Using qualitative research to explore intervention mechanisms: findings from the trial of the Learning Together whole-school health intervention
Open accessAbstract
Background: This study reports on qualitative research conducted within a randomised controlled trial to explore possible intervention mechanisms. It focuses on the ‘Learning Together’ whole-school intervention delivered in secondary schools in England from 2014 to 2017 aiming to prevent bullying and aggression and improve student health. Intervention schools received staff training in restorative practice, a social and emotional learning curriculum, and an external facilitator and manual to convene and run a student/staff action group tasked with coordinating the intervention, focusing this on local needs. Methods: Informed by realist approaches to evaluation, we analysed qualitative data to explore intervention mechanisms and how these might interact with school contexts to generate outcomes. Qualitative analysis drew on 45 interviews and 21 focus groups across three case-study schools and employed thematic content analysis to explore how intervention resources were taken up and used by local actors, how participants described the intervention mechanisms that then ensued, and how these might have generated beneficial outcomes. Results: The thematic content analysis identified three social mechanisms that recurred in participant accounts: (1) building student commitment to the school community, (2) building healthy relationships by modelling and teaching pro-social skills, and (3) de-escalating bullying and aggression and enabling re-integration within the school community. Conclusions: Our analysis provides in-depth exploration of possible mechanisms and the contextual contingencies associated with these, allowing refinement of the initial intervention theory of change. Trial registration: ISRCTN registry 10751359. Registered on 11 March 2014
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Desirable changes did not need to be observed across a whole school or even multiple children in a classroom; teachers responded positively and favourably when change was observed with just one student.
“Often, desirable changes did not need to be observed across a whole school, or even multiple children in a classroom; teachers responded positively and favourably when change was observed with just one student (e.g., Warren et al. 2020).”
From School‐Based Interventions for Reducing Disciplinary School Exclusion. An Updated Systematic Review (2025) · cites this paper as Warren et al. 2020
In Results, ‘Increasing student commitment to the school community’ (page unavailable), a staff member praises one boy’s improved maturity, supporting the point that a teacher could respond positively to an individual change. But the paper does not say that change across a classroom or school was unnecessary; the same passage emphasizes how that boy’s participation could influence other students. (LLM, conf=0.82)
Experimental — accuracy not yet measuredGroup discussion was particularly positive when it allowed for discussion and collaboration with participants from other schools, providing different perspectives and shared experiences.
“Group discussion was particularly positive when it allowed for discussion and collaboration with participants from other schools; providing different perspectives and shared experiences (e.g., Warren et al. 2020).”
From School‐Based Interventions for Reducing Disciplinary School Exclusion. An Updated Systematic Review (2025) · cites this paper as Warren et al. 2020
The Results section, “Increasing student commitment to the school community” (page not available), reports that students valued action-group conversations and hearing others’ views. The Discussion’s “Summary of key findings” describes students and staff sharing perspectives and experiences. Neither passage supports the specific claim that participants discussed or collaborated with people from other schools; the groups described were within schools. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe effect of seeing the impact of an intervention on student behaviour was a considerable facilitator to the implementation of programmes.
“Finally, the effect of seeing the impact of an intervention on student behaviour was a considerable facilitator to the implementation of programmes (e.g., Middleton 2022; Warren et al. 2020).”
From School‐Based Interventions for Reducing Disciplinary School Exclusion. An Updated Systematic Review (2025) · cites this paper as Warren et al. 2020
The Results sections on increasing student commitment and building healthy relationships describe changes in student behaviour and conditions for implementing Learning Together. They do not say that seeing those behavioural changes facilitated implementation. Searches for staff seeing results or changes in students did not establish that link. (LLM, conf=0.70)
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Self-citation
- Authors
- Warren, E., Melendez-Torres, G. J., Viner, R., & Bonell, C.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- University College London (GB)
- Corresponding author
- Warren, Emily
- Venue
- Trials
- Published
- 2020-09-10
- Volume
- 21
- Issue
- 1
- Pages
- 774-774
- ISSN
- 1745-6215 (ISSN-L)
- PMC
- PMC7488057
- OpenAlex
- W4241911387
- Cited by
- 32
- References
- 32
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 7 · 2023: 4 · 2022: 12 · 2021: 1 · 2020: 1
- FWCI
- 4.70
- Type
- journal article
- Language
- en
- Update notices
- correction (2020-09-23)
- Open access
- gold
- doi.org
- Locations
- Trials (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- La Trobe University (cc-by)
- Funders
- National Institute of Health Research (12/153/60)
- Education Endowment Foundation (no award number)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Social Sciences › Decision Sciences › Management Science and Operations Research › Evaluation and Performance Assessment
- Keywords
- bullying prevention, aggression prevention, restorative practices, social-emotional learning, intervention mechanisms, realist evaluation, school community, prosocial skills, student-staff relationships, student reintegration, theory of change, secondary schools
- MeSH terms
- England, Humans, Interviews as Topic, Schools, Students, Focus Groups, Qualitative Research, Bullying
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