A Scalable Teacher Professional Development and Wellness Program in Primary Schools: A Cluster Randomized Clinical Trial

In Uganda and other low-income settings with prevalent mental health problems and limited resources, scalable professional development (PD) models are needed to strengthen teachers' capacity to apply evidence-based practices to support child mental health.

To examine the short-term effectiveness of PD and PD with a teacher-wellness enhancement (PDT) compared with a control condition on teacher knowledge and use of evidence-based practices, teacher stress, and teacher stress management; implementation outcomes; and the differential outcomes between urban and rural primary schools in Uganda.

This cluster randomized clinical trial was conducted in 47 urban and rural schools in Uganda between August 2021 and February 2025. Participating teachers in the schools were followed-up 24 months after the intervention, and the present trial focused on short-term teacher outcomes. Statistical analysis followed the intention-to-treat principle.

Schools and teachers were randomized to 1 of 3 conditions: PD, PDT, and control. The PD intervention (mWEL-PD or Mental Wellbeing and Empowering Lives of the School Community: Professional Development) consisted of 3 days of training and 8 one-hour coaching sessions in person for 2 to 3 months. The PDT intervention (mWEL-PD with a teacher-wellness enhancement) was provided as the PD program plus a 1-day workshop and 3 group support sessions. The control condition offered no intervention during year 1, but mental health knowledge and promotion materials and a 1-day teacher-wellness workshop were provided in year 2.

The primary outcomes for PD and PDT groups were knowledge and use of evidence-based practices. Teachers completed 15 self-report measures assessing 4 key outcomes: knowledge of evidence-based practices, use of evidence-based practices, teacher stress, and teacher stress management. Implementation outcomes, self-assessed after completion of the intervention, included teacher engagement in the intervention, teacher perception of acceptability and usefulness of the content, and teacher perception of the competence of the program facilitators.

A total of 47 schools with 509 teachers (mean [SD] age, 40.60 [11.12] years; 368 females [72.3%]) were included in the analysis. Among the schools, 15 (31.9%) were randomly assigned to the control, 16 (34.0%) to the PD, and 16 (34.0%) to the PDT groups. Among teachers, 165 (32.4%) were randomly assigned to the control, 187 (36.7%) to the PD, and 157 (30.8%) to the PDT groups. Teacher attendance at training and coaching sessions and ratings of relevance and facilitator competence were high in both urban and rural contexts. Compared with teachers in the PD group, those in the PDT group were more likely to attend all training days offered (120 of 187 [64.1%] in the PD group vs 127 of 157 [80.9%] in the PDT group) and participated in more coaching sessions (mean [SD] number, 4.58 [2.91] vs 6.09 [2.28]). Compared with teachers in the control condition, teachers in the PDT condition benefited on all 4 key outcomes: increased knowledge (standardized mean difference [SMD], 0.57; 95% CI, 0.26-0.88) and use (SMD, 0.36; 95% CI, 0.01-0.71) of evidence-based practices, increased stress management (SMD, 0.50; 95% CI, 0.19-0.80), and decreased stress (SMD, -0.27; 95% CI, -0.54 to 0.01). Benefits of PD were limited to knowledge of evidence-based practices (SMD, 0.33; 95% CI, 0.03-0.62).

This trial of a scalable teacher PD program delivered through existing educational infrastructure and resources demonstrates the program's feasibility, acceptability, and impact on self-reported teacher outcomes. The finding of short-term benefits for teacher practice and wellness suggests the potential of the PDT model for school-based mental health promotion.

ClinicalTrials.gov Identifier: NCT04383327.