Interventionen zur Vorbeugung von Mobbing am Arbeitsplatz
Referencias
References to studies included in this review
References to studies excluded from this review
Additional references
Characteristics of studies
Characteristics of included studies [ordered by study ID]
Ir a:
| Methods | Five‐arm cluster randomised trial | |
| Participants | 272 participants engaged in focus groups pre‐survey; 2505 questionnaires distributed to workers from 5 public sector organisations at pre‐intervention stage; return rate of 41.5% (N = 1041 questionnaires) Gender: 36.2% male; 63.8% female. 150 workers (in total) allocated to one of five intervention groups in each organisation (including one group that acted as a control and did not have an intervention) Post‐intervention 2499 questionnaires distributed, with a return rate of 35.4% (N = 884 questionnaires) Gender: 36.4% male, 63.6% female Age: mean age of participants at both time points was 43 years Eight focus groups six months post‐intervention; number of participants not stated Geographical Setting: London & North & South of England | |
| Interventions | Programme of interventions: 1. One policy communication session of 30 minutes duration (we judged this at organisation/employer level) 2. One policy communication session of 30 minutes and one stress management training session of three hours duration (at organisation/employer and job task levels) 3. One policy communication session of 30 minutes and one negative behaviour awareness training session of three 3 hours duration (at organisation/employer and individual/job interface levels) 4. One day‐long event comprising of a policy communication session, stress management and negative behaviour awareness training (at organisation/employer, job task and individual/job interface levels) | |
| Outcomes | Self‐report of bullying using Bullying Risk Assessment Tool (BRAT); witnessing of bullying, sickness absence, measured approximately six months post‐intervention | |
| Notes | Broad theoretical underpinning: intervention designed using literature review and knowledge of local context Funding source: British Occupational Health Research Foundation (BOHRF) Declarations of interest: none stated We requested raw data from the authors to conduct proper analysis on it but they did not respond. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Blinding Subjects | High risk | no blinding |
| Blinding Outcome Assessors | High risk | no blinding |
| Retrospective unplanned subgroup analyses | Low risk | no evidence of data dredging |
| Follow‐up | Unclear risk | approximately six months; based on unmatched self‐report of behaviour |
| Statistical tests | Unclear risk | appropriate but mainly descriptive |
| Compliance | Unclear risk | problems with compliance reported; "unwillingness/resistance on behalf of participants to engage" |
| Outcome measures | High risk | self‐reported outcome measures susceptible to social desirability; descriptive & qualitative data reported; " showing increases in scores as +; decreases as ‐; and no changes as 0". |
| Selection bias (population) | Unclear risk | employees from different types of public sector organisations |
| Selection bias (time) | Low risk | all participants recruited within the same timeframe |
| Randomisation | Low risk | cluster randomisation |
| Allocation concealment | Unclear risk | Unable to determine (UTD), assignment not reported |
| Adjustment for confounding | High risk | Influencing factors have been described but not taken into account |
| Incomplete outcome data | Unclear risk | loss indicated but not possible to determine if taken into account |
| Methods | Controlled before and after study | |
| Participants | 49 employees; 46 completed study (three did not complete study or had missing data); type of employment was not specified. Gender: 13 males & 33 female Age: age range 19 to 62 years; mean age 35.1 years; SD = 11.6) Geographical Setting: New South Wales or Queensland, Australia | |
| Interventions | The intervention was self‐administered expressive writing. All participants (control and intervention) were asked to write for 20 minutes per day over the 3 days following submission of the pre‐test survey. The extent to which participants complied with the writing instructions was assessed by asking participants to report on how many days (out of the 3 days) they wrote in their journals, and on how many of the days they wrote for the full 20 minutes. The intervention group was asked to write on their 'deepest thoughts and feelings' related to their past work‐day. The control group was asked to write on any topic not related to their work‐day. (individual/job interface level) | |
| Outcomes | Emotional self‐efficacy, emotional intelligence, mood, incivility victimisation, incivility perpetration; measured two weeks post‐intervention | |
| Notes | The following tools were used pre‐intervention, and again two weeks after finishing the 3‐day writing intervention. All were shown as having moderate to high internal consistency, with levels of Cronbach’s alpha 0.75 to 0.92:
Theoretical underpinning: self‐efficacy Funding source: none stated Declarations of interest: none stated | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Blinding Subjects | High risk | not possible |
| Blinding Outcome Assessors | High risk | no blinding |
| Retrospective unplanned subgroup analyses | Low risk | no data dredging |
| Follow‐up | Unclear risk | Details of pre‐ and post‐intervention for the experimental group are provided (two week time frame). No data provided for control group. |
| Statistical tests | Low risk | ANCOVA |
| Compliance | Low risk | acceptable compliance was reported |
| Outcome measures | Unclear risk | outcome measures were self‐reported, susceptible to social desirability but used scales with acceptable Cronbach's Alpha reported |
| Selection bias (population) | High risk | convenience sample of employees in both arms; "on an alternating basis" |
| Selection bias (time) | Unclear risk | timescale not reported |
| Randomisation | High risk | no randomisation |
| Allocation concealment | High risk | no randomisation |
| Adjustment for confounding | High risk | confounders not identified |
| Incomplete outcome data | Low risk | three participants dropped out and were withdrawn |
| Methods | Controlled before and after study | |
| Participants | Time 1 (before the intervention): 1173 health care workers in three district health authorities and two hospitals completed a survey (N = 262 in the intervention units and N = 911 in the comparison units). Time 2 (6 months after the start of the intervention): 907 health care workers completed the survey (N = 181 in intervention units; N = 726 in comparison units). 472 participants completed surveys at both Time 1 and Time 2. Gender: Participants were predominantly female at both time points. Time 1: (N = 1009, 86.0%; male: N = 139, 11.8%; 25 non‐responders). Time 2: participants were mainly female (N = 793, 87.4%; male: N = 96, 10.6%, 18 non‐responders). Employment Status: Full‐time (N = 833, 71.0%); Part‐time (N = 232, 19.8%); Casual (N = 85, 7.2%); and Temporary (N = 8, 0.7%). Geographical Setting: Nova Scotia and Ontario | |
| Interventions | 'Civility, Respect, and Engagement in the Workforce' (CREW) is a tailored, flexible intervention that responds to identified work group needs. The goal of CREW is to support work units to identify their strengths and areas for improvement with regard to civility. It comprises: identification of facilitators, self‐report surveys (pre and post‐intervention), and facilitated group work based on survey findings. During the intervention, the organizations hold weekly workgroup‐level conversations about civility. A comprehensive educational toolkit is made available to each intervention site to support facilitators (organisational/employer level). | |
| Outcomes | 1. Workplace civility levels at the participating sites; measured as the average of an 8‐item civility self‐report scale; range 1 (strongly disagree) to 5 (strongly agree); 2. Experienced incivility supervisor; average of 10 items measured with a Likert scale ranging from 0 (never to 6 (daily) 3. Experienced incivility co‐worker; average of 10 items measured with a Likert scale ranging from 0 (never to 6 (daily) 4. Instigated incivility (incivility perpetration); average of five items measured with a Likert scale ranging from 0 (never) to 6 (daily) 5. Self‐reported number of days off work due to sickness in the past month All measured at 6 months after the intervention. In addition the authors measured a number of other outcome measures but they did not match with the ones we used as inclusion criteria. | |
| Notes | Theoretical underpinning: social interactions at work Funding: from the Partnerships in Health Services Improvement of the Canadian Institutes for Health Research, the Nova Scotia Health Research Foundation, the Ontario Ministry of Health, and the Social Sciences and Humanities Research Council of Canada awarded to Michael P Leiter (principal investigator). Additional 12 month follow‐up reported separately (Leiter 2011) Declarations of interest: None stated. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Blinding Subjects | High risk | no blinding |
| Blinding Outcome Assessors | High risk | no blinding |
| Retrospective unplanned subgroup analyses | Low risk | no evidence of data dredging |
| Follow‐up | Low risk | details provided and addressed |
| Statistical tests | Low risk | "three‐level hierarchical linear modelling" (HLM) |
| Compliance | Unclear risk | not reported |
| Outcome measures | Unclear risk | all outcome measures were self‐reported, susceptible to social desirability but used valid & reliable scales |
| Selection bias (population) | Unclear risk | participants from different settings |
| Selection bias (time) | Low risk | all participants recruited within the same time frame |
| Randomisation | High risk | no randomisation |
| Allocation concealment | High risk | not randomised, not applicable |
| Adjustment for confounding | High risk | Confounders not identified |
| Incomplete outcome data | Unclear risk | loss indicated but not possible to determine if taken into account |
| Methods | Controlled before and after study | |
| Participants | 60 adults with mild or moderate intellectual disabilities from 3 work centres (42 intervention/18 control) Gender: work centre A: 10 men/10 women, N = 20; work centre B: 10 Men/12 Women, N = 22; work centre C: 8 Men/10 Women, N = 18 Age: work centre A: 17 to 52 years; mean age 36 years (SD = 8.98); work centre B: 17 to 55 years; mean age 35 years (SD = 13.76); work centre C: 18 to 60 years; mean age 33 years (SD = 11.07) Geographical setting: Southwest Ireland | |
| Interventions | A ten‐week anti‐bullying programme; cognitive behavioural in nature; one 90‐minute session each week at centre A; the same programme at centre B with additional community input; centre. C acted as a waiting list control (no intervention). (individual/job interface level) | |
| Outcomes | Levels of victimisation and bullying behaviour; a modified version of the Mencap Bullying Questionaire (1999) was used to measure victimisation pre‐, post‐intervention, and at three‐month follow‐up. | |
| Notes | Very specific group of participants; findings not generalisable to population as a whole No information on how or why the intervention might work. Theoretical underpinning: cognitive behavioural approach Funding source: none stated Declarations of interest: none stated. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Blinding Subjects | High risk | no blinding |
| Blinding Outcome Assessors | High risk | no blinding |
| Retrospective unplanned subgroup analyses | Low risk | no data dredging |
| Follow‐up | Low risk | "Participants were re‐interviewed...three months after first administration..., and again for a three month follow‐up immediate post intervention and three month follow‐up" |
| Statistical tests | Low risk | appropriate for a small study |
| Compliance | Low risk | explicit |
| Outcome measures | High risk | self‐reported outcome measures, susceptible to social desirability |
| Selection bias (population) | Low risk | similar work centres in neighbouring towns |
| Selection bias (time) | Low risk | recruited over same time |
| Randomisation | High risk | no randomisation |
| Allocation concealment | High risk | no randomisation |
| Adjustment for confounding | High risk | confounders not identified |
| Incomplete outcome data | Low risk | data provided, no loss to follow‐up |
| Methods | Controlled before and after study (two administrations; CREW‐1 & CREW‐2) | |
| Participants | CREW‐1: Eight VHA facilities provided 899 participants (included eight intervention workgroups); although two workgroups could not be matched. This resulted in six intervention workgroups; N = 425 pretest and N = 328 posttest matched to six comparison workgroups (participants N = 236 pre‐test, and N = 407 post‐test). CREW‐2:Twenty VHA facilities provided thirty‐eight workgroups, from 1 to 5 workgroups each; 1295 participants altogether. Of the 38 workgroups, 17 intervention groups could be matched (N = 688 pre‐test, and N = 647 post‐test), and 17 comparison groups (N = 607 pre‐test, and N = 680 post‐test). Demographic details were not assessed Gender: not provided Age: not provided Geographical setting: all over the US | |
| Interventions | 'Civility, Respect, and Engagement in the Workforce' (CREW) is a tailored, flexible intervention that responds to identified work group needs. The goal of CREW is to support work units to identify their strengths and areas for improvement with regard to civility. It comprises: identification of facilitators, self‐report surveys (pre and post‐intervention), and facilitated group work based on survey findings. During the intervention, the organizations hold weekly workgroup‐level conversations about civility. A comprehensive educational toolkit is made available to each intervention site to support facilitators (organisational/ employer level). | |
| Outcomes | Civility levels at the participating sites; measured by an 8‐item civility self‐report scale Follow‐up was 11 and 14 months post intervention for CREW 1 and CREW 2 respectively. | |
| Notes | Theoretical underpinning: social interactions at work Funding: research undertaken by staff from Veterans Health Administration National Center for Organization Development Declarations of interest: none stated | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Blinding Subjects | High risk | not possible |
| Blinding Outcome Assessors | High risk | not possible, outcomes self‐assessed |
| Retrospective unplanned subgroup analyses | Low risk | no unplanned subgroup analysis |
| Follow‐up | Unclear risk | Follow‐up 11‐14 months; "...matching individual CREW participants' ratings from pre‐intervention to post‐intervention surveys was impossible" |
| Statistical tests | Low risk | ANOVA |
| Compliance | Unclear risk | not reported |
| Outcome measures | Unclear risk | all outcome measures were self‐reported, susceptible to social desirability but used valid & reliable scales |
| Selection bias (population) | Unclear risk | participants from different settings |
| Selection bias (time) | Low risk | recruited over same time |
| Randomisation | High risk | no randomisation |
| Allocation concealment | High risk | not randomised |
| Adjustment for confounding | High risk | confounders not identified |
| Incomplete outcome data | Unclear risk | loss indicated but not possible to determine if taken into account |
Characteristics of excluded studies [ordered by study ID]
Ir a:
| Study | Reason for exclusion |
| Did not include outcome measures as specified in our PICOS. This study examined the effect of a targeted team‐building intervention (organisation/employer level) that was aimed at improving group cohesion, turnover and nurse satisfaction in an acute care teaching hospital in the United States of America (US). It was a quasi‐experimental pre‐post intervention design without a control group. There was no matching of participants pre‐ and post‐test and each unit in which participants were located had its own individual dynamics and issues that needed to be addressed.The study outcomes did not include a change in the number of reported cases of bullying or level of absenteeism. | |
| Study design not as specified in our PICOS. A qualitative case study to compare two anti‐bullying initiatives (organisation/employer level); one in the public and one in the private sector in the United Kingdom (UK).They highlighted the complexity of bullying in the workplace and called for a more grounded approach to engage with the specific workforce. Not a control study. | |
| Study design not as specified in our PICOS. This study examined the predictors of bullying (individual/job interface level) in an observational study among nurses in public hospital corporations in northern Italy. It showed that leadership style explained 33.5% of the variance in the onset of bullying: this is useful, but no intervention was tested. | |
| Did not include an intervention as specified in our PICOS. This study tested a participative intervention (job/task level; see Bourbonnais 2006b for full details of intervention) to prevent workplace‐related mental health problems among 'care providing personnel' in two hospitals in Quebec, Canada. Whilst it was effective in that regard, their focus did not extend to prevention of bullying per se.This is a psychosocial intervention, not focused on bullying. | |
| Did not include an intervention as specified in our PICOS. This study from the US takes a long‐term approach consisting of several interventions (organisation/employer level) and although some interesting effects were seen on workplace engagement and job satisfaction, their study lacked precision and did not focus on bullying prevention.The improvements/interventions are spread over long periods and the 'results' are diffuse, and due to the prolonged timeframe, it was not possible to control a number of variables. | |
| Did not include an intervention as specified in our PICOS. This was a pre‐ and post‐intervention survey of registered nurses’ perception of lateral violence and turnover in the workplace (organisation or employer level). Improvements were noted following workshops designed to enhance assertive communication skills, raise awareness of the impact of lateral violence behaviour, and develop healthy conflict resolution skills. No control group was used. | |
| This was a pilot study described as a 'quasi‐experimental pre‐test and post‐test comparison' of an educational programme (individual/job interface level), with 16 participants.The group acted as their own control. | |
| Study design not specified in our PICOS. This was a case study, examining a team‐based approach to the retention of nursing staff (organisation/employer level) in a hospital in East Melbourne, Australia. This study only had an indirect impact on bullying and there was no control group. | |
| Study design not specified in our PICOS. This was a survey of a convenience sample of 727 employees from nine healthcare organisations in New Zealand, which focused on the potential buffering effects of perceived organisational support, and organisational anti‐bullying initiatives (organisation/employer level). | |
| Did not include outcome measures specified in our PICOS. Reports on two organisational interventions in two organisations in the UK aimed at preventing bullying in the workplace. The first intervention was the implementation of the Dignity at Work Policy and procedures in an organisation where bullying had been identified as an issue (society/policy level). The outcomes from the policy implementation were not clear. The second organisational intervention briefly described was the response of an organisation to the systematic bullying of staff by a manager (individual/job interface). It was reported that the bully left the organisation but the reason was not stated. There was insufficient detail about the intervention and lack of data from which evidence of effectiveness of either intervention could be determined.The study outcomes did not include a change in the number of reported cases of bullying or level of absenteeism. | |
| Did not include an intervention as specified in our PICOS. This study from the US provides weak evidence that education workshops have an effect on knowledge of student nurses. However, it is not prevention in a workplace setting (unclassified level of intervention). | |
| Did not include an intervention as specified in our PICOS. A case control design was used, in educational workplace settings in the US, to analyse nine different written violence policies and their impact on work‐related physical assault (unclassified level of intervention). | |
| Study design not specified in our PICOS. This is a case study which was focused on workplace incivility from the US. It mainly includes a description of the workshops and feedback from participants (organisation/employer level). | |
| Study design not specified in our PICOS. A survey of 238 students from a business school in the US, which sought to understand the complexities of workplace bullying by exploring the use of a bullying policy as a means of mitigation, particularly in relation to gender norms (society/policy level). | |
| Did not include outcome measures as specified in our PICOS. Reports on a pilot of an aggression minimisation programme for all public health staff who were at risk in New South Wales (Individual/job interface level). It involved twenty‐two hours of training divided into four modules. Two pilot samples were evaluated and the outcomes focused on the perceived confidence of staff in dealing with incidents of aggression and not on the outcomes of relevance to this review. | |
| Did not include an intervention as specified in our PICOS. An exploratory design from the US with an applied intervention of ‘cognitive rehearsal techniques', which staff were encouraged to use as a shield against incidences of lateral violence (Individual/job interface level). There was no control nor any pre‐ or post‐test measures. The intervention was focused on 'how to respond' if bullied. Hence, it was considered to be a management of bullying intervention rather than prevention of bullying. | |
| Study design not specified in our PICOS. This paper reports on a consultancy project from the UK where managers in a company of 900 staff were trained to implement a new harassment and bullying policy (society/policy level), through involvement in work‐based projects. This was a case study with no control. | |
| Study design not specified in our PICOS This study was a non‐controlled before and after study from Turkey, which focused on assertiveness training for nurses who had scored 204 points or more on a mobbing instrument which 'demonstrated that they had experienced mobbing'.There was no control (Individual and/ job interface level). | |
| Did not include outcome measures as specified in our PICOS. This was an interrupted time series study from the US, which focused on a three‐part educational intervention (organisation/employer level), addressing incivility in the workplace. | |
| Did not include an intervention as specified in our PICOS. This study from the US was based on a description of the impact of a mentor and advocacy programme on the broader context of a healthcare workforce environment (organisation/employer level). The outcomes were measured through a survey, with the focus on perceptions of the impact of the programme on the environment in which the registered nurses worked and not specifically on bullying.The intervention was not focused on bullying at work. | |
| Study design not specified in our PICOS. This was a programme evaluation of a healthcare workforce partnership community collaboration from the US, aimed at nursing retention (society/policy level). It involved a range of initiatives which culminated in a train the trainer conference. There was no control group. | |
| Did not include an intervention as specified in our PICOS. This was a two‐wave prospective intervention study in a Spanish manufacturing corporation, which focused on conflict management training of 42 employees, not on prevention (organisation/employer level). It did not employ a control group. | |
| Did not include outcome measures as specified in our PICOS. An experimental educational intervention using a pre/post design with a control group from Ontario, Canada. The intervention was computer‐based learning, using avatars in scenarios to address horizontal violence (individual/job interface level). The study outcomes did not include change in the number of reported cases of bullying or level of absenteeism. | |
| Did not include outcome measures as specified in our PICOS. A case study approach to the implementation and evaluation of a zero tolerance of bullying and harassment programme (organisation/employer level) in one hospital in Australia. There was no control, and outcomes were based on employee satisfaction surveys. | |
| Did not include an intervention as specified in our PICOS. This study focused on three experiments that tested the outcomes of being a recipient of contempt in the work domain (individual/job interface level) at a university in the US. Contempt is a possible component of bullying, but the study did not focus on prevention. | |
| Did not include outcome measures as specified in our PICOS. This Danish study used a quasi‐experimental approach to evaluate interventions in two organisations (organisation/employer level). The Interventions were largely educational in nature, including directed teaching sessions, meetings, and paper‐based information. The results were broadly qualitative and there were no control groups. Source of funding: Danish Work Environment Research Fund and The National Research Centre for the Working Environment. | |
| Did not include outcome measures as specified in our PICOS. This was a before‐and‐after design from the US, with 38 participants, testing an educational intervention on the causes and effects of incivility, using case studies and discussion of team building skills and ways to prevent incivility (job/task level). The study did not employ a control group. | |
| Did not include an intervention or outcome measures as specified in our PICOS. This was an evaluation of an aggression management training programme from The Netherlands (Individual/job interface level). Using an alternative approach to a control group, the authors of the study referred to as an internal referencing strategy, which they considered 'ruled out some major threats to internal validity without the need for a control group'. The intervention dealt with the management of aggression rather than prevention of bullying at work. The study outcomes did not include change in the number of reported cases of bullying or level of absenteeism. The intervention was not focused on bullying at work. | |
| Did not include outcome measures as specified in our PICOS. This was a longitudinal study, which produced limited data on perceptions of bullying in a single organisation in the UK, following the implementation of bullying and harassment policies (organisation/employer level). It clearly indicated how leadership by a CEO can effect a perception of positive change in an organisation, but pointed to the difficulty of measuring the success of workplace bullying policies. The study did not employ a control group. | |
| Did not include outcome measures as specified in our PICOS. The authors reported on initial outcomes that appeared to improve employees' knowledge and understanding of the interrelated job associated problems (society/policy level). The International Labour Organisation multilevel longitudinal intervention (SOLVE) focused on the reduction of psychosocial problems in the workplace; stress, tobacco, alcohol, and drugs, HIV/AIDS and violence. However, the data did not allow for a comprehensive evaluation of SOLVE, but were limited to giving an indication of how employees had gained knowledge. The intervention was not focused on bullying at work. | |
| Did not include an intervention as specified in our PICOS. This study utilised an intervention designed by Griffin 2004. While this study from the US was aimed at determining whether cognitively rehearsed responses to common bullying behaviours decreased bullying, we judged that it did not focus on prevention but rather on how to increase staff nurses' knowledge of workplace bullying management (Individual/job interface level). | |
| Study design not specified in our PICOS. This was a case study within a broad review of the workplace, conducted in a large Australian teaching hospital (organisation/employer level). No research was involved. | |
| Study design not specified in our PICOS. This was a Swedish study, which employed a community‐based, participatory research approach (society/policy level), which aimed to achieve zero tolerance for bullying. | |
| Study design and outcome measures not as specified in our PICOS. This was a post‐hoc analysis, with 339 participants in the US, who undertook training in new norms of workplace culture to prevent and resolve incidents of workplace violence (organisation/employer level). The study did not include measures of effectiveness or outcome measures; it was not a before‐after design, nor did it have a control group. | |
| Study design not specified in our PICOS. This was a case study from the UK, designed to explore the policies and procedures in place to prevent bullying, and to examine the extent and quality of local implementation of bullying policies (organisation/employer level). No comparative research was involved. |
Data and analyses
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Self‐reported civility Show forest plot | 2 | Mean Difference (Random, 95% CI) | 0.17 [0.07, 0.28] | |
| Analysis 1.1  Comparison 1 CREW intervention vs no intervention, Outcome 1 Self‐reported civility. | ||||
| 2 Self‐reported co‐worker incivility Show forest plot | 1 | Mean Difference (Random, 95% CI) | Totals not selected | |
| Analysis 1.2  Comparison 1 CREW intervention vs no intervention, Outcome 2 Self‐reported co‐worker incivility. | ||||
| 3 Self‐reported supervisor incivility Show forest plot | 1 | Mean Difference (Random, 95% CI) | Totals not selected | |
| Analysis 1.3  Comparison 1 CREW intervention vs no intervention, Outcome 3 Self‐reported supervisor incivility. | ||||
| 4 Self‐reported frequency of incivility perpetration Show forest plot | 1 | Mean Difference (Random, 95% CI) | Totals not selected | |
| Analysis 1.4  Comparison 1 CREW intervention vs no intervention, Outcome 4 Self‐reported frequency of incivility perpetration. | ||||
| 5 Self‐reported absenteeism in previous month Show forest plot | 1 | Mean Difference (Random, 95% CI) | Totals not selected | |
| Analysis 1.5  Comparison 1 CREW intervention vs no intervention, Outcome 5 Self‐reported absenteeism in previous month. | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Incivility victimisation (25th percentile pre‐test) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| Analysis 2.1  Comparison 2 Expressive writing vs. control writing, Outcome 1 Incivility victimisation (25th percentile pre‐test). | ||||
| 2 Incivility victimisation (50th percentile pre‐test) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 2.2  Comparison 2 Expressive writing vs. control writing, Outcome 2 Incivility victimisation (50th percentile pre‐test). | ||||
| 3 Incivility victimisation (75th percentile pre‐test) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 2.3  Comparison 2 Expressive writing vs. control writing, Outcome 3 Incivility victimisation (75th percentile pre‐test). | ||||
| 4 Incivility victimisation (pooled) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 2.4  Comparison 2 Expressive writing vs. control writing, Outcome 4 Incivility victimisation (pooled). | ||||
| 5 Incivility perpetration Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 2.5  Comparison 2 Expressive writing vs. control writing, Outcome 5 Incivility perpetration. | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Victimisation Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Analysis 3.1  Comparison 3 Cognitive Behavioural intervention vs. no intervention, Outcome 1 Victimisation. | ||||
| 1.1 Pre‐intervention | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 1.2 Post‐intervention | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 1.3 Follow‐up at three months | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 2 Perpetration Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Analysis 3.2  Comparison 3 Cognitive Behavioural intervention vs. no intervention, Outcome 2 Perpetration. | ||||
| 2.1 Pre‐intervention | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 2.2 Post‐intervention | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 2.3 Follow‐up at three months | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
PRISMA Study flow diagram.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies using the Downs 1998 checklist.
Risk of bias summary: review authors' judgements about each risk of bias item for included studies.
Comparison 1 CREW intervention vs no intervention, Outcome 1 Self‐reported civility.
Comparison 1 CREW intervention vs no intervention, Outcome 2 Self‐reported co‐worker incivility.
Comparison 1 CREW intervention vs no intervention, Outcome 3 Self‐reported supervisor incivility.
Comparison 1 CREW intervention vs no intervention, Outcome 4 Self‐reported frequency of incivility perpetration.
Comparison 1 CREW intervention vs no intervention, Outcome 5 Self‐reported absenteeism in previous month.
Comparison 2 Expressive writing vs. control writing, Outcome 1 Incivility victimisation (25th percentile pre‐test).
Comparison 2 Expressive writing vs. control writing, Outcome 2 Incivility victimisation (50th percentile pre‐test).
Comparison 2 Expressive writing vs. control writing, Outcome 3 Incivility victimisation (75th percentile pre‐test).
Comparison 2 Expressive writing vs. control writing, Outcome 4 Incivility victimisation (pooled).
Comparison 2 Expressive writing vs. control writing, Outcome 5 Incivility perpetration.
Comparison 3 Cognitive Behavioural intervention vs. no intervention, Outcome 1 Victimisation.
Comparison 3 Cognitive Behavioural intervention vs. no intervention, Outcome 2 Perpetration.
| Controlled before and after study | |||||
| Patient or population: Employees | |||||
| Outcomes | Absolute effects* | № of participants | Quality of the evidence | Comments | |
| Risk with no intervention | Risk with CREW (95% CI) | ||||
| Self‐reported workplace civility, on a scale of 1 to 5; higher score more civility | Mean civility score was 3.58 points | Mean civility score was 0.17 higher (0.07 higher to 0.28 higher) | 2969 | ⊕⊝⊝⊝1 | |
| Self‐reported co‐worker incivility, on a scale of 0 to 6; higher score more frequent incivility Follow‐up: 6 months | Mean coworker incivility score was 0.76 points | Mean co‐worker incivility score was 0.08 lower (0.22 lower to 0.06 higher) | 907 | ⊕⊝⊝⊝1 | |
| Self‐reported supervisor incivility, on a scale of 0 to 6; higher score more frequent incivility Follow‐up: 6 months | Mean supervisor incivility score was 0.57 points | Mean supervisor incivility score was 0.17 lower (0.33 lower to 0.01 lower) | 907 | ⊕⊝⊝⊝1 | |
| Self‐reported frequency of incivility instigation, on a scale of 0 (never) ‐ 6 (daily) **; higher score more frequent incivility Follow‐up: 6 months | Mean incivility instigation score was 0.50 | Mean incivility instigation score was 0.05 lower (0.15 lower to 0.05 higher) | 907 | ⊕⊝⊝⊝1 | |
| Self‐reported days of absenteeism in previous month. Follow‐up: 6 months | Mean absenteeism in previous month was 0.83 days | Mean absenteeism in previous month was 0.63 days lower (0.92 lower to 0.34 lower) | 907 | ⊕⊝⊝⊝1 | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) | |||||
| GRADE Working Group grades of evidence | |||||
| 1 We would have downgraded the quality of evidence twice due to high risk of bias caused by study limitations (lack of randomisation and blinding, and use of self‐reporting instrument) and once due to imprecision (limited sample available for outcome measurement, limited matching pre‐ and post intervention). However, once was enough to reach very low quality evidence as we started at low quality evidence because the included studies used a controlled before‐after design. We found no reason to upgrade the quality of the evidence. | |||||
| Five‐arm cluster randomised trial | |||
| Patient or population: employees | |||
| Outcomes | Effect of the intervention | № of participants | Quality of the evidence |
| Bullying | Insufficient data reported for analysis | 1041 (1 study) | ⊕⊝⊝⊝ |
| Absenteeism | Insufficient data reported for analysis | 1041 (1 study) | ⊕⊝⊝⊝ |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||
| GRADE Working Group grades of evidence | |||
| 1 We would have downgraded the quality of evidence once due to high risk of bias caused by study limitations (lack of blinding and use of self‐reporting instrument) and twice due to imprecision (study conducted in mixed settings and with unclear number of participants). However, once was enough to reach very low quality evidence as we started at low quality evidence because the included studies used a controlled before‐after design. We found no reason to upgrade the quality of the evidence. | |||
| Controlled before and after study | |||||
| Patient or population: employees | |||||
| Outcomes | Absolute effects* (95% CI) | № of participants | Quality of the evidence | Comments | |
| Risk with Control writing | Risk with Expressive‐Writing | ||||
| Self‐reported frequency of incivility victimisation. | Mean number of incivility victimisations was 26 | Mean incivility victimisation in the intervention group was 3.3 fewer occurrences (5.4 fewer to 1.2 fewer) | 46 | ⊕⊝⊝⊝1 | |
| Self‐reported frequency of incivility perpetration. | Mean number of incivility perpetrations was 23 | Mean incivility perpetration in the intervention group was 3.5 fewer occurrences (6.2 fewer to 0.8 fewer) | 46 | ⊕⊝⊝⊝1 | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||||
| GRADE Working Group grades of evidence | |||||
| 1. We would have downgraded the quality of evidence twice due to high risk of bias caused by study limitations (lack of randomisation and blinding, and use of self‐reporting instrument) and once due to imprecision (small sample size). However once was enough to reach very low quality evidence as we started at low quality evidence because the included studies used a controlled before‐after design. We found no reason to upgrade the quality of the evidence. | |||||
| Controlled before and after study | ||||||
| Patient or population: Adult workers with a learning disability | ||||||
| Outcomes | Absolute effects* (95% CI) | Relative effect | No of participants | Quality of the evidence | Comments | |
| Risk with no intervention (Waiting‐list control) | Risk with cognitive behavioural intervention | |||||
| Self‐reported victimisation. | 39 per 100 (18 to 64) | 21 per 100 (11 to 37) | RR 0.55 (0.24 to 1.25) | 60 | ⊕⊝⊝⊝1 | |
| Self‐reported victimisation. | 39 per 100 (18 to 64) | 19 per 100 (9.1 to 35) | RR 0.49 (0.21 to 1.15) | 60 | ⊕⊝⊝⊝1 | |
| Self‐reported perpetration. Post intervention. | 33 per 100 (14 to 59) | 21 per 100 (11 to 37) | RR 0.64 (0.27 to 1.54) | 60 | ⊕⊝⊝⊝1 | |
| Self‐reported perpetration. Three‐month follow‐up. | 28 per 100 (11 to 54) | 17 per 100 (7.5 to 32) | RR 0.69 (0.26 to 1.81) | 60 | ⊕⊝⊝⊝1 | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group Grades of Evidence | ||||||
| 1. We would have downgraded the quality of evidence twice due to high risk of bias caused by study limitations (lack of randomisation and blinding, and use of self‐reporting instrument) and once due to imprecision (small sample size). However, once was enough to reach very low quality evidence as we started at low quality evidence because the included studies used a controlled before‐after design. We found no reason to upgrade the quality of the evidence. | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Self‐reported civility Show forest plot | 2 | Mean Difference (Random, 95% CI) | 0.17 [0.07, 0.28] | |
| 2 Self‐reported co‐worker incivility Show forest plot | 1 | Mean Difference (Random, 95% CI) | Totals not selected | |
| 3 Self‐reported supervisor incivility Show forest plot | 1 | Mean Difference (Random, 95% CI) | Totals not selected | |
| 4 Self‐reported frequency of incivility perpetration Show forest plot | 1 | Mean Difference (Random, 95% CI) | Totals not selected | |
| 5 Self‐reported absenteeism in previous month Show forest plot | 1 | Mean Difference (Random, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Incivility victimisation (25th percentile pre‐test) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 2 Incivility victimisation (50th percentile pre‐test) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3 Incivility victimisation (75th percentile pre‐test) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 4 Incivility victimisation (pooled) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 5 Incivility perpetration Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Victimisation Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 1.1 Pre‐intervention | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 1.2 Post‐intervention | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 1.3 Follow‐up at three months | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 2 Perpetration Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 2.1 Pre‐intervention | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 2.2 Post‐intervention | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 2.3 Follow‐up at three months | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
