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Referencias

منابع مطالعات واردشده در این مرور

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Kirk BA, Schutte NS, Hine DW. The Effect of an Expressive‐writing Intervention for Employees on Emotional Self‐Efficacy, Emotional Intelligence, Affect, and Workplace Incivility. Journal of Applied Social Psychology 2011;41(1):179‐95. CENTRAL

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Leiter MP, Day A, Gilin Oore D, Spence Laschinger HK. Getting better and staying better: assessing civility, incivility, distress and job attitudes one year after a civility intervention. Journal of Occupational Health Psychology 2012;17(4):425‐34. CENTRAL
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McGrath L, Jones RSP, Hastings RP. Outcomes of anti‐bullying interventions for adults with intellectual disabilities. Research in Developmental Disabilities 2010;31:376‐80. CENTRAL

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Osatuke K, Moore SC, Ward C, Dyrenforth SR, Belton L. Civility, Respect, Engagement in the Workforce (CREW): Nationwide Organization Development Intervention at Veterans Health Administration. The Journal of Applied Behavioural Science 2014;45:304‐410. CENTRAL

منابع مطالعات خارج‌شده از این مرور

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Barrett A, Korber S, Padula C. Lessons learned from a lateral violence and team‐building intervention. Nursing Administration Quarterly 2009;33(4):342‐51. CENTRAL

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Beirne M, Hunter P. Workplace bullying and the challenge of pre‐emptive management. Personnel Review 2013;42(5):595‐612. CENTRAL

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Feda DM, Gerberich SG, Ryan AD, Nachreiner NM, McGovern PM. Written violence policies and risk of physical assault against Minnesota educators. Journal of Public Health Policy 2010;31(4):461‐77. CENTRAL

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Gedro J, Wang G. Creating civil and respectful organizations through the scholar‐practitioner bridge. Advances in Developing Human Resources 2013;15(3):284‐95. CENTRAL

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Griffin M. Teaching cognitive rehearsal as a shield for lateral violence: an intervention for newly registered nurses. The Journal of Continuing Education in Nursing 2004;35(6):257‐63. CENTRAL

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Holme CA. Impact not intent. Industrial and Commercial Training 2006;38(5):242‐7. CENTRAL

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Meloni M, Austin M. Implementation and outcomes of a zero tolerance of bullying and harassment program. Australian Health Review 2011;35(1):92‐4. CENTRAL

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

Hoel 2006

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

Kirk 2011

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:

  • The Emotional Self‐Efficacy Scale assesses confidence in emotional processing (Kirk 2008);

  • The Assessing Emotions Scale is a 33‐item measure of self‐rated characteristic emotional intelligence (Schutte 1998);

  • The Positive Affect and Negative Affect Schedule (PANAS) assesses positive and negative mood (Watson 1988);

  • Workplace incivility victimisation was assessed using the Uncivil Workplace Behavior Questionnaire (UWBQ; Martin 2005);

  • A modified perpetrator version of the UWBQ (the UWBQ‐P) was used to assess incivility perpetration. The item content for the new measure was the same as for the original UWBQ. The only difference was that respondents were asked to indicate how often they had engaged in the uncivil behaviours listed in the measure (as opposed to being the target of the behaviours) over the past 2 weeks.

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

Leiter 2011

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).
Age: Time 1: Average age of 42.54 years (SD 10.12); Time 2: Average age of 42.27 years (SD 10.60).

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

McGrath 2010

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

Osatuke 2009

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]

Study

Reason for exclusion

Barrett 2009

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.

Beirne 2013

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.

Bortoluzzi 2014

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.

Bourbonnais 2006a

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.

Brunges 2014

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.

Ceravolo 2012

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.

Chipps 2012

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.

Collette 2004

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.

Cooper‐Thomas 2013

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).

Crawford 1999

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.

Egues 2014

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).

Feda 2010

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).

Gedro 2013

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).

Gilbert 2013

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).

Grenyer 2004

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.

Griffin 2004

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.

Holme 2006

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.

Karakas 2015

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).

Lasater 2015

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.

Latham 2008

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.

Longo 2011

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.

Léon‐Pérez 2012

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.

Mallette 2011

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.

Meloni 2011

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.

Melwani 2011

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.

Mikkelsen 2011

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.

Nikstatis 2014

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.

Oostrom 2008

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.

Pate 2010

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.

Probst 2008

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.

Stagg 2011

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).

Stevens 2002

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.

Strandmark 2014

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.

Wagner 2012

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.

Woodrow 2014

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

Open in table viewer
Comparison 1. CREW intervention vs no intervention

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.

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.

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.

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.

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.

Comparison 1 CREW intervention vs no intervention, Outcome 5 Self‐reported absenteeism in previous month.

Open in table viewer
Comparison 2. Expressive writing vs. control writing

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).

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).

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).

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).

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.

Comparison 2 Expressive writing vs. control writing, Outcome 5 Incivility perpetration.

Open in table viewer
Comparison 3. Cognitive Behavioural intervention vs. no intervention

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.

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.

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.
Figuras y tablas -
Figure 1

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.
Figuras y tablas -
Figure 2

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.
Figuras y tablas -
Figure 3

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.
Figuras y tablas -
Analysis 1.1

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.
Figuras y tablas -
Analysis 1.2

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.
Figuras y tablas -
Analysis 1.3

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.
Figuras y tablas -
Analysis 1.4

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.
Figuras y tablas -
Analysis 1.5

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).
Figuras y tablas -
Analysis 2.1

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).
Figuras y tablas -
Analysis 2.2

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).
Figuras y tablas -
Analysis 2.3

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).
Figuras y tablas -
Analysis 2.4

Comparison 2 Expressive writing vs. control writing, Outcome 4 Incivility victimisation (pooled).

Comparison 2 Expressive writing vs. control writing, Outcome 5 Incivility perpetration.
Figuras y tablas -
Analysis 2.5

Comparison 2 Expressive writing vs. control writing, Outcome 5 Incivility perpetration.

Comparison 3 Cognitive Behavioural intervention vs. no intervention, Outcome 1 Victimisation.
Figuras y tablas -
Analysis 3.1

Comparison 3 Cognitive Behavioural intervention vs. no intervention, Outcome 1 Victimisation.

Comparison 3 Cognitive Behavioural intervention vs. no intervention, Outcome 2 Perpetration.
Figuras y tablas -
Analysis 3.2

Comparison 3 Cognitive Behavioural intervention vs. no intervention, Outcome 2 Perpetration.

Summary of findings for the main comparison. Organisational level workplace culture intervention versus no intervention

Controlled before and after study

Patient or population: Employees
Setting: Workplaces in US and Canada
Intervention: CREW: complex group‐based, at the organisational level
Comparison: no intervention

Outcomes

Absolute effects*

№ of participants
(studies)

Quality of the evidence
(GRADE)

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
Follow‐up: 6 to 12 months

Mean civility score was 3.58 points

Mean civility score was 0.17 higher (0.07 higher to 0.28 higher)

2969
(2 studies)

⊕⊝⊝⊝1
VERY LOW

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
(1study)

⊕⊝⊝⊝1
VERY LOW

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 study)

⊕⊝⊝⊝1
VERY LOW

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 study)

⊕⊝⊝⊝1
VERY LOW

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 study)

⊕⊝⊝⊝1
VERY LOW

*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)
** 0‐6 scale confirmed by email correspondence from author
CI: Confidence interval.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

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.

Figuras y tablas -
Summary of findings for the main comparison. Organisational level workplace culture intervention versus no intervention
Summary of findings 2. Multilevel educational intervention versus no intervention

Five‐arm cluster randomised trial

Patient or population: employees
Setting: workplaces in several locations in the UK
Intervention: education and policy development, at organisational level
Comparison: no education

Outcomes

Effect of the intervention

№ of participants
(studies)

Quality of the evidence
(GRADE)

Bullying
assessed with: Self report
Follow up: mean 6 months

Insufficient data reported for analysis

1041

(1 study)

⊕⊝⊝⊝
VERY LOW 1

Absenteeism
assessed with: organisational data

Insufficient data reported for analysis

1041

(1 study)

⊕⊝⊝⊝
VERY LOW 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).

CI: Confidence interval.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

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.

Figuras y tablas -
Summary of findings 2. Multilevel educational intervention versus no intervention
Summary of findings 3. Individual level expressive‐writing versus control‐writing

Controlled before and after study

Patient or population: employees
Setting: New South Wales and Queensland, Australia
Intervention: expressive writing, at the individual level
Comparison: control writing

Outcomes

Absolute effects* (95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with Control writing

Risk with Expressive‐Writing

Self‐reported frequency of incivility victimisation.
Follow up: 2 weeks

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 study)

⊕⊝⊝⊝1
VERY LOW

Self‐reported frequency of incivility perpetration.
Follow up: 2 weeks

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 study)

⊕⊝⊝⊝1
VERY LOW

*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).

CI: Confidence interval

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

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.

Figuras y tablas -
Summary of findings 3. Individual level expressive‐writing versus control‐writing
Summary of findings 4. Individual level cognitive behavioural intervention versus no intervention

Controlled before and after study

Patient or population: Adult workers with a learning disability
Setting: three work centres in South West Ireland
Intervention: cognitive behavioural intervention, at the individual level
Comparison: waiting‐list control (i.e. no treatment)

Outcomes

Absolute effects* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with no intervention

(Waiting‐list control)

Risk with cognitive

behavioural intervention

Self‐reported victimisation.
Post intervention.

39 per 100

(18 to 64)

21 per 100

(11 to 37)

RR 0.55

(0.24 to 1.25)

60
(1 study)

⊕⊝⊝⊝1
VERY LOW

Self‐reported victimisation.
Three‐month follow‐up.

39 per 100

(18 to 64)

19 per 100

(9.1 to 35)

RR 0.49

(0.21 to 1.15)

60
(1 study)

⊕⊝⊝⊝1
VERY LOW

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 study)

⊕⊝⊝⊝1
VERY LOW

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 study)

⊕⊝⊝⊝1
VERY LOW

*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).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group Grades of Evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

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.

Figuras y tablas -
Summary of findings 4. Individual level cognitive behavioural intervention versus no intervention
Comparison 1. CREW intervention vs no intervention

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

Figuras y tablas -
Comparison 1. CREW intervention vs no intervention
Comparison 2. Expressive writing vs. control writing

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

Figuras y tablas -
Comparison 2. Expressive writing vs. control writing
Comparison 3. Cognitive Behavioural intervention vs. no intervention

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]

Figuras y tablas -
Comparison 3. Cognitive Behavioural intervention vs. no intervention