasibility and Acceptability of a School-Based Emotion Regulation Prevention Intervention (READY-Nepal) for Secondary School Students in Post-Earthquake Nepal" International Journal of Environmental Research and Public Health 19, no. 21: 14497. https://doi.org/10.3390/ijerph192114497