ArticlePDF AvailableLiterature Review

Organisational interventions for improving wellbeing and reducing work-related stress in teachers

April 2015
Cochrane Database of Systematic Reviews 4(4):CD010306

DOI:10.1002/14651858.CD010306.pub2

Source
PubMed

Authors:

Paul Montgomery

University of Birmingham

Christopher Bonell

London School of Hygiene and Tropical Medicine

Marc Thompson

University of Oxford

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Background: The teaching profession is an occupation with a high prevalence of work-related stress. This may lead to sustained physical and mental health problems in teachers. It can also negatively affect the health, wellbeing and educational attainment of children, and impose a financial burden on the public budget in terms of teacher turnover and sickness absence. Most evaluated interventions for the wellbeing of teachers are directed at the individual level, and so do not tackle the causes of stress in the workplace. Organisational-level interventions are a potential avenue in this regard. Objectives: To evaluate the effectiveness of organisational interventions for improving wellbeing and reducing work-related stress in teachers. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, ASSIA, AEI, BEI, BiblioMap, DARE, DER, ERIC, IBSS, SSCI, Sociological Abstracts, a number of specialist occupational health databases, and a number of trial registers and grey literature sources from the inception of each database until January 2015. Selection criteria: Randomised controlled trials (RCTs), cluster-RCTs, and controlled before-and-after studies of organisational-level interventions for the wellbeing of teachers. Data collection and analysis: We used standard methodological procedures expected by Cochrane. Main results: Four studies met the inclusion criteria. They were three cluster-randomised controlled trials and one with a stepped-wedge design.Changing task characteristicsOne study with 961 teachers in eight schools compared a task-based organisational change intervention along with stress management training to no intervention. It found a small reduction at 12 months in 10 out of 14 of the subscales in the Occupational Stress Inventory, with a mean difference (MD) varying from -3.84 to 0.13, and a small increase in the Work Ability Index (MD 2.27; 95% confidence interval (CI) 1.64 to 2.90; 708 participants, low-quality evidence).Changing organisational characteristicsTwo studies compared teacher training combined with school-wide coaching support to no intervention. One study with 59 teachers in 43 schools found no significant effects on job-related anxiety (MD -0.25 95% CI -0.61 to 0.11, very low-quality evidence) or depression (MD -0.26 95% CI -0.57 to 0.05, very low-quality evidence) after 24 months. The other study with 77 teachers in 18 schools found no significant effects on the Maslach Burnout Inventory subscales (e.g. emotional exhaustion subscale: MD -0.05 95% CI -0.52 to 0.42, low-quality evidence) or the Teacher Perceived Emotional Ability subscales (e.g. regulating emotions subscale: MD 0.11 95% CI -0.11 to 0.33, low-quality evidence) after six months.Multi-component interventionOne study with 1102 teachers in 34 schools compared a multi-component intervention containing performance bonus, job promotion opportunities and mentoring support to a matched-comparison group consisting of 300 schools. It found moderately higher teacher retention rates (MD 11.50 95% CI 3.25 to 19.75 at 36 months follow-up, very low-quality evidence). However, the authors reported results only from one cohort out of four (eight schools), demonstrating a high risk of reporting bias. Authors' conclusions: We found low-quality evidence that organisational interventions lead to improvements in teacher wellbeing and retention rates. We need further evaluation of the effects of organisational interventions for teacher wellbeing. These studies should follow a complex-interventions framework, use a cluster-randomised design and have large sample sizes.

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Cochrane Database of Systematic Reviews

Organisational interventions for improving wellbeing and

reducing work-related stress in teachers (Review)

Naghieh A, Montgomery P, Bonell CP, Thompson M, Aber JL

Naghieh A, Montgomery P, Bonell CP, Thompson M, Aber JL.

Organisational interventions for improving wellbeing and reducing work-related stress in teachers.

Cochrane Database of Syst ematic Reviews 2015, Issue 4. Art. No.: CD010306.

DOI: 10.1002/14651858.CD010306.pub2.

www.cochranelibrary.com

Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

T A B L E O F C O N T E N T S

1HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . . . . . . . . . . . . . . . . . . .

7BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Figure 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

19ADDITIONAL SUMMARY OF FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . .

25DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

26AUTHORS’ CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

27ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

27REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

39DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Analysis 1.1. Comparison 1 Changing task characteristics versus no intervention, Outcome 1 Occupational Stress

Inventory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Analysis 1.2. Comparison 1 Changing task characteristics versus no intervention, Outcome 2 Work Ability Index. . 41

Analysis 2.1. Comparison 2 Changing organisational characteristics versus no intervention, Outcome 1 Job Related

Anxiety- 12 months. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Analysis 2.2. Comparison 2 Changing organisational characteristics versus no intervention, Outcome 2 Job Related

Anxiety- 24 months. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Analysis 2.3. Comparison 2 Changing organisational characteristics versus no intervention, Outcome 3 Job Related

Depression- 12 months. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Analysis 2.4. Comparison 2 Changing organisational characteristics versus no intervention, Outcome 4 Job Related

Depression- 24 months. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Analysis 2.5. Comparison 2 Changing organisational characteristics versus no intervention, Outcome 5 Maslach Burnout

Inventory- Educators Survey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Analysis 2.6. Comparison 2 Changing organisational characteristics versus no intervention, Outcome 6 Emotional

Ability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Analysis 3.1. Comparison 3 Multi-component intervention versus no intervention(matched comparison), Outcome 1

Retention rates, Cohort 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

46APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

69CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70DIFFERENCES BETWEEN PROTOCOL AND REVIEW . . . . . . . . . . . . . . . . . . . . .

70INDEX TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

iOrganisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

[Intervention Review]

Organisational interventions for improving wellbeing and

reducing work-related stress in teachers

Ali Naghieh1, Paul Montgomery1, Christopher P Bonell2, Marc Thompson3, J Lawrence Aber4

1Centre for Evidence-Based Intervention, Social Policy & Intervention, University of Oxford, Oxford, UK. 2Social Science Research

Unit, Instituteof Education, University of London, London, UK. 3Said Business School, University of Oxford, Oxford, UK. 4Steinhardt

School of Culture, Education & Human Development, New York University, New York, USA

Contact address: Ali Naghieh, Centre for Evidence-Based Intervention, Social Policy & Intervention, University of Oxford, Barnett

House 32 Wellington Square, Oxford, Oxfordshire, OX1 2ER, UK. ali.naghieh@spi.ox.ac.uk.

Editorial group: Cochrane Work Group.

Publication status and date: New, published in Issue 4, 2015.

Citation: Naghieh A, Montgomery P, Bonell CP, Thompson M, Aber JL. Organisational interventions for improving wellbeing

and reducing work-related stress in teachers. Cochrane Database of Systematic Reviews 2015, Issue 4. Art. No.: CD010306. DOI:

10.1002/14651858.CD010306.pub2.

A B S T R A C T

Background

The teaching profession is an occupation with a high prevalence of work-related stress. This may lead to sustained physical and mental

health problems in teachers. It can also negatively affect the health, wellbeing and educational attainment of children, and impose

a ﬁnancial burden on the public budget in terms of teacher turnover and sickness absence. Most evaluated interventions for the

wellbeing of teachers are directed at the individual level, and so do not tackle the causes of stress in the workplace. Organisational-level

interventions are a potential avenue in this regard.

Objectives

To evaluate the effectiveness of organisational interventions for improving wellbeing and reducing work-related stress in teachers.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, ASSIA, AEI, BEI,

BiblioMap, DARE, DER, ERIC, IBSS, SSCI, Sociological Abstracts, a number of specialist occupational health databases, and a

number of trial registers and grey literature sources from the inception of each database until January 2015.

Selection criteria

Randomised controlled trials (RCTs), cluster-RCTs, and controlled before-and-after studies of organisational-level interventions for

the wellbeing of teachers.

Data collection and analysis

We used standard methodological procedures expected by Cochrane.

Main results

Four studies met the inclusion criteria. They were three cluster-randomised controlled trials and one with a stepped-wedge design.

Changing task characteristics

1Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

One study with 961 teachers in eight schools compared a task-based organisational change intervention along with stress management

training to no intervention. It found a small reduction at 12 months in 10 out of 14 of the subscales in the Occupational Stress

Inventory, with a mean difference (MD) varying from -3.84 to 0.13, and a small increase in the Work Ability Index (MD 2.27; 95%

conﬁdence interval (CI) 1.64 to 2.90; 708 participants, low-quality evidence).

Changing organisational characteristics

Two studies compared teacher training combined with school-wide coaching support to no intervention. One study with 59 teachers

in 43 schools found no signiﬁcant effects on job-related anxiety (MD -0.25 95% CI -0.61 to 0.11, very low-quality evidence) or

depression (MD -0.26 95% CI -0.57 to 0.05, very low-quality evidence) after 24 months. The other study with 77 teachers in 18

schools found no signiﬁcant effects on the Maslach Burnout Inventory subscales (e.g. emotional exhaustion subscale: MD -0.05 95%

CI -0.52 to 0.42, low-quality evidence) or the Teacher Perceived Emotional Ability subscales (e.g. regulating emotions subscale: MD

0.11 95% CI -0.11 to 0.33, low-quality evidence) after six months.

Multi-component intervention

One study with 1102 teachers in 34 schools compared a multi-component intervention containing performance bonus, job promotion

opportunities and mentoring support to a matched-comparison group consisting of 300 schools. It found moderately higher teacher

retention rates (MD 11.50 95% CI 3.25 to 19.75 at 36 months follow-up, very low-quality evidence). However, the authors reported

results only from one cohort out of four (eight schools), demonstrating a high risk of reporting bias.

Authors’ conclusions

We found low-quality evidence that organisational interventions lead to improvements in teacher wellbeing and retention rates. We

need further evaluation of the effects of organisational interventions for teacher wellbeing. These studies should follow a complex-

interventions framework, use a cluster-randomised design and have large sample sizes.

P L A I N L A N G U A G E S U M M A R Y

Work changes to prevent and decrease stress in teachers

Background

Teachers often experience stress at work, which can lead to physical and mental health problems, increased sickness absence, teacher

resignations, and decline in children’s performance and health. Individual stress management and counselling programmes directed at

teachers only target stress symptoms, while interventions directed at the school organisation target the causes of stress. We searched for

studies until January 2015 to assess the evidence on work changes to improve wellbeing and reduce work-related stress in teachers.

Study Characteristics

We found four studies that included a total of 2199 teachers. They evaluated three types of work changes. One intervention consisted

of changes in teachers’ tasks such as redesigning work, establishing ﬂexible work schedules and redesigning the work environment.

Another intervention consisted of a school-wide coaching support network alongside individual training for teachers, in order to deliver

a child development programme. The third intervention consisted of several components: performance bonus pay, job promotion

opportunities and mentoring.

Results

Changes in tasks of teachers

In one study with 961 teachers in eight schools, changes in tasks of teachers combined with stress management training resulted in

a small reduction in work stress levels after one year follow-up compared to no intervention. There was also a small increase in work

ability, meaning how well a worker is able to perform his or her work. However, the authors did not report how they changed teachers’

tasks, limiting the results’ usefulness elsewhere.

Changing organisational features

There were two studies of school-wide coaching support combined with teacher training. In one study with 43 schools and 59

participating teachers, there was no considerable effect on anxiety or depression after two years follow-up compared to no intervention.

2Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

In the other study with 18 schools and 77 participating teachers, there was no considerable effect on burnout or emotional ability after

six months follow-up compared to no intervention. Burnout is a state of prolonged severe stress. Emotional ability means understanding

other people’s emotions, and understanding and controlling ones own emotions. Both studies had a small number of participants.

Multicomponent programme

In one study with 34 schools and 1102 teachers, the intervention included performance bonus pay, job promotion opportunities and

mentoring. After three years follow-up and compared to 300 similar schools, there was a moderate reduction in resignation of teachers

in the intervention schools. However, authors reported results only for eight schools.

Quality of the evidence

The quality of the evidence was low for all interventions because the authors did not report all the results and lost many participants

for follow-up. All included studies also had interventions directed at individual teachers combined with changes at schools. Therefore,

new and better quality studies directed at schools will probably change the conclusions of this review.

Conclusion

Changing the way teachers’ work is organised at schools may improve the teachers’ wellbeing and may reduce teacher resignations. We

need better-designed research in the development and testing of work changes in schools. In future studies, whether work at schools is

changed or not should be determined according to chance. These studies should also have several hundred participants.

3Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

S U M M A R Y O F F I N D I N G S F O R T H E M A I N C O M P A R I S O N [Explanation]

Changing task characterist ics versus no int ervention for improving we ll being and re ducing work - related st ress in teachers

Population: Teach er s

Set tings: Scho ols

Intervention: Tas k-based org anisat ional chang e int erventi on al ong w ith st res s m anagem ent t rai nin g vers us no i nterventio n

Outcomes Illustra tive compa rative risk s* (9 5% CI) Relati ve ef fect

(9 5% CI )

No of Part icipants

(studi es)

Quality of the evidence

(GRADE)

Comments

Assumed risk Corre sponding risk

No intervention Task- based organisa-

tional change interven-

tion along with stress

manage ment t raining

Occupational Stress

Inve ntory - Role Over-

load

The mean occu pat ional

st res s invent o ry - role

overlo ad in the c ont rol

groups was

27 . 2 7

The mean occ upat ion al

st res s invent o ry - role

ov erlo ad i n the i nt erve n-

ti on group s w as

0. 9 4 lower

(1 .61 t o 0.2 7 low er)

70 8

(1 s t udy)

⊕⊕

low1,2

Occupational Stress

Inve ntory - Role Ambi-

guity

The mean occu pat ional

st res s invent o ry - role

am bigui t y in the c ont rol

groups was

16 . 7 8

The mean occ upat ion al

st res s invent o ry - role

am b igu ity in the int er-

ven t ion g rou ps was

0. 2 3 lower

(0 .84 l ower t o 0 .38

higher)

70 8

(1 s t udy)

⊕⊕

low1,2

Occupational Stress

Inve ntory - Responsi-

bility

The mean occu pat ional

st res s in vent o ry - re-

sp ons ibil ity in the con -

tr ol gr oup s w as

20 . 7 1

The mean occ upat ion al

st res s invento ry - re-

sp ons ibil ity in the int er-

ven t ion g rou ps was

1. 1 9 lower

70 8

(1 s t udy)

⊕⊕

low1,2

4Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

(1 .91 t o 0.4 7 low er)

Occupational Stress

Inve ntory - Vocational

Strain

The mean occu pat ional

st res s inventor y - voca-

ti ona l s t rain in t he co n-

tr ol gr oup s w as

17 . 0 0

The mean occ upat ion al

st res s inventor y - voca-

ti ona l s t ra in in t he in ter-

ven t ion g rou ps was

0. 7 8 lower

(1 .42 t o 0.1 4 low er)

70 8

(1 s t udy)

⊕⊕

low1,2

Occupational Stress

Inve ntory - Int erper-

sonal Strain

The mean occu pat ional

st res s i nvent ory - int er-

pers ona l strain in th e

co ntrol gro ups w a s

23 . 3 7

The mean occ upat ion al

st res s i nvent ory - int er-

pers onal strain i n the i n-

terven tio n g roups was

0. 7 8 lower

(1 .33 t o 0.2 3 low er)

70 8

(1 s t udy)

⊕⊕

low1,2

Occupational Stress

Inve ntory - Social Sup-

port

The mean occu pat ional

st res s i nven to ry - s oci al

su ppo rt in the c o ntr ol

groups was

37 . 3 2

The mean occ upat ion al

st res s i nven to ry - s oci al

su ppo rt in the i nterven -

ti on group s w as

0. 5 0 lower

(1 .49 l ower t o 0 .49

higher)

70 8

(1 s t udy)

⊕⊕

low1,2

Work Ability Index

Sca le f rom : 7 to 49.

The mean work abil-

it y ind ex in th e c ont rol

groups was

36 . 9 8

The mean work a bil ity

in dex in the i nterv entio n

groups was

2. 2 7 highe r

(1 .64 t o 2.9 0 hig her)

70 8

(1 s t udy)

⊕⊕

low1,2

* Th e ba sis fo r t he assumed risk (e.g. th e m edi an cont rol gro up ris k across stud ies ) i s pro vi ded in f ootn otes. The corresponding risk (and its 9 5% con f idence int erval) i s

based on the assu m ed risk in t he co m par iso n g ro up and t he rel ative eff ect o f t he in ter vent io n ( and it s 95 % CI).

CI: Co nfidenc e int erval ;

5Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

GRADE Workin g Group grades of evid en ce

High quality: Fu rth er researc h is very unl ikely to c hange o ur con f idence in the est i m ate of eff ect .

Moderate quality: Furt her researc h is likel y to ha ve an impo rtant im pac t on our c onf idenc e in the est im ate of ef f ect and m ay chan ge the es t im ate.

Low quality: Fu rt h er resear ch is very li kely to have an important impa ct o n our c o nfid enc e in t he es t imat e o f ef f ect and is likely t o cha nge t he es t im ate.

Very low quality: We are very u ncert ain abo ut t he estim ate.

1The st udy has attritio n bias and rep ort ing b ias . It di d not acc oun t f or cl ust eri ng in t he analys is, wh ich w as cor rected b y review

autho rs . The stud y do es not m ent ion a t tri t ion i n the dat a and t here is no mentio n of i ntent i on-t o-tr ea t ana lysis

2Interv en tion p ackage i ncludes i ndi vi dua l-level int er venti on

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

6Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

B A C K G R O U N D

This review evaluated studies that report on the effectiveness of

organisational interventions aimed at improving wellbeing and

reducing work-related stress, or both, in school teachers.

Wellbeing at work and work-related stress are important policy

challenges in current times. Teacher occupational wellbeing is de-

ﬁned as a positive emotional state resulting from harmony between

the sum of speciﬁc environmental factors onthe one hand, and per-

sonal needs and expectations of teachers on the other (Aelterman

2007). Wellbeing at work is often measured by an individual’s

job satisfaction, feelings of self efﬁcacy, work stress or burnout

(Bricheno 2009), as well as organisational indicators such as sick-

ness absence and staff turnover. Work stress can refer to stressors,

as well as the stress response. Stressors are the conditions at work

that generate stress, while the stress response refers to how people

feel, think and behave in response to the stressors. The Fourth

European Working Conditions survey (EuroFound 2007) found

that 20% of workers from the EU15 and 30% from the 10 new

member states believed that their health was at risk due to work-

related stress. Health and Safety Executive statistics show that for

2006/07, stress, depression, or anxiety accounted for 46% of days

lost due to work-related illness and constitute the single largest

cause of all absences attributable to work-related illness (Cooper

2008). It is estimated that each year one in six workers in England

and Wales is affected by anxiety, depression and unmanageable

stress (Mind 2011).

The psychosocial work environment is an established and promi-

nent social determinant of health and health inequalities (Benach

2007;Black 2008). Siegrist 2004 deﬁnes psychosocial environ-

ment as the “socio-structural range of opportunities that is avail-

able to an individual person to meet his or her needs of wellbeing,

productivity and positive self-experience” (p. 1465). Concentrat-

ing on the two main organisational stress models, they argue that

exposure to an adverse psychosocial environment, deﬁned in terms

of job tasks by high demands and low control (demand-control-

support model, (Karasek 1990)) and by effort-reward imbalance

(Siegrist 1996) or both, elicits sustained stress reactions with neg-

ative long-term consequences for health. In an analysis based on

the Whitehall II Study, North 1996 found that the psychosocial

work environment predicts rates of sickness absence, and argued

that increased levels of control and support at work could have

beneﬁcial effects in terms of improving the health and wellbeing

of employees, increasing productivity, and reducing the costs of

sickness absence. A substantial body of evidence links adverse psy-

chosocial work environments with an increase in the incidence of

cardiovascular disease (Belkic 2004;Chandola 2008;Hemingway

1999;Karasek 1990;Kivimäki 2002;Kuper 2003;Schnall 1994).

Psychosocialwork stressors such as job strain, low decision latitude,

low social support, high psychological demands, effort-reward im-

balance, and high job insecurity have all been implicated as causes

of work stress-related anxiety and depressive illnesses (Stansfeld

2006). In an umbrella review of existing systematic reviews on

managing stress at work, Bhui 2012 asserts that psychosocial work

stressors can only be tackled by organisational and systemic strate-

gies and policies.

Psychosocial risks at the workplace are a major policy concern and

have resulted in the formation of a large European Union con-

sortium to develop the European framework for psychosocial risk

management (PRIMA-EF). Work-related psychosocial risks refer

to aspects of the design and management of work and its social and

organisational contexts that have the potential for causing psycho-

logical or physical harm (Leka 2003). The PRIMA-EF and the

related regulatory framework provide guidance for psychosocial

risk management in the workplace, to be utilised by stakeholders

within policy and practice (WHO 2008).

Description of the condition

Kyriacou 2011 deﬁnes ’teacher stress’ as the experience by teachers

of unpleasant negative emotions, resulting from aspects of their

work as a teacher that are triggered by a perception of threat in

dealing with the demands made upon them. This trigger of threat

involves three elements: having to deal with the demand, the fear

of being unable to deal with the demand satisfactorily, and the fear

that not dealing with the demand satisfactorily may have negative

consequences. Another concept used in the literature with close

links and overlaps is ’teacher burnout’, which refers to a state of

emotional, attitudinal and physical exhaustion that follows from

a prolonged exposure to chronic stress (Vandenberghe 1999).

Schwab 1986 provide a vivid description of the dimensions of

teacher burnout:

“The ﬁrst sign of burnout is a feeling of being emotionally exhausted

from one’s work...emotionally exhausted teachers might say they

feel drained or used-up, that they are at the end of their rope

and are physically fatigued...they cope by depersonalizing their co-

workers and students by putting distance between themselves and

others. They develop a ”detached concern“, become cynical, and

feel calloused toward others in the organization. A third aspect

of burnout is a feeling of low personal accomplishment. Many in-

dividuals began their careers with great expectations of making a

contribution to their employer and to society. After a year or two

on the job, they begin to realize they are not living up to these

expectations... these employees may not recognize the role of the

organization in producing their frustration. Instead, they may feel

personally responsible and begin to think of themselves as f ailures”

(pp. 14 - 15).

A report for the Health & Safety Executive (Smith 2000) com-

pared stress levels in different occupations in the year 2000. Fig-

ures for teachers were more than double the average at 42%. Sim-

ilarly, the three-year estimate (2008 to 2011) of the Self-reported

Work-related Illness questionnaire module in the national Labour

Force Survey in the UK demonstrates more than double the mean

7Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

rates of self-reported stress, depression and anxiety for the teaching

profession (HSE 2012).

The majority of the evidence for identifying the main work stres-

sors facing teachers point to speciﬁc factors: heavy workload, re-

lationships with colleagues and management, poor working envi-

ronment, pupil behaviour, long working hours, providing cover

for teacher shortages and absences, pressure of school targets

and inspections, coping with change and administrative duties

(Benmansour 1998;Lambert 2006;NUT 2011;Travers 1996).

There is an extensive body of observational research worldwide

documenting symptoms and consequences of teacher stress, in-

cluding studies in the UK (Dunham 1992;Rothi 2010), Australia

(Goddard 2006), Greece (Lazuras2006), Norway (Skaalvik 2009),

Switzerland (Huberman 1993), Qatar (Al-Mohannadi 2007) and

China (Chan 1995;Yang 2011). Kyriacou 2011 categorises symp-

toms of teacher stress in the three broad areas of mental (e.g. de-

pression, loss of self conﬁdence), physical (e.g. back aches, indi-

gestion) and behavioural (e.g. loss of temper, sleeplessness) char-

acteristics. Teacher stress and burnout thus leads to adverse con-

sequences for the physical and psychological health of the teacher,

as well as to a negative impact on learning, behaviour, educational

performance and thus the future prospects of pupils. It can also

have adverse effects on school climate and organisational goals and

targets and direct ﬁnancial burdens to the public budget due to a

high prevalence of sickness absence and teacher turnover.

Description of the intervention

Organisational interventions alter the psychosocial work environ-

ment by changing some aspect of the organisation, such as struc-

tures, policies, processes, culture, climate, programmes, roles or

tasks. They aim to improve the health and wellbeing of individu-

als, as well as inﬂuencing organisational outcomes such as sickness

absence and staff turnover.

Murphy 1988 categorises interventions to reduce organisational

stress as primary (e.g. structural or organisational interventions),

secondary (e.g. stress management), and tertiary (e.g. employee as-

sistance programmes; workplace counselling). Lamontagne 2007

refers to primary interventions as preventive and proactive, sec-

ondary interventions as ameliorative, and tertiary interventions as

reactive. Primary interventions, which are the focus of this review,

aim to adapt the environment to ﬁt individual staff members,

while secondary and tertiary interventions are directed at individ-

ual-level changes in behaviours, attitudes, and practices. At the

individual level, stress management and counselling interventions

emphasise training in coping strategies in an effort to alter either

the physiological, emotional, or behavioural responses to potential

stressors, or all of them. At the organisational level, emphasis is

placed on changing those aspects of the teacher’s work environ-

ment that are potential sources of stress (Cecil 1990).

Organisational interventions are, by nature, organisational change

interventions. The two main approaches to organisational change

are planned change and emergent change (Bamford 2003;Burnes

1996). The planned change approach views organisational change

as a process that moves from one ﬁxed state to another through

a series of pre-planned steps. Planned change is concerned with

the planning and implementation of change interventions in or-

ganisations, with a prescribed sequence and plan of action, affect-

ing the whole organisation or a department within an organisa-

tion. Within the planned change approaches, organisational de-

velopment has emerged as the dominant approach to organisa-

tional change across the Western world, and is increasing glob-

ally (Boje 2011). Organisational development aims to build the

capacity of individuals and groups, empowering them to engage

with organisational problems. It is based on the methodology of

action research and the imperative to diagnose the needs of the or-

ganisation clearly before making an intervention (Grieves 2010).

The emergent change approach views change as more of a con-

tinuous process, whereby organisations seek to align and re-align

themselves to an unpredictable, many-faceted and rapidly chang-

ing environment (Burnes 1996). Within this approach, organisa-

tional change is viewed as less dependent on detailed plans and

projections than on reaching an actual understanding of the com-

plexity of the issues involved and identifying the range of possi-

ble options (Dawson 1994). Emergent change thus focuses more

on continuous development and organisational learning, in con-

trast to providing clear and time-bounded intervention strategies.

Due to the nature of organisational interventions as designed and

planned change projects with speciﬁc objectives such as enhancing

employee wellbeing, models within the planned change approach

appear to be most applicable to such interventions. However, some

of the tenets of the emergent change approach might prove value-

adding in the diagnostic stages of intervention design, as well as

in the endeavour of sustaining effective interventions.

The scope of organisational interventions to improve wellbeing

and reduce work-related stress in teachers can be described within

the three categories of organisational-level interventions proposed

by Newman 1979, as changing:

1. Organisational characteristics/conditions (e.g. school-level

policy and governance; communication; school climate, culture,

or ethos);

2. Role characteristics/conditions (e.g. senior management

practice and culture; teacher autonomy and empowerment; role

conﬂicts);

3. Task characteristics/conditions (e.g. workload; work

environment).

Organisational interventions may be mediated by factors such as

organisational structure, organisational culture, physical environ-

ment, legal and regulatory conﬁnes, job insecurity, role of power,

control, and resistance to change from stakeholders, role of the

change agent, and institutional legitimacy of the intervention. In-

dividual characteristics such as personality factors, general state of

physical and psychological health, and pressures outside work may

also mediate the outcome of organisational interventions. Due to

8Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

the complex nature of such interventions, the aforementioned fac-

tors can act as moderators as well as mediators. Moderators explain

variation in impact of interventions, while mediators are factors in

the causal pathway of interventions. For example, the differential

impact of an intervention can depend on the structure of one or-

ganisation relative to another. However, organisational interven-

tions need to work through elements of the organisational struc-

ture, and depending on the intervention, redesign the structure if

needed. Other examples include organisational interventions such

as installing social support mechanisms or systems of collaborative

decision-making. Their impact can be dependent on the culture

of the organisation, but they also work through adapting to cer-

tain elements and transforming other elements of the culture and

norms of the organisation.

How the intervention might work

Organisational interventions to improve wellbeing and reduce

work-related stress may work by a) changing the organisation to

have better communication, social support or a culture of recogni-

tion; b) modifying the role of the teacher or their line managers to

give teachers more control over their work, increase their decision

latitude over their work environment and reduce role conﬂicts; or

c) redesigning objective workload levels or the work environment

within which the teacher is situated.

Organisational interventions will be situated within an organisa-

tional change model, which would explain the process of change

within the intervention. The focus of the intervention will be on

organisational wellbeing concepts, such as organisational stress

models. The two main organisational stress models are the ’de-

mand-control-support model’ (Karasek 1990) and the ’effort-re-

ward imbalance model’ (Siegrist 1996). The demand-control-sup-

port model is based on the notion that high psychological de-

mands placed on the working person, coupled with a low degree

of control available to the person to perform the required tasks,

and low levels of social support at work will lead to sustained stress

reactions. The effort-reward imbalance model is based on the no-

tion of reciprocity, and suggests that stress responses arise fromthe

imbalance between the effort that the working person puts into

work, and the rewards (whether esteem-based or monetary) that

they obtain from work.

The mechanism of each approach to organisational interventions

can be explained by utilising the two overarching models of organ-

isational stress. Changing organisational characteristics such as im-

proving communication of policy and management decisions will

reduce role ambiguity and role conﬂict, and so aims to eliminate

unwarranted demands by line managers and increase the decision

latitude of the teacher. This will in turn lead to a better balance

between the psychological demands of the work and the control

that the teacher has over their work. Another example of chang-

ing organisational characteristics can be modifying the culture and

installing structures for reward and recognition of hard work and

achievements, which would reduce the high levels of effort-reward

imbalance experienced by teachers. The second approach focuses

on changing role characteristics and conditions, and by doing so

aims to empower the teacher in relation to their direct respon-

sibilities as well as to the school in which they work, resulting

in increasing the teacher’s decision latitude and enhancing their

control over their work. Such interventions may also work along

the effort-reward imbalance pathway, as greater involvement in

organisational decision-making may enhance self esteem, as well

as increasing the recognition of the teacher. In the third approach,

interventions would aim to redesign the workload or the work en-

vironment of the teacher. This would lead to a more manageable

workload, or a work environment that is more conducive to the

psychosocial needs of the teacher. In turn, such interventions can

increase the teacher’s control, and reduce excessive psychological

demands and the resulting job strain associated with the teaching

profession.

Why it is important to do this review

To date, two reviews in the areas of occupational stress and wellbe-

ing interventions exist that are relevant to teachers. In the Teachers

Health and Wellbeing Study Scotland (Dunlop 2004), which in-

corporated the results of an unpublished systematic review, only 23

interventions were identiﬁed in the international literature. The

vast majority of the interventions (17) were focused on the teacher

as an individual. In addition, only four interventions addressed

structural issues. The review lacked a comprehensive search strat-

egy for identifying organisational interventions, and the authors

accept the paucity of studies and the fact that none of the inter-

ventions in the review had been subject to rigorous evaluations.

In a Teacher Support Network report titled Teacher Wellbeing: A

Review of the Evidence,Bricheno 2009 found that interventions

have focused mainly on secondary and tertiary management tech-

niques. The authors assert that some evidence suggests that indi-

vidual interventions are the most effective for mental health prob-

lems, but organisational interventions are the most effective for

job-related stress reduction. Further, the stakeholders interviewed

in the study paid most attention to primary strategies. The au-

thors concluded that most intervention strategies for teachers have

been tertiary, and so less likely to counter the problems of stressful

work environments. The review reported on longitudinal, cross-

sectional and case studies, and the authors did not claim to have

followed a thorough and systematic search and review process for

ﬁnding and synthesising effective interventions for teacher well-

being.

A synthesis of the evidence for managing stress at work from sys-

tematic reviews published up to July 2011 (Bhui 2012) found a

greater effect size of individual interventions on individual out-

comes. Organisational interventions showed mixed evidence of

beneﬁt, although the authors conﬂate worksite health promotion

programmes with the deﬁnition that we have outlined for organi-

9Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

sational interventions as changing the structure or context or both

of the work environment. Moreover, none of the studies were

conducted in a school setting. Due to the distinct nature of the

teaching profession and the context of educational settings, and

also the potential for organisational interventions to adequately

tackle psychosocial work stressors, school-level intervention de-

velopment and evaluation would require a high-quality context-

speciﬁc evidence base. The present systematic review aims to ﬁll

this important gap in the research literature.

O B J E C T I V E S

To evaluate the effectiveness of organisational interventions for

improving wellbeing and reducing work-related stress in teachers.

M E T H O D S

Criteria for considering studies for this review

Types of studies

We considered all eligible randomised controlled trials (RCTs),

cluster-randomised controlled trials (c-RCTs) and controlled be-

fore-and-after studies (CBAs). We considered studies that featured

randomisation at the classroom, department, or school level. We

included studies that combine orcompare individual-level and or-

ganisational-level interventions, but excluded studies with inter-

ventions only at the individual level.

Types of participants

We considered the inclusion of studies conducted with teachers

working at primary and secondary schools, serving children aged

between 4 and 18 years.

Types of interventions

Organisational interventions for employee wellbeing target the

stressors in the work environment, rather than the stress response

of the individual employee. They aim to alter the psychosocial

work environment by changing some aspect of the organisation,

such as structures, policies, processes, climate, programmes, roles,

tasks, etc. Included interventions can be described within the fol-

lowing categories:

•Changing organisational characteristics or conditions: e.g.

school-level policy and governance; communication; school

climate, culture, or ethos

•Changing role characteristics or conditions: e.g. senior

management practice and culture; teacher autonomy and

empowerment; role conﬂicts

•Changing task characteristics or conditions: e.g. workload

or the work environment

We considered the inclusion of studies where the intervention is

compared to non-intervention controls or usual practice, as well

as studies that compare interventions with one or more alternative

interventions.

We make a distinction between organisational prevention and

individual stress management interventions. Further, we regard

worksite health promotion interventions and educational inter-

ventions as typically targeting individuals, rather than aiming to

change organisational characteristics. We therefore excluded any

intervention directed at the individual and not the organisation,

except for those individually-directed interventions that were 1:

universally delivered, and 2: had an organisation change compo-

nent that supported implementation. The latter may include or-

ganisational policy changes or installing support functions (e.g.

coaching). These components can change practices and affect or-

ganisational culture, which may subsequently lead to health and

wellbeing outcomes for individuals within organisations.

For example, Cullen 1999 was a school-wide health promotion

intervention, but the study explicitly states that: “no special en-

vironmental support or school policy changes were implemented

to support the program”. On the other hand, Tyson 2009 and

Brown 2010 are individually-directed educational interventions

that we treat as included studies. Both studies have a ‘coaching’

component, which extends the intervention from a limited set of

training sessions to provision of school-wide support for the im-

plementation of the intervention for its full duration. In the case

of Tyson 2009, there are two intervention arms: teacher training,

and teacher training plus coaching. We decided that the arm with

teacher training only is strictly an educational intervention, as it

aims to equip individual teachers with knowledge of a particular

programme to be delivered to children. However, the coaching

component aims to provide “assistance in implementing speciﬁc

content from the programs, and in structuring and time-tabling

the programs; and getting support for individual student or class

issues as well as support for teacher and parent issues”. This remit

for the coaching component of the intervention suggests an en-

vironmental support function, which can be interpreted with the

demand-control-support model of organisational stress. Due to

its school-wide implementation, the coaching can affect organisa-

tional culture and climate, and the organisation may subsequently

be perceived as having better support functions in place. This

component can also have a governance function, ensuring and

enhancing school-wide implementation, while the training-only

arm does not address teacher engagement with the programme,

implementation, and programme ﬁdelity.

Another example of an individually-directed intervention with an

organisation change component is illustrated in the distinction

10Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

between the studies by Goodman 2010 and Glazerman 2012.

Goodman 2010 evaluated the provision of performance bonuses,

without any school-level organisation change supplements to this

cash transfer intervention. The objective was to raise teacher effort

and school results, and the study was not concerned with teacher

wellbeing or organisational climate. For example, the measure of

absenteeism combined sickness absencewith personal business ab-

sence, aiming to determine whether cash transfers would motivate

teachers to take less leave of absence. On the other hand, the trial by

Glazerman 2012 involved an intervention that provided teachers

with performance bonuses, along with job promotion opportuni-

ties and tools to track and improve their performance (classroom

observations and weekly mentoring). This organisational comple-

ment to the individual cash transfers provides support functions to

achieve performance aims, and improve the recognition of teach-

ers via promotion opportunities. Both factors may affect the cul-

ture and climate of the organisation, and subsequently improve

the health and wellbeing outcome of individual teachers.

Types of outcome measures

Primary outcomes

1. Subjective measures: validated measures of work stress and

wellbeing e.g. Maslach Burnout Inventory (Maslach 1996),

Teacher Stress Inventory (Fimian 1988), Occupational Stress

Inventory (Osipow 1998), Work Ability Index (Tuomi 1998),

Minnesota Satisfaction Questionnaire (Weiss 1967),

Organisational Climate Description Questionnaire (Hoy 1991),

Organisational Health Inventory (Hoy 1991).

2. Objective measures: teacher turnover (retention rates) and

sickness absence.

Secondary outcomes

1. Biological measures such as cardiovascular outcomes

(Steptoe 1999) and cortisol levels (e.g. Steptoe 2000).

2. Where possible, we planned to consider the relationship

between teacher wellbeing and student attainment, but no

studies provided these data.

Search methods for identiﬁcation of studies

We developed a search strategy based on the inclusion criteria to

be used in electronic database searching. We took the following

essential concepts of the inclusion criteria to develop the search

string: teachers; stress/wellbeing; school organisation. We consid-

ered the combination of these three concepts to be speciﬁc enough

to include all available studies, regardless of study design.

To locate studies for inclusion, we used a sensitive and precision-

maximising search strategy as recommended by Cochrane (Chap-

ter 6 of the Cochrane Handbook for Systematic Reviews of Interven-

tions) (Higgins 2011). For PubMed databases we used the most

sensitive search strategy proposed by the Occupational Safety and

Health Review Group (Verbeek 2005). We did not restrict the

searches by date, language or publication type. The date of the last

search was 23 January 2015.

See Appendix 1 for the search strategy to be used in PsycINFO.

We adapted this search strategy for other databases accordingly

(Appendix 2).

Electronic searches

We searched the following databases from inception to 23 January

2015:

•ASSIA (Applied Social Science Index and Abstracts);

•AEI (Australian Education Index);

•BiblioMap (Database of health promotion research);

•BEI (British Education Index);

•CENTRAL (Cochrane Central Register of Controlled

Trials);

•CISDOC (The Health and Safety Information Centre of

the International Labour Ofﬁce);

•DARE (Database of Abstracts of Reviews of Effects);

•DER (Database of Educational Research);

•EMBASE;

•ERIC (Education Resources Information Centre);

•HSELINE (UK Health and Safety Executive Information

Services);

•IBSS (International Bibliography of the Social Sciences);

•International Bibliographic;

•International Clinical Trials Registry Platform;

•MEDLINE (PubMed);

•NIOSHTIC and NIOSHTIC2 (US National Institute for

Occupational Safety and Health);

•OpenGrey (System for Information on Grey Literature in

Europe);

•Proquest Dissertations and Theses;

•PsycINFO;

•RILOSH (Ryerson International Labour Occupational

Safety and Health);

•SSCI (Social Science Citation Index);

•Sociological Abstracts;

•TRoPHI (Trials Register of Promoting Health

Interventions).

Searching other resources

1. We searched reference lists from all studies that met the

inclusion criteria.

2. We searched for references to relevant studies in

international government reports and in teacher union and non-

governmental organisation (NGO) publications available on the

Internet.

11Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

3. We contacted subject experts to identify unpublished or

ongoing research.

4. We searched all available trial registers (e.g.

www.clinicaltrials.gov) for relevant ongoing and unpublished

trials.

Data collection and analysis

Selection of studies

We imported all search results into a reference management soft-

ware package. Three review authors (AN, PM, and CB) operated

in two teams to independently screen the title and abstract of each

reference in light of the inclusion criteria for our review. If the

two screening teams independently agreed that an article does not

fulﬁl the inclusion criteria, we excluded the study from the review.

We obtained full reports for studies that the title and abstract sug-

gested should be included, or which contained insufﬁcient infor-

mation in the title and abstract to make a clear decision regarding

inclusion for review. Where the two review teams disagreed, they

met to discuss this and if possible reach a consensus. In the case

that we could not reach consensus regarding inclusion of a speciﬁc

article, we planned to refer judgement for selection to a third re-

view author (LA). We maintained a record of the selection process

for all screened material.

Data extraction and management

Two review authors (AN and PM) independently extracted data

from studies meeting the inclusion criteria, using a piloted data

extraction form developed for this review. Where the two authors

disagreed, they met to discuss this and if possible reach a consensus.

If they could not reach consensus regarding the particulars of data

extraction for a speciﬁc study, they planned to refer judgement to

a third review author (CB).

We extracted information pertaining to: basic study details (in-

dividual and organizational participant characteristics, study lo-

cation, timing and duration, research questions or hypotheses);

study design and methods (design, allocation, blinding, sample

size, accounting for data clustering, data collection, attrition, anal-

ysis); intervention characteristics (including timing and duration,

programme development, theoretical framework, content and ac-

tivities, providers, details of any intervention offered to the con-

trol group, and uptake of intervention and control by partici-

pants); process evaluation of the intervention (including accept-

ability, reach, ﬁdelity/adherence, intensity and context of interven-

tion); outcome measures at post-treatment and follow-ups where

reported, as well as effect size and costs of intervention. The data

extraction form also incorporated assessment of the included stud-

ies’ risk of bias (see below for details). The two review authors

entered data from the data extraction forms into Review Manager

5 (RevMan 2014). We contacted study authors to provide data

that may be missing from the study reports or to resolve any un-

certainty about reported information.

Assessment of risk of bias in included studies

We assessed risk of bias within each included study by using the

tool outlined in the Cochrane Handbook for Systematic Reviews of

Interventions (Higgins 2011). For each study, the two review au-

thors engaged with data extraction independently judged the like-

lihood of bias in six domains: sequence generation, allocation con-

cealment, blinding (of participants, personnel, or outcome asses-

sors), incomplete outcome data, selective outcome reporting, and

other sources of bias (e.g. recruitment bias in cluster-randomised

studies). We subsequently allocated each study a score of ‘high

risk’, ‘low risk’ or ‘unclear risk’ within each domain. In cases of

disagreement, the review authors met to establish a consensus.

Where the two review authors could not agree on categorisation

for risk of bias for a speciﬁc study, we planned to refer judgement

to a third review author (CB).

Measures of treatment effect

We plotted the results of each trial as means and standard devia-

tions (SD) for continuous outcomes. When the results could not

be plotted, we described them in the ‘Characteristics of included

studies’ table and the ‘Effects of interventions’ section.

Unit of analysis issues

Interventions addressing departments or whole schools require

randomisation at the group (rather than individual) level. For some

outcomes, analysis was conducted at the school level and thus did

not require special statistical analysis. Where studies reported data

at the individual level, we assessed whether the study accounted

for the effect of clustering using appropriate statistical techniques

such as multi-level modelling. Where this was not done, we at-

tempted to correct for this clustering following methods set out

in section 16.3.4 of the Cochrane Handbook for Systematic Reviews

of Interventions (Higgins 2011).

Dealing with missing data

If statistics such as SDs or correlation coefﬁcients were missing

and we could not obtain them from the authors, we planned to

calculate them from other available statistics such as P values, ac-

cording to the methods described in the Cochrane Handbook for

Systematic Reviews of Interventions (Higgins 2011). In the event

of missing or unclear data within the included studies (e.g. group

means, standard deviations, details of dropouts), we planned to

contact the authors for further information. If authors were not

traceable or information was unavailable from them within two

months of contacting them, we planned to record that the study

12Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

information is missing on the data extraction form, and we cap-

tured this in our ’Risk of bias’ assessment of the study.

Assessment of heterogeneity

Considering the diversity of the range of organisational interven-

tions to improve employee wellbeing, we expected to ﬁnd content

and methodological diversity arising from different types of inter-

ventions, outcome measurements, and study designs. Prior to data

synthesis, we planned to group together studies that we judged to

be sufﬁciently homogeneous regarding intervention content, re-

search design, time to outcome measurement, and outcome mea-

sures. We considered all teaching tasks as similar. We considered

interventions as similar if they fell into one of the pre-deﬁned

categories of interventions (as elaborated in the section: ’Criteria

for considering studies for this review’). We considered stress and

burnout measures as similar. We regarded follow-up times of less

than three months, three months to one year, and more than one

year as different.

For each study grouping with a sufﬁcient number of studies to

undertake meta-analysis, we planned to produce forest plots, cal-

culate Chi² tests and the I² statistic (Higgins 2003) to measure

heterogeneity. We planned to evaluate the results of these statistical

tests in accordance with Higgins 2011. If we considered that we

detected statistical heterogeneity in any of our study groupings,

we planned to investigate it further using subgroup and sensitivity

analyses. If we found an indication of substantial heterogeneity

(e.g. I² value greater than 50%), we planned not to produce a

pooled estimate, but to present a narrative summary of our ﬁnd-

ings.

Assessment of reporting biases

We assessed reporting bias according to Sterne 2011. We reduced

the effect of reporting bias by including studies and not publica-

tions in order to avoid the introduction of duplicated data (i.e. two

articles could represent duplicate publications of the same study).

Following the Cho 2000 statement on redundant publications,

we attempted to detect duplicate studies and, if more articles re-

ported on the same study, we planned to extract data only once.

We prevented location bias by searching across multiple databases.

We prevented language bias by not excluding any article based on

language. If we found sufﬁcient studies, we planned to draw fun-

nel plots to assess the presence of possible publication bias (trial

effect versus standard error). Whilst funnel plot asymmetry may

indicate publication bias, this can be misleading with a small num-

ber of studies (Lau 2006). We planned to discuss possible expla-

nations for any asymmetry in the review in light of the number of

included studies. We assessed outcome reporting bias during the

data extraction process by determining if all outcomes that had

been stated to have been collected were reported in analyses.

Data synthesis

We planned to undertake meta-analysis and produce a pooled esti-

mate using Review Manager 5 software (RevMan 2014), as well as

a narrative account for each study group, in the e vent that we iden-

tiﬁed groups of clinically homogeneous studies (those with similar

intervention content, research design, time to outcome measure-

ment, and same outcome measures). We planned to use weighted

mean differences with 95% conﬁdence intervals for combining

continuous outcomes, and standardised mean differences where

we found different scales measuring the same outcome. When we

found studies to be statistically heterogeneous, we planned to use

a random-effects model. When using the random-effects model,

we planned to conduct a sensitivity check by using the ﬁxed-effect

model to reveal differences in results.

We planned to separately analyse data from short-term and long-

term effects for potential included studies that had conducted a

series of follow-up outcome measurements.

If substantial heterogeneity was present for any group of studies,

we planned not to produce a pooled estimate, but to present a

narrative summary of ﬁndings. The narrative report would classify

and present studies according to: intervention content, research

design, time to outcome measurement, outcome measure, and

intervention effect.

We usedth e GRADE approach as described in the Cochrane Hand-

book for Systematic Reviews of Interventions (Higgins 2011) and as

implemented in the GRADEPro 3 software (GRADE 2008) to

present the quality of evidence and ‘Summary of ﬁndings’ tables.

The downgrading of the quality of a body of evidence for a speciﬁc

outcome was based on ﬁve factors.

1. Limitations of study

2. Indirectness of evidence

3. Inconsistency of results

4. Imprecision of results

5. Publication bias

The GRADE approach speciﬁes four levels of quality: high, mod-

erate, low and very low.

Subgroup analysis and investigation of heterogeneity

Had we found sufﬁcient included studies, we planned to investi-

gate the moderating effects of the following factors on the studied

interventions, using subgroup analysis with formal tests for inter-

action:

1. Primary schools versus secondary schools;

2. Teacher status (seniority);

3. Individual characteristics (gender, socioeconomic status,

ethnicity or state of health of teachers), or;

4. Organisational characteristics.

Sensitivity analysis

13Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

We planned to undertake a sensitivity analysis to explore whether

the ﬁndings of the review are robust in light of the decisions made

during the review process.

In order to check for the inﬂuence of small-study effects, we

planned to carry out a sensitivity analysis to compare the point

estimates from ﬁxed-effect meta-analysis to those from random-

effects meta-analysis. We also planned to assess the impact of risk

of bias in the included studies by restricting analyses to studies

deemed to be at low risk of selection bias, performance bias, and

attrition bias.

R E S U L T S

Description of studies

See Characteristics of included studies table

Four studies (Brown 2010;Glazerman 2012;Tyson 2009;Wu

2006) fulﬁlled our inclusion criteria and thus we included them in

this review. Two were conducted in the USA, one in Australia, and

one in China. Three studies were conducted in primary schools

and one in middle schools. Interventions included task-based or-

ganisational change, child-centred interventions with organisa-

tional change components, and performance-related cash transfer

with job promotion and mentoring support components. Three

of the studies were cluster-randomised trials, and one study had

a stepped-wedge design. The follow-up periods of the included

studies ranged from six to 36 months.

Results of the search

The search strategy identiﬁed titles and abstracts for 8543 publica-

tions after de-duplication. Upon ﬁrst assessment by the two review

author teams, we identiﬁed 138 studies for further assessment,

and subsequently found four studies that met the inclusion crite-

ria following further examination and obtaining full texts where

necessary. Of the four included studies, two were published in

journals, one study was a conference presentation, and one study

was a non-peer-reviewed report by a policy research organisation.

The study selection process is outlined in Figure 1.

14Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

Figure 1. PRISMA Study ﬂow diagram.

15Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

Included studies

Study designs

Three studies (Brown 2010;Tyson 2009;Wu 2006) were cluster-

randomised controlled trials. One study (Glazerman 2012) was a

stepped-wedge design with two types of control groups, includ-

ing random assignment of schools to year of implementation, and

propensity-score matching of intervention schools to non-inter-

vention schools in the district. Wu 2006 and Brown 2010 had ‘no

intervention’ control groups. Tyson 2009 had a ‘usual care’ control

group, who received a local health education curriculum.

Place where studies conducted

Two studies were carried out in the USA (Brown 2010;Glazerman

2012), in New York and Chicago respectively. One study was

carried out in Perth, Australia (Tyson 2009), and one study in

Sichuan Province, China (Wu 2006).

Type of schools

Three studies (Brown 2010;Glazerman 2012;Tyson 2009) were

conducted in primary schools. One study (Wu 2006) was con-

ducted in middle schools.

Participants

Wu 2006 included 961 teachers in eight schools. The inter vention

group consisted of 459 teachers in four schools, and the control

group consisted of 502 teachers in four schools. After adjusting

for clustering using the intra-cluster correlation coefﬁcient (0.003)

provided by Brown 2010, the numbers of participants we used in

the analysis were 338 and 370 respectively.

Tyson 2009 included 405 teachers in 63 schools. Authors reported

only data for teachers who completed the outcome measures at all

three time points (n = 96). Further, considering that this study was

a three-arm trial, we deemed only one of the intervention groups

to contain an organisational intervention relevant to this review.

Thus the total number of participants analysed for this review was

59 teachers in 43 schools. The intervention group consisted of

26 teachers in 22 schools, and the control group consisted of 33

teachers in 21 schools. In the analysis the authors properly adjusted

for the clustering effect.

Brown 2010 included 77 teachers in 18 schools. The intervention

group consisted of 43 teachers in nine schools, and the control

group consisted of 34 teachers in nine schools. In the analysis the

authors properly adjusted for the clustering effect.

Glazerman 2012 included 34 schools randomly assigned to four

intervention years. Eight schools in cohort 2 served as the control

group for eight schools in cohort 1 (intervention group). The con-

trol group was used for the outcome of teacher attitudes. Three

hundred matched comparison schools were used as controls for

the outcome of teacher retention. For teacher attitudes, the au-

thors report a sample size of 270 to 278 teachers, without any in-

dication of the number of teachers in the intervention and control

groups. For teacher retention, the authors report a sample size of

1102 teachers for one-year rates, 881 teachers for two-year rates,

and 781 teachers for three-year rates. There is no indication of

the speciﬁc number of teachers in the intervention and matched

comparison schools. In the analysis the authors properly adjusted

for the clustering effect.

Follow-up periods

The follow-up periods of the included studies ranged from six to

36 months. Wu 2006 had a 12-month follow-up. Tyson 2009 had

two follow-ups, at 12 months and at 24 months. Brown 2010

was a three-year study, although the publications only provide

analysis for the ﬁrst year of the study (six-month follow-up).

Glazerman 2012 was a four-year study, with assignment of a new

cohort of schools in each year of the study. For this reason, Cohort

2 served as the control to Cohort 1 and Cohort 4 served as the

control to Cohort 3 for only one year, before implementation of

the intervention began in those schools. The outcome measure for

which the control groups was used (teacher attitudes) therefore had

a 12-month follow-up. The outcomes measure that utilised the

matched-comparison groups (teacher retention) had three follow-

ups at 12, 24, and 36 months.

Interventions and outcomes

From the four included studies, one study (Wu 2006) contained a

task-based organisational change intervention, with teacher stress

and wellbeing measured as the primary outcome. One study

(Glazerman 2012) had a multi-component intervention contain-

ing performance bonus, job promotion opportunities and men-

toring support, measuring teacher attitudes and teacher retention

outcomes. Two studies (Brown 2010;Tyson 2009) had teacher

training for child-centred interventions along with school-wide

coaching support, with teacher-affective wellbeing measures as sec-

ondary outcomes.

Changing task characteristics

Wu 2006 contained an intervention involving both individual

(stress management training) and organisational approaches (e.g.

redesigning the task, establishing ﬂexible work schedules and re-

designing the work environment). There is no furthe r information

on the content of the organisational component of the interven-

tion. However, the authors have alluded to feeding the baseline

data back to the participants in order to develop the intervention.

Outcome measures include the Occupational Health Inventory

and the Work Ability Index.

Changing organisational characteristics

Tyson 2009 contained an intervention titled the Aussie Optimism

programme, which is a universal, mental-health promotion pro-

gramme, delivered by teachers and aimed at preventing anxiety and

depression in children and adolescents. The aim of the study was

to assess whether programme training and implementation has a

secondary positive impact on teachers’ job-related affective wellbe-

16Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

ing. The study involved two intervention arms: teacher training,

and teacher training along with school-wide coaching support.

Outcome measures include the Job-related Anxiety-Contentment

Scale and the Job-related Depression-Enthusiasm Scale.

Brown 2010 contained an intervention titled the 4Rs Programme,

which is a universal, school-based intervention in literacy develop-

ment, social-emotional learning, and conﬂict resolution delivered

by teachers. The basis for the study was that positive changes in

teacher-affective and pedagogical processes and practices underlie

positive change in children. Teachers in the intervention group

receive training and school-wide coaching support for the delivery

of the 4Rs curriculum to school children. Outcome measures in-

clude the Maslach Burnout Inventory and the Teacher Perceived

Emotional Ability scale.

Multi-component intervention

Glazerman 2012 contained an intervention titled the Chicago

Teacher Advancement Program (TAP), which is a school-wide in-

tervention whereby teachers can earn extra pay and take on in-

creased responsibilities through promotion, and become eligible

for annual performance bonuses based on a combination of their

contribution to student achievement and observed performance

in the classroom. The intervention also involved classroom ob-

servations and weekly mentoring in order to track and improve

the performance of teachers. The amount available in the bonus

pool was an average of USD 2000 per teacher per year. Payments

were expected to average USD 500 per teacher based on class-

room observations and up to USD 1500 per teacher based on

school-wide student achievement growth. Job promotion oppor-

tunities involved the positions of Chicago TAP Lead and Mentor

Teachers, who received an additional USD 15,000 and USD 7000

respectively, as compensation for assuming more responsibility.

Outcome measures included teacher retention rates and an unval-

idated teacher attitudes questionnaire to assess school climate.

Excluded studies

See Characteristics of excluded studies table

We rejected studies failing to meet the inclusion criteria in the

initial stage of study selection, for reasons such as study design,

randomisation at the individual level, no control group, no mea-

sure of stress or wellbeing, and individually-directed intervention

without an organisational component. Other studies had to be as-

sessed with more scrutiny, and we excluded them for the following

reasons.

•Worksite health promotion programmes that are effectively

individually-directed interventions, such as Allegrante 1990,

Blair 1986 and Cullen 1999.

•Educational interventions that focus on strengthening

individuals, such as classroom management training e.g. Bishop

1983,Sharp 1982, and Sharp 1985; discipline management

training e.g. Snyder 1986.

•Support groups in isolation, as opposed to a new

organisational function e.g. Cecil 1990.

•Cash transfer interventions without an organisational

change component and not addressing outcomes of interest e.g.

Goodman 2010.

•No measure of school-level effects e.g. Larsson 1990.

•Full text unavailable- Coad 1976 and Charters 1978

seemed to have potential for inclusion, but they were conference

proceedings and we had no success in making contact with the

authors.

Risk of bias in included studies

Allocation

The authors of all the included studies had stated having con-

ducted randomised studies. Only one study elaborated on their

sequence generation (Brown 2010), utilising a MATLAB uniform

random numbers generator. Glazerman 2012 alluded to their se-

quence generation by reporting that a lottery was conducted in

May 2007 for Cohorts 1 and 2, and in March 2009 for Cohorts

3 and 4. Glazerman 2012 was also the only study that alluded to

allocation concealment, reporting that after having conducted the

lottery assigning schools into cohorts, the research team sent the

school assignments to the local education authority, who subse-

quently informed the school principals of their assignment.

Two studies (Brown 2010;Glazerman 2012) used a stratiﬁed ran-

dom sampling approach. Glazerman 2012 imposed constraints

on the randomisation based on observable school characteristics

to improve homogeneity of the two groups. Brown 2010 pair-

wise matched schools based on a range of demographic and school

characteristics prior to randomising. In this regard, Brown 2010

stated that: “because the ﬁnal set of 18 schools was not randomly

selected from the initially recommended pool of 41 schools, nor

drawn randomly from the entire population of elementary schools

in this city, the external validity or generalizability of the results

from the present study is compromised“.

Blinding

The study designs and the nature of the interventions evaluated in

these studies make blinding of participants and personnel impos-

sible. None of the studies mention any attempt to blind outcome

assessment, which was conducted by researchers in all included

studies.

Incomplete outcome data

We contacted all authors to obtain missing data. The authors of

Wu 2006 were not traceable, and the required information was

unavailable from Tyson 2009 and Glazerman 2012 within two

months of contacting them. We judged attrition bias to be at

17Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

high risk for two studies (Tyson 2009;Wu 2006). Wu 2006 did

not provide any information on attrition in the data, and the

sample size for the pre- and post-intervention data appear to be

the same. When we conducted mean difference calculations of

the data in RevMan 2014, we found a signiﬁcant effect in one

of the subscales (Role Insufﬁciency) for which the study reports a

non-signiﬁcant result. This could be due to our assuming sample

sizes for pre- and post-intervention data to be the same, while

the authors may have calculated the mean difference with the

actual post-intervention sample size (after attrition). We can thus

assume from the evidence that they did not conduct an intention-

to-treat analysis. Tyson 2009 only reported results for teachers who

completed the outcome measures at both post-intervention time

points, which equates to 96 teachers from the total of 405 teachers

in the study sample.

Selective reporting

We judged reporting bias to be at high risk for two studies

(Glazerman 2012;Tyson 2009). Tyson 2009 did not report an

intention-to-treat analysis that they conducted for the total sam-

ple of 405 teachers as it showed no signiﬁcant results. Glazerman

2012 only reported 12-month, 24-month, and 36-month reten-

tion rates for Cohort 1. They did not report retention rates for the

other cohorts independently, and only reported them in combi-

nation with other cohorts, limiting their usefulness.

Other potential sources of bias

The knowledge of whether each school is an intervention or con-

trol could affect the types of participants who respond to surveys,

and this can be overcome by conducting baseline measures prior

to randomisation of clusters. None of the studies reported any

attempts to address this recruitment bias. All studies except Wu

2006 accounted for clustering in their analysis. Glazerman 2012

used an unvalidated survey to measure teacher attitudes on school

climate. Further, there is no clear indication of the number of

teachers in each cohort and in total. In Tyson 2009, mean differ-

ences did not show any signiﬁcant effects, but the authors utilised

hierarchical regression analysis to claim signiﬁcant effects on job-

related anxiety at 24-month assessment and job-related depression

at both 12- and 24-month assessments compared to the control

group. Brown 2010 did not provide data on the total teacher pop-

ulation (sampling frame) or on non-responders.

Effects of interventions

See: Summary of ﬁndings for the main comparison Changing

task characteristics versus no intervention for improving wellbeing

and reducing work-related stress in teachers;Summary of ﬁndings

2Changing organisational characteristics versus no intervention

for improving wellbeing and reducing work-related stress in

teachers;Summary of ﬁndings 3 Multi-component intervention

versus no intervention for improving wellbeing and reducing

work-related stress in teachers

The studies in this review vary greatly with respect to their ob-

jectives, types of interventions, and outcome measures. We did

not perform any meta-analysis, as the interventions were too het-

erogeneous to be combined meaningfully. Utilising the three cat-

egories of organisational-level interventions as changing organi-

sational, role, or task characteristics, we categorised the included

studies as follows. Wu 2006 contained a task-based organisational

change intervention, which we categorised as changing task char-

acteristics. Glazerman 2012 had a multi-component intervention

containing performance bonus, job promotion opportunities and

mentoring support, which we categorised as changing organisa-

tional and role characteristics. Brown 2010 and Tyson 2009 both

evaluated teacher training for child-centred interventions with a

school-wide coaching support component, which we categorised

as changing organisational characteristics. The latter two studies

had clear differences in study design and quality, intervention con-

tent, study objectives, and outcome measures. Tyson 2009 aimed

to assess whether programme training and implementation had a

secondary positive impact on teachers’ job-related affective well-

being, while the basis for the study by Brown 2010 was that pos-

itive changes in teacher affective and pedagogical processes and

practices underlie positive change in children. The former mea-

sured job-related anxiety and depression, while the latter measured

burnout and emotional ability.

Changing task characteristics versus no intervention

Wu 2006 was a cluster-randomised controlled trial of 961 teachers

in eight middle schools. The authors did not account for cluster-

ing. We employed the intra-cluster correlation coefﬁcient for the

burnout scale (0.003) provided by Brown 2010 in a personal com-

munication. After adjusting for clustering, the total number of

participants used in the analysis was 708 teachers in eight schools.

Intervention involved both individual (stress management train-

ing) and organisational approaches (e.g. redesigning the task, es-

tablishing ﬂexible work schedules and redesigning the work en-

vironment). Compared to the control group at 12 months, there

was a modest reduction in most of the subscales in the Occupa-

tional Stress Inventory (See Data and analyses table), and a mod-

est increase in the Work Ability Index (MD 2.27; 95% CI 1.64

to 2.90). The six subscales of the Occupational Stress Inventory

(from 14) we report in the corresponding Summary of ﬁndings

for the main comparison we selected as derived from the theo-

ries of change explained under How the intervention might work.

These include Role Overload (MD -0.94; 95% CI -1.61 to -0.27),

Role Ambiguity (MD -0.23; 95% CI -0.84 to 0.38) Responsibil-

ity (MD -1.19; 95% CI -1.91 to -0.47), Vocational Strain (MD

-0.78; 95% CI -1.42 to -0.14), Interpersonal Strain (MD -0.78;

95% CI -1.33 to -0.23), and Social Support (MD -0.50; 95% CI

-1.49 to 0.49).

Changing organisational characteristics versus no intervention

18Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

Tyson 2009 was a cluster-randomised controlled trial involving 59

teachers in 43 primary schools in the analysis. The intervention was

teacher training in the Aussie Optimism programme along with

school-wide coaching support. The Aussie Optimism programme

is a universal, mental-health promotion programme, delivered by

teachers and aimed at preventing anxiety and depression in chil-

dren and adolescents. The aim of the study was to assess whether

the programme had a secondary positive impact on teachers’ job-

related affective wellbeing. Compared to the control group, there

was no signiﬁcant effect on the Job-related Anxiety-Contentment

scale or the Job-related Depression-Enthusiasm scale after 12 and

24 months. These include Job-related Anxiety at 12 months (MD

-0.25; 95% CI -0.72 to 0.22), Job-related Anxiety at 24 months

(MD -0.25; 95% CI -0.61 to 0.11), Job-related Depression at 12

months (MD -0.38; 95% CI -0.76 to 0), and Job-related Depres-

sion at 24 months (MD -0.26; 95% CI -0.57 to 0.05).

Brown 2010 was a cluster-randomised controlled trial involving

77 teachers in 18 primary schools. The intervention was the 4Rs

Program, a universal, school-based intervention in literacy devel-

opment, social-emotional learning, and conﬂict resolution. Teach-

ers in the intervention group received training and school-wide

coaching support for the delivery of the 4Rs curriculum to school

children. Compared to the control group at six months, there

was no signiﬁcant effect on the Maslach Burnout Inventory or

the Teacher Perceived Emotional Ability subscales. These include

Maslach Burnout Inventory- emotional exhaustion (MD -0.05;

95% CI -0.52 to 0.42), Maslach Burnout Inventory- deperson-

alisation (MD -0.17; 95% CI -0.72 to 0.39), Maslach Burnout

Inventory- personal accomplishment (MD 0.06; 95% CI -0.23 to

0.35), Emotional Ability- perceiving emotions (MD 0.13; 95% CI

-0.13 to 0.38), Emotional Ability- understanding emotions (MD

-0.07; 95% CI -0.27 to 0.13), and Emotional Ability- regulating

emotions (MD 0.11; 95% CI -0.11 to 0.33).

Multi-component intervention versus no intervention

(matched comparison)

Glazerman 2012 was a stepped-wedge design involving 34 pri-

mary schools with two types of control groups, including random

assignment of schools to year of implementation, and propen-

sity-score matching of intervention schools to non-intervention

schools in the district. The intervention was the Chicago Teacher

Advancement Program (TAP), which is a school-wide interven-

tion whereby teachers can earn extra pay and take on increased

responsibilities through promotion, and become eligible for an-

nual performance bonuses based on a combination of their contri-

bution to student achievement and observed performance in the

classroom. Compared to a matched-comparison group, the study

found higher teacher retention rates at 12-month (MD 7.90; 95%

CI 2.00 to 13.80), 24-month (MD 18.30; 95% CI 8.75 to 27.85),

and 36-month (MD 11.50; 95% CI 3.25 to 19.75) follow-ups.

The mean differences are percentages, and so demonstrate moder-

ate effect sizes, albeit with wide conﬁdence intervals. What is more,

these ﬁndings are based on only a small subset of all data as the

authors report data only for the ﬁrst cohort (eight schools). Results

of an unvalidated teacher attitudes survey also demonstrate that

Chicago TAP had no effect on school climate in the intervention

schools, compared to control schools and to matched comparison

schools at 12 months.

Grading of the evidence

We employed the ﬁve factors in the GRADE Approach for as-

sessing the quality of evidence for each outcome as follows. We

utilised our assessments of the studies’ risk of bias for the ‘Limita-

tions of study’ factor. ‘Indirectness of evidence’ was present in all

comparisons as all intervention packages in the included studies

had an individual-level intervention thus confounding the effect

of the organisational-level component. Findings for each outcome

were based on only one study. Due to the paucity of studies in this

review, we could not adequately examine ‘Inconsistency of results’

and ’Publication bias’. ‘Imprecision of results’ was present in the

‘Changing organisational characteristics’ and the ’Multi-compo-

nent intervention’ comparisons due to underpowered studies and

thus wide conﬁdence intervals.

19Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

A D D I T I O N A L S U M M A R Y O F F I N D I N G S [Explanation]

Changing organisational characterist ics versus no int ervention for improving we llbeing and reducing work - related st ress in teachers

Population: Teach er s

Set tings: Scho ols

Intervention: Teach er t raini ng along w ith sc hool -wid e c oac hing sup por t versu s no in tervent ion

Outcomes Illustra tive compa rative risk s* (9 5% CI) Relati ve ef fect

(9 5% CI )

No of Part icipants

(studi es)

Quality of the evidence

(GRADE)

Comments

Assumed risk Corre sponding risk

No intervention Te acher training of a

mental health promo-

tion programme for

chil dre n al ong with

school- wide coaching

support

Job- rRelated Anxiety-

24 m ont hs

Sca le f rom : 1 to 6.

The mean job-relat ed

anxiet y- 24 m ont hs in

th e cont rol g ro ups was

2. 3 1

The mean job r el ated

anxiet y- 24 m ont hs in

th e int erventio n gro ups

was

0. 2 5 lower

(0 .61 l ower t o 0 .11

higher)

(1 s t udy)

⊕

very low1234

Job- re lated Depres-

sion- 24 months

Sca le f rom : 1 to 6.

The mean job r el ated

depr es s ion - 24 m o nths

in t he con tro l grou ps

was

1. 7 0

The mean job re-

lated depress ion- 2 4

mon t hs in the i nterv en -

ti on group s w as

0. 2 6 lower

(0 .57 l ower t o 0 .05

higher)

(1 s t udy)

⊕

very low1234

20Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

Maslach Burnout I n-

vent ory- Emotional Ex-

haustion

Sca le f rom : 0 to 6.

The m ean em ot ion al ex-

haus t ion in t he contro l

groups was 3 . 3 1

The m ean em ot ion al ex-

ha ust ion i n the i nt erve n-

ti on group s w as

0. 0 5 lower

(0 .52 l ower t o 0 .42

higher)

(1 s t udy)

⊕⊕

low2,4,5

Maslach Burnout I n-

vent ory- Depe rsonali-

sation

Sca le f rom : 0 to 6.

The mean deperson al-

is ati on in t he co ntrol

groups was 1 . 5 8

The mean deperson al-

is ati on in the i nterv en -

ti on group s w as

0. 1 7 lower

(0 .72 l ower t o 0 .39

higher)

(1 s t udy)

⊕⊕

low2,4,5

Maslach Burnout I n-

vent ory- P ersonal Ac-

complishment

Sca le f rom : 0 to 6.

The mean personal a c-

co m p lis hmen t in the

co ntrol gro ups w a s 4 .

The mean personal a c-

co m p lis hmen t in the in-

terven tio n g roups was

0. 0 6 highe r

(0 .23 l ower t o 0 .35

higher)

(1 s t udy)

⊕⊕

low2,4,5

Emotional Ability- P er-

ceiving Emotions

Sca le f rom : 1 to 5.

The mean perceiving

em otio ns i n t h e con t ro l

groups was 3 . 9 5

The mean perceivi ng

em otio ns i n t he in t er-

ven t ion g rou ps was

0. 1 3 highe r

(0 .13 l ower t o 0 .38

higher)

(1 s t udy)

⊕⊕

low2,4,5

Emotional Abi lity- Reg-

ulating Emotions

Sca le f rom : 1 to 5.

The mean regul ati ng

em otio ns i n t h e con t ro l

groups was 3 . 7 9

The mean regul ati ng

em otio ns i n t he in t er-

ven t ion g rou ps was

0. 1 1 highe r

(0 .11 l ower t o 0 .33

higher)

(1 s t udy)

⊕⊕

low2,4,5

21Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

* Th e ba sis fo r t he assumed risk (e.g. th e m edi an cont rol gro up ris k across stud ies ) i s pro vi ded in f ootn otes. The corresponding risk (and its 9 5% con f idence int erval) i s

based on the assu m ed risk in t he co m par iso n g ro up and t he rel ative eff ect o f t he in ter vent io n ( and it s 95 % CI).

CI: Co nfidenc e int erval ;

GRADE Workin g Group grades of evid en ce

High quality: Fu rth er researc h is very unl ikely to c hange o ur con f idence in the est i m ate of eff ect .

Moderate quality: Furt her researc h is likel y to ha ve an impo rtant im pac t on our c onf idenc e in the est im ate of ef f ect and m ay chan ge the es t im ate.

Low quality: Fu rt h er resear ch is very li kely to have an important impa ct o n our c o nfid enc e in t he es t imat e o f ef f ect and is likely t o cha nge t he es t im ate.

Very low quality: We are very u ncert ain abo ut t he estim ate.

1The st udy has bias i n t er m s of incorrect analysis a nd repo rting bia s. Only da ta f or teach ers ( n = 96 ) w ho compl eted t he

af fec tive w ellb eing sca les at all 3 ti m e poin ts have been rep orted , w ithout ITT an alysi s.

2Interv en tion p ackage i ncludes i ndi vi dua l-level int er venti on

3The st udy evalu atio n ef fect i vely involved 5 9 t eac hers in 43 sc hool s, and s o i s heavi ly und erp owered

4Wide c onf idenc e i ntervals

5No m ent i on of the tota l teacher populat i on (s am pli ng fram e) and n on-responders, and n o ind icat ion o f wh et her the s tud y

was s uff ici ent ly powered, con sid ering t hat s ample siz e was 7 7 teachers in 18 s c hoo ls

22Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

Multi-compone nt intervention versus no inte rve ntion for improving well- being and reducing work- related stress in te achers

Population: Teach er s

Set tings: Scho ols

Intervention: Perform ance-bas ed bonus , job pr om otio n op port unities and mentoring sup port vers us no intervent ion

Outcomes Illustra tive compa rative risk s* (9 5% CI) Relati ve ef fect

(9 5% CI )

No of Part icipants

(studi es)

Quality of the evidence

(GRADE)

Comments

Assumed risk Corre sponding risk

No intervention Perform ance- based

bonus, job promotion

oppor tunit ies an d men-

toring support

Retent ion rates, 12

mont hs, Cohort 1

Sca le fro m : 0 to 1 00.

The mean retentio n

rates, 12 m ont hs, co-

hort 1 in the i nterven-

ti on group s w as

7. 9 pe rcent higher

(2 .00 t o 13. 80 hi gher)

11 02

(1 s t udy)

⊕

very low1,2,3

co ntrol m eans were no t

available

Retent ion rates, 24

mont hs, Cohort 1

Sca le fro m : 0 to 1 00.

The mean retentio n

rates, 24 m ont hs, co-

hort 1 in the i nterven-

ti on group s w as

18 . 3 0 percent higher

(8 .75 t o 27. 85 hi gher)

88 1

(1 s t udy)

⊕

very low1,2,3

co ntrol m eans were no t

available

Retent ion rates, 36

mont hs, Cohort 1

Sca le fro m : 0 to 1 00.

The mean retentio n

rates, 36-m o nth s, co-

hort 1 in the i nterven-

ti on group s w as

11 . 5 0 percent higher

(3 .25 t o 19. 75 hi gher)

78 1

(1 s t udy)

⊕

very low1,2,3

co ntrol m eans were no t

available

23Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

* Th e ba sis fo r t he assumed risk (e.g. th e m edi an cont rol gro up ris k across stud ies ) i s pro vi ded in f ootn otes. The corresponding risk (and its 9 5% con f idence int erval) i s

based on the assu m ed risk in t he co m par iso n g ro up and t he rel ative eff ect o f t he in ter vent io n ( and it s 95 % CI).

CI: Co nfidenc e int erval ;

GRADE Workin g Group grades of evid en ce

High quality: Fu rth er researc h is very unl ikely to c hange o ur con f idence in the est i m ate of eff ect .

Moderate quality: Furt her researc h is likel y to ha ve an impo rtant im pac t on our c onf idenc e in the est im ate of ef f ect and m ay chan ge the es t im ate.

Low quality: Fu rt h er resear ch is very li kely to have an important impa ct o n our c o nfid enc e in t he es t imat e o f ef f ect and is likely t o cha nge t he es t im ate.

Very low quality: We are very u ncert ain abo ut t he estim ate.

1Repo rting bia s is present. Rete nti on is repo rted f or Cohort 1 as 1-year, 2-year, and 3-year rates . How ever, they are not report ed

independent l y f o r eac h o f t he ot her 3 c oho rts, an d o nly r ep ort ed in combi nat ion, li m i ting their us eful ness

2Interv en tion p ackage i ncludes i ndi vi dua l-level int er venti on

3Wide c onf idenc e i ntervals

24Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

D I S C U S S I O N

Summary of main results

Based on one study, changing task characteristics resulted in mod-

est reductions in stress levels and improvements in work ability

when compared to no intervention. Based on two studies, chang-

ing organisational characteristics resulted in no signiﬁcant effects

on burnout, emotional ability, job-related anxiety and job-related

depression when compared to no intervention. Based on one study,

multi-component intervention resulted in a moderate increase in

retention rates at 12 months, 24 months, and 36 months when

compared to a matched-comparison group. Overall the results are

generally positive but small to moderate in effect size and yield

low-quality evidence mainly due to the included studies being un-

derpowered.

Overall completeness and applicability of

evidence

Wehave included four studies in this review, which aimed to assess

the evidence for organisational interventions to improve wellbeing

and reduce work-related stress in teachers. As expected, there are

generally far more studies on individually-directed interventions

compared to those that aim to change some aspect of the work

environment to improve staff wellbeing. Two of the four included

studies (Brown 2010;Tyson 2009) were in fact teacher training

for child-centred interventions. We included them because they

had a secondary organisational change component.

There are some common patterns in the four included studies. For

example, three studies had a mentoring or coaching component.

Moreover, all studies had an individually-directed intervention

component. This affected the directness of the body of evidence

by confounding outcome effects resulting from the organisational

component of the intervention package. In other words, we did

not ﬁnd any studies that exclusively tested an organisational in-

tervention. The included studies were from the USA, China, and

Australia, with no studies identiﬁed in Europe, Africa, and Latin

America, further limiting the applicability of the evidence. The

organisational intervention content was not elaborated in any of

the studies. Therefore it would be difﬁcult to replicate the inter-

ventions in practice. Furthermore, none of the studies included

an economic evaluation of the intervention or the trial. Organi-

sational interventions to improve staff wellbeing can involve sig-

niﬁcant costs, and the cost effectiveness of interventions would be

crucial in decisions to scale up the evaluations by researchers or to

adopt the interventions by policy-makers.

Quality of the evidence

Most of the trials in this review were affected by methodological

problems. Wu 2006 did not account for clustering in the analy-

sis, which we corrected by employing the intra-cluster correlation

coefﬁcient for the burnout scale (0.003) provided by Brown 2010

following our request for further information. The study does not

refer to attrition in the data and there is no mention of intention-

to-treat (ITT) analysis. Further, the intervention in this study is

not replicable, mainly because its content is unclear. If the analysis

for this study had been done correctly and if the organisational

component of the intervention were more explicit, it would still

be difﬁcult to draw conclusions from the results for the effective-

ness of organisational interventions, as the intervention also in-

volved an individually-directed component (stress management

training).

Tyson 2009 only reported data for teachers (n = 96) who completed

the outcome measures at both post-intervention time points, with-

out an ITT analysis. An ITT analysis for 405 teachers who partic-

ipated in the study showed no signiﬁcant results and the authors

did not report it. The study reports that non-completers of the

surveys had signiﬁcantly higher levels of pre-test job-related anxi-

ety and depression than the completers at the pre-test, and at 12-

month and 24-month assessments. The authors suggest that this

may explain why ITT analyses were non-signiﬁcant. An evalua-

tion that effectively involves only 59 teachers in 43 schools would

lead to spurious results, predominantly because the study is heavily

underpowered. Another methodological error in this study is the

utilisation of the same control group for both intervention arms.

Brown 2010 was a well-conducted trial of a higher methodologi-

cal quality compared to the other included studies. However, the

follow-up period was only six months, and the study was not suf-

ﬁciently powered, with a sample size of 77 teachers in 18 schools.

Moreover, there was no mention of the total teacher population

(sampling frame) or of non-responders.

Glazerman 2012 was a well-conducted trial with clear justiﬁca-

tions for study design choices. For the teacher retention outcome,

the authors adopted a matched-comparison approach as opposed

to utilising the control group. They gathered administrative data

on over 300 Chicago schools that were not participating in the

Chicago Teacher Advancement Program (TAP), and then used

propensity-score matching to identify the schools that were closely

matched to each group of Chicago TAP schools. The rationale

for this decision was that for outcomes that can be affected by

knowledge of future implementation, such as teacher retention,

the randomised control group is not a pure standard of compari-

son. The control group is also affected by Chicago TAP, although

less directly than the treatment group, as the school’s staff know

that they will be implementing Chicago TAP in the future, and

that knowledge could change their behaviour. On the other hand,

the matched-comparison group can be much larger than the ran-

domised control group, and its members continue to be non-TAP

schools during the course of the study, allowing more years for

a comparison between Chicago TAP and non-TAP schools. The

25Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

study reports and elaborates a rigorous procedure for the propen-

sity-score matching. Shortcomings of the study include reporting

bias, as the authors report results only for the ﬁrst cohort for all

three follow-up time points. The authors did not report retention

rates for the other three cohorts independently, and only reported

them in combination with other cohorts, thus limiting their use-

fulness. Further, the study does not provide a clear indication of

the number of teachers in each cohort and in total. In order to as-

sess school climate, the study utilised an unvalidated survey, with

no reporting of its psychometric properties.

The included studies in this review were of mixed quality in terms

of reporting process and implementation data, and elaborating

on the design, delivery, and participant uptake of the interven-

tion. Wu 2006 did not report any process and implementation

data. Tyson 2009 referred to intervention developers, and pro-

vided some description of the delivery and participant uptake of

the intervention but apparently did not conduct a formal pro-

cess evaluation. Brown 2010 elaborated on the intervention de-

sign, reported having collected implementation data, and provided

some description of the participant uptake of the intervention.

Glazerman 2012 elaborated on a process evaluation in their study,

including quantitative surveys, qualitative interviews, and admin-

istrative data. The authors provided information on delivery and

uptake of the intervention, including teacher pay-outs, interven-

tion ﬁdelity, and teacher attitudes. They also provide information

on contextual factors affecting these variables. Components of the

process evaluation were conducted by external bodies, including

teacher surveys and focus groups by the local education authority,

and intervention ﬁdelity ratings by a national regulatory body.

Potential biases in the review process

We made every effort to conduct this review to the highest stan-

dards recommended in the Cochrane Handbook of Systematic Re-

views of Interventions (Higgins 2011). It seems that this is an emer-

gent and inter-disciplinary ﬁeld, and although we searched an ex-

tensive number of sources, we may not have had an exhaustive

strategy for non-database searching. We identiﬁed two older stud-

ies for potential inclusion, but we were not able to obtain full-text

articles and this may have inﬂuenced our conclusions. Further,

due to the paucity of included studies, we were unable to assess

for publication bias.

Another potential source of bias may be our strict inclusion cri-

teria with respect to study design. Researchers may ﬁnd it chal-

lenging to incorporate organisational change interventions into

an experimental design, and we might have excluded potentially

useful studies with lower-quality study designs.

Agreements and disagreements with other

studies or reviews

This is the ﬁrst systematic review looking at the impact of organ-

isational interventions on teacher wellbeing. Two related studies

that contained non-systematic reviews of interventions for teacher

wellbeing (Bricheno 2009;Dunlop 2004) suggest a major focus in

research and practice on individually-directed interventions, and

a paucity of evidence for organisational interventions. Our review

conﬁrms this, and provides a basis for further intervention devel-

opment and testing in this area. Further, none of the included

studies appeared in the previous reviews, since all but one (Wu

2006) were published after these reviews appeared.

A U T H O R S ’ C O N C L U S I O N S

Implications for practice

Because of the paucity of organisational intervention studies for

teacher wellbeing, low-quality evidence in this review, and the

heterogeneous nature of the interventions in the four included

studies, implications for practice are currently very limited. Such

organisational interventions could usefully be conducted in or-

ganisations in the context of a research study. They can safely be

put into practice as a trial for the purposes of intervention de-

velopment and efﬁcacy evaluations. All studies reported beneﬁts,

although interventions for changing organisational characteristics

did not yield statistically signiﬁcant results. Furthermore, there is

no evidence or rational arguments for harm arising from these in-

terventions.

Implications for research

Organisational interventions for teacher wellbeing should follow

the MRC Complex Interventions Framework and use a cluster-

randomised controlled trial design. A qualitative review should

provide further grounds for intervention development and pilot-

ing in this area. Intervention studies need to have a concrete con-

ceptual understanding of organisational interventions and their

theory of change. They need to provide full details of the interven-

tion content and on process evaluation. Collection of contextual

data in no-intervention control schools will help the understand-

ing of why and how the intervention has worked. Socio-economic

or performance indicators need to be used to justify similarities

between the initial pool of schools prior to randomisation so that

they can be meaningfully compared. Further, sample size calcula-

tions need to be conducted to ensure sufﬁciently powered trials,

taking into account the effect of clustering. Drawing on data from

the included studies and following Roberts 2005, a minimum of

18 schools (nine per trial arm) would be required for a pool of

schools with an average of 50 teacher participants per school. This

calculation was conducted with a power of 0.8, an alpha of 0.05,

and using the clsampsi.ado package in Stata 11. The outcome

should preferably be a combination of objective (e.g. teacher reten-

tion) and subjective (e.g. teacher burnout; organisational climate)

26Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

measures. It is also important for the outcome to be measured at

a sufﬁcient medium- or long-term follow-up, such as three years

after the intervention was conducted. Structural interventions will

take time to be fully embedded, and for their impact to be realised.

A C K N O W L E D G E M E N T S

We are grateful to the Managing Editor of the Cochrane Occu-

pational Safety and Health (COSH) Review Group, Jani Ruot-

salainen, for his able support in developing this review. We are

also grateful to Jos Verbeek for his support. We thank Tom Cox,

Saija Mauno, Karen Nieuwenhuijsen and Consol Serra for their

helpful comments. Gratitude is also due to Leena Isotalo, Trials

Search Co-ordinator for the COSH Review Group, for her timely

assistance in devising the search strategy and conducting searches

in CENTRAL, MEDLINE/PubMed, EMBASE, PsycINFO, and

OSH-update. Further, we are grateful to Kate Williams for con-

ducting searches in additional databases for this review as well as

Kate Cahill and Jani Ruotsalainen for copy editing the text.

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Verbeek J, Salmi J, Pasternack I, Jauhiainen M, Laamanen

I, Schaafsma F. A search strategy for occupational health

intervention studies. Occupational and Environmental

Medicine 2005;62(10):682–7.

Weiss 1967

Weiss DJ, Dawis RV, England GW, Lofquist LH. Manual

for the Minnesota Satisfaction Questionnaire. Minneapolis:

University of Minnesota, Industrial Relations Center, 1967.

WHO 2008

World Health Organization (WHO). PRIMA-EF Guidance

on the European Framework for Psychosocial Risk

Management. Protecting Worker’s Health Series No.9

2008.

Yang 2011

Yang X, Wang L, Ge C, Hu B, Chi T. Factors associated

with occupational strain among Chinese teachers: a cross-

sectional study. Public Health 2011;125(2):106–13.

References to other published versions of this review

Naghieh 2013

Naghieh A, Montgomery P, Bonell CP, Thompson M, Aber

JL. Organisational interventions for improving wellbeing

and reducing work-related stress in teachers. Cochrane

Database of Systematic Reviews 2013, Issue 1. [DOI:

10.1002/14651858.CD010306]

∗Indicates the major publication for the study

30Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

C H A R A C T E R I S T I C S O F S T U D I E S

Characteristics of included studies [ordered by study ID]

Brown 2010

Methods Cluster-randomized trial

Participants 77 teachers in 18 primary schools. 9 intervention (n=43) and 9 control (n=34) schools

in New York City, USA

Interventions 1- 4Rs Programme- universal, school-based intervention in literacy development, social-

emotional learning, and conﬂict resolution

2- No-intervention control

Outcomes Teacher Perceived Emotional Ability Scale, Maslach Burnout Inventory

Surveys conducted at baseline and 6 months post intervention

Notes Teachers in the intervention group receive training and ongoing coaching in the delivery

of the 4Rs curriculum to school children

Date of the intervention: 2004-2005

Funding: Institute of Education Sciences, U.S. Department of Education, in collabora-

tion with the Centers for Disease Control and Prevention, U.S. Department of Health

and Human Services (Grant R305L030003); William T. Grant Foundation

Conﬂict of interest: No

Risk of bias Risk of bias

Bias Authors’ judgement Support for judgement

Random sequence generation (selection

bias)

Low risk Schools pair-wise matched and then randomly assigned us-

ing a uniform random numbers generator

Allocation concealment (selection bias) Unclear risk Not reported

Blinding of participants and personnel

(performance bias)

All outcomes

Unclear risk Not reported, not applicable

Blinding of outcome assessment (detection

bias)

All outcomes

Unclear risk Not reported

Incomplete outcome data (attrition bias)

All outcomes

Low risk It is stated that there was no attrition from fall to spring in

the assessment of the ﬁrst year of the study, and data were

collected from 4 additional teachers

Selective reporting (reporting bias) Low risk All stated outcome data reported

Recruitment bias Unclear risk Not reported

31Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

Brown 2010 (Continued)

Baseline imbalance Low risk The authors report that the 2 groups did not differ signif-

icantly on a range of demographic and school characteris-

tics employed in the matching procedures. However, teach-

ing experience was signiﬁcantly higher for the control group

compared to intervention group, which may only be con-

cerning if it was vice versa

Incorrect analysis Low risk 2-level hierarchical linear model used, and clustering taken

into account

Other bias Unclear risk No mention of the total teacher population (sampling frame)

and non-responders, and no indication of whether the study

was sufﬁciently powered

Glazerman 2012

Methods Stepped-wedge design with 2 types of control groups (depending on the outcome mea-

sure):

1- Random assignment of schools to year of implementation

2- Propensity-score matching of intervention schools to non-intervention schools in the

district

Participants 34 elementary schools in Chicago, USA

Random assignment as follows:

Cohort 1: 8 schools to start Chicago Teacher Advancement Program (TAP) in 2007

Cohort 2: 8 schools to start Chicago TAP in 2008 (serving as control for Cohort 1)

Cohort 3: 9 schools to start Chicago TAP in 2009

Cohort 4: 9 schools to start Chicago TAP in 2010 (serving as control for Cohort 3)

The control group was used for the outcomeof teache rattitudes. Three hundred matched

comparison schools were used as controls for the outcome of teacher retention. For

teacher attitudes, a sample size of 270 to 278 teachers isreported, without any indication

of the number of teachers in the intervention and control groups. For teacher retention,

a sample size of 1102 teachers is reported for one-year rates, 881 teachers for two-year

rates, and 781 teachers for three-year rates. There is no indication of the speciﬁc number

of teachers in the intervention and matched comparison schools

Interventions 1- Chicago TAP- school-wide intervention whereby teachers can earn extra pay and take

on increased responsibilities through promotion, and become eligible for annual perfor-

mance bonuses based on a combination of their contribution to student achievement

and observed performance in the classroom

2- No-intervention (wait list) control

Outcomes Teacher retention- measured as percentage of teachers returning to work at the same

school in subsequent academic years at 12, 24, and 36 months post intervention

Teacher attitudes (school climate) unvalidated survey, conducted at baseline and subse-

quently 12, 24, and 36 months post intervention

32Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

Glazerman 2012 (Continued)

Notes The theory of change for TAP is that giving teachers performance incentives, along with

tools to track their performance and improve instruction, will help schools attract and

retain talented teachers and help all teachers raise student achievement

Date of the intervention: 2007-2011

Funding: U.S. Department of Education Teacher Incentive Fund (TIF) granted to

Chicago Public Schools (CPS)

Conﬂict of interest: No

Risk of bias Risk of bias

Bias Authors’ judgement Support for judgement

Random sequence generation (selection

bias)

Low risk Lottery conducted in May 2007 for Co-

horts 1 & 2, and March 2009 for Cohorts

3 & 4

Stratiﬁed random sampling was utilised.

Quote:

”We used the many observable characteris-

tics of schools to improve the chances that

schools assigned to the treatment versus

control group would have similar charac-

teristics....In assigning cohorts 1 and 2 we

imposed constraints on the randomisation

so that the largest and smallest school (in

terms of student enrolment) were in the

same Chicago TAP cohort (treatment or

control), the three schools with a predomi-

nantly non-African American student body

were not in the same cohort, and neither

cohort had more than one pair of schools

from the same geographic area of the city.

In assigning cohorts 3 and 4 we imposed

constraints so that the difference in average

enrolment between cohorts was less than

100 students, the difference in average to-

tal score on the Illinois Standards Achieve-

ment Test (ISAT) was less than six scale

points, the three schools where fewer than

95 percent of students were African-Amer-

ican were not all in the same cohort, and

both cohorts had representation of each ge-

ographic area that contained more than one

school“

Allocation concealment (selection bias) Low risk After the lottery assigning schools into co-

horts, the research team sent the school as-

signments to the local education author-

ity, who subsequently informed the school

principals of their assignment

33Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

Glazerman 2012 (Continued)

Blinding of participants and personnel

(performance bias)

All outcomes

Unclear risk Not reported, not applicable

Blinding of outcome assessment (detection

bias)

All outcomes

Unclear risk Not reported

Incomplete outcome data (attrition bias)

All outcomes

Low risk Attrition was accounted for and ITT anal-

ysis conducted

Selective reporting (reporting bias) High risk Retention is reported for Cohort 1 as 1-

year, 2-year, and 3-year rates. However,

they are not reported independently for

each of the other cohorts, and only reported

in combination

Recruitment bias Unclear risk Not reported

Baseline imbalance Low risk Baseline characteristics have been reported

for TAP schools (Cohorts 1 & 3), control

schools (Cohorts 2 & 4), and matched-

comparison schools. No signiﬁcant base-

line differences in school characteristics,

and in teacher age, gender, race, and ex-

perience (P > 0.05). The only signiﬁcant

difference (P < 0.05) was in the percentage

of teachers who have a master’s degree or

higher between Cohort 3 TAP schools and

the matched-comparison group. However,

there were no signiﬁcant differences be-

tween other indicators of educational level

such as ’National board certiﬁcation’ and

’Alternative education’

Incorrect analysis Low risk Clustering of teachers within schools was

accounted for, and impact estimates were

calculated as regression-adjusted means

Other bias Unclear risk There is no clear indication of the number

of teachers in each cohort and in total

34Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

Tyson 2009

Methods Cluster-randomized trial

Participants 405 teachers in 63 primary schools in Western Australia

Only data for teachers (n = 96) who completed the affective wellbeing scales at all 3 time

points have been reported, without ITT analysis. Considering that this study was a three-

arm trial, we deemed only one of the intervention groups to contain an organisational

intervention relevant to this review. Thus the total number of participants analysed

for this review was 59 teachers in 43 schools. The intervention group consisted of 26

teachers in 22 schools, and the control group consisted of 33 teachers in 21 schools. The

individual-level intervention excluded from this review consisted of 37 teachers in 20

schools

Interventions The Aussie Optimism programme is a universal, mental-health promotion programme,

delivered by teachers and aimed at preventing anxiety and depression in children and

adolescents. The aim of the study is to assess whether the programme has a secondary

positive impact on teachers’ job-related affective wellbeing

The study contains 1 control and 2 intervention groups:

1- Teacher training in Aussie Optimism

2- Teacher training in Aussie Optimism along with coaching for the duration of the

study

3- Usual care- implementing the regular Western Australian Health Education Curricu-

lum

Outcomes Job-related Anxiety-Contentment Scale, Job-related Depression-Enthusiasm Scale

Surveys conducted at baseline, and subsequently 12 months and 24 months post inter-

vention

Notes The main purpose of this study was mental-health promotion in children; job-related

affective wellbeing in teachers was investigated as a secondary outcome

Date of the intervention: Not reported

Funding: Not reported

Conﬂict of interest: Unknown

Risk of bias Risk of bias

Bias Authors’ judgement Support for judgement

Random sequence generation (selection

bias)

Unclear risk Schools were randomly allocated to the 3 study groups, but

no mention of method of sequence generation

Allocation concealment (selection bias) Unclear risk Not reported

Blinding of participants and personnel

(performance bias)

All outcomes

Unclear risk Not reported, not applicable

Blinding of outcome assessment (detection

bias)

All outcomes

Unclear risk Not reported

35Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

Tyson 2009 (Continued)

Incomplete outcome data (attrition bias)

All outcomes

High risk Only data for teachers (n = 96) who completed the affec-

tive wellbeing scales at all 3 time points have been reported,

without ITT analysis

Selective reporting (reporting bias) High risk ITT analysis for 405 teachers who participated in the study

showed no signiﬁcant results and was not reported

Recruitment bias Unclear risk Not reported

Baseline imbalance Unclear risk Not reported

Incorrect analysis High risk Clustering of teachers within schools was accounted for.

However, the reported analysis was for teachers who com-

pleted the surveys, and ITT analysis was not reported

Other bias High risk Although mean differences did not show any signiﬁcant ef-

fects, the authors utilised hierarchical regression analysis to

claim signiﬁcant effects on job-related anxiety at 24-month

assessment and job-related depression at both 12- and 24-

month assessments compared to the control group

Wu 2006

Methods Cluster-randomized trial

Participants 961 teachers in 8 middle schools. 4 intervention (n = 459) and 4 co ntrol (n = 502) schools

in Sichuan Province, China. After adjusting for clustering, the number of participants

used in the analysis were 338 and 370 respectively

Interventions 1- Intervention strategies involving both individual (stress management) and organi-

sational approaches (e.g. redesigning the task, establishing ﬂexible work schedules and

redesigning the work environment)

2- No-intervention control

Outcomes Occupational Stress Inventory-Revised Edition, Work Ability Index

Surveys conducted at baseline and 12 months post intervention

Notes Results of baseline measures were fed back to teachers in the intervention schools in

order to develop the organisational component of the intervention. There is no further

information on the ﬁnal content of the organisational component

Date of the intervention: Not reported

Funding: National Natural Science Foundation of China (Grant 39970623)

Conﬂict of interest: Unknown

Risk of bias Risk of bias

Bias Authors’ judgement Support for judgement

36Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

Wu 2006 (Continued)

Random sequence generation (selection

bias)

Unclear risk Schools were randomly selected into study group and control

group, but no mention of method of sequence generation

Allocation concealment (selection bias) Unclear risk Not reported

Blinding of participants and personnel

(performance bias)

All outcomes

Unclear risk No evidence, not applicable

Blinding of outcome assessment (detection

bias)

All outcomes

Unclear risk Not reported

Incomplete outcome data (attrition bias)

All outcomes

High risk No mention of attrition in data and no mention if ITT

analysis. Mean difference calculation in Review Manager 5

revealed a signiﬁcant effect in the Role Insufﬁciency subscale,

while the study does not report it to be signiﬁcant. This may

be due to the authors calculating the mean difference with

the actual numbers after attrition, while we had to assume

numbers pre- and post-intervention to be the same

Selective reporting (reporting bias) Low risk All stated outcome data reported

Recruitment bias Unclear risk Not reported

Baseline imbalance Low risk No relevant baseline differences in age, gender, educational

level and marital status (P > 0.05)

Incorrect analysis High risk There is no mention of accounting for clustering in the anal-

ysis, and so we assume that clustering has not been taken

into account. We corrected for clustering by employing the

intracluster correlation coefﬁcient for the burnout scale (0.

003) provided by Brown 2010

Other bias Unclear risk Not reported

Characteristics of excluded studies [ordered by study ID]

Study Reason for exclusion

Allegrante 1990 Individually-directed worksite health promotion intervention

Bishop 1983 Individually-directed classroom management training

Blair 1986 Individually-directed worksite health promotion intervention

37Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

(Continued)

Cecil 1990 Support groups in isolation, as opposed to a new organisational function

Charters 1978 Full text unavailable- conference proceeding

Coad 1976 Full text unavailable- conference proceeding

Cullen 1999 Individually-directed worksite health promotion intervention

Goodman 2010 Cash transfer intervention without an organisation change component; not addressing outcomes of interest

Larsson 1990 No measure of school-level effects

Sharp 1982 Individually-directed classroom management training

Sharp 1985 Individually-directed classroom management training

Snyder 1986 Individually-directed discipline management training

Characteristics of ongoing studies [ordered by study ID]

Naghieh 2014

Trial name or title Aligning staff wellbeing with organisational development: A pilot trial of the Change Laboratory in UK

secondary schools

Methods Pilot trial including 2 intervention and 2 control schools

Participants Teachers in 4 secondary schools in UK

Interventions Change Laboratory- intervention methodology of Activity Theory

Outcomes Maslach Burnout Inventory, Teacher Stress Inventory, Organisational Health Inventory, Collective Efﬁcacy

Scale, Sickness absence, Teacher turnover

Starting date 2013

Contact information Ali Naghieh: ali.naghieh@spi.ox.ac.uk

Notes This ongoing study is being conducted by the lead review author, and was not found in our search

38Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

D A T A A N D A N A L Y S E S

Comparison 1. Changing task characteristics versus no intervention

Outcome or subgroup title No. of

studies

No. of

participants Statistical method Effect size

1 Occupational Stress Inventory 1 Mean Difference (IV, Random, 95% CI) Totals not selected

1.1 Role Overload 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

1.2 Role Insufﬁciency 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

1.3 Role Ambiguity 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

1.4 Role Boundary 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

1.5 Responsibility 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

1.6 Physical Environment 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

1.7 Vocational Strain 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

1.8 Psychological Strain 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

1.9 Interpersonal Strain 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

1.10 Physical Strain 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

1.11 Recreation 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

1.12 Self care 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

1.13 Social Support 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

1.14 Rational/Cognitive

Coping

1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

2 Work Ability Index 1 Mean Difference (IV, Random, 95% CI) Totals not selected

Comparison 2. Changing organisational characteristics versus no intervention

Outcome or subgroup title No. of

studies

No. of

participants Statistical method Effect size

1 Job Related Anxiety- 12 months 1 Mean Difference (IV, Random, 95% CI) Totals not selected

2 Job Related Anxiety- 24 months 1 Mean Difference (IV, Random, 95% CI) Totals not selected

3 Job Related Depression- 12

months

1 Mean Difference (IV, Random, 95% CI) Totals not selected

4 Job Related Depression- 24

months

1 Mean Difference (IV, Random, 95% CI) Totals not selected

5 Maslach Burnout Inventory-

Educators Survey

1 Mean Difference (IV, Random, 95% CI) Totals not selected

5.1 Emotional Exhaustion 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

5.2 Depersonalization 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

5.3 Personal Accomplishment 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

6 Emotional Ability 1 Mean Difference (IV, Random, 95% CI) Totals not selected

6.1 Perceiving Emotions 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

6.2 Understanding Emotions 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

6.3 Regulating Emotions 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]

39Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

Comparison 3. Multi-component intervention versus no intervention(matched comparison)

Outcome or subgroup title No. of

studies

No. of

participants Statistical method Effect size

1 Retention rates, Cohort 1 1 Mean Difference (Random, 95% CI) Totals not selected

1.1 12 months follow-up 1 Mean Difference (Random, 95% CI) 0.0 [0.0, 0.0]

1.2 24 months follow-up 1 Mean Difference (Random, 95% CI) 0.0 [0.0, 0.0]

1.3 36 months follow-up 1 Mean Difference (Random, 95% CI) 0.0 [0.0, 0.0]

Analysis 1.1. Comparison 1 Changing task characteristics versus no intervention, Outcome 1 Occupational

Stress Inventory.

Review: Organisational inter ventions for improving wellbeing and reducing work-related stress in teachers

Comparison: 1 Changing task characteristics versus no inter vention

Outcome: 1 Occupational Stress Inventor y

Study or subgroup Experimental Control

Mean

Difference

Mean

Difference

N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI

1 Role Overload

Wu 2006 338 26.33 (4.42) 370 27.27 (4.67) -0.94 [ -1.61, -0.27 ]

2 Role Insufﬁciency

Wu 2006 338 21.38 (3.5) 370 22.19 (4.11) -0.81 [ -1.37, -0.25 ]

3 Role Ambiguity

Wu 2006 338 16.55 (3.29) 370 16.78 (4.86) -0.23 [ -0.84, 0.38 ]

4 Role Boundary

Wu 2006 338 18.13 (4.98) 370 21.52 (5.1) -3.39 [ -4.13, -2.65 ]

5 Responsibility

Wu 2006 338 19.52 (4.73) 370 20.71 (5.09) -1.19 [ -1.91, -0.47 ]

6 Physical Environment

Wu 2006 338 25 (6.17) 370 28.84 (5.33) -3.84 [ -4.69, -2.99 ]

7 Vocational Strain

Wu 2006 338 16.22 (3.5) 370 17 (5.1) -0.78 [ -1.42, -0.14 ]

8 Psychological Strain

Wu 2006 338 22.53 (5.45) 370 22.4 (6.05) 0.13 [ -0.72, 0.98 ]

9 Interpersonal Strain

Wu 2006 338 22.59 (3.07) 370 23.37 (4.37) -0.78 [ -1.33, -0.23 ]

-4 -2 0 2 4

Favours intervention Favours control

(Continued ...)

40Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

(. . . Continued)

Study or subgroup Experimental Control

Mean

Difference

Mean

Difference

N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI

10 Physical Strain

Wu 2006 338 20.61 (5.21) 370 20.72 (5.1) -0.11 [ -0.87, 0.65 ]

11 Recreation

Wu 2006 (1) 338 28.66 (4.49) 370 30.24 (4.99) -1.58 [ -2.28, -0.88 ]

12 Self care

Wu 2006 (2) 338 29.19 (5.03) 370 32.39 (4.19) -3.20 [ -3.89, -2.51 ]

13 Social Support

Wu 2006 (3) 338 37.32 (5.53) 370 37.82 (7.79) -0.50 [ -1.49, 0.49 ]

14 Rational/Cognitive Coping

Wu 2006 (4) 338 36.41 (5.25) 370 37.43 (4.11) -1.02 [ -1.72, -0.32 ]

-4 -2 0 2 4

Favours intervention Favours control

(1) Recreation, Self-care, Social Suppor t, % Rational/Cognitive Coping sub-scales reverse coded for correct graphical representation

(2) Recreation, Self-care, Social Suppor t, % Rational/Cognitive Coping sub-scales reverse coded for correct graphical representation

(3) Recreation, Self-care, Social Suppor t, % Rational/Cognitive Coping sub-scales reverse coded for correct graphical representation

(4) Recreation, Self-care, Social Suppor t, % Rational/Cognitive Coping sub-scales reverse coded for correct graphical representation

Analysis 1.2. Comparison 1 Changing task characteristics versus no intervention, Outcome 2 Work Ability

Index.

Review: Organisational inter ventions for improving wellbeing and reducing work-related stress in teachers

Comparison: 1 Changing task characteristics versus no inter vention

Outcome: 2 Work Ability Index

Study or subgroup Experimental Control

Mean

Difference

Mean

Difference

N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI

Wu 2006 338 39.25 (4.34) 370 36.98 (4.22) 2.27 [ 1.64, 2.90 ]

-4 -2 0 2 4

Favours control Favours inter vention

41Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

Analysis 2.1. Comparison 2 Changing organisational characteristics versus no intervention, Outcome 1 Job

Related Anxiety- 12 months.

Review: Organisational inter ventions for improving wellbeing and reducing work-related stress in teachers

Comparison: 2 Changing organisational characteristics versus no inter vention

Outcome: 1 Job Related Anxiety- 12 months

Study or subgroup Experimental Control

Mean

Difference

Mean

Difference

N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI

Tyson 2009 26 2.21 (0.95) 33 2.46 (0.86) -0.25 [ -0.72, 0.22 ]

-2 -1 0 1 2

Favours intervention Favours control

Analysis 2.2. Comparison 2 Changing organisational characteristics versus no intervention, Outcome 2 Job

Related Anxiety- 24 months.

Review: Organisational inter ventions for improving wellbeing and reducing work-related stress in teachers

Comparison: 2 Changing organisational characteristics versus no inter vention

Outcome: 2 Job Related Anxiety- 24 months

Study or subgroup Experimental Control

Mean

Difference

Mean

Difference

N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI

Tyson 2009 26 2.06 (0.66) 33 2.31 (0.75) -0.25 [ -0.61, 0.11 ]

-1 -0.5 0 0.5 1

Favours intervention Favours control

42Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

Analysis 2.3. Comparison 2 Changing organisational characteristics versus no intervention, Outcome 3 Job

Related Depression- 12 months.

Review: Organisational inter ventions for improving wellbeing and reducing work-related stress in teachers

Comparison: 2 Changing organisational characteristics versus no inter vention

Outcome: 3 Job Related Depression- 12 months

Study or subgroup Experimental Control

Mean

Difference

Mean

Difference

N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI

Tyson 2009 26 1.46 (0.6) 33 1.84 (0.87) -0.38 [ -0.76, 0.00 ]

-0.5 -0.25 0 0.25 0.5

Favours intervention Favours control

Analysis 2.4. Comparison 2 Changing organisational characteristics versus no intervention, Outcome 4 Job

Related Depression- 24 months.

Review: Organisational inter ventions for improving wellbeing and reducing work-related stress in teachers

Comparison: 2 Changing organisational characteristics versus no inter vention

Outcome: 4 Job Related Depression- 24 months

Study or subgroup Experimental Control

Mean

Difference

Mean

Difference

N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI

Tyson 2009 26 1.44 (0.43) 33 1.7 (0.77) -0.26 [ -0.57, 0.05 ]

-0.5 -0.25 0 0.25 0.5

Favours intervention Favours control

43Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

Analysis 2.5. Comparison 2 Changing organisational characteristics versus no intervention, Outcome 5

Maslach Burnout Inventory- Educators Survey.

Review: Organisational inter ventions for improving wellbeing and reducing work-related stress in teachers

Comparison: 2 Changing organisational characteristics versus no inter vention

Outcome: 5 Maslach Burnout Inventory- Educator s Survey

Study or subgroup Experimental Control

Mean

Difference

Mean

Difference

N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI

1 Emotional Exhaustion

Brown 2010 43 3.26 (1.023) 34 3.31 (1.061) -0.05 [ -0.52, 0.42 ]

2 Depersonalization

Brown 2010 43 1.415 (1.187) 33 1.58 (1.247) -0.17 [ -0.72, 0.39 ]

3 Personal Accomplishment

Brown 2010 43 4.778 (0.63) 33 4.72 (0.655) 0.06 [ -0.23, 0.35 ]

-100 -50 0 50 100

Favours intervention Favours control

44Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

Analysis 2.6. Comparison 2 Changing organisational characteristics versus no intervention, Outcome 6

Emotional Ability.

Review: Organisational inter ventions for improving wellbeing and reducing work-related stress in teachers

Comparison: 2 Changing organisational characteristics versus no inter vention

Outcome: 6 Emotional Ability

Study or subgroup Experimental Control

Mean

Difference

Mean

Difference

N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI

1 Perceiving Emotions

Brown 2010 42 4.075 (0.538) 33 3.95 (0.569) 0.13 [ -0.13, 0.38 ]

2 Understanding Emotions

Brown 2010 42 3.734 (0.428) 34 3.81 (0.455) -0.07 [ -0.27, 0.13 ]

3 Regulating Emotions

Brown 2010 42 3.898 (0.48) 34 3.79 (0.501) 0.11 [ -0.11, 0.33 ]

-100 -50 0 50 100

Favours experimental Favours control

45Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

Analysis 3.1. Comparison 3 Multi-component intervention versus no intervention(matched comparison),

Outcome 1 Retention rates, Cohort 1.

Review: Organisational inter ventions for improving wellbeing and reducing work-related stress in teachers

Comparison: 3 Multi-component intervention versus no inter vention(matched comparison)

Outcome: 1 Retention rates, Cohort 1

Study or subgroup Mean Difference (SE)

Mean

Difference

Mean

Difference

IV,Random,95% CI IV,Random,95% CI

1 12 months follow-up

Glazerman 2012 7.9 (3.01) 7.90 [ 2.00, 13.80 ]

2 24 months follow-up

Glazerman 2012 18.3 (4.87) 18.30 [ 8.75, 27.85 ]

3 36 months follow-up

Glazerman 2012 11.5 (4.21) 11.50 [ 3.25, 19.75 ]

-20 -10 0 10 20

Favours control Favours inter vention

A P P E N D I C E S

Appendix 1. PsycINFO search strategy

#1 (school teacher* OR teaching assistant OR teaching profession* OR teaching staff OR school personnel OR school staff OR head

teacher* OR school employee*).mp.

#2 teachers/ OR college teachers/ OR elementary school teachers/ OR junior high school teachers/ OR middle school teachers/

#3 ”teacher*“.ti.

#4 1 OR 2 OR 3

#5 occupational stress/

#6 (burnout OR burn out OR psychological workload OR psychological work load OR job satisfaction OR occupational stress*).mp.

#7 5 OR 6

#8 4 AND 7

#9 stress/ OR psychological stress/ OR anxiety/ OR distress/ OR health/ OR mental health/ OR well being/

#10 4 AND 9

#11 (well being OR wellbeing OR stress* OR burnout OR anxie* OR anxious* OR depress* OR satisfaction OR strain OR burden

OR absent* OR turnover OR retention).mp.

#12 (work* OR occupation* OR job OR jobs OR employee* OR organisation* OR organization* OR school OR college OR academy

OR classroom).mp.

#13 11 AND 12

#14 4 AND 13

#15 8 OR 14

46Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

#16 (intervention OR promotion OR prevention OR programme OR program* OR evaluat* OR effect* OR service OR change OR

modif* OR switch* OR alter* OR substitut* OR shift OR promot* OR transform* OR control*).mp.

#17 15 AND 16

#18 (school level policy OR school level governance OR management practice OR management culture OR school ethos OR (school

ADJ5 climate) OR (school ADJ5 culture) OR (school ADJ5 environment) OR (school ADJ5 manag*) OR (school ADJ5 leader*)

OR (school ADJ5 organisation*) OR (school ADJ5 organization*) OR (school ADJ5 governance) OR (teaching ADJ3 practices) OR

(teaching ADJ3 standard*) OR (teaching ADJ3 style*) OR (teaching ADJ3 method*) OR (teaching ADJ3 differen*) OR (teaching

ADJ3 varia*) OR education* context* OR classroom manag* OR organization* structure OR organisation* structure OR organisation*

culture OR organization* culture OR communication OR work environment OR (education* ADJ3 practices) OR (education* ADJ3

culture) OR (education* ADJ3 manag*) OR (education* ADJ3 leader*) OR (education* ADJ3 communicat*)).mp.

#19 17 AND 18

Appendix 2. Search strategies for other databases

ASSIA

all(”school teacher*“ OR ”teaching assistant“ OR ”teaching profession*“ OR ”Teaching staff“ OR ”school personnel“ OR ”School

staff“ or ”head teacher“ OR ”school employee“) OR ti(teacher*)

AEI

(”school teacher*“ OR ”teaching assistant“ OR ”teaching profession*“ OR ”Teaching staff“ OR ”school personnel“ OR ”School staff“

or ”head teacher“ OR ”school employee“) OR ti. teacher*

BiblioMap

1 Freetext: ”teacher*“

2 Freetext: ”stress*“

3 Combine 1 and 2

4 Keyword term: Focus of the report: mental health

5 Combine 1 and 4

6 Combine 3 or 5

BEI

(”school teacher*“ OR ”teaching assistant“ OR ”teaching profession*“ OR ”Teaching staff“ OR ”school personnel“ OR ”School staff“

or ”head teacher“ OR ”school employee“) OR ti(teacher*)

SU.EXACT.EXPLODE(”Licensed

Teachers“) OR SU.EXACT.EXPLODE(”Physical Education Teachers“) OR SU.EXACT.EXPLODE(”Middle School Teach-

ers“) OR SU.EXACT.EXPLODE(”Special Education Teachers“) OR SU.EXACT.EXPLODE(”Secondary School Teachers“) OR

SU.EXACT.EXPLODE(”Black Teachers“) OR SU.EXACT.EXPLODE(”Minority Group

Teachers“) OR SU.EXACT.EXPLODE(”Substitute Teachers“) OR SU.EXACT.EXPLODE(”Business Education Teachers“) OR

SU.EXACT.EXPLODE(”Careers Teachers“) OR SU.EXACT.EXPLODE(”Art Teachers“) OR SU.EXACT.EXPLODE(”Geography

Teachers“) OR SU.EXACT.EXPLODE(”Music Teachers“) OR

SU.EXACT.EXPLODE(”Science Teachers“) OR SU.EXACT.EXPLODE(”Biology Teachers“) OR SU.EXACT.EXPLODE(”Home

Economics Teachers“) OR SU.EXACT.EXPLODE(”Mathematics Teachers“) OR SU.EXACT.EXPLODE(”Primary School Teachers“)

OR SU.EXACT.EXPLODE(”Physics Teachers“) OR SU.EXACT.EXPLODE(”Craft

Education Teachers“) OR SU.EXACT.EXPLODE(”Part Time Teachers“) OR SU.EXACT.EXPLODE(”Bilingual Teachers“) OR

SU.EXACT.EXPLODE(”Vocational Education Teachers“) OR SU.EXACT.EXPLODE(”Technology

Teachers“) OR SU.EXACT.EXPLODE(”English Studies Teachers“) OR SU.EXACT.EXPLODE(”History Teachers“) OR

SU.EXACT.EXPLODE(”Remedial Teachers“) OR SU.EXACT.EXPLODE(”Language Teachers“) OR

SU.EXACT.EXPLODE(”Chemistry Teachers“) OR SU.EXACT.EXPLODE(”Drama

Teachers“) OR SU.EXACT.EXPLODE(”Deputy Head Teachers“) OR SU.EXACT.EXPLODE(”Religious Education Teach-

ers“) OR SU.EXACT.EXPLODE(”Peripatetic Teachers“) OR SU.EXACT.EXPLODE(”Advanced Skills Teachers“) OR

SU.EXACT.EXPLODE(”Head Teachers“) OR SU.EXACT.EXPLODE(”Technical

Education Teachers“) OR SU.EXACT.EXPLODE(”Women Teachers“) OR SU.EXACT.EXPLODE(”Adult Education Teachers“) OR

47Organisational interventions for improving wellbeing and reducing work-related stress in teachers (Review)

SU.EXACT.EXPLODE(”Support Teachers“) OR SU.EXACT.EXPLODE(”Teachers“) OR SU.EXACT.EXPLODE(”Reading Teach-

ers“) OR SU.EXACT.EXPLODE(”Further Education Teachers“)

((”school teacher*“ OR ”teaching assistant“ OR ”teaching profession*“ OR ”Teaching staff“ OR ”school personnel“ OR

”School staff“ OR ”head teacher“ OR ”school employee“) OR ti(teacher*)) OR (SU.EXACT.EXPLODE(”Licensed Teach-

ers“) OR SU.EXACT.EXPLODE(”Physical Education Teachers“) OR SU.EXACT.EXPLODE(”Middle School Teachers“)

OR SU.EXACT.EXPLODE(”Special Education Teachers“) OR SU.EXACT.EXPLODE(”Secondary School Teachers“) OR

SU.EXACT.EXPLODE(”Black Teachers“) OR SU.EXACT.EXPLODE(”Minority Group

Teachers“) OR SU.EXACT.EXPLODE(”Substitute Teachers“) OR SU.EXACT.EXPLODE(”Business Education Teachers“) OR

SU.EXACT.EXPLODE(”Careers Teachers“) OR SU.EXACT.EXPLODE(”Art Teachers“) OR SU.EXACT.EXPLODE(”Geography

Teachers“) OR SU.EXACT.EXPLODE(”Music Teachers“) OR

SU.EXACT.EXPLODE(”Science Teachers“) OR SU.EXACT.EXPLODE(”Biology Teachers“) OR SU.EXACT.EXPLODE(”Home

Economics Teachers“) OR SU.EXACT.EXPLODE(”Mathematics Teachers“) OR SU.EXACT.EXPLODE(”Primary School

Teachers“) OR SU.EXACT.EXPLODE(”Physics Teachers“) OR SU.EXACT.EXPLODE(”Craft Education Teachers“) OR

SU.EXACT.EXPLODE(”Part Time Teachers“) OR SU.EXACT.EXPLODE(”Bilingual

Teachers“) OR SU.EXACT.EXPLODE(”Vocational Education Teachers“) OR SU.EXACT.EXPLODE(”Technology Teachers“) OR

SU.EXACT.EXPLODE(”English Studies Teachers“) OR SU.EXACT.EXPLODE(”Part

Time Teachers“) OR SU.EXACT.EXPLODE(”Bilingual Teachers“) OR SU.EXACT.EXPLODE(”Vocational Education Teachers“)

OR SU.EXACT.EXPLODE(”Technology Teachers“) OR SU.EXACT.EXPLODE(”English

Studies Teachers“) OR SU.EXACT.EXPLODE(”History Teachers“) OR SU.EXACT.EXPLODE(”Remedial Teachers“) OR

SU.EXACT.EXPLODE(”Language Teachers“) OR SU.EXACT.EXPLODE(”Chemistry

Teachers“) OR SU.EXACT.EXPLODE(”Drama Teachers“) OR SU.EXACT.EXPLODE(”Deputy Head Teachers“) OR

SU.EXACT.EXPLODE(”Religious

Education Teachers“) OR SU.EXACT.EXPLODE(”Peripatetic Teachers“) OR SU.EXACT.EXPLODE(”Advanced Skills Teachers“)

OR SU.EXACT.EXPLODE(”Head Teachers“) OR SU.EXACT.EXPLODE(”Technic al

Education Teachers“) OR SU.EXACT.EXPLODE(”Women Teachers“) OR SU.EXACT.EXPLODE(”Adult Education Teachers“) OR

SU.EXACT.EXPLODE(”Support Teachers“) OR SU.EXACT.EXPLODE(”Teacher s“) OR SU.EXACT.EXPLODE(”Reading Teach-

ers“) OR SU.EXACT.EXPLODE(”Further Education Teachers“))

SU.EXACT.EXPLODE(”Teacher Burnout“) OR SU.EXACT.EXPLODE(”Burnout“)

burnout OR ”burn out“ OR ”psychological workload“ OR ”psychological work load“ OR ”Job satisfaction“ OR ”occupational stress“

OR ”work related stress“ OR ”vocational stress“

(SU.EXACT.EXPLODE(”Teacher Burnout“) OR SU.EXACT.EXPLODE(”Burnout “)) OR (burnout OR ”burn out“ OR ”psycholog-

ical workload“ OR ”psychological work load“ OR ”Job satisfaction“ OR ”occupational stress“ OR ”work related stress“ OR ”vocational

stress“)

SU.EXACT.EXPLODE(”Special Education Teachers“) OR SU.EXACT.EXPLODE(”Secondary

School Teachers“) OR SU.EXACT.EXPLODE(”Black Teachers“) OR SU.EXACT.EXPLODE(”Minority Group Teach-

ers“) OR SU.EXACT.EXPLODE(”Substitute Teachers“) OR SU.EXACT.EXPLODE(”Business Education Teachers“) OR