Interpretation
Overall, there were no statistically significant differences noted on the global SROM as well as within the constructs (PSD, SP, VI); however, on subscales, the results seemed consistent. The results, however, showed that the direction of change of the treatment effect was consistent with the hypothesis, with a difference of as large as 3.30—which is the upper limit of the 95% CI for the difference in the global SROM score. There were additionally no statistically significant differences in quintile subgroups and sensitivity analysis showed similar results with ITT. Additionally, there were no significant subgroup differences. However, the direction of the treatment effect was consistent with the hypothesis. Despite contextual discrepancies in the schools included in this study, the CCR intervention showed that the lower and higher quintile schools behaved similarly. This result is interesting given the contextual complexities of schools in the WC and the use of quintile classification. It signals that the CCR intervention may be useful for both quintiles in future planning related to this study and possibly to guide future teasing and bullying related school policy.
A cluster RCT conducted with grade 7 learners in peer attitudes towards disability in France noted that the study of cognitive, affective and behavioural components is important when measuring peer attitudes [
27]. This finding supports the use of the SROM which includes these components within the constructs of PSD, SP and VI. Despite the inclusion of these components, it is possible that the SROM is not sensitive enough to pick up changes in attitudes. However, in the absence of another outcomes measure, the SROM was used given the available data on the reliability and validity testing so far [
16]. A similar study targeting classroom-based peer attitudes through teacher administered activities and videos for peers with Tourette’s syndrome also used the condition as an example to improve general attitudes and beliefs towards disabling conditions [
10], much like the CCR intervention. The study of peer attitudes towards Tourette’s syndrome recommended that baseline and post-intervention findings yield important results but that classroom observations should also be considered because of the changing nature of attitudes over time, i.e. to see if any attitudinal changes persist over time [
10] and manifest beyond that of the outcomes measure.
In addition to the potential reduced sensitivity of the SROM to measure peer attitudes, it should also be considered that attitude and attitude change is cited as being a complex topic to study [
11,
12]. In fact, it is reported that quantifying, measuring and exploring attitude is challenging and that there is no one way of doing so [
12]. It is particularly complex to measure attitude knowing that the formation of attitude and attitude change changes over time because attitude is learnt [
28] as a continuous process [
29]. As such, it is possible that six months was too short to allow for attitudinal change to be measured. Perhaps this CCR intervention study should consider two things: (1) thoughts and beliefs cannot solely be measured using questionnaires and so additional observational data may be needed; and (2) there is no one optimal time frame in which attitude can be measured. It is important that when complex topics (such as peer attitude) are being studied, other measures and methods of commenting on the effectiveness of interventions are drawn upon without solely relying on statistically significant results.
Another crucial factor to consider is the time frame challenges that were experienced in this study due to the context of school-based research. First, school-based research comes with its own challenges such as time constraints that research imposes on schools as well as those stipulated by the Western Education Department (WCED), schools and teachers. Given the busy academic schedule, research can only be conducted when and where the school is able to accommodate the research. As mentioned, the WCED has strict regulations around when school-based research may take place and as such it was stipulated that the research could only be conducted between 1 February and 29 September 2017. These dates, however, do not consider school holidays, other school-specific commitments and the time needed to set up research. The tasks needed to set up the research required careful planning and included recruitment, obtaining permission, consent and assent from schools, principals, teachers, parents and participants, as well as arranging suitable dates and times for baseline data, teacher training, administration of the CCR and follow-up dates for the six months of post-intervention data. As illustrated by the details of the logistics of the research processes in schools, this meant that the data were unable to be collected over the eight-month period as stipulated by the WCED. As a result, the six-month period after the administration of the CCR intervention was the longest possible time frame that could be made available for this research. The research could also not be extended as the participants moved to the next grade and or school in January 2018 and thus there could be no way of including all participants beyond September 2017. In conclusion, this study could therefore be improved by replicating its findings, further study of the CCR intervention, publishing the findings around the sensitivity and psychometric properties of the SROM and considering additional other measurement tools such as observations.