Interventions for prevention of bullying in the workplace: Cochrane systematic review

Abstract

Background

Bullying has been identified as one of the leading workplace stressors, with adverse consequences for the individual employee, groups of employees, and whole organisations. Employees who have been bullied have lower levels of job satisfaction, higher levels of anxiety and depression, and are more likely to leave their place of work. Organisations face increased risk of skill depletion and absenteeism, leading to loss of profit, potential legal fees, and tribunal cases. It is unclear to what extent these risks can be addressed through interventions to prevent bullying.

Objectives

To explore the effectiveness of workplace interventions to prevent bullying in the workplace.

Search methods

We searched: the Cochrane Work Group Trials Register (August 2014); Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2016, issue 1); PUBMED (1946 to January 2016); EMBASE (1980 to January 2016); PsycINFO (1967 to January 2016); Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus; 1937 to January 2016); International Bibliography of the Social Sciences (IBSS; 1951 to January 2016); Applied Social Sciences Index and Abstracts (ASSIA; 1987 to January 2016); ABI Global (earliest record to January 2016); Business Source Premier (BSP; earliest record to January 2016); OpenGrey (previously known as OpenSIGLE-System for Information on Grey Literature in Europe; 1980 to December 2014); and reference lists of articles.

Selection criteria

Randomised and cluster-randomised controlled trials of employee-directed interventions, controlled before and after studies, and interrupted time-series studies of interventions of any type, aimed at preventing bullying in the workplace, targeted at an individual employee, a group of employees, or an organisation.

Data collection and analysis

Three authors independently screened and selected studies. We extracted data from included studies on victimisation, perpetration, and absenteeism associated with workplace bullying. We contacted study authors to gather additional data. We used the internal validity items from the Downs and Black quality assessment tool to evaluate included studies' risk of bias.

Main results

Five studies met the inclusion criteria. They had altogether 4116 participants. They were underpinned by theory and measured behaviour change in relation to bullying and related absenteeism. The included studies measured the effectiveness of interventions on the number of cases of self-reported bullying either as perpetrator or victim or both. Some studies referred to bullying using common synonyms such as mobbing and incivility and antonyms such as civility.

Organisational/employer level interventions

Two studies with 2969 participants found that the Civility, Respect, and Engagement in the Workforce (CREW) intervention produced a small increase in civility that translates to a 5% increase from baseline to follow-up, measured at 6 to 12 months (mean difference (MD) 0.17; 95% CI 0.07 to 0.28).

One of the two studies reported that the CREW intervention produced a small decrease in supervisor incivility victimisation (MD -0.17; 95% CI -0.33 to -0.01) but not in co-worker incivility victimisation (MD -0.08; 95% CI -0.22 to 0.08) or in self-reported incivility perpetration (MD -0.05 95% CI -0.15 to 0.05). The study did find a decrease in the number of days absent during the previous month (MD -0.63; 95% CI -0.92 to -0.34) at 6-month follow-up.

Individual/job interface level interventions

One controlled before-after study with 49 participants compared expressive writing with a control writing exercise at two weeks follow-up. Participants in the intervention arm scored significantly lower on bullying measured as incivility perpetration (MD -3.52; 95% CI -6.24 to -0.80). There was no difference in bullying measured as incivility victimisation (MD -3.30 95% CI -6.89 to 0.29).

One controlled before-after study with 60 employees who had learning disabilities compared a cognitive-behavioural intervention with no intervention. There was no significant difference in bullying victimisation after the intervention (risk ratio (RR) 0.55; 95% CI 0.24 to 1.25), or at the three-month follow-up (RR 0.49; 95% CI 0.21 to 1.15), nor was there a significant difference in bullying perpetration following the intervention (RR 0.64; 95% CI 0.27 to 1.54), or at the three-month follow-up (RR 0.69; 95% CI 0.26 to 1.81).

Multilevel Interventions

A five-site cluster-RCT with 1041 participants compared the effectiveness of combinations of policy communication, stress management training, and negative behaviours awareness training. The authors reported that bullying victimisation did not change (13.6% before intervention and 14.3% following intervention). The authors reported insufficient data for us to conduct our own analysis.

Due to high risk of bias and imprecision, we graded the evidence for all outcomes as very low quality.

Authors' conclusions

There is very low quality evidence that organisational and individual interventions may prevent bullying behaviours in the workplace. We need large well-designed controlled trials of bullying prevention interventions operating on the levels of society/policy, organisation/employer, job/task and individual/job interface. Future studies should employ validated and reliable outcome measures of bullying and a minimum of 6 months follow-up.

Author(s)

Gillen Patricia A, Sinclair Marlene, Kernohan W George, Begley Cecily M, Luyben Ans G

Summary

Are there ways in which workplace bullying can be prevented?

Background

Bullying in the workplace can reduce the mental health of working people. It can also harm the organisations where these people work. There has been much research about bullying in the workplace. However, most studies have looked at how to manage bullying once it has happened, rather than trying to stop it happening in the first place. Many people who have been bullied choose to leave their job rather than face up to the bully. It is important to know if the actions workplaces take to prevent bullying are effective.

Our review question

What are the benefits of different ways of trying to prevent bullying in the workplace?

What the studies showed

We included five studies conducted with 4116 participants that measured being victim of bullying or being a bully and consequences of bullying such as absenteeism. We classified two interventions as organisational-level, two as individual-level and one as multi-level. There were no studies about interventions conducted at the society/policy level.

Organisational-level interventions

Two studies found that organisational interventions increased civility, the opposite of bullying, by about five percent. One of these studies also showed a reduction in coworker and supervisor incivility. They also found that the average time off work reduced by over one third of a day per month.

Individual-level interventions

An expressive writing task with 46 employees, showed a reduction in the amount of bullying. A cognitive behavioural educational intervention was conducted with 60 employees who had a learning disability, but there was no significant change in bullying.

Multilevel interventions

One study evaluated a combination of education and policy interventions across five organisations and found no significant change in bullying.

What is the bottom line?

This review shows that organisational and individual interventions may prevent bullying in the workplace. However, the evidence is of very low quality. We need studies that use better ways to measure the effect of all kinds of interventions to prevent bullying.

Reviewer's Conclusions

Implications for practice

We found very low quality evidence from two large-scale studies of small improvements in civility after an intensive and long-term organisational intervention in healthcare organisations. There were no studies of organisational interventions in other occupations or branches of industry.

We found only one study evaluating an intervention at the individual level. It engaged a diverse range of individual employees using an expressive writing intervention. The study found very low quality evidence of a reduction in the incidence of incivility victimisation for those participants who showed a low or moderate pretest score. There was one other study that found very low quality evidence of a cognitive behavioural intervention having no effect on the occurrence of bullying.

We found no studies evaluating societal or policy level interventions to prevent bullying at work.

Implications for research

We recommend that future studies should follow the UK Medical Research Council Complex Interventions Framework (MRC 2008; Moore 2014). Whilst the randomised controlled trial design is still regarded as the preferred design to elicit efficacy, future trials need to ensure the appropriate unit of randomisation, which, depending on the nature of the intervention, may be the individual, the work group, or an entire organisation. However, randomisation is difficult at the group level in workplaces. Controlled before-after studies that take account of the workplace context and fully understand the mechanisms of action to maximise the benefits of interventions are a more feasible approach. Bearing all this in mind, we suggest that future studies should combine the benefits of randomised controlled trials with more realistic evaluation methods to bring the benefits of efficacy together with the understanding of contextual factors and mechanisms of action, for example, following a realist approach (Bonell 2012). In particular, assessing how the various components of an intervention interact with each other and with local contextual factors is important, as is examining the effects of the separate components. This can be done effectively using multi-arm studies and factorial trials (Bonell 2012). The complexity of workplace bullying calls for a multi-level approach to prevention, which may start with policy but ultimately needs to meet the needs of employees and organisations within a diverse and ever-changing context that is the workplace. We do not know if successful prevention interventions need to operate across all the levels advocated by Vartia 2011. Therefore, we need rigorous assessment of the effectiveness of legal and regulation frameworks (society/policy level); interventions focused on workplace culture (organisation/employer level); interventions to address the psychosocial environment (job/task level); and training and educational interventions (individual/ job interface level).

We recommend that studies of interventions at the society/policy level and those addressing the psychosocial environment at job/task level be conducted, as we found none to include in this review. We recommend further research on the CREW intervention (Leiter 2011; Osatuke 2009) as it aims to improve workers’ behaviours at the level of workplace culture. Interventions at individual/job interface level could include a similar expressive writing task to that used by Kirk 2011, as it is a simple, cost-effective intervention to implement. Cognitive-behavioural interventions should also be tested with a larger sample size and longer follow-up period to that used by McGrath 2010. Ideally, interventions would be drawn from a comprehensive evidence-based 'menu' to address all affected levels from individual to organisational. When a specific intervention has been shown to be effective, a cost-benefit analysis should be instigated. The proliferation of online communication within workplaces adds a new dimension to an already complex context. Hong 2014 has reported that online cyber-bullying can occur within organisations, which may require special attention by researchers. On the other hand, the online environment may also provide suitable tools for conducting and evaluating interventions.

In considering the treatment that control group participants should receive, a consideration of research ethics is required. This means taking full account of ethical principles such as beneficence, non-maleficence, autonomy and justice (Beauchamp 2012). We agree that when there is a known issue of bullying, there are ethical implications of including a control group which denies participants benefits from interventions. However, increasingly the proven effectiveness of interventions is being demanded and this is difficult to demonstrate without a control or comparison group. Future studies on prevention of bullying can circumvent claims regarding the unethical treatment of half the randomised participants by using a wait-list control group. Here no one is denied the possible benefits of the intervention, as the control group receives the same intervention after a waiting period.

Simple effective outcome measures, such as bullying victimisation and perpetration, should continue to be used but they require standardisation. For example, the Civility scale (Leiter 2011; Osatuke 2009), the Workplace Incivility Scale, documented rates of absenteeism (Leiter 2011), or rates of reported victimisation (McGrath 2010) could all be useful outcome measures. Although it would be desirable to establish long-term outcomes, we recognise the inherent difficulties in this, due to the highly dynamic nature of employment in all settings. However, in keeping with Leiter 2011, we recommend a minimum of 6 months follow-up, preferably 12 months, in order to demonstrate a sustained change. Giving feedback to employees, or providing continued small amounts of intervention input, may help participants to stay motivated and continue in the process. Future work should include demographic factors as potential explanatory variables as this may assist in targeting interventions to those most susceptible to bullying victimisation and perpetration.

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