A cluster randomised control trial of the impact of the ‘Breaking the Man Code’ workshops on adolescent boys’ intentions to seek help

INTERVENTION: Brief Name: The ‘Breaking the Man Code’ Workshops delivered by Tomorrow Man to male secondary school students in Australia. One workshop delivered to year 10, 11 or 12 male secondary school students in Australia by a trained facilitator from Tomorrow Man (tomorrowman.com.au). The workshop is usually provided within school class time to male students of one year level at secondary school and comprises interactive group activities. The workshop delivery is face‐to‐face and takes approximately 2 hours. Each workshop includes between 30 to 35 male students, with an average of three workshops to three different groups of students, totalling an average of 100 students per school. Multiple workshops at the one school are usually delivered by the one facilitator. The workshop explores the impact of the ‘man code’ – the unwritten rules about how to be a man – on the wellbeing of Australian men. It explores who wrote the rules and investigates why men feel obliged to live up to gender expectations and stereotypes. The workshop then allows boys to open up about their experience living with the ‘man code’ in order to understand that they can write their own rules. The workshop aims to lessen the negative impact of some masculine norms and to develop protective factors such as positive attitudes towards help‐seeking, emotional expressiveness, and social support. Students will complete a baseline questionnaire approximately 2 weeks prior to the workshop and a follow‐up questionnaire 4‐6 weeks after the workshop. Adherence to the intervention will not be monitored. CONDITION: Mental Health ‐ Suicide Mental health;Suicide; ; Mental health ; Suicide Public Health ‐ Health promotion/education PRIMARY OUTCOME: Difference between the two study arms for mean change in intentions to seek help, as measured by an adapted version of the General Help Seeking Questionnaire (GHSQ) (Wilson et al. 2005. Measuring help seeking intentions: Properties of the General Help Seeking Questionnaire. Canadian Journal of Counselling, Vol. 39(1), 15‐28.).; ; The GHSQ has been found to have reliability and validity, and to be a suitable measure of help‐seeking intentions in a range of contexts. Item or total scores can be used in analysis, and the scale can be modified to add in extra response items. The GHSQ asks participants: “If you were having a personal or emotional problem, how likely is it that you would seek help from the following people or services?” Response items include an intimate partner, friend or doctor. Three purpose‐designed items were added, namely: online health chat rooms, online searches for health information, and social media. The final scale comprises 10 items and participants responded on a seven‐point Likert scale (range 10‐70). Higher scores reflect higher intentions to seek help. [The baseline assessment will occur after randomisation of schools, within the two weeks prior to the intervention group receiving the workshop. The follow‐up assessment will occur four to six weeks after the intervention group receives the workshop.] SECONDARY OUTCOME: Difference between the two study arms in mean change in depression risk as measured by the Male Depression Risk Scale (Rice et al. 2013 Development and preliminary validation of male depression risk scale: Furthering the assessment of depression in men. Journal of Affective Disorders, 151: 950‐958). ; ; ; ; ; INCLUSION CRITERIA: School inclusion: 1. Request a ‘Breaking the Man Code’ workshop for their year 10, 11 or 12 males in 2021 or 2022. 2. Agree to schedule the workshop within either the intervention period or wait list period (after the trial is complete) as instructed by the researchers. Student inclusion: 1. Student within a participating school in years 10, 11 or 12. ; This 22‐item scale was chosen to capture the externalising symptoms of depression common to males ‐ emotional suppression, drug use, alcohol use, anger and aggression, somatic symptoms, and risk taking. Items are answered on an 8‐point likert scale (1 = not at all to 7 = almost always), range 22 – 154. High scores indicate higher depression risk. The MDRS‐22 reports satisfactory preliminary psychometric properties with validated subscales enabling multidimensional assessment of theorised externalising symptom sub‐domains. ; [After randomisation of schools, within the two weeks prior to the intervention group receiving the workshop and four to six weeks after the intervention group receives the workshop.] Difference between the two study arms in mean change in health‐related masculine values as measured by the Health‐Related Masculine Values scale (Oliffe., et al (2019). A mixed‐methods study of the health‐related masculine values among young Canadian men. Psychology of Men & Masculinities, 20(3), 310–323. ; This 15‐item scale assess men’s level of agreement with five values: selflessness, openness, well‐being, strength, and autonomy. Answers are provided on a 5‐point likert scale (1 = strongly disagree to 5 = strongly agree), range 15 – 75, with higher scores reflecting higher endorsement of the values. A preliminary factor analysis has confirmed the structure of the scale (Oliffe et al., 2018). ; [After randomisation of schools, within the two weeks prior to the intervention group receiving the workshop and four to six weeks after the intervention group receives the workshop.] Difference between the two study arms in mean change in subjective social support as measured by the Subjective Support Subscale of the Abbreviated Duke Social Support Index. Koenig,. et al. (1993). Abbreviating the Duke Social Support Index for use in chronically ill elderly individuals. Psychosomatics. 34(1): p. 61‐69. ; This 7‐item scale asks participants about the availability of friends and family for support. The first 6 items are answered using a 3‐point likert scale (1 = hardly ever to 3 = most of the time). The 7th question about overall satisfaction with relationships is also answered on 3‐point likert scale (1 = very dissatisfied to 3 = satisfied). Total scale range is 7 – 21. Higher scores reflect higher perceived social support. It has been validated for use in older people (Koenig et al. 1993) and has demonstrated high reliability and validity in young people (Jia & Zhang, 2012). ; [After randomisation of schools, within the two weeks prior to the intervention group receiving the workshop and four to six weeks after the intervention group receives the workshop.] Difference between the two study arms in mean change in well‐being as measured by the Warwick‐Edinburgh Well‐being Scale (WEWBS) (Tennant et al. (2007). The Warwick‐Edinburgh Mental Well‐being Scale (WEMWBS): development and UK validation. Health and Quality of Life Outcomes. 5: 63‐76. ; This 14‐item scale covers aspects of mental health including positive affect, satisfying interpersonal relationships, and positive function in the past two weeks. Answers are provided using a 5‐point likert scale (1 = none the time to 5 = all of the time). Range 14 – 70. Higher scores indicate higher well‐being. The scale has demonstrated sound validity and reliability (Tennant et al., 2007). 2. Self‐identified male 3. Enrolled to take part in a workshop 4. Parent has provided consent for them to take part in the trial ; [After randomisation of schools, within the two weeks prior to the intervention group receiving the workshop and four to six weeks after the intervention group receives the workshop.] Difference between the two study arms in mean change of conformity to masculine norms as measured by the Conformity to Masculine Norms Inventory (Mahalik et al. (2003). Development of the Conformity to Masculine Norms Inventory. Psychology of Men & Masculinity, 4: 3‐25). ; The Conformity to Masculine Norms Inventory (CMNI‐22) is a 22‐item scale will assess participants’ conformity to 11 potentially harmful masculine norms: emotional control; risk‐taking; violence; dominance; playboy; self‐reliance; primary of work; power over women; heterosexual presentation; physical toughness; and pursuit of status (Mahalik et al., 2003). Items are answered on a 4‐point likert scale (0 = strongly disagree to 3 = strongly agree), range 0 – 66. Higher scores indicate higher conformity to masculine norms. The CMNI‐22 has been found to have good internal consistency, differential validity, and test‐retest reliability (Mahalik et al. 2003). [After randomisation of schools, within the two weeks prior to the intervention group receiving the workshop and four to six weeks after the intervention group receives the workshop.] Difference between the two study arms in mean change of intentions to recommend that a female friend seek help as measured by an adapted version of the General Help Seeking Questionnaire (GHSQ) (Wilson et al. 2005. Measuring help seeking intentions: Properties of the General Help Seeking Questionnaire. Canadian Journal of Counselling, Vol. 39(1), 15‐28.).[After randomisation of schools, within the two weeks prior to the intervention group receiving the workshop and four to six weeks after the intervention group receives the workshop.] Difference between the two study arms in mean change of intentions to recommend that a male friend seek help as measured by an adapted version of the General Help Seeking Questionnaire (GHSQ) (Wilson et al. 2005. Measuring help seeking intentions: Properties of the General Help Seeking Questionnaire. Canadian Journal of Counselling, Vol. 39(1), 15‐28.).[After randomisation of schools, within the two weeks prior to the intervention group receiving the workshop and four to six weeks after the intervention group receives the workshop.] 3. Agree to distribute study information to parents of boys enrolled in the workshop and to allocated two class times, 2‐3 months apart, for students to complete the baseline and follow‐up questionnaire.