JMIR Publications

ABSTRACT

Background:

Social-emotional competence and bullying/cyberbullying prevention increasingly are being prioritized by schools, so development of novel, low-cost and high-yield programs addressing these topics is important. Further, rigorous assessment of interventions prior to widespread dissemination is crucial.

Objective:

This study assessed the effectiveness and implementation fidelity of the ACT Out! Social Issue Theater program, a one-hour psychodramatic intervention by professional actors; it also measured students’ receptiveness to the intervention.

Methods:

This study was a two-arm cluster randomized control trial with 1:1 allocation that randomized at the classroom level (n = 76 classrooms in 12 schools across five counties in Indiana, comprised of n = 1,571 students at pretest in 4th, 7th, and 10th grades). The primary outcomes were self-reported social-emotional competence, bullying perpetration, and bullying victimization, and the secondary outcomes were receptiveness to the intervention, implementation fidelity (independent observer observation), and prespecified sub-analyses of social-emotional competence for 7th and 10th grade students. All outcomes were collected at baseline and two-week posttest, with planned three-month posttest data collection being prevented by the COVID-19 pandemic.

Results:

Intervention fidelity was uniformly excellent (> 96% adherence), and students were highly receptive to the program. However, trial results did not support the hypothesis that the intervention would increase participants’ social-emotional competence. The intervention’s impact on bullying was complicated to interpret and included some evidence of small interaction effects (reduced cyberbullying victimization and increased physical bullying perpetration). However, there were also statistically and clinically significant reductions in physical, verbal, and relational bullying victimization in the full sample (pooled across both study arms). While not appropriate for causal attribution, the occurrence of these effects across 12 schools in different counties, with 76 classrooms, within a span of two weeks, by chance, was implausible, though we cannot state with certainty why these effects manifested.

Conclusions:

We conceptually discuss several potential alternative explanations. As a next step, we encourage research into whether the ACT Out! intervention may engender a bystander effect not amenable to randomization by classroom. We therefore recommend a larger trial of the ACT Out! intervention that is focused specifically on cyberbullying, measures bystander behavior, is randomized by school, and is controlled for extant bullying prevention efforts at each school. Clinical Trial: This study was prospectively registered with Clinicaltrials.gov (NCT04097496), and the study protocol is available at https://doi.org/10.2196/17900.