41 Mindfulness-Based Stress Reduction intervention for elementary school teachers: a mixed method study Participant characteristics The study population will consist of Dutch teachers in primary education teaching group 1-8, comparable to grades 1 to 6 in the US school system. Eligibility criteria We will include teachers who meet the following criteria: a) teaching at least two days in the same group during a school year between the start of the school year and March; b) willing to fill out questionnaires in Dutch three times in a school year; and c) able to start the program in either September or March. Exclusion criteria will be previous participation in a Mindfulness Based Cognitive Therapy, MBSR program or a mindfulness-based workshop of more than three hours duration. During the trial, there will be no restrictions with regard to concomitant interventions. However, participants will be requested to not participate on an MBSR course offered elsewhere if they are allocated to the wait list control condition. Procedure and allocation Recruitment will take place in a large urban area in the Netherlands. School boards in the study area will be informed about the study and asked to make their teachers aware of it. Teachers will also be recruited by social media and by presentations at schools. Interested teachers will receive an information leaflet and be invited for a screening interview by telephone. Teachers who are willing to participate will provide written informed consent which will be obtained by one of the researchers (JL). Participants will receive online questionnaires, which will be processed anonymously. Questionnaires will be administered before and after the MBSR or wait list period (September and November), and at 3 months follow-up (March). As participants will be aware whether they have or have not participated in the course by the time they complete the follow-up assessments, they cannot be kept completely blinded. We will compare data related to teacher absenteeism from the school year prior to that in which they participate in the research. After completion of the follow-up teachers of the control group will be offered the MBSR program as well. To include the required 155 participants, the intervention procedure between September and June will be repeated for three consecutive school years. The Ethics Committee Social Science (Radboud University) agreed (ECSW-2019-029) that there was no risk of physical or mental harm for participants during this trial. The Faculty of Social Science takes the juridical responsibility for accidents and damage caused by participating in the research. If participants report any adverse events during the trial, either during the MBSR course or during the wait list control condition, this will be registered in the electronic database system Castor. In case of serious adverse events, these will be reported to the Ethics Committee. If participants require additional mental health support, they will be referred to the regular services, but it is also possible for participants to consult with an appointed psychologist if they so request, or if the trainer 3
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