A Cluster-randomized Control Trial of PAX Good Behavior Game in Swedish Elementary Schools

NCT05407623 | Recruiting

• 1 other identifier: 2020-03848
• Study Type: interventional
• Target: 2,184
• Locations: 1 country
• Sites: 1

Brief Summary

Two important challenges that primary school in Sweden is confronted by are increasing levels of mental illness among children and adolescents and increasing rates of stress related symptoms and sick leave associated with mental illness in primary school teachers. Primary school is an important arena to address these issues. PAX is implemented as a part of the regular classroom activities and gives the teacher tools to promote behaviors that are constructive and learning oriented. The programme has been shown to improve student health and performance both short- and long-term. The teachers also receive tools to lessen stressors in their working environment. A Swedish uncontrolled pilot study showed increased well-being in children and reduced teacher stress as well as improved work related well-being at post-intervention. The aim of this project is to study the effects of PAX on student well-being and teacher stress. In a cluster-randomized design, 84 teachers from 28 schools (clusters) will be randomized to either implement PAX, or to an active control group that receives the same amount of support but with different content. The PAX group will get a two-day education in PAX at the start of the term, followed by an implementation-term. The measurements include self-assessment, blind observer assessments, objectively measuring sound levels, data on sick leave and qualitative interviews. Baseline measurements are performed before implementation and primary end point is one year after. Costs and savings related to PAX will be measured and put in relation to the quality-adjusted life years of students and teachers. Long-term effects on student performance, health and participation in society will be evaluated in a follow-up project.

Conditions

Well-being in Elementary School Children; Mental Health in Elementary School Children; Work-related Stress in Teachers; Academic Performance in Elementary School Children

Keywords

Prevention; Pedagogy; Psychology; Leadership; Pedagogical leadership; Learning; Work-related stress; Mental health; Work environment; School-based research; Qualitative reserach; Quantitative research; Good classroom environment; Math skills

Outcome Measures

Primary Outcomes (4)

• [Pupil-focused] KIDSCREEN-10 extended with 3 items

  The 10-items questionnaire for assessing children and adolescents health and well-being KIDSCREEN-10 and 7 additional items from the full KIDSCREEN-52 (self-assessment versions). A selection of 13 of these items will be summarized and used as the primary outcome on pupil level. The scores of the extended scale range between 13 and 65 with a higher score indicating higher level of health and well-being.

  Up to 24 months. See Detailed Description section for the details of the measurement points.

• [Pupil-focused] KIDSCREEN-10 extended Teacher-rated

  N=13 items from KIDSCREEN-10 and KIDSCREEN-52 for assessing children and adolescents health and well-being (Parent versions completed by the teachers), corresponding to the 13 items rated by the pupils as the primary outcome measure. The items are selected based on relevance in the school context. The scores of the extended scale range between 13 and 65 with a higher score indicating higher level of health and well-being.

  Up to 24 months. See Detailed Description section for the details of the measurement points.

• [Teacher-focused] Teacher Stress Inventory (TSI) (an 8 items subscale).

  TSI is a self assessment instrument measuring work-related stress in teachers. The subscale Discipline and motivation (8 items in total) will be used as the primary outcome measure. The total score of the subscale ranges between 8 and 40 with higher scores indicating more severe work-related stress in teachers.

  Up to 24 months. See Detailed Description section for the details of the measurement points.

• [Classroom-focused] Frequency of on-task/off-task behaviors occurring in the classroom during an observation by a research assistant.

  Classroom-observations by a trained observer will be conducted during two or three lessons during the same or conceding days, for a minimum time of 20 minutes for each class according to a standardized observational schedule. Actual frequencies of on-task/off-task behaviors in the classroom, unrelated to the person performing the behavior, will be counted.

  Up to 24 months. See Detailed Description section for the details of the measurement points.

Secondary Outcomes (42)

• [Pupil-focused] Child Health Utilities - 9 dimensions (CHU9D)

  At baseline, then after 12 and 24 months. See Detailed Description section for the details of the measurement points.

• [Pupil-focused] KIDSCREEN-10

  At baseline, then after 6, 12 and 24 months. See Detailed Description section for the details of the measurement points.

• [Pupil-focused, administered by the teacher] Strengths and Difficulties Questionnaire (SDQ) [the 5-items dysregulation profile]

  Up to 24 months. See Detailed Description section for the details of the measurement points.

• [Pupil-focused, administered by the teacher] Strengths and Difficulties Questionnaire (SDQ) [the 15-items dysregulation profile]

  At baseline, then after 12 and 24 months. See Detailed Description section for the details of the measurement points.

• [Pupil-focused] School absence

  A total measure for comparison between the randomization groups 12 months after baseline, and for comparison to a matched control group 24 months after baseline.

Study Arms (2)

PAX Good Behavior Game

EXPERIMENTAL

PAX Good Behavior Game (GBG) is based on its precursor programme Good Behavior Game (GBG) that trains teachers to use principles of social learning in order to maximize the childrens' task-oriented and prosocial behaviors and minimize the occurrence of disruptive and off-task behaviors.

Behavioral: PAX Good Behavior Game

Active control (choice between on of two active interventions)

ACTIVE COMPARATOR

\[The project has two alternative control interventions for the schools to choose between, in order to increase their engagement in the control intervention. They are hence only provided with one of these interventions, not both.\] Count On Me! is an adaptive application teaching fluency in addition and subtraction facts (i.e., math facts), equality, compose and decompose numbers and a few more basic mathematical skills taught in the first grades of schooling. Collegial earning is based on five cyclical steps for professional learning for teachers.

Behavioral: Count on Me!; Behavioral: Collegial Learning Community

Interventions

PAX Good Behavior Game BEHAVIORAL

PAX GBG is packaged into ten specific tools that the teachers are trained to introduce in in their classroom management practice. The program introduces verbal and visual cues that facilitate prosocial and attentive behaviors One of the core elements of the program is the PAX-game, meaning that the children - while focusing on ordinary school tasks like math - get to play a game in teams where each team tries to make as few classroom rules infractions as possible during a certain period of time. The teams that succeed in achieving predetermined goals get a reward (often a fun and desirable activity) that serves as a reinforcer of prosocial and task-oriented behaviors. Supervision is performed individually with each teacher and included that the PAX-trainer observes a lecture given by the teacher before each supervision session.

PAX Good Behavior Game

Count on Me! BEHAVIORAL

Count on me! is set in adventure game where the child has an avatar that travels thru different worlds/platforms by using their mathematical skills. The child starts of in the home of the avatar, in a house like environment, where the child discovers a magical map that brings the child into a different world called Numberia. During the adventures in Numberia the child learns that it has certain skills, called the mathemagical powers, that will be used to liberate Numberia from the evil Prince Claw that has captured all the beautiful things (e.g., the birds that used to sing in the forest). Count on me! was developed within a behavior analytic framework using a nonlinear programming process.

Active control (choice between on of two active interventions)

Collegial Learning Community BEHAVIORAL

Collegial learning community is a feasible way of professional learning for teachers according to the five cyclical steps. The teachers go through the first step that is to assess the skill or knowledge gaps for students, using various data sources (for example testing, grades, surveys, student interviews). The second step is to reflect upon what skills the teacher needs to acquire in order to help the students to meet the goals. The third step is to deepen the professional knowledge and skills. The fourth step is engaging the students in the new practice, and in the fifth step to evaluate the impact the new practice has had on student outcomes. In Collegial learning community teachers take help from their peers in each of these steps in a structured way. For example, way of deepening tacit or procedural knowledge (in step two) is to visit a colleague during class and make observations on their classroom practice.

Active control (choice between on of two active interventions)

Eligibility Criteria

• Age: 6 Years - 10 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• The school uses the general study plan (i.e. the school is not only working with students with special needs)
• There is at least one teacher that is willing to participate, signs the study consent, and will be able to start the implementation in his/her class at the earliest in the second semester in the first grade or at the latest the first semester in the third grade.
• The principal has signed an agreement to participate in the project, to allow some time for measurements to be administrated, aid in delivering information to the parents, and that the school are responsible for implementing the methods within their regular operation (given that supervision is provided by the research team)

You may not qualify if:

• Another method that specifically aims to improve study and classroom environment is being implemented
• Another method that is expected to be time and energy consuming for teachers is being implemented during the same period
• ON TEACHER LEVEL:
• The teacher has signed the informed consent
• The teacher has expressed plans to terminate their employment during the upcoming two years
• A major change in the composition of the class is planned during the upcoming year.

Sponsors & Collaborators

• Linnaeus University: lead
• Stockholm University: collaborator
• Karolinska Institutet: collaborator
• Uppsala University: collaborator
• KTH Royal Institute of Technology: collaborator
• Vestigio (NGO): collaborator

Study Sites (1)

Several Schools in Sweden will be recruited, although as participants and not independent sites

Stockholm, Sweden

RECRUITING

MeSH Terms

Conditions

Occupational Stress; Psychological Well-Being

Condition Hierarchy (Ancestors)

Occupational Diseases; Stress, Psychological; Behavioral Symptoms; Behavior; Personal Satisfaction

Study Officials

• Viktor Kaldo, PhD

  Linnaeus University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Viktor Kaldo, PhD

CONTACT

0046707373859; viktor.kaldo@lnu.se

Ekaterina Ivanova, PhD

CONTACT

0046765807416; ekaterina.ivanova@ki.se

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: April 23, 2021
• First Posted: June 7, 2022
• Study Start: April 21, 2021
• Primary Completion (Estimated): June 15, 2026
• Study Completion (Estimated): June 15, 2027
• Last Updated: April 11, 2025

Record last verified: 2025-04

Locations

SE (1)