Child resilience in Afghanistan study
| ISRCTN | ISRCTN83632872 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN83632872 |
| Secondary identifying numbers | CRAS01092021 |
- Submission date
- 22/11/2024
- Registration date
- 27/11/2024
- Last edited
- 27/11/2024
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Mental and Behavioural Disorders
Plain English summary of protocol
Background and study aims
Growing evidence indicates that school-based psychosocial interventions may help address the mental health gap in low- and middle-income countries, including conflict and crisis contexts. This study aims to compare a psychosocial intervention with usual teaching in Afghanistan. A two-arm cluster-randomised trial was implemented in 83 rural primary schools within three provinces of Afghanistan. This study will assess whether school-based interventions delivered by trained field education officers can effectively promote child mental health in conflict and crisis settings and have great potential for scalability.
Who can participate?
All children in grades 3 to 5, their teacher and one adult family member (mother or father, older sibling) at enrolment.
What does the study involve?
Schools were randomly assigned (1:1) to one of two groups: a psychosocial intervention group composed of whole classes with a one-week classroom-based teacher and children component and a one-day family engagement component; and, a control group. Children, teachers and parents were surveyed at baseline and four months postintervention.
What are the possible benefits and risks of participating?
There was the possible benefits to improve learning skills both academic and non academic (lifeskills) learning skills. There was no risk in participating in this research.
Where is the study run from?
Washington University in St. Louis, USA
When is the study starting and how long is it expected to run for?
August 2021 to December 2023
Who is funding the study?
1. Economic Social Research Council (ESRC)
2. Norwegian Development Agency
Who is the main contact?
Dr Jean-Francois Trani, jtrani@wustl.edu
Contact information
Public, Scientific, Principal Investigator
Brown School, Washington University, One Brookings drive
St Louis
63130
United States of America
 ORCID ID |
0000-0002-9187-0946 |
|---|---|
| Phone | +13149359277 |
| jtrani@wustl.edu |
Study information
| Study design | Two-arm cluster-randomized trial |
|---|---|
| Primary study design | Interventional |
| Secondary study design | Cluster randomised trial |
| Study setting(s) | School |
| Study type | Quality of life |
| Participant information sheet | Not available in web format please use contact details to request a participant information sheet |
| Scientific title | Classroom-based psychosocial randomised trial in primary schools of Afghanistan |
| Study acronym | CRAS |
| Study objectives | School based psycho-social intervention to improve child mental well-being and resilience in Afghanistan |
| Ethics approval(s) |
1. Approved 30/08/2021, Human Research Protection Office Washington University in St Louis (One Brookings drive, St Louis, 63130, United States of America; +1 314-747-6800; ehiggs@wustl.edu), ref: 201712020 2. Approved 17/09/2022, Norwegian Afghanistan Committee Board (Kolstadgata 1, Oslo, 0652, Norway; +47 994 09 159; t.watterdal@nacaf.org), ref: - |
| Health condition(s) or problem(s) studied | Anxiety and depression |
| Intervention | This study is a two-arm cluster-randomised trial implemented in 83 rural primary schools within three provinces of Afghanistan. Eligible participants were all children in grades 3 to 5, their teacher and one adult family member (mother or father, older sibling) at enrolment. All primary schools in each province were first enumerated, either governmental or community-based schools, receiving some support from the two NGOs and having at least one classroom of grades 3 through 5. Among 292 schools across these three provinces, a random number generator was used to select schools within each province (83 schools). To avoid the risk of contamination, sampling without replacement was used to ensure that only one school was selected per village. Schools within each province were randomly assigned in a 1:1 ratio to one of two groups (40 to the intervention group, and the remaining to the control group). Within each school, whole grades 3 through 5 classes were selected when the total number was below 20 children per class. In classes with more than 20 children, 20 children were randomly selected as participants. From a total cohort of 3254 children, 1522 children were enrolled in the intervention group and 1732 in the control group. Children, their teacher (one per class), and their parents formed this study’s participants. Schools were randomly assigned (1:1) to one of two groups, with the intervention group consisting of (1) a week-long classroom-based training with teachers and children together, and (2) a one-day training with parents using a culturally adapted version of the “A hopeful, healthy, and happy living and learning toolkit” developed by the International Federation of the Red Cross and Red Crescent Societies in response to the COVID-19 pandemic, and a control group. The final program for teachers and children was delivered in Dari and Pashto, composed of 42 activities consisting of a week of training including reflective exercises, didactic short lectures on lessons learned, drama, games, mindfulness, and breathing exercises. The parent component of the intervention was delivered in Dari and Pashto and consisted of one day spent on a series of activities aiming at promoting psycho-social well-being at home after cultural adaptation of the parent-caregiver toolkit by the same team. |
| Intervention type | Behavioural |
| Primary outcome measure | The following primary outcome measures were assessed at baseline and endline after 4 months: 1. Child anxiety and depression measured using the simplified revised child anxiety and depression scale 2. Life skills core domains measured using the multidimensional scale of life skills in late childhood 3. Self-efficacy measured using the self-efficacy questionnaire for children 4. Resilience measured using the child and youth resilience measure 5. School-based discrimination measured using the discrimination scale developed for the Maryland adolescent development in context study 6. Stigma measured using the discrimination and stigma scale |
| Secondary outcome measures | Proficiency in reading and mathematical literacy measured using the Monitoring Education Development in Afghanistan (MED-A) framework developed by the Australian Council for Educational Research (ACER 2013) that includes comprehensive and context-appropriate definitions of “literacy score” to evaluate reading and writing in Dari/Pashto, as well as mathematics at baseline and endline after 4 months |
| Overall study start date | 30/08/2021 |
| Completion date | 30/12/2023 |
Eligibility
| Participant type(s) | Learner/student |
|---|---|
| Age group | Child |
| Lower age limit | 8 Years |
| Upper age limit | 14 Years |
| Sex | Both |
| Target number of participants | 20% of students of grades 3 and 5 in each of the 83 randomly selected schools |
| Total final enrolment | 2592 |
| Key inclusion criteria | Enrolled in grade 3 or 5 in participating schools |
| Key exclusion criteria | Children in 1, 2, 4 or 6 grade |
| Date of first enrolment | 01/05/2022 |
| Date of final enrolment | 30/03/2023 |
Locations
Countries of recruitment
- Afghanistan
- France
Study participating centres
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Afghanistan
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Afghanistan
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Afghanistan
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Afghanistan
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Afghanistan
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Afghanistan
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Afghanistan
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Afghanistan
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Afghanistan
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Afghanistan
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Afghanistan
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France
Sponsor information
University/education
One Brookings Drive
St Louis
63130
United States of America
| Phone | +1314-935-6600 |
|---|---|
| brownschool@wustl.edu | |
| Website | https://brownschool.washu.edu/contact-us/ |
"ROR" |
https://ror.org/01yc7t268 |
Funders
Funder type
Research council
Government organisation / National government
- Alternative name(s)
- ESRC
- Location
- United Kingdom
No information available
Results and Publications
| Intention to publish date | 31/03/2025 |
|---|---|
| Individual participant data (IPD) Intention to share | Yes |
| IPD sharing plan summary | Stored in publicly available repository |
| Publication and dissemination plan | Planned publication in peer-reviewed journals. Two papers are planned, one looking at the effect of the intervention on main outcomes and one looking at factors influencing child wellbeing from a system dynamics perspective |
| IPD sharing plan | The datasets generated and analysed during the current study will be stored in a public available repository at the UK Data Service: http://reshare.ukdataservice.ac.uk/ • The type of data stored: .csv data • Timing for availability: end of 2024 • Whether consent from participants was required and obtained: All participants provided written (or witnessed, if they were unable to read and write) informed consent. • Comments on data anonymization: The data is stored encrypted in the database without any name or other possibility of individual identification. The database is protected by a password. All unique identifiers have been be deleted once the database is complete. The database is totally anonymous. The only copies of the database is stored on the encrypted cloud of the Brown School at Washington University in St Louis • Any ethical or legal restrictions: none • Any additional comments: none |
Editorial Notes
22/11/2024: Study's existence confirmed by the Washington University in St. Louis Institutional Review Board.
