Psychosocial Support Program for Public School Teachers

Early and Sustained change in the score in the Mental health Knowledge & Attitudes Questionnaire

Same instrument used in the primary outcome

Time frame: Baseline (T0) to after the second training session (approximately 1 week after baseline)/after ending of the asynchronous training (T1); Baseline (T0) to 1-month follow-up (T3)

Appropriate Response to a Student Mental Health Concern: Open-Ended Classroom Scenario

Participants are asked to recall a recent situation in their classroom in which they noticed behaviors in a student that raised a possible concern about the student's mental health or psychosocial well-being. Participants provide an open-ended description of the situation and the behaviors they observed and describe what, if anything, they did to support the student. Responses will be evaluated to determine whether the actions described by the participant are considered appropriate (1) or not (0) based on the principles taught in the training. This assessment will be blind to the allocation group. The percentage of responses classified as appropriate will be calculated and compared across the three intervention arms. The recall period varies by assessment time point: at T1 and T2, situations occurring during the past week; and at T3, situations occurring during the past month.

Time frame: after the second training session (approximately 1 week after baseline)/after ending of the asynchronous training (T1); post-intervention at 2-4 weeks (T2); 1-month follow-up (T3)

Self-rated knowledge

Assessed using two self-report items developed for this study. One item assesses participants' perceived knowledge of mental health, rated on a five-point scale from very poor to excellent. A second item assesses participants' confidence in their ability to identify students with psychosocial or mental health difficulties, rated on a five-point scale from not at all confident to extremely confident. Higher scores indicate greater self-rated knowledge and confidence. Participants may also select prefer not to answer.

Time frame: baseline (T0); after the second training session (approximately 1 week after baseline)/after ending of the asynchronous training (T1); post-intervention at 2-4 weeks (T2); 1-month follow-up (T3)

Changes in helping behaviors toward students

Assessed using a retrospective self-report scale developed to capture mental health-related helping behaviors toward students ("Helping Behaviors Scale"), including identifying emotional distress, providing support, and facilitating referral to appropriate services. The scale includes five items describing specific helping behaviors. Each item is rated as yes, no, or does not apply. Higher endorsement indicates a greater number of supportive actions taken by the respondent in the past week.

Time frame: Baseline (T0) to after the second training session (approximately 1 week after baseline)/after ending of the asynchronous training (T1); Baseline (T0) to post-intervention at 2-4 weeks (T2); Baseline (T0) to 1-month follow-up (T3)

Change in the levels of teacher burnout

Teacher burnout will be assessed using the 12-item version of the Burnout Assessment Tool (BAT-12), a self-report questionnaire developed to assess burnout as a multidimensional psychological syndrome. It evaluates four core dimensions of burnout: exhaustion, mental distance, cognitive impairment, and emotional impairment. Each item is rated on a five-point frequency scale ranging from 1 (never) to 5 (always). A total burnout score will be calculated as the mean of the 12 items, with higher scores indicating greater burnout symptoms.

Time frame: Baseline (T0); after the second training session (approximately 1 week after baseline)/after ending of the asynchronous training (T1); post-intervention at 2-4 weeks (T2); 1-month follow-up (T3)

Training acceptability & satisfaction

Assessed using a post-training self-report questionnaire developed for this study. The questionnaire includes one item assessing perceived adequacy of training length, rated as too short, about right, or too long; one item assessing whether the training included sufficient practice of the skills taught, rated on a five-point Likert scale ranging from strongly disagree to strongly agree. Higher ratings indicate greater satisfaction with the training components. An optional open-ended item collects additional qualitative feedback about the training.

Time frame: Post-intervention at 2-4 weeks (T2)

Cost-effectiveness of the intervention

Cost-effectiveness will be calculated as the cost per improvement unit in the Mental health Knowledge \& Attitudes Questionnaire described previously

Time frame: Baseline (T0) to post-intervention at 2-4 weeks (T2)