{"paper_id":"43f3ff0f-d8bf-494d-a862-ca9dd9a2bfb3","body_text":"School bullying prevention among left-behind children: An intervention study based on social ecological model in China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article School bullying prevention among left-behind children: An intervention study based on social ecological model in China Jinyu Huang, yichao chen, Yueliang Chen, Qingchen Da, Liping Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5135455/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 4 You are reading this latest preprint version Abstract Background School bullying among left-behind children (LBC) is a significant public health concern in China. To promote their healthy development, school bullying prevention intervention based on the theory of social ecological model (SEM) in four levels (individual, relationship, campus and society) among LBC was carried out in this study. Methods 190 left-behind children were recruited from two middle schools in Shantou city(mean age 13.52 ± 0.70). Differences within groups were analyzed using t-test or chi square test. Furthermore, differences in scores of school bullying prevention knowledge and attitude were examined with differences-in-differences (DID) approach to test the effectiveness of intervention. Results Results showed that after the intervention, the knowledge scores in the two group both increased with statistically significant differences (all P < 0.05). While the attitude scores increased in the SEM based intervention group with statistical significance while not in the control group. What’s more, it presented that knowledge and attitude of preventing school bullying were improved in SEM based intervention group more than the control group. However, we didn’t find significant difference in the incidence of school bullying before and after the intervention between the two groups. Conclusions Interventions based on the SEM are effective in improving left-behind children's knowledge and attitudes toward school bullying, but additional strategies are needed to achieve actual behavioral change. A comprehensive, multi-level approach that combines SEM-based interventions with behavioral strategies can serve as a model for reducing school bullying in China and globally. school bullying left-behind children influencing factors intervention study social ecological model 1 Introduction School bullying is a significant public health issue that affects children's health and well-being globally, and China is no exception. Research indicates that bullying prevalence rates vary across different regions, with some studies suggesting that around 50% or more of children aged 2–17 worldwide have experienced some form of violence (Hillis et al., 2016 ). In China, recent studies have shown that the prevalence of bullying among school-aged children is similarly high, highlighting a critical need for attention and intervention (Fei et al., 2022 ). Such experiences can lead to a range of negative outcomes, impacting not only mental health but also social skills and academic performance for both bullies and victims (Wang et al., 2009 ). Substantial evidence has shown that bullying among school aged adolescents is quite common in China. It’s estimated that 19–54.9% middle school adolescents had been bullied(H. Wang, et al., 2012 ; Zhu & Chan, 2015 ). A nationally representative sample from four capital cities represented that 25.7% of middle school students had been bullied in the last month(Cheng, et al., 2010 ). Furthermore, the prevalence and severity of school bullying perpetration and victimization were higher in left-behind children (LBC) than that of non-LBC (NLBC), rendering LBC a crucial target population when reducing bullying(Tu, et al., 2023 ). Associated risk factors of bullying among LBC have been already explored from different aspects, while limited studies have been conducted on specific bullying interventions and verifying its efficacy. In China, LBC are a special group which is concerned by the society. It refers to children under the age of 18 who are left in the place of registered residence and cannot live with both of their parents because one of their parents (or both) works in somewhere else(K. Li, et al., 2013 ). According to national surveys in 2021, the number of rural LBC during compulsory education was more than 8.2 million, accounting for 5% of students in the period(Statistics, 2022). From a social-ecological perspective, individual development is shaped by multiple layers of influence, including the immediate environment (microsystem), interactions between environments (mesosystem), broader social settings (exosystem), and the wider societal context (macrosystem) (Miller et al., 2009 ). This model is particularly relevant for studying bullying as it helps identify risk factors at different levels, allowing for more targeted and effective interventions. At the microsystem level, left-behind children (LBC) often face challenges such as a lack of parental care and companionship, which can lead to negative emotional states and difficulties in daily life, including economic hardship, loss of peer group function, and low social integration and support (Wu, 2017 ). At the mesosystem level, inadequate intergenerational education and neglect of school management further exacerbate these issues, contributing to both physical and psychological problems among LBC compared to non-left-behind children (NLBC) (Shen, 2015; Zhou et al., 2020 ). At the exosystem and macrosystem levels, broader socio-cultural factors and community dynamics may also increase vulnerability. Due to these multi-level disadvantages, LBC are more susceptible to experiencing bullying than their peers (Shen, 2015). In addition to a higher prevalence, the consequences of bullying may be even more severe among LBC for there is a lack of socio-emotional support(Yan, et al., 2023 ). Therefore, it’s crucial to take measures in reducing bullying among LBC to promote their healthy development. At present, the research on school bullying of children is relatively sufficient, while little attention has been paid to this special group(Kim, et al., 2004 ; Moon & Lee, 2020 ; Webb, et al., 2021 ). In view of the frequent school bullying phenomenon, government and scholars have taken some measures, such as anti-bullying legislation, school intervention projects, family intervention projects, etc.(Zhekuan, 2019 ). However, effective intervention study on school bullying for LBC has remained insufficient. To prevent violence, Dahlberg(L. L. Dahlberg & Krug, 2006 ) proposed a social ecological model (SEM), which holds that influencing factors of violence should be thoroughly explored to prevent violence well. Furthermore, Centers for Disease Control and Prevention use four level SEM to understand and explain violence and potential preventive measures(L. Dahlberg & Krug, 2002). The model considers the influence and interaction among individual, relationship, community and social factors when faced with violence. In the meantime, it proposed that measures taken from multiple levels mentioned above at the same time could enhance the effect of prevention when compared with single intervention. To be specific, the model can be divided into four main levels of behavioral factors: individuals, interpersonal relationships, school environment and social environment. The individual level includes physiological and psychological characteristics, knowledge, attitude and skills. The relationship level includes the life mode of personal experience, social role and interpersonal relationship with peers, parents and teachers. The influencing factors of campus environment level refer to the environment in which individuals are not directly involved but are directly affected, such as the campus natural and social environment. The social environment level refers to the social culture, code of conduct and regulation, as well as beliefs and ways of thinking. Many studies have shown that intervention based on SEM is effective in violence like bullying, gun violence, suicide prevention, health promotion, etc.(Allchin, et al., 2019 ; Ayers, et al., 2012 ; Cross, et al., 2015 ; Hong, et al., 2014 ; Wold & Mittelmark, 2018 ) However, research on the effectiveness and efficacy of intervention based on SEM in LBC was limited. Therefore, aiming at reducing school bullying by improving the knowledge and attitude in LBC, we designed reasonable intervention measures based on SEM in combination with the actual situation. We hope that it can provide reference for better prevention and intervention of left-behind children's school bullying in the future. 2 Methods 2.1. Study Participants 190 LBC in grade eighth were recruited from two middle schools in Haojiang District of Shantou City in the intervention study. The inclusion criteria were as follows: (1) In recent years, one or both parents worked in other places/ Unable to live with both parents for parents' migration. (2) Informed consent and voluntary participation in this survey. Exclusion criteria: (1) Those with cognitive and communication barriers. (2) Don’t live with both parents due to divorce or death or other reasons. (3) Unwilling to participate in this survey. 2.2. Program development Participants were divided into two groups for intervention study, 95 of whom were included in the SEM based intervention group and 95 in the control group (general education intervention). The main intervention content of the intervention group based on SEM is the intervention plan designed based on the four-level theory of SEM and the actual situation of local schools, while the control group carries out publicity and education on unintentional injury, including the prevention of drowning, poisoning, animal bites and other related knowledge. In case of penetration of information, LBC in the intervention group and the control group were from different middle schools, respectively. Before the intervention, a balance test was conducted for the two groups, which included: gender, score of knowledge and attitude of school bullying, situation of suffering from school bullying and situation of bullying others on campus. The intervention had been implemented for once a month from September 2021 to January 2022. After the intervention, a questionnaire survey would be conducted again to evaluate the effect of the intervention. Considering the actual situation of the campus, the intervention group based on SEM adopted the following intervention strategies. (1) Individual level: To improve students' coping skills and individual cognition level of school bullying and get rid of bad habits, the specific intervention included: distributing the Prevention Manual of school bullying to students (including the definition of school bullying, the harm of school bullying, the skills and methods to deal with school bullying and the skills to form good habits, etc.) (2) Relationship level: To improve students' peer relationship and parent-child relationship, the specific intervention measures were as follows: teaching students the knowledge and skills of getting along with peers, suggesting teachers to adopt the form of learning group in the class, distributing brochures to students' parents (including: correct parenting style, positive parent-child relationship skills, how to identify school bullying and how to deal with it). (3) Campus level: To create a social and cultural atmosphere against bullying on campus, the specific intervention measures were holding large-scale school bullying theme lectures and setting up some propaganda slogans and pictures against school bullying on the bulletin board on the campus. (4) Social level: Improving students' awareness of social laws and regulations to make them realize that bullying could be constrained. The specific measures were as follows: It is suggested that the head teacher should add some school bullying punishment to the class rules. At the same time, some knowledge about the social legal norms of school bullying could be added to the content of the theme lecture as well. The specific intervention forms and contents are shown in Table 1 . Table 1 Form and specific content of intervention study Form Content Intervention object 1st intervention Brochure & explanation The definition of school bullying, the harm of school bullying, the skills to deal with school bullying and the skills to get along with peers, etc Students 2nd intervention Brochure Correct parenting style, positive parent-child relationship skills, and how to identify and deal with school bullying Parents 3rd intervention Propaganda & education It is suggested that teachers should adopt the form of study group in the class and the punishment system of school bullying Teachers 4thintervention Poster display & publicity slogan The content of the picture and text is the harm of school bullying, relevant knowledge of preventing campus bullying, skills of developing good habits, etc Students 5th intervention Educational lectures The prevalence and related knowledge of school bullying, the importance of advocating inclusive and harmonious school atmosphere and the knowledge of social legal norms Students 2.3. Measures The contents of the questionnaire include basic information, left-behind state, family support, school connection, the occurrence of school bullying, knowledge and attitude of school bullying, etc. The revised multidimensional peer bullying scale (MPVS)(Mynard & Joseph, 2000 ; Raine, et al., 2011 ) were adopted to know about the victims of school bullying. The revised MPVS scale refers to the research of Li Jiameng et al(J. Li, 2020 )., adding the dimension of cyberbullying. The scale includes five dimensions, including physical bullying, relationship bullying, verbal bullying, property bullying and cyberbullying, with a total of 20 items. In this study, Cronbach α of the five dimensions of MPVS scale are 0.767, 0.741, 0.832, 0.792 and 0.902, respectively. In addition, KMO(Kaiser-Meyer-Olkin) value, Bartlett ball value, p -value and the cumulative variance interpretation rate (after rotation) is 0.870, 419.282, <0.001 and 76.502%, respectively, indicating that the scale has good validity. To understand the occurrence of bullying others, we utilized the revised multidimensional peer bullying scale (MPVS-RB)(Betts, et al., 2015 ), which refers to the research of Li Jiameng et al. (J. Li, 2020 ) and adds the dimension of cyberbullying others. The scale includes 5 dimensions, including physical bullying others, relationship bullying others, verbal bullying others, property bullying others and cyberbullying others, with a total of 20 items. In this study, Cronbach α of the five dimensions of the MPVS-RB scale is 0.743, 0.834, 0.631, 0.786 and 0.927, respectively. In addition, KMO(Kaiser-Meyer-Olkin) value, Bartlett ball value, p -value and the cumulative variance interpretation rate (after rotation) is 0.870, 419.282, <0.001 and 76.502%, respectively, indicating that the scale has good validity. All items of MPVS scale and MPVS-RB scale are scored by Likert 5-point scoring method, which are \"None\", \"1–2 times\", \"2–3 times / month\", \"1 time / week\" and \"more than one week\". The corresponding is 0, 1, 2, 3 or 4. The sum of the five dimensions ranges from 0 to 20, which is proportional to the frequency of bullying Then, in terms of victims of school bullying, it means that respondent has been bullied when the total score is ≥ 1. The bullying type could be determined if the corresponding bullying type score is ≥ 1. In terms of school bullying others, the judgment standard is consistent with that of being bullied on campus. The self-made knowledge and attitude scale for preventing campus bullying was used to measure the level of knowledge and attitude for preventing school bullying of the subjects. The preparation of the scale mainly refers to the research of TA Park, V. M et.al.(Ta Park, et al., 2020 ), being modified according to the suggestions of relevant experts and pre-survey. The school bullying prevention knowledge and attitude scales both have a total of 8 items. Each item uses Likert's 5-point scoring method, which is \"very disagree\", \"disagree\", \"neutral\", \"agree\" and \"fully agree\", scoring from 1 to 5 correspondingly. There are 8 items in the school bullying prevention attitude scale. Cronbach's α of knowledge and attitude is 0.922 and 0.952, respectively. In addition, in terms of validity, KMO(Kaiser-Meyer-Olkin) value, Bartlett ball value, p -value and the cumulative variance interpretation rate (after rotation) is 0.788, 1620.511, <0.001, and 84.342%, indicating that the scale has good validity. 2.4.Statistical analysis The data was input by EpiData 3.1 and collated by Excel. Descriptive analysis was used to show the social-demographic information, where continuous and categorical variables were represented by frequency and constituent ratio, mean and standard deviation ( \\(\\:\\stackrel{-}{X}\\) ± SD ) respectively. Comparative analysis of the differences between groups was analyzed with t-test or chi square test by SPSS 25.0. Differences in scores of school bullying prevention knowledge and attitude were examined with Differences in Differences(DID) by SPSSAU. All tests were 2-sided and P <0.05 considered to have statistical significance. 3 Results After the intervention, 174 effective questionnaires were collected in total. In the intervention group, 5 of the intervention group were lost to follow-up, with a loss of follow-up rate of 5.3%. 90 effective questionnaires were collected, including 48 (53.3%) males and 42 (46.7%) females. In the control group, 11 participants were lost to follow-up, with a loss rate of 11.6%. 84 valid questionnaires were collected, of which 41 (48.8%) were male and 43 (51.2%) were female. As shown in Table 2 , before the intervention, the balance test between the SEM intervention group and the control group found that there was no significant difference in gender ratio, school bullying knowledge score, school bullying attitude score and school bullying incidence. Table 2 Balance test of SEM intervention group and control group before intervention for left-behind children in Shantou Intervention group( n , %) control group( n , %) χ² P Gender 0.356 0.551 male 48(53.3) 41(48.8) female 42(46.7) 43(51.2) Knowledge score 26.53 ± 3.75 25.51 ± 7.69 -1.101 0.273 Attitude score 46.08 ± 6.31 44.58 ± 9.51 -1.213 0.227 Being school bullying 58(64.4) 52(61.9) 0.121 0.728 School bullying others 41(45.6) 38(45.2) 0.002 0.966 As for knowledge of school bullying, it showed that in the SEM intervention group, the baseline survey score of the participants' knowledge of school bullying was 26.53 ± 3.75, and the post intervention score was 33.87 ± 2.49. In the control group, the baseline survey score was 25.51 ± 7.69, and the post intervention score was 27.86 ± 6.92. After the intervention, the knowledge scores of students in the two groups on school bullying increased by 7.58 ± 4.25 and 2.35 ± 2.96, respectively, P both < 0.05 (Table 3 ). In addition, the subjects in the SEM intervention group improved their knowledge scores on school bullying more than those in the control group, increased by 4.988, P< 0.001 (Table 4 ). Table 3 Changes of knowledge and attitude scores of subjects on campus bullying before and after intervention in SEM intervention group and control group Group Average score Difference t P -value Knowledge SEM Intervention group(n = 90) Before intervention 26.53 ± 3.75 7.58 ± 4.25 -15.458 <0.001** After intervention 33.87 ± 2.49 control group(n = 84) Before intervention 25.51 ± 7.69 2.35 ± 2.96 -2.078 0.039* After intervention 27.86 ± 6.92 Attitude SEM Intervention group(n = 90) Before intervention 46.08 ± 6.31 8.23 ± 7.68 -10.363 <0.001** After intervention 54.31 ± 4.12 control group(n = 84) Before intervention 44.58 ± 9.51 1.86 ± 2.32 -1.345 0.181 After intervention 46.44 ± 8.35 * P < 0.05 ** P < 0.01 Table 4 Comparison of knowledge and attitude scores between SEM intervention group and control group before and after intervention Group Control (n = 84) SEM (n = 90) Difference SD t P-value Knowledge Before intervention 25.512 26.533 1.021 0.845 1.208 0.228 After intervention 46.44 54.311 7.871 1.108 7.103 <0.001** Diff-in-Diff 4.988 1.195 4.173 <0.001** Attitude Before intervention 44.583 46.078 1.494 1.108 1.349 0.178 After intervention 46.44 54.311 7.871 1.108 7.103 <0.001** Diff-in-Diff 6.376 1.567 4.069 <0.001** * p < 0.05 ** p < 0.01 Table 4 Comparison of knowledge scores and attitude between SEM intervention group and control group before and after intervention Group Control (n = 84) SEM (n = 90) Difference SD t P-value Knowledge Before intervention 25.512 26.533 1.021 0.845 1.208 0.228 After intervention 46.440 54.311 7.871 1.108 7.103 <0.001 Diff-in-Diff 4.988 1.195 4.173 <0.001 Attitude Before intervention 44.583 46.078 1.494 1.108 1.349 0.178 After intervention 46.440 54.311 7.871 1.108 7.103 <0.001 Diff-in-Diff 6.376 1.567 4.069 <0.001 As for attitude towards to school bullying, it presented that in the SEM intervention group, the baseline survey score of the respondents' attitude towards school bullying was 46.08 ± 6.31, while the score after the intervention was 54.31 ± 4.12, with 8.23 ± 7.68 increased ( P <0.001). In the control group, the students' baseline survey score was 44.58 ± 9.51, while the score after the intervention was 46.44 ± 8.35. However, there’s no significant difference before and after general education intervention in the control group (Table 3 ). In addition, the attitude scores of the subjects in the SEM intervention group towards school bullying were higher than those in the control group, increased by 6.376, P <0.001 (Table 4 ). Table 5 showed the incidence of school bullying in SEM intervention group and control group before and after intervention. Before the intervention, 58 (64.4%) participants in the SEM intervention group have suffered from school bullying and 41 (45.6%) have bullied others on campus. For bullying victims, verbal bullying (63.3%), relationship bullying (41.1%) and property bullying (40.0%) were main bullying types. Similarly, bullying perpetration types were mainly comprised of property bullying(37.8%), verbal bullying (22.2%) and relationship bullying (9.0%). In the control group, 52 (61.9%) LBC have been bullied and 38 (45.2%) have bullied others. Main bullying victimization types were Verbal bullying (50.0%), property bullying(19.0%), relationship bullying(9.5%) and cyberbullying(9.5%). Main bullying perpetration types were verbal bullying (32.1%), property bullying (13.1%) and relationship bullying (9.5%). After intervention, 54 (60.0%) participants in the SEM intervention group suffered from school bullying and 43 (47.8%) have bullied others on campus. Verbal bullying (56.7%), property bullying (41.1%) and relationship bullying (33.3%) were dominant bullying types. As for bullying perpetration, verbal bullying (44.4%), relationship bullying (25.6%) and property bullying (12.2%) were primary bullying types. In the control group, it’s reported that 50(59.5%) participants being bullied and 34 (40.5%) have bullied others on campus. Main types of bullying consisted of verbal bullying, property bullying and relationship bullying in both victimization and perpetration bullying. (Table 5 ) Nonetheless. there was no statistically significant difference in the incidence of school bullying and bullying others before and after the intervention both in the SEM intervention group and the control group, Table 5 . Table 5 Incidence of school bullying in SEM intervention group and control group before and after intervention Before intervention( n , %) After intervention( n , %) χ² P SEM Intervention group(n = 90) Being school bullying 58(64.4) 54(60.0) 0.378 0.539 Being physical bullying 15(16.7) 18(20.0) 0.334 0.563 Being relationship bullying 37(41.1) 30(33.3) 1.165 0.280 Being verbal bullying 57(63.3) 51(56.7) 0.833 0.361 Being property bullying 36(40.0) 37(41.1) 0.023 0.879 Being cyberbullying 13(14.4) 19(21.1) 1.368 0.242 School bullying others 41(45.6) 43(47.8) 0.089 0.765 Physical bullying others 7(7.8) 9(10.0) 0.274 0.600 Relationship bullying others 20(22.2) 23(25.6) 0.275 0.600 Verbal bullying others 34(37.8) 40(44.4) 0.826 0.363 Property bullying others 11(12.2) 11(12.2) 0.000 1.000 Cyberbullying others 3(3.3) 6(6.7) 1.053 0.305 control group(n = 84) Being school bullying 52(61.9) 50(59.5) 0.100 0.752 Being physical bullying 5(6.0) 7(8.3) 0.359 0.549 Being relationship bullying 8(9.5) 9(10.7) 0.065 0.798 Being verbal bullying 42(50.0) 41(48.8) 0.024 0.877 Being property bullying 16(19.0) 14(16.7) 0.162 0.687 Being cyberbullying 8(9.5) 7(8.3) 0.073 0.787 School bullying others 38(45.2) 34(40.5) 0.389 0.533 Physical bullying others 5(6.0) 5(6.0) 0.000 1.000 Relationship bullying others 8(9.5) 7(8.3) 0.073 0.787 Verbal bullying others 27(32.1) 25(29.8) 0.111 0.739 Property bullying others 11(13.1) 9(10.7) 0.227 0.634 Cyberbullying others 2(2.4) 3(3.6) - 1.000 4 Discussion Based on SEM, combined with the actual situation and cultural background of local schools, this study conducted a comprehensive intervention to prevent bullying among LBC from four aspects: individual, interpersonal relationship, school and social norms. The results of the intervention showed that the scores of LBC in the SEM intervention group and the control group were higher after the intervention in terms of the improvement both of school bullying knowledge and attitude scores with statistical differences. LBC in the intervention group improved their knowledge scores on school bullying more than those in the control group with statistically significant difference, which shows that SEM based interventions can effectively improve the level of school bullying knowledge and attitude of left-behind children, leaving a more positive effect better than that on the control group. In terms of changes in the incidence of school bullying. The results showed that the incidence of school bullying had not changed both in the intervention and the control group. It showed that the effect of SEM based school bullying intervention on preventing and controlling the occurrence of school bullying of LBC was not obvious. Although SEM based interventions could effectively improve the knowledge and attitude of LBC on school bullying, there was no significant change in the incidence of school bullying. This may be relevant to the fact that the duration of intervention was too short to convert from the improvement of knowledge and attitude to behavioral modification. Therefore, we should continue to increase the intensity and length of intervention on LBC, aiming to reduce the occurrence of school bullying more effectively in the future. Besides, Haoyuan, Zhang(Zhang, 2020 ) found that the SEM based intervention group can reduce the rate of victimization of cyberbullying after the intervention and improve the cognition of cyberbullying solutions in college students, which was consistent with our results in cognitive situation. Nevertheless, the effect of behavioral change was better than ours. The reason may be that the participants were quite different. Children's knowledge level and various social development abilities are far lower than those of college students. For LBC, more long-term intervention may be required to change their behaviors. There are few intervention studies on children's school bullying in China at present, in which ordinary educational intervention is the main measure, lacking effective and comprehensive intervention measures on campus. Future research can design more scientific interventions based on SEM for prevention of school bullying and evaluate their long-term effects on the prevention of school bullying in LBC. This study has the following limitations. Firstly, this study is a self-reported questionnaire survey, in which respondents needed to recall the occurrence and experience of school bullying in the past, leading to memory bias. Future studies need the report from parents and teachers. Secondly, school bullying is a sensitive topic. The respondents may exaggerate or conceal some sensitive issues. LBC performance monitoring in school should be taken into consideration in the future. Thirdly, the intervention time of this study is relatively short, which may not reflect the long-term effect of the intervention measures. Future studies should lengthen the period of intervention to observe the effect. Fourthly, the sample size was too small due to the few amount of left-behind students and we cannot represent the whole country. Future studies should focus on a large sample study in the whole country. 5 Conclusions Interventions based on the SEM are effective in enhancing left-behind children's knowledge and attitudes toward school bullying, but these changes alone do not guarantee behavioral change. To more effectively reduce school bullying, it is crucial to integrate SEM-based interventions with strategies like skills training and continuous support. Given the high prevalence of bullying and the vulnerabilities of left-behind children in China, a comprehensive, multi-level approach is needed. This framework can also be applied in other regions to create safer and more supportive school environments globally. Declarations Author Contributions: J.H. undertook the data analysis, wrote the research process, literature reviews and interpreted the results. J.H., Y.C., Y.C and Q. D. performed the data collection, complete statistical tables and result analysis. L.L. was in charge of the conception, undertook the design of the study framework, and takes responsibility for the integrity of the data and the accuracy of the data, and interpreted the conclusion. L.L. ultimately modified the manuscript. All authors have read and agreed to the published version of the manuscript. Funding: This research received no external funding. Institutional Review Board Statement: The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of Shantou University Medical College (project no. SUMC-2021-92). Informed Consent Statement: Informed consent was obtained from all subjects involved in the study. Data Availability Statement: The datasets used and analyzed in the study are available from the corresponding author on reasonable request. Conflicts of Interest: The authors declare no conflicts of interests. Clinical trial number: not applicable. References Allchin, A., Chaplin, V., & Horwitz, J. (2019). Limiting access to lethal means: applying the social ecological model for firearm suicide prevention. Injury Prevention, 25 , i44-i48. doi: 10.1136/injuryprev-2018-042809 Ayers, S. L., Wagaman, M. A., Geiger, J. M., Bermudez-Parsai, M., & Hedberg, E. C. (2012). Examining School-Based Bullying Interventions Using Multilevel Discrete Time Hazard Modeling. 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J Clin Child Adolesc Psychol, 38 (4), 538-550. doi: 10.1080/15374410902976270 Moon, H., & Lee, S. (2020). Moderating effects of socio-ecological factors on the relationship between adolescent exposure to media violence and attitudes towards school bullying. Journal of Advanced Nursing, 76 (11), 2921-2932. doi: 10.1111/jan.14478 Mynard, H., & Joseph, S. (2000). Development of the multidimensional peer-victimization scale. Aggressive Behavior, 26 (2), 169-178. doi: 10.1002/(SICI)1098-2337(2000)26:2<169::AID-AB3>3.0.CO;2-A Raine, A., Fung, A. L., & Lam, B. Y. (2011). Peer Victimization Partially Mediates the Schizotypy-Aggression Relationship in Children and Adolescents. Schizophrenia Bulletin, 37 (5), 937-945. doi: 10.1093/schbul/sbr082 Shen, J., Liu, X., Zhao, J., & Shi, B. . (2015). The psychological development of chinese left-behind children and migrant children in urbanization process Psychological Development and Education, 31 (1), 108–116. doi: https://doi.org/10.16187/j.cnki.issn1001-4918.2015.01.15 National Burea of Statistics, (2022). China statistical yearbook 2022 . Beijing China Statistics Press. Ta Park, V. M., Suen Diwata, J., Win, N., Ton, V., Nam, B., Rajabally, W., & Jones, V. C. (2020). Promising Results from the Use of a Korean Drama to Address Knowledge, Attitudes, and Behaviors on School Bullying and Mental Health among Asian American College-Aged Students. International Journal of Environmental Research and Public Health, 17 (5), 1637. doi: 10.3390/ijerph17051637 Tu, Y., Qing, Z. H., Lin, C. X., Yan, C. H., Yin, H. Z., Ighaede-Edwards, I. G., . . . Liu, X. Q. (2023). The Prevalence and Severity of School Bullying among Left-Behind Children: A Meta-Analysis. Trauma Violence Abuse , 15248380231195888. doi: 10.1177/15248380231195888 Wang, H., Zhou, X., Lu, C., Wu, J., Deng, X., Hong, L., . . . He, Y. (2012). Adolescent Bullying Involvement and Psychosocial Aspects of Family and School Life: A Cross-Sectional Study from Guangdong Province in China. Plos One, 7 (7). doi: 10.1371/journal.pone.0038619 Wang, J., Iannotti, R. J., & Nansel, T. R. (2009). School bullying among adolescents in the United States: Physical, verbal, relational, and cyber. Journal of Adolescent Health, 45 (4), 368-375. doi: 10.1016/j.jadohealth.2009.03.021 Webb, L., Clary, L. K., Johnson, R. M., & Mendelson, T. (2021). Electronic and School Bullying Victimization by Race/Ethnicity and Sexual Minority Status in a Nationally Representative Adolescent Sample. Journal of Adolescent Health, 68 (2), 378-384. doi: 10.1016/j.jadohealth.2020.05.042 Wold, B., & Mittelmark, M. B. (2018). Health-promotion research over three decades: The social-ecological model and challenges in implementation of interventions. Scandinavian Journal of Public Health, 46 , 20-26. doi: 10.1177/1403494817743893 Wu, Q. (2017). A Research on the Influence of Bullying of Left-Behind Adolescents on Campus. (dissertation/master’s thesis), Anhui University. Yan, R., Ding, W., Wang, D., Lin, X., Lin, X., Li, W., & Xie, R. (2023). Longitudinal relationship between child maltreatment, bullying victimization, depression, and nonsuicidal self-injury among left-behind children in China: 2-year follow-up. J Clin Psychol, 79 (12), 2899-2917. doi: 10.1002/jclp.23585 Zhang, H. (2020). Study on the Influencing Factors and Intervention Based on Social-Ecological Model of Cyberbullying among College Students in Shantou. (dissertation/master’s thesis), Shantou University. Zhekuan, P. (2019). School Bullying KAP Survey and Effect Evaluation of Education Intervention among Middle School Students. (dissertation/master’s thesis), Shantou University. Zhou, Y. Y., Cheng, Y. L., Liang, Y. M., Wang, J. Z., Li, C. N., Du, W. J., . . . Liu, Z. K. (2020). Interaction status, victimization and emotional distress of left-behind children: A national survey in China. Children and Youth Services Review, 118 , 8. doi: 10.1016/j.childyouth.2020.105348 Zhu, Y., & Chan, K. L. (2015). Prevalence and Correlates of School Bullying Victimization in Xi'an, China. Violence and Victims, 30 (4), 714-732. doi: 10.1891/0886-6708.Vv-d-14-00006 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 01 Oct, 2024 Editor assigned by journal 26 Sep, 2024 Submission checks completed at journal 26 Sep, 2024 First submitted to journal 23 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5135455\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":360953322,\"identity\":\"7836829d-e82d-4fc8-b7ba-13e7dcebc6c0\",\"order_by\":0,\"name\":\"Jinyu Huang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shantou University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jinyu\",\"middleName\":\"\",\"lastName\":\"Huang\",\"suffix\":\"\"},{\"id\":360953324,\"identity\":\"ce2d1581-b5de-45df-a607-7f447a30e345\",\"order_by\":1,\"name\":\"yichao chen\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shantou University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"yichao\",\"middleName\":\"\",\"lastName\":\"chen\",\"suffix\":\"\"},{\"id\":360953327,\"identity\":\"42bf72cd-ea3b-436b-9eb3-d056690fb594\",\"order_by\":2,\"name\":\"Yueliang Chen\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shantou University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yueliang\",\"middleName\":\"\",\"lastName\":\"Chen\",\"suffix\":\"\"},{\"id\":360953332,\"identity\":\"fd811cfa-4b4f-4ae9-9d7f-baf28af3b52a\",\"order_by\":3,\"name\":\"Qingchen Da\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shantou University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Qingchen\",\"middleName\":\"\",\"lastName\":\"Da\",\"suffix\":\"\"},{\"id\":360953333,\"identity\":\"f806673f-8b6f-4fae-864b-62b90193dc27\",\"order_by\":4,\"name\":\"Liping Li\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAqUlEQVRIiWNgGAWjYBACPgbmhgMfIGwD4rSwMTA2HJwBUU2CFmYe0rRINzYetvnzJ7GBvXmbBEPNHSK0yBxsOJzbZpDYwHOsTILh2DMitEgkArU0ALVI5JhJMDYcJlKLxR+gFvk3pGhhYAPZwkOsFqBfDva2GRu38aQVWyQcI0ILv3Tz4Q8//sjJ9rMf3njjQw0RWhgkYNaBiAQiNCC0jIJRMApGwSjACQDBfDbxFL3eMQAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Shantou University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Liping\",\"middleName\":\"\",\"lastName\":\"Li\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-09-23 06:07:14\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-5135455/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-5135455/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":68413760,\"identity\":\"8d734485-8770-4b34-a7af-044e803111b0\",\"added_by\":\"auto\",\"created_at\":\"2024-11-07 04:31:02\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":685014,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5135455/v1/55ccc2c1-2c7a-4fde-9d5b-8ffe232b5f92.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"School bullying prevention among left-behind children: An intervention study based on social ecological model in China\",\"fulltext\":[{\"header\":\"1 Introduction\",\"content\":\"\\u003cp\\u003eSchool bullying is a significant public health issue that affects children's health and well-being globally, and China is no exception. Research indicates that bullying prevalence rates vary across different regions, with some studies suggesting that around 50% or more of children aged 2\\u0026ndash;17 worldwide have experienced some form of violence (Hillis et al., \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e2016\\u003c/span\\u003e). In China, recent studies have shown that the prevalence of bullying among school-aged children is similarly high, highlighting a critical need for attention and intervention (Fei et al., \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e2022\\u003c/span\\u003e). Such experiences can lead to a range of negative outcomes, impacting not only mental health but also social skills and academic performance for both bullies and victims (Wang et al., \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e2009\\u003c/span\\u003e). Substantial evidence has shown that bullying among school aged adolescents is quite common in China. It\\u0026rsquo;s estimated that 19\\u0026ndash;54.9% middle school adolescents had been bullied(H. Wang, et al., \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e2012\\u003c/span\\u003e; Zhu \\u0026amp; Chan, \\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e2015\\u003c/span\\u003e). A nationally representative sample from four capital cities represented that 25.7% of middle school students had been bullied in the last month(Cheng, et al., \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e2010\\u003c/span\\u003e). Furthermore, the prevalence and severity of school bullying perpetration and victimization were higher in left-behind children (LBC) than that of non-LBC (NLBC), rendering LBC a crucial target population when reducing bullying(Tu, et al., \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e2023\\u003c/span\\u003e). Associated risk factors of bullying among LBC have been already explored from different aspects, while limited studies have been conducted on specific bullying interventions and verifying its efficacy.\\u003c/p\\u003e \\u003cp\\u003eIn China, LBC are a special group which is concerned by the society. It refers to children under the age of 18 who are left in the place of registered residence and cannot live with both of their parents because one of their parents (or both) works in somewhere else(K. Li, et al., \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e2013\\u003c/span\\u003e). According to national surveys in 2021, the number of rural LBC during compulsory education was more than 8.2\\u0026nbsp;million, accounting for 5% of students in the period(Statistics, 2022). From a social-ecological perspective, individual development is shaped by multiple layers of influence, including the immediate environment (microsystem), interactions between environments (mesosystem), broader social settings (exosystem), and the wider societal context (macrosystem) (Miller et al., \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e2009\\u003c/span\\u003e). This model is particularly relevant for studying bullying as it helps identify risk factors at different levels, allowing for more targeted and effective interventions. At the microsystem level, left-behind children (LBC) often face challenges such as a lack of parental care and companionship, which can lead to negative emotional states and difficulties in daily life, including economic hardship, loss of peer group function, and low social integration and support (Wu, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e). At the mesosystem level, inadequate intergenerational education and neglect of school management further exacerbate these issues, contributing to both physical and psychological problems among LBC compared to non-left-behind children (NLBC) (Shen, 2015; Zhou et al., \\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e2020\\u003c/span\\u003e). At the exosystem and macrosystem levels, broader socio-cultural factors and community dynamics may also increase vulnerability. Due to these multi-level disadvantages, LBC are more susceptible to experiencing bullying than their peers (Shen, 2015). In addition to a higher prevalence, the consequences of bullying may be even more severe among LBC for there is a lack of socio-emotional support(Yan, et al., \\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e2023\\u003c/span\\u003e). Therefore, it\\u0026rsquo;s crucial to take measures in reducing bullying among LBC to promote their healthy development. At present, the research on school bullying of children is relatively sufficient, while little attention has been paid to this special group(Kim, et al., \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e2004\\u003c/span\\u003e; Moon \\u0026amp; Lee, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e2020\\u003c/span\\u003e; Webb, et al., \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e). In view of the frequent school bullying phenomenon, government and scholars have taken some measures, such as anti-bullying legislation, school intervention projects, family intervention projects, etc.(Zhekuan, \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e). However, effective intervention study on school bullying for LBC has remained insufficient.\\u003c/p\\u003e \\u003cp\\u003eTo prevent violence, Dahlberg(L. L. Dahlberg \\u0026amp; Krug, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e2006\\u003c/span\\u003e) proposed a social ecological model (SEM), which holds that influencing factors of violence should be thoroughly explored to prevent violence well. Furthermore, Centers for Disease Control and Prevention use four level SEM to understand and explain violence and potential preventive measures(L. Dahlberg \\u0026amp; Krug, 2002). The model considers the influence and interaction among individual, relationship, community and social factors when faced with violence. In the meantime, it proposed that measures taken from multiple levels mentioned above at the same time could enhance the effect of prevention when compared with single intervention. To be specific, the model can be divided into four main levels of behavioral factors: individuals, interpersonal relationships, school environment and social environment. The individual level includes physiological and psychological characteristics, knowledge, attitude and skills. The relationship level includes the life mode of personal experience, social role and interpersonal relationship with peers, parents and teachers. The influencing factors of campus environment level refer to the environment in which individuals are not directly involved but are directly affected, such as the campus natural and social environment. The social environment level refers to the social culture, code of conduct and regulation, as well as beliefs and ways of thinking. Many studies have shown that intervention based on SEM is effective in violence like bullying, gun violence, suicide prevention, health promotion, etc.(Allchin, et al., \\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e; Ayers, et al., \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2012\\u003c/span\\u003e; Cross, et al., \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e2015\\u003c/span\\u003e; Hong, et al., \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e2014\\u003c/span\\u003e; Wold \\u0026amp; Mittelmark, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e2018\\u003c/span\\u003e) However, research on the effectiveness and efficacy of intervention based on SEM in LBC was limited.\\u003c/p\\u003e \\u003cp\\u003eTherefore, aiming at reducing school bullying by improving the knowledge and attitude in LBC, we designed reasonable intervention measures based on SEM in combination with the actual situation. We hope that it can provide reference for better prevention and intervention of left-behind children's school bullying in the future.\\u003c/p\\u003e\"},{\"header\":\"2 Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2.1. Study Participants\\u003c/h2\\u003e \\u003cp\\u003e190 LBC in grade eighth were recruited from two middle schools in Haojiang District of Shantou City in the intervention study. The inclusion criteria were as follows: (1) In recent years, one or both parents worked in other places/ Unable to live with both parents for parents' migration. (2) Informed consent and voluntary participation in this survey. Exclusion criteria: (1) Those with cognitive and communication barriers. (2) Don\\u0026rsquo;t live with both parents due to divorce or death or other reasons. (3) Unwilling to participate in this survey.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2.2. Program development\\u003c/h2\\u003e \\u003cp\\u003eParticipants were divided into two groups for intervention study, 95 of whom were included in the SEM based intervention group and 95 in the control group (general education intervention). The main intervention content of the intervention group based on SEM is the intervention plan designed based on the four-level theory of SEM and the actual situation of local schools, while the control group carries out publicity and education on unintentional injury, including the prevention of drowning, poisoning, animal bites and other related knowledge. In case of penetration of information, LBC in the intervention group and the control group were from different middle schools, respectively. Before the intervention, a balance test was conducted for the two groups, which included: gender, score of knowledge and attitude of school bullying, situation of suffering from school bullying and situation of bullying others on campus. The intervention had been implemented for once a month from September 2021 to January 2022. After the intervention, a questionnaire survey would be conducted again to evaluate the effect of the intervention.\\u003c/p\\u003e \\u003cp\\u003eConsidering the actual situation of the campus, the intervention group based on SEM adopted the following intervention strategies. (1) Individual level: To improve students' coping skills and individual cognition level of school bullying and get rid of bad habits, the specific intervention included: distributing the Prevention Manual of school bullying to students (including the definition of school bullying, the harm of school bullying, the skills and methods to deal with school bullying and the skills to form good habits, etc.) (2) Relationship level: To improve students' peer relationship and parent-child relationship, the specific intervention measures were as follows: teaching students the knowledge and skills of getting along with peers, suggesting teachers to adopt the form of learning group in the class, distributing brochures to students' parents (including: correct parenting style, positive parent-child relationship skills, how to identify school bullying and how to deal with it). (3) Campus level: To create a social and cultural atmosphere against bullying on campus, the specific intervention measures were holding large-scale school bullying theme lectures and setting up some propaganda slogans and pictures against school bullying on the bulletin board on the campus. (4) Social level: Improving students' awareness of social laws and regulations to make them realize that bullying could be constrained. The specific measures were as follows: It is suggested that the head teacher should add some school bullying punishment to the class rules. At the same time, some knowledge about the social legal norms of school bullying could be added to the content of the theme lecture as well. The specific intervention forms and contents are shown in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eForm and specific content of intervention study\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eForm\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eContent\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eIntervention object\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e1st intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eBrochure \\u0026amp; explanation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eThe definition of school bullying, the harm of school bullying, the skills to deal with school bullying and the skills to get along with peers, etc\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eStudents\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e2nd intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eBrochure\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCorrect parenting style, positive parent-child relationship skills, and how to identify and deal with school bullying\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eParents\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e3rd intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePropaganda \\u0026amp; education\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eIt is suggested that teachers should adopt the form of study group in the class and the punishment system of school bullying\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eTeachers\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e4thintervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePoster display \\u0026amp; publicity slogan\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eThe content of the picture and text is the harm of school bullying, relevant knowledge of preventing campus bullying, skills of developing good habits, etc\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eStudents\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e5th intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eEducational lectures\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eThe prevalence and related knowledge of school bullying, the importance of advocating inclusive and harmonious school atmosphere and the knowledge of social legal norms\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eStudents\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2.3. Measures\\u003c/h2\\u003e \\u003cp\\u003eThe contents of the questionnaire include basic information, left-behind state, family support, school connection, the occurrence of school bullying, knowledge and attitude of school bullying, etc.\\u003c/p\\u003e \\u003cp\\u003eThe revised multidimensional peer bullying scale (MPVS)(Mynard \\u0026amp; Joseph, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e2000\\u003c/span\\u003e; Raine, et al., \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e2011\\u003c/span\\u003e) were adopted to know about the victims of school bullying. The revised MPVS scale refers to the research of Li Jiameng et al(J. Li, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e2020\\u003c/span\\u003e)., adding the dimension of cyberbullying. The scale includes five dimensions, including physical bullying, relationship bullying, verbal bullying, property bullying and cyberbullying, with a total of 20 items. In this study, Cronbach α of the five dimensions of MPVS scale are 0.767, 0.741, 0.832, 0.792 and 0.902, respectively. In addition, KMO(Kaiser-Meyer-Olkin) value, Bartlett ball value, \\u003cem\\u003ep\\u003c/em\\u003e-value and the cumulative variance interpretation rate (after rotation) is 0.870, 419.282, \\u0026lt;0.001 and 76.502%, respectively, indicating that the scale has good validity. To understand the occurrence of bullying others, we utilized the revised multidimensional peer bullying scale (MPVS-RB)(Betts, et al., \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e2015\\u003c/span\\u003e), which refers to the research of Li Jiameng et al. (J. Li, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e2020\\u003c/span\\u003e) and adds the dimension of cyberbullying others. The scale includes 5 dimensions, including physical bullying others, relationship bullying others, verbal bullying others, property bullying others and cyberbullying others, with a total of 20 items. In this study, Cronbach α of the five dimensions of the MPVS-RB scale is 0.743, 0.834, 0.631, 0.786 and 0.927, respectively. In addition, KMO(Kaiser-Meyer-Olkin) value, Bartlett ball value, \\u003cem\\u003ep\\u003c/em\\u003e-value and the cumulative variance interpretation rate (after rotation) is 0.870, 419.282, \\u0026lt;0.001 and 76.502%, respectively, indicating that the scale has good validity. All items of MPVS scale and MPVS-RB scale are scored by Likert 5-point scoring method, which are \\\"None\\\", \\\"1\\u0026ndash;2 times\\\", \\\"2\\u0026ndash;3 times / month\\\", \\\"1 time / week\\\" and \\\"more than one week\\\". The corresponding is 0, 1, 2, 3 or 4. The sum of the five dimensions ranges from 0 to 20, which is proportional to the frequency of bullying Then, in terms of victims of school bullying, it means that respondent has been bullied when the total score is \\u0026ge;\\u0026thinsp;1. The bullying type could be determined if the corresponding bullying type score is \\u0026ge;\\u0026thinsp;1. In terms of school bullying others, the judgment standard is consistent with that of being bullied on campus.\\u003c/p\\u003e \\u003cp\\u003eThe self-made knowledge and attitude scale for preventing campus bullying was used to measure the level of knowledge and attitude for preventing school bullying of the subjects. The preparation of the scale mainly refers to the research of TA Park, V. M et.al.(Ta Park, et al., \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e2020\\u003c/span\\u003e), being modified according to the suggestions of relevant experts and pre-survey. The school bullying prevention knowledge and attitude scales both have a total of 8 items. Each item uses Likert's 5-point scoring method, which is \\\"very disagree\\\", \\\"disagree\\\", \\\"neutral\\\", \\\"agree\\\" and \\\"fully agree\\\", scoring from 1 to 5 correspondingly. There are 8 items in the school bullying prevention attitude scale. Cronbach's \\u003cem\\u003eα\\u003c/em\\u003e of knowledge and attitude is 0.922 and 0.952, respectively. In addition, in terms of validity, KMO(Kaiser-Meyer-Olkin) value, Bartlett ball value, \\u003cem\\u003ep\\u003c/em\\u003e-value and the cumulative variance interpretation rate (after rotation) is 0.788, 1620.511, \\u0026lt;0.001, and 84.342%, indicating that the scale has good validity.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2.4.Statistical analysis\\u003c/h2\\u003e \\u003cp\\u003eThe data was input by EpiData 3.1 and collated by Excel. Descriptive analysis was used to show the social-demographic information, where continuous and categorical variables were represented by frequency and constituent ratio, mean and standard deviation (\\u003cspan class=\\\"InlineEquation\\\"\\u003e\\u003cspan class=\\\"mathinline\\\"\\u003e\\\\(\\\\:\\\\stackrel{-}{X}\\\\)\\u003c/span\\u003e\\u003c/span\\u003e\\u0026plusmn;\\u003cem\\u003eSD\\u003c/em\\u003e) respectively. Comparative analysis of the differences between groups was analyzed with t-test or chi square test by SPSS 25.0. Differences in scores of school bullying prevention knowledge and attitude were examined with Differences in Differences(DID) by SPSSAU. All tests were 2-sided and \\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05 considered to have statistical significance.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"3 Results\",\"content\":\"\\u003cp\\u003eAfter the intervention, 174 effective questionnaires were collected in total. In the intervention group, 5 of the intervention group were lost to follow-up, with a loss of follow-up rate of 5.3%. 90 effective questionnaires were collected, including 48 (53.3%) males and 42 (46.7%) females. In the control group, 11 participants were lost to follow-up, with a loss rate of 11.6%. 84 valid questionnaires were collected, of which 41 (48.8%) were male and 43 (51.2%) were female. As shown in Table \\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e, before the intervention, the balance test between the SEM intervention group and the control group found that there was no significant difference in gender ratio, school bullying knowledge score, school bullying attitude score and school bullying incidence.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eBalance test of SEM intervention group and control group before intervention for left-behind children in Shantou\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntervention group(\\u003cem\\u003en\\u003c/em\\u003e, %)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003econtrol group(\\u003cem\\u003en\\u003c/em\\u003e, %)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eχ\\u0026sup2;\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGender\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.356\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.551\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003emale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e48(53.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e41(48.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003efemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e42(46.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e43(51.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eKnowledge score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e26.53\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.75\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e25.51\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.69\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e-1.101\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.273\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAttitude score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e46.08\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e44.58\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.51\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e-1.213\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.227\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBeing school bullying\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e58(64.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e52(61.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.121\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.728\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSchool bullying others\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e41(45.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e38(45.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.002\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.966\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eAs for knowledge of school bullying, it showed that in the SEM intervention group, the baseline survey score of the participants' knowledge of school bullying was 26.53\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.75, and the post intervention score was 33.87\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.49. In the control group, the baseline survey score was 25.51\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.69, and the post intervention score was 27.86\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.92. After the intervention, the knowledge scores of students in the two groups on school bullying increased by 7.58\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.25 and 2.35\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.96, respectively, \\u003cem\\u003eP\\u003c/em\\u003e both\\u003cem\\u003e\\u0026lt;\\u003c/em\\u003e0.05 (Table \\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e). In addition, the subjects in the SEM intervention group improved their knowledge scores on school bullying more than those in the control group, increased by 4.988, \\u003cem\\u003eP\\u0026lt;\\u003c/em\\u003e0.001 (Table \\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eChanges of knowledge and attitude scores of subjects on campus bullying before and after intervention in SEM intervention group and control group\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGroup\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAverage score\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eDifference\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003et\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eKnowledge\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSEM Intervention group(n\\u0026thinsp;=\\u0026thinsp;90)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBefore intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e26.53\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.75\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" morerows=\\\"1\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e7.58\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.25\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" morerows=\\\"1\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e-15.458\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.001**\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAfter intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e33.87\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.49\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003econtrol group(n\\u0026thinsp;=\\u0026thinsp;84)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBefore intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25.51\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.69\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" morerows=\\\"1\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e2.35\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.96\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003e-2.078\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.039*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAfter intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e27.86\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.92\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c6\\\" namest=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAttitude\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c6\\\" namest=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSEM Intervention group(n\\u0026thinsp;=\\u0026thinsp;90)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBefore intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e46.08\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003e8.23\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.68\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003e-10.363\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.001**\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAfter intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e54.31\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003econtrol group(n\\u0026thinsp;=\\u0026thinsp;84)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBefore intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e44.58\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.51\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003e1.86\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.32\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003e-1.345\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.181\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAfter intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e46.44\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.35\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"7\\\"\\u003e* \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 ** \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eComparison of knowledge and attitude scores between SEM intervention group and control group before and after intervention\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGroup\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eControl\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;84)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSEM\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;90)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eDifference\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eSD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003et\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eP-value\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eKnowledge\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBefore intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25.512\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e26.533\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.845\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.208\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.228\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAfter intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e46.44\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e54.311\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7.871\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.108\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e7.103\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.001**\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDiff-in-Diff\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4.988\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.195\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e4.173\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.001**\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAttitude\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBefore intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e44.583\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e46.078\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.494\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.108\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.349\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.178\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAfter intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e46.44\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e54.311\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7.871\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.108\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e7.103\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.001**\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDiff-in-Diff\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6.376\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.567\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e4.069\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.001**\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"7\\\"\\u003e* p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 ** p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab5\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eComparison of knowledge scores and attitude between SEM intervention group and control group before and after intervention\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGroup\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eControl\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;84)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSEM\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;90)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eDifference\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eSD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003et\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eP-value\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eKnowledge\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBefore intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25.512\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e26.533\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.845\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.208\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.228\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAfter intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e46.440\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e54.311\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7.871\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.108\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e7.103\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDiff-in-Diff\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4.988\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.195\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e4.173\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAttitude\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBefore intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e44.583\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e46.078\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.494\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.108\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.349\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.178\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAfter intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e46.440\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e54.311\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7.871\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.108\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e7.103\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDiff-in-Diff\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6.376\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.567\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e4.069\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eAs for attitude towards to school bullying, it presented that in the SEM intervention group, the baseline survey score of the respondents' attitude towards school bullying was 46.08\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.31, while the score after the intervention was 54.31\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.12, with 8.23\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.68 increased (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.001). In the control group, the students' baseline survey score was 44.58\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.51, while the score after the intervention was 46.44\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.35. However, there\\u0026rsquo;s no significant difference before and after general education intervention in the control group (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e). In addition, the attitude scores of the subjects in the SEM intervention group towards school bullying were higher than those in the control group, increased by 6.376, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.001 (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab6\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e showed the incidence of school bullying in SEM intervention group and control group before and after intervention. Before the intervention, 58 (64.4%) participants in the SEM intervention group have suffered from school bullying and 41 (45.6%) have bullied others on campus. For bullying victims, verbal bullying (63.3%), relationship bullying (41.1%) and property bullying (40.0%) were main bullying types. Similarly, bullying perpetration types were mainly comprised of property bullying(37.8%), verbal bullying (22.2%) and relationship bullying (9.0%). In the control group, 52 (61.9%) LBC have been bullied and 38 (45.2%) have bullied others. Main bullying victimization types were Verbal bullying (50.0%), property bullying(19.0%), relationship bullying(9.5%) and cyberbullying(9.5%). Main bullying perpetration types were verbal bullying (32.1%), property bullying (13.1%) and relationship bullying (9.5%).\\u003c/p\\u003e \\u003cp\\u003eAfter intervention, 54 (60.0%) participants in the SEM intervention group suffered from school bullying and 43 (47.8%) have bullied others on campus. Verbal bullying (56.7%), property bullying (41.1%) and relationship bullying (33.3%) were dominant bullying types. As for bullying perpetration, verbal bullying (44.4%), relationship bullying (25.6%) and property bullying (12.2%) were primary bullying types. In the control group, it\\u0026rsquo;s reported that 50(59.5%) participants being bullied and 34 (40.5%) have bullied others on campus. Main types of bullying consisted of verbal bullying, property bullying and relationship bullying in both victimization and perpetration bullying. (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab6\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003eNonetheless. there was no statistically significant difference in the incidence of school bullying and bullying others before and after the intervention both in the SEM intervention group and the control group, Table\\u0026nbsp;\\u003cspan refid=\\\"Tab6\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab6\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 5\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eIncidence of school bullying in SEM intervention group and control group before and after intervention\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eBefore intervention(\\u003cem\\u003en\\u003c/em\\u003e, %)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eAfter intervention(\\u003cem\\u003en\\u003c/em\\u003e, %)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eχ\\u0026sup2;\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSEM Intervention group(n\\u0026thinsp;=\\u0026thinsp;90)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBeing school bullying\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e58(64.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e54(60.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.378\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.539\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBeing physical bullying\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e15(16.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e18(20.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.334\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.563\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBeing relationship bullying\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e37(41.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e30(33.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.165\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.280\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBeing verbal bullying\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e57(63.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e51(56.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.833\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.361\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBeing property bullying\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e36(40.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e37(41.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.023\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.879\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBeing cyberbullying\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e13(14.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e19(21.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.368\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.242\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSchool bullying others\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e41(45.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e43(47.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.089\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.765\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePhysical bullying others\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e7(7.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9(10.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.274\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.600\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRelationship bullying others\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e20(22.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e23(25.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.275\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.600\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVerbal bullying others\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e34(37.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e40(44.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.826\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.363\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eProperty bullying others\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11(12.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11(12.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCyberbullying others\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3(3.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6(6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.053\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.305\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003econtrol group(n\\u0026thinsp;=\\u0026thinsp;84)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBeing school bullying\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e52(61.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e50(59.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.100\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.752\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBeing physical bullying\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5(6.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7(8.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.359\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.549\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBeing relationship bullying\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8(9.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9(10.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.065\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.798\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBeing verbal bullying\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e42(50.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e41(48.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.024\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.877\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBeing property bullying\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e16(19.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e14(16.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.162\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.687\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBeing cyberbullying\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8(9.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7(8.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.073\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.787\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSchool bullying others\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e38(45.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e34(40.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.389\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.533\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePhysical bullying others\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5(6.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5(6.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRelationship bullying others\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8(9.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7(8.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.073\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.787\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVerbal bullying others\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e27(32.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e25(29.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.111\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.739\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eProperty bullying others\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11(13.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9(10.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.227\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.634\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCyberbullying others\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2(2.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3(3.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e\"},{\"header\":\"4 Discussion\",\"content\":\"\\u003cp\\u003eBased on SEM, combined with the actual situation and cultural background of local schools, this study conducted a comprehensive intervention to prevent bullying among LBC from four aspects: individual, interpersonal relationship, school and social norms. The results of the intervention showed that the scores of LBC in the SEM intervention group and the control group were higher after the intervention in terms of the improvement both of school bullying knowledge and attitude scores with statistical differences. LBC in the intervention group improved their knowledge scores on school bullying more than those in the control group with statistically significant difference, which shows that SEM based interventions can effectively improve the level of school bullying knowledge and attitude of left-behind children, leaving a more positive effect better than that on the control group.\\u003c/p\\u003e \\u003cp\\u003eIn terms of changes in the incidence of school bullying. The results showed that the incidence of school bullying had not changed both in the intervention and the control group. It showed that the effect of SEM based school bullying intervention on preventing and controlling the occurrence of school bullying of LBC was not obvious. Although SEM based interventions could effectively improve the knowledge and attitude of LBC on school bullying, there was no significant change in the incidence of school bullying. This may be relevant to the fact that the duration of intervention was too short to convert from the improvement of knowledge and attitude to behavioral modification. Therefore, we should continue to increase the intensity and length of intervention on LBC, aiming to reduce the occurrence of school bullying more effectively in the future. Besides, Haoyuan, Zhang(Zhang, \\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e2020\\u003c/span\\u003e) found that the SEM based intervention group can reduce the rate of victimization of cyberbullying after the intervention and improve the cognition of cyberbullying solutions in college students, which was consistent with our results in cognitive situation. Nevertheless, the effect of behavioral change was better than ours. The reason may be that the participants were quite different. Children's knowledge level and various social development abilities are far lower than those of college students. For LBC, more long-term intervention may be required to change their behaviors.\\u003c/p\\u003e \\u003cp\\u003eThere are few intervention studies on children's school bullying in China at present, in which ordinary educational intervention is the main measure, lacking effective and comprehensive intervention measures on campus. Future research can design more scientific interventions based on SEM for prevention of school bullying and evaluate their long-term effects on the prevention of school bullying in LBC.\\u003c/p\\u003e \\u003cp\\u003eThis study has the following limitations. Firstly, this study is a self-reported questionnaire survey, in which respondents needed to recall the occurrence and experience of school bullying in the past, leading to memory bias. Future studies need the report from parents and teachers. Secondly, school bullying is a sensitive topic. The respondents may exaggerate or conceal some sensitive issues. LBC performance monitoring in school should be taken into consideration in the future. Thirdly, the intervention time of this study is relatively short, which may not reflect the long-term effect of the intervention measures. Future studies should lengthen the period of intervention to observe the effect. Fourthly, the sample size was too small due to the few amount of left-behind students and we cannot represent the whole country. Future studies should focus on a large sample study in the whole country.\\u003c/p\\u003e\"},{\"header\":\"5 Conclusions\",\"content\":\"\\u003cp\\u003eInterventions based on the SEM are effective in enhancing left-behind children's knowledge and attitudes toward school bullying, but these changes alone do not guarantee behavioral change. To more effectively reduce school bullying, it is crucial to integrate SEM-based interventions with strategies like skills training and continuous support. Given the high prevalence of bullying and the vulnerabilities of left-behind children in China, a comprehensive, multi-level approach is needed. This framework can also be applied in other regions to create safer and more supportive school environments globally.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAuthor Contributions:\\u003c/strong\\u003e J.H. undertook the data analysis, wrote the research process, literature reviews and interpreted the results. J.H., Y.C., Y.C and Q. D. performed the data collection, complete statistical tables and result analysis. L.L. was in charge of the conception, undertook the design of the study framework, and takes responsibility for the integrity of the data and the accuracy of the data, and interpreted the conclusion. L.L. ultimately modified the manuscript. All authors have read and agreed to the published version of the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding:\\u003c/strong\\u003e This research received no external funding.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eInstitutional Review Board Statement:\\u003c/strong\\u003e The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of Shantou University Medical College (project no. SUMC-2021-92).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eInformed Consent Statement:\\u003c/strong\\u003e Informed consent was obtained from all subjects involved in the study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData Availability Statement:\\u0026nbsp;\\u003c/strong\\u003eThe datasets used and analyzed in the study are available from the corresponding author on reasonable request.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConflicts of Interest:\\u003c/strong\\u003e The authors declare no conflicts of interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eClinical trial number:\\u003c/strong\\u003e not applicable.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eAllchin, A., Chaplin, V., \\u0026amp; Horwitz, J. (2019). 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Longitudinal relationship between child maltreatment, bullying victimization, depression, and nonsuicidal self-injury among left-behind children in China: 2-year follow-up. \\u003cem\\u003eJ Clin Psychol, 79\\u003c/em\\u003e(12), 2899-2917. doi: 10.1002/jclp.23585\\u003c/li\\u003e\\n\\u003cli\\u003eZhang, H. (2020). \\u003cem\\u003eStudy on the Influencing Factors and Intervention Based on \\u003c/em\\u003e\\u003cem\\u003eSocial-Ecological Model of Cyberbullying among College Students \\u003c/em\\u003e\\u003cem\\u003ein Shantou.\\u003c/em\\u003e (dissertation/master\\u0026rsquo;s thesis), Shantou University. \\u003c/li\\u003e\\n\\u003cli\\u003eZhekuan, P. (2019). \\u003cem\\u003eSchool Bullying KAP Survey and Effect Evaluation of Education \\u003c/em\\u003e\\u003cem\\u003eIntervention among Middle School Students.\\u003c/em\\u003e (dissertation/master\\u0026rsquo;s thesis), Shantou University. \\u003c/li\\u003e\\n\\u003cli\\u003eZhou, Y. Y., Cheng, Y. L., Liang, Y. M., Wang, J. Z., Li, C. N., Du, W. J., . . . Liu, Z. K. (2020). Interaction status, victimization and emotional distress of left-behind children: A national survey in China. \\u003cem\\u003eChildren and Youth Services Review, 118\\u003c/em\\u003e, 8. doi: 10.1016/j.childyouth.2020.105348\\u003c/li\\u003e\\n\\u003cli\\u003eZhu, Y., \\u0026amp; Chan, K. L. (2015). Prevalence and Correlates of School Bullying Victimization in Xi\\u0026apos;an, China. \\u003cem\\u003eViolence and Victims, 30\\u003c/em\\u003e(4), 714-732. doi: 10.1891/0886-6708.Vv-d-14-00006\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-public-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"pubh\",\"sideBox\":\"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/pubh/default.aspx\",\"title\":\"BMC Public Health\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"school bullying, left-behind children, influencing factors, intervention study, social ecological model\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-5135455/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-5135455/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eSchool bullying among left-behind children (LBC) is a significant public health concern in China. To promote their healthy development, school bullying prevention intervention based on the theory of social ecological model (SEM) in four levels (individual, relationship, campus and society) among LBC was carried out in this study.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003e190 left-behind children were recruited from two middle schools in Shantou city(mean age 13.52\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.70). Differences within groups were analyzed using t-test or chi square test. Furthermore, differences in scores of school bullying prevention knowledge and attitude were examined with differences-in-differences (DID) approach to test the effectiveness of intervention.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eResults showed that after the intervention, the knowledge scores in the two group both increased with statistically significant differences (all \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). While the attitude scores increased in the SEM based intervention group with statistical significance while not in the control group. What\\u0026rsquo;s more, it presented that knowledge and attitude of preventing school bullying were improved in SEM based intervention group more than the control group. However, we didn\\u0026rsquo;t find significant difference in the incidence of school bullying before and after the intervention between the two groups.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eInterventions based on the SEM are effective in improving left-behind children's knowledge and attitudes toward school bullying, but additional strategies are needed to achieve actual behavioral change. A comprehensive, multi-level approach that combines SEM-based interventions with behavioral strategies can serve as a model for reducing school bullying in China and globally.\\u003c/p\\u003e\",\"manuscriptTitle\":\"School bullying prevention among left-behind children: An intervention study based on social ecological model in China\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-11-07 04:22:55\",\"doi\":\"10.21203/rs.3.rs-5135455/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2024-10-01T06:30:58+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2024-09-26T07:07:45+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2024-09-26T07:07:13+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Public Health\",\"date\":\"2024-09-23T06:05:51+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-public-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"pubh\",\"sideBox\":\"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/pubh/default.aspx\",\"title\":\"BMC Public Health\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"fbe7ec91-cbb7-4cbf-9d5d-bce6a7e091d6\",\"owner\":[],\"postedDate\":\"November 7th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"in-revision\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-02-06T13:09:51+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-11-07 04:22:55\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-5135455\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-5135455\",\"identity\":\"rs-5135455\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}