The effectiveness of KiVa to reduce bullying in UK primary schools
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Bullying in childhood is one of the most tractable public mental health problems facing young people [1]. It is generally defined as a pattern of ‘unwanted, aggressive behaviour … that involves a real or perceived imbalance of power’ [2]. The psychiatric morbidity arising from bullying is substantial; population studies suggest that 25–40% of mental health problems including depression, anxiety and self-harm in young adults may be attributable to childhood bullying [3, 4].
Bullied children access more school health, primary care and specialist child mental health services than their counterparts [5] and experience poor mental health into adulthood [5, 6]. Bullying is also associated with school absenteeism [7, 8] impacting future educational attainment and employment prospects. Children who bully are also at risk of harm and more likely to show later violent behaviour and illicit drug use [9, 10].
This paper describes the protocol for a two-arm pragmatic multicentre cluster randomised controlled Trial (RCT) trial with an embedded process and cost effectiveness evaluation of the Kiusaamisen Vastaan (“KiVa”) anti-bullying programme, the most widely used bullying prevention programme across Europe. In a Finnish RCT (2007–2009) in 234 schools, KiVa significantly reduced bullying and victimisation among 7 to 11-year-old students [11] across all forms of bullying, including verbal, physical, racist, and cyber-bullying [12] and reduced anxiety and depression [13]. Since 2009, KiVa has been scaled up into over 90% of Finnish public schools (approximately 2700 schools) and demonstrated year on year positive effects [14].
A cost effectiveness analysis reported an increased cost of €829 for a gain of 0.47 victim-free years per student, and a cost per QALY gained of €13,823 considered cost-effective when compared to the Swedish health policy threshold of around €50,000 per QALY [15].
Unlike the UK, Finland’s education system has negligible attainment differences between schools: no selection, tracking or streaming during basic education and highly educated primary school teachers with a mandatory fve-year master’s degree qualifcation [16]. Finland is also one of the wealthiest countries in the world and has less income inequality than the United Kingdom (https://data.oecd.org/inequality/income-inequality.htm). It is, therefore, not certain that KiVa intervention effects will transfer to the UK context.
KiVa trials in Italy and the Netherlands [17, 18] found reduced levels of bullying and victimisation with variable effect sizes. A small pilot study in Wales however found no statistically significant reduction in victimization and bullying [19]. The Stand Together RCT is being conducted in UK primary schools with students aged 7 to 11 years, and will include a comprehensive process and health economic evaluation.