Co-design of an online teacher training program tailored for rural Japanese teachers to deliver neuroscience-informed mental health interventions to children Open Access

CBT

= Cognitive behaviour therapy;

COVID-19

= Corona virus disease of 2019;

F

= Females;

M

= Males or mean;

N-CBT

= Neuroscience-informed cognitive behaviour therapy;

NIMH

= Ineuroscience-informed mental health intervention;

OECD

= The Organization for Economic Cooperation and Development;

PhD

= Doctor of Philosophy;

SEL

= Social emotional learning;

SST

= Social skills training; and

TARGET

= Trauma adaptive recovery group education and therapy.

There is a pressing need for early interventions addressing the mental health of Japanese children. The mental health of school-aged children influences their development, impacting academic achievement, physical well-being and future socioeconomic status (Wolf et al., 2021). Nevertheless, mental disorders among Japanese children have escalated, with diagnosed cases surging from 117,000 in 1999 to 329,000 in 2020, as reported by the Ministry of Health, Labour and Welfare (2021). Among Japanese children, emotional problems, especially depression and anxiety, are the most widespread mental health problems, as indicated by the Ministry of Education, Culture, Sports, Science and Technology Japan (2021). The number of suicides among Japanese children has seen an alarming rise, from 137 incidents in 2011 to 514 in 2022 (Ministry of Health, Labour and Welfare, 2023).

Japanese schools are key providers of early mental health support for children, but their efforts are compromised by inadequate resources, notably limited availability of school counsellors. The Japanese government struggles to increase funding for enhancing children’s education and healthcare, burdened by escalating healthcare and social welfare costs tied to an aging population (The Ministry of Education, Culture, Sports, Science and Technology, 2020). Consequently, a large proportion of Japanese schools allocate limited time for school counsellors, with 73.5% of primary schools, 30.1% of junior high schools and 56.9% of senior high schools providing less than 4 h of counselling services per week (Ministry of Health, Labour and Welfare, 2021). These conditions impose a significant responsibility on Japanese teachers to provide mental health support to their students. Unfortunately, teachers’ limited training in mental health intervention exacerbates the difficulties they face in delivering sufficient support to students.

Mental health intervention training for pre-service teachers is often insufficient in Japanese universities (Yamaguchi et al., 2021). In-service teacher training programs for mental health intervention are mostly available in major cities, such as Tokyo and Osaka, and are predominantly conducted face-to-face. Furthermore, Japanese teachers usually do not receive paid leave for professional development and are burdened with excessively heavy workloads, averaging 55 h per week, surpassing all other OECD countries (Deguchi et al., 2018; OECD, 2021). Moreover, teachers with families have a commitment to take care of children outside of work hours. These circumstances create extra challenges for teachers working in rural areas to access teacher training and develop adequate knowledge and skills in providing mental health intervention to children because they require more time and incur higher costs for travelling to major cities compared to those in urban and suburban areas. This situation creates an educational gap between teachers working in rural areas and those in urban/suburban areas, potentially causing difficulties in providing adequate mental health intervention to children.

A potential solution to address the educational gap in mental health intervention between teachers in diverse locations may be to provide online training program to teachers in rural areas. These programs require teachers to be proficient in internet and computer usage (Mythilli, 2019). However, online training provides geographical flexibility, allowing rural teachers greater accessibility compared to traditional face-to-face sessions, which are often concentrated in urban areas (Sheperis et al., 2020).

A comprehensive search of major databases, including Google Scholar and PubMed, yielded no studies specifically assessing the effectiveness of online training for teaching mental health interventions to teachers. However, research comparing online and face-to-face training for other professionals, such as psychologists and counsellors, indicates that online training is equally effective in improving knowledge, skills and self-efficacy (Dimeff et al., 2009; Snow et al., 2018). A systematic review that synthesised the results from 11 randomised controlled trials and cohort studies that investigated the effectiveness of online teacher training in diverse topics found that online training that accommodates different learning styles by offering a combination of activities (e.g., reading, discussions and assignments), offers practical learning content and fosters engagement between peers, and that online program facilitators are particularly effective for promoting teachers’ learning satisfaction and improving teachers’ knowledge for practice (Bragg et al., 2021).

Online training may suit rural Japanese teachers due to the nation’s robust internet infrastructure, reaching even remote areas. (Nakabayashi, 2022). Hence, adopting an online format for teaching mental health intervention to Japanese teachers in rural areas would be helpful. There is a study that investigated the feasibility, learning needs and goals required to develop an online training program for teaching mental health intervention to Japanese mental health professionals (Takizawa et al., 2022a). Notably, there is a research gap regarding the development of online training programs tailored for Japanese teachers, particularly those in rural areas, to provide mental health interventions for Japanese children. There is a pressing need for an online teacher training program that provides mental health interventions for Japanese children, bridging the educational divide between teachers in disparate locations and ultimately enhancing the mental health of children nationwide.

Online training might offer a solution to bridge educational gaps among teachers in diverse locations, yet a direct conversion of existing teacher programs to an online format may not be ideal due to limitations within current teacher training programs in Japan. Presently, Japanese teachers can access two main types of professional development training focused on mental health interventions for children: training programs that enhance mental health literacy and standardized group programs that provide structured mental health interventions (Harada and Watanabe, 2021; Yamaguchi et al., 2021). Mental health literacy training aims to enhance teachers’ abilities in identifying mental health problems, providing initial support to children and acquiring knowledge about risk factors, causes and attitudes that encourage appropriate help-seeking (Ojio et al., 2015; Yamaguchi et al., 2020a, 2020b). Professional development initiatives for standardized group mental health programs focus on enhancing teachers’ knowledge and skills, incorporating evidence-based approaches, such as group social skills training (group SST)(Harada and Watanabe, 2021), group cognitive behaviour therapy (group CBT)(Yamamoto et al., 2017) and stress-management education (Tanaka et al., 2014). These initiatives provide structured training in essential social-emotional competencies, including self-awareness, social awareness, emotional control, interpersonal skills and judicious decision-making, to foster optimal mental health outcomes in children (Urao et al., 2021; Yamamoto et al., 2017).

There are limitations with the effectiveness of these programs. A meta-analysis of 16 international studies found that mental health literacy training has a large effect on improving teachers’ knowledge about mental health (Cohen d = 0.8) (Yamaguchi et al., 2020a). Nevertheless, the program’s scope is limited to instructing educators on teaching active listening skills to students, and there is insufficient evidence to substantiate its effectiveness in enhancing children’s mental health outcomes. Additionally, a comprehensive systematic review of 85 studies revealed that standardized group-based mental health interventions, including group SST, group CBT and stress management education, yield modest effects in alleviating emotional problems (Hedges’s g = 0.22) and conduct problems (Hedges’s g = 0.20) in children (Takizawa et al., 2023a). These findings suggest that adapting existing teacher training programs for mental health literacy and standardized group interventions into an online platform may help bridge the educational disparities among Japanese teachers across various regions. However, simply adapting existing programs may not adequately address the mental health needs of diverse Japanese children. A novel, tailored online teacher training program is necessary to effectively promote the mental health of Japanese children from diverse backgrounds.

Although it represents a novel approach, research suggests that a teacher training program focused on providing neuroscience-informed mental health interventions (NIMHI) may offer a valuable strategy for effectively enhancing the mental health and well-being of Japanese children. Operating as a biopsychosocial framework, NIMHI leverages neuroscientific research findings to inform a deeper understanding of mental health and develop tailored, evidence-based interventions. (Grawe, 2017). Although neuroscientific insights are essential for understanding mental health and developing interventions, NIMHI integrates therapeutic strategies from diverse psychotherapeutic approaches, including CBT and mindfulness-based interventions, to provide comprehensive support for individuals’ mental health (Beeson and Field, 2017). The literature features various NIMHI models, including neuroscience-informed CBT (N-CBT) (Field et al., 2015), neuropsychotherapy (Grawe, 2017) and trauma adaptive recovery group education and therapy (TARGET) (Ford, 2015). These models integrate techniques and therapeutic elements from CBT and other psychotherapeutic approaches, with the goal of promoting both bottom-up and top-down regulatory processes to enhance overall mental health.

Bottom-up regulation encompasses the modulation of subcortical brain regions, including the amygdala and hypothalamus, which govern the autonomic nervous system and regulate emotional and physiological responses, such as arousal and stress (Field et al., 2019). This regulation enables better control over higher brain areas, notably the prefrontal cortex, facilitating the restoration of cognitive functions like learning, memory and executive functioning. In contrast, top-down regulation involves the prefrontal cortex and other higher brain regions, which oversee cognitive processes to modulate lower brain regions and manage emotional and physiological responses (Grawe, 2017). Research has identified various strategies for promoting bottom-up regulation, including lifestyle modifications such as diet, hydration, sleep, physical activity, sun exposure, social interactions and relaxing baths. Additional strategies encompass diaphragmatic breathing, muscle relaxation, maintaining posture, imagery exercises, emotional expression, engaging in artistic activities, exposure to nature and environmental regulation techniques (Lohaus et al., 2010; Wang et al., 2022). Research has also shown that cognitive restructuring and mindfulness practices are effective strategies for enhancing top-down regulation, enabling individuals to better manage their cognitive and emotional responses (Clark, 2013; Seminowicz et al., 2013). For instance, N-CBT (Field et al., 2015) incorporates CBT techniques such as meditation, diaphragmatic breathing and cognitive restructuring, which collectively promote both bottom-up and top-down brain regulatory processes. Neuropsychotherapy (Grawe, 2017) integrates CBT techniques and techniques and highlights the significance of a positive therapeutic alliance in promoting clients’ mental health, thereby facilitating regulation across both bottom-up and top-down neurobiological pathways. Similarly, TARGET model incorporates guided practices from diverse psychotherapeutic approaches, including CBT, mindfulness therapy, experiential therapy, psychodynamic therapy and art therapy, to address trauma and foster regulation across both bottom-up and top-down neurobiological pathways (Ford, 2015).

Currently, there is a scarcity of empirical research examining the efficacy of NIMHI in terms of treatment outcomes, particularly when compared to established interventions, such as CBT (Takizawa et al., 2022b). Qualitative findings indicate that psychotherapists who have undergone training in N-CBT generally regard it as a credible approach and anticipate positive treatment outcomes (Field et al., 2017, 2019). Neuropsychotherapy is supported by a collection of case studies demonstrating qualitative improvements in the treatment of depression and anxiety disorders, underscoring its potential therapeutic benefits (Rossouw, 2014). Research consistently suggests that incorporating neuroscientific knowledge enables therapists to better understand and address the complex needs of adult clients, facilitating personalized interventions. Furthermore, clinical trials have demonstrated that TARGET yields superior reductions in anxiety symptoms among both children and adults, outperforming relational supportive therapy and person-centred therapy (Ford et al., 2012, 2018). These findings suggest that NIMHI models potentially hold promise in effectively enhancing the mental health of both children and adults.

Although research has yet to develop and assess teacher training programs specifically tailored for implementing NIMHI with children, international studies suggest that neuroscience education can enhance teachers’ capacity to provide more effective mental health support to students (Brick et al., 2021a; Dubinsky et al., 2019). For example, a study by Dubinsky et al. (2019) investigated the impact of neuroscience education on 296 primary and high school teachers in the USA, covering topics such as the neuroscience of learning and memory, emotions, mirror neurons, the autonomic nervous system and stress management. Analysis of teacher interviews and classroom observations revealed that the training led to enhanced teaching confidence, increased social and emotional support for students and more effective teacher-student communication. These results indicate that neuroscience education focused on children’s mental health and development can improve teachers’ understanding of their students and the quality of mental health support provided, even in the absence of explicit intervention strategies. Thus, creating a novel online teacher training program tailored for rural Japanese educators to implement NIMHI with Japanese children may be a worthwhile pursuit.

This study focused on developing a tailored online training program to equip rural Japanese teachers with the necessary skills to effectively deliver NIMHI to Japanese children. This initiative aimed to bridge the educational gap between rural and urban teachers, aiming for enhanced mental health support across diverse regions. By developing an online training program specifically for Japanese primary school teachers, this study aimed to capitalize on the critical window of early intervention, recognizing that providing mental health support to younger children is pivotal in mitigating the broader societal prevalence of mental health issues. Specifically, the study sought to co-design the program by integrating insights from prior needs-analysis research with rural Japanese teachers, expert input and feedback from a rural teacher focus group. Co-design involves active collaboration between developers and users, valuing users’ expertise in their experiences. Studies have shown that this approach promotes a more nuanced understanding of user requirements, resulting in more engaging and effective services (Marín et al., 2018). Moreover, incorporating expert feedback ensures that the program’s design and content are well-suited to the needs of the intended audience (Skivington et al., 2021).

Prior to the present study, the authors conducted a needs analysis study involving semi-structured interviews with 20 Japanese teachers (M = 11; F = 9) and surveys administered to 245 Japanese students (M = 133; F = 112) aged 8–12, in a rural public primary school in Western Japan (Takizawa et al., 2023b). Aligning with the National Center for Child Health and Development’s survey (2021), this study identified nearly 30% of students in the school having poor mental health with low subjective well-being and high emotional problems. Teacher interviews revealed around 80% of them expressing moderate/strong interest in learning NIMHI. Furthermore, the interviews revealed that inadequate teacher training in mental health interventions may be a critical factor contributing to the prevalence of poor mental health outcomes among children. These findings from the study supported the need of the online teacher training for delivering NIMHI to Japanese children. The study highlighted Japanese teachers’ appreciation for self-paced learning, adaptable to their busy schedules. They also value live interactive content, allowing engagement with trainers and peers for deepening their learning experience, despite facing challenges attending full or half-day live interactive sessions. The interviews also highlighted the need for an easily accessible online training program catering to teachers with limited technological literacy. Many teachers in the study preferred learning from hardcopy materials over online resources. Moreover, Japanese teachers highly value training that offers practical materials usable in their classrooms.

Building on the feedback from teachers gathered during the needs analysis, this study aimed to co-design an online training program that integrates a self-paced learning booklet, comprising 6–10 concise modules (15–20 min each), with a concise live online session (1–2 h) requiring basic technological proficiency. The present study also aimed to integrate the opinions from Japanese teachers in the needs-analysis to develop an online teacher training program that is easy to understand and designed in a highly practical manner and providing ready-to-use intervention material.

This study aimed to explore answers to the following two research questions:

The present study co-designed an online teacher training program for rural Japanese teachers to deliver neuroscience-informed mental health intervention. This process involved integrating feedback from Japanese teachers, who are potential participants of the training program, and incorporating insights from experts in the field. Initially, a prototype was created, incorporating insights gleaned from the authors’ needs analysis study, which included self-paced learning materials and slides for a live interactive session. This prototype was presented to experts for feedback and subsequent revisions. Furthermore, a focus group comprising primary school teachers offered valuable insights and feedback on the program’s appropriateness, informing subsequent refinements and ultimately leading to the completion of the online teacher training program.

Five of the 20 primary school teachers from the authors’ needs analysis study participated in the focus group interviews. These participants, homeroom teachers from grades 3–6, ranged in age from 34 to 55 years old (M = 46.5 years) and possessed teaching experience spanning 10–33 years (M = 20.4 years). All held a bachelor’s degree in education but lacked prior education in neuroscience. The panel of experts contributing to the study comprised five professionals from diverse fields: neuroscience, clinical psychology, educational psychology, education and Japanese culture. These experts were drawn from the researcher’s professional network in Japan. They included a neuroscientist and professor specializing in molecular biogenetics at Osaka University’s Graduate School of Medicine. Another panellist, a professor at Tokushima Bunri University’s School of Early Childhood Education, held a bachelor’s degree in teaching and psychology and a PhD in educational psychology. Additionally, a Japanese certified psychologist and associate professor at Tottori University’s Teacher Training Centre participated. Another certified psychologist, an associate professor at Kobe University’s Graduate School of Human Development and Environment, contributed expertise in clinical psychology. Finally, an expert in Japanese education and culture, possessing a teaching bachelor’s degree and a PhD in medicine, shared insights gained from over 30 years of experience as a primary school teacher in Wakayama prefecture, Japan.

Following receipt of ethical clearance from the University of Queensland Ethics Committees (Approval Number: 2022/HE000833), the researcher created a comprehensive 90-page self-paced learning booklet and a corresponding set of 45 PowerPoint slides designed for interactive online delivery. The booklet aimed to equip teachers with knowledge and skills necessary for delivering neuroscience-informed mental health interventions. The booklet’s content encompassed a range of topics, including the neurobiological underpinnings of mental health concerns, methods for assessing student mental health and approaches to fostering both bottom-up and top-down regulation to prevent and address issues such as depression and anxiety (Table 1).

The booklet outlined a range of evidence-based bottom-up regulation strategies, including lifestyle modifications (such as balanced diet, hydration, sleep, exercise, sunlight exposure, social connections and warm baths), as well as techniques like diaphragmatic breathing, muscle relaxation, posture awareness, visualization, emotional release, creative expression, nature immersion and environmental adjustments (Lohaus et al., 2010; Wang et al., 2022). Top-down regulation strategies included cognitive restructuring and mindfulness techniques (Clark, 2013; Seminowicz et al., 2013). The booklet was structured into seven chapters, each requiring 15–20 min for completion, drawing from previously developed neuroscience education programs for teachers (Brick et al., 2021b; Dubinsky et al., 2019), existing school-based mental health interventions in Japan (e.g., SST, group CBT programs, stress management education) (Matsumoto and Shimizu, 2016) and relevant literature in neuroscience-informed mental health intervention, neuroscience, psychotherapy and psychology (Grawe, 2017). The researcher devised a checklist to complement the self-paced learning booklet, encompassing various activities and environmental factors aligned with the intervention strategies introduced in the booklet. These factors included lifestyle habits, diaphragm breathing, posture, muscle relaxation, imagery, emotional expression, artistic engagement, positive interaction with animals, nature exposure, environmental elements, cognitive restructuring and mindfulness (Lohaus et al., 2010; Wang et al., 2022). This checklist aimed to assist teachers in pinpointing specific activities and environmental aspects that might be lacking or insufficient in children, enabling the implementation of tailored intervention strategies to address these deficiencies and regulate the associated environmental factors. Ultimately, the objective of this approach was to effectively promote and support the mental health of children within the familiar and supportive environment of their classroom.

The researcher created a set of PowerPoint slides to support a 90-min live interactive online session. These slides were designed to provide a concise overview of the booklet’s key takeaways, while also facilitating group discussions and the sharing of insights gleaned from the booklet’s exercises. The inclusion of an interactive session was influenced by the findings of the needs-analysis study, which highlighted the value that Japanese teachers place on interactive learning opportunities with the facilitator and other teachers for deepening their learning experience. The 90-min duration of the interactive session was determined based on advice from the school principal of the participating school, who suggested that this would be the maximum time that could be allocated for busy Japanese teachers.

The researcher presented the self-paced learning booklet and presentation slides for an online interactive session to the five experts. The neuroscience expert reviewed the accuracy and language of the neuroscientific information presented in the booklet, providing feedback and suggestions for improvement. The researcher incorporated the feedback, for example, adding a more detailed description of the neuroscientific functioning of sleep and vitamin D synthesis from sunlight. Two experts specializing in clinical and educational psychology assessed the appropriateness of intervention strategies for fostering bottom-up and top-down regulation in Japanese children, ensuring cultural relevance and effectiveness. The researcher, for example, revised the pace of diaphragm breathing based on feedback, ensuring it was appropriate for Japanese primary school-aged children. Two experts in Japanese education and culture reviewed the contents and formats of the booklet to ensure suitability for Japanese primary school teachers. The researcher incorporated their feedback, such as adding a summary of key points at the beginning of each chapter and more diagrams and images to improve comprehension. After incorporating feedback and revising the contents and formats of the booklet based on the insights provided by the experts, the researcher finalized a prototype of the teacher training program material.

The researcher contacted Japanese primary school teachers who participated in the needs-analysis study to recruit participants who can participate in an online focus group and provide feedback for the prototype teacher training material developed. The researcher scheduled a date for a 1-hour online focus group with five Japanese teachers who agreed to participate via emails and phone calls. The researcher obtained a consent from teachers for an audio recording of the focus group session. During the focus group, the researcher provided a concise overview of the self-paced learning booklet and PowerPoint slides for the live online session, and then facilitated an online discussion to gather feedback on the suitability and format of the online teacher training program, as well as suggestions for enhancing its content and delivery. The researcher transcribed the focus group recording for qualitative analysis.

The qualitative analysis used phenomenological approach and explored the subjective, lived experiences and perspectives of participants (Sundler et al., 2019). The primary author performed a thematic analysis to examine the qualitative data gathered from the teacher group, assessing the suitability of the prototype teacher training materials’ content and format and identifying teachers’ recommendations for refinement and enhancement (Braun and Clarke, 2006). The thematic analysis entailed an iterative process of data immersion, coding and theme identification and refinement, enabling a systematic and rigorous examination of the data through ongoing interrogation and engagement (Braun et al., 2019). Among various qualitative analysis methodologies, thematic analysis stands out as a particularly popular and robust approach for systematically uncovering meaningful patterns within qualitative data and providing insightful answers to research questions (Howitt, 2019). The transcribed focus group data was organised by the NVivo version 12 (Lumivero, 2020) for thematic analysis.

The primary author used NVivo version 14 (QSR International, 2023), a qualitative data analysis computer software package, to conduct a thorough analysis. After reading and becoming familiar with the entire data set, the author manually coded excerpts from the focus group data and identified a set of potential themes for each focus group topic by sorting different codes and collating all relevant coded data extracts within identified themes. Thematic maps were constructed for each topic and refined to categorize codes into themes. The primary author then iteratively reviewed and refined a set of preliminary themes by examining the compiled extracts for each theme, identifying coherent patterns and verifying the validity of individual themes to ensure they accurately reflected the data’s meaning. Once a satisfactory set of themes was established for each topic, the primary author defined and labelled each set. The co-authors reviewed and confirmed the appropriateness of the identified themes. Any discrepancies were discussed, revised and refined until a consensus was reached.

Thematic analysis identified themes regarding the suitability of learning contents, suitability of learning format and suggestions for improvement (Table 2).

The results provided a response to RQ1: “Is the content of the prototype online teacher training program suitable for Japanese school teachers?” All teachers agreed that the contents of neuroscience-informed mental health intervention presented in the booklet and PowerPoint slides are interesting and relevant for Japanese teachers. Three teachers also reported that it is empowering for them to learn intervention strategies based on scientific evidence because many Japanese teachers currently try to support students primarily based on their instinct from their experience. Four teachers also reported that the checklist included in the booklet would be helpful in the classroom because Japanese teachers currently do not know how to effectively assess and understand what type of intervention may be needed for students. All teachers also reported that the contents of the booklet and PowerPoint slides are easy to understand for Japanese teachers.

Four teachers reported that while some tips and protocols for implementing different bottom-up and top-down regulation strategies are described in the booklet, these descriptions would not be sufficient for enabling Japanese teachers to implement the intervention in the classroom and that they would need more detailed guidelines that inform them precisely what they need to do for implementing each intervention strategies for promoting bottom-up and top-down regulation. One teacher explained that Japanese teachers are busy and have limited time for planning mental health interventions for students.

The results provided a response to RQ2: “Is the format of the online teacher training program prototype suitable for Japanese school teachers?” All teachers agreed that the volume of the self-paced learning booklet (90 pages) and the number of slides (45 slides) for the online live interactive sessions are mostly appropriate. Four teachers agreed they could easily complete reading and exercise in the self-paced learning booklet by findings small times (15–20 min) for learning if they have two weeks. Four teachers also agreed that the volume of PowerPoint slides would be suitable for 90 min live interactive online session because it allows teachers to focus on the contents of learning on each slide and provide opportunities for questions and discussions without rushing through contents. All teachers also agreed that simple online live interactive session that only involves listening and speaking with headphone will be suitable for Japanese teachers because Japanese teachers became familiar with attending online training and meeting that involve listening and speaking with a speaker and microphone under the COVID-19 pandemic but they are still not used to using online technologies for online training. All teachers also agreed that the booklet for the online teacher training program has a suitable format. One teacher explained that the booklet included diagrams and photo images that helped them understand the neurobiological mechanisms of mental health issues more clearly. Another teacher explained that the booklet included exercises with case studies, effectively allowing them to practice applying the knowledge learned in the workshop to themselves for improving their own mental health, as well as to their students’ mental health in the classroom.

While all teachers were mostly satisfied with the booklet and PowerPoint slides format for online live interactive sessions, teachers also reported that it is difficult to read words on the booklet and PowerPoint slides because of the small font size and the crowdy words. Furthermore, three teachers reported that difficulty in reading because of small font size and wordiness could demotivate Japanese teachers from learning and potentially reduce the effectiveness of training.

Four teachers recommended that the training include a concise summary of guidelines, offering step-by-step instructions for implementing various intervention strategies that support both bottom-up and top-down regulation, to facilitate easier application in the classroom. One teacher explained that a summary of guidelines for implementing different intervention strategies would be helpful because it can inform teachers precisely what they need to do to provide intervention without hassles, and it would increase the adaptation of intervention strategies learnt in training. Furthermore, three teachers suggested that it would be valuable to have follow-up consultations by email, telephone and online video chat after attending online live interactive sessions because they feel that they require additional guidance for providing assessments with a checklist to students and implementing bottom-up and top-down regulation strategies for individual and group students in the classroom.

Four teachers also proposed that the training include a practical worksheet that teachers can use directly with students in the classroom to implement various intervention strategies, acknowledging that teachers’ time is limited and preparation time for interventions is often scarce. All teachers suggested that to help teachers more easily understand the learning contents, improving the readability of the booklet and PowerPoint presentation slides will be helpful by increasing font size, decreasing the number of words and increasing images and diagrams.

Integrating the suggestions made by teachers, the researcher created a summary of guideline sheet that inform protocol for teachers to implement intervention strategies for promoting bottom-up and top-down regulation of children. In addition, the researcher also created intervention worksheets that teachers can use with students for implementing each intervention strategy in the classroom. The guideline sheet and intervention sheet were developed in reference to the material used in the standardized group mental health intervention programs, such as SST, group CBT, SEL programs and stress management education (Matsumoto et al., 2020; Yamamoto et al., 2017). The researcher also decided to provide follow-up consultations by email, telephone and online video chat after teachers attend online live interactive sessions to ensure that teachers can adequately provide assessments with a checklist and implement interventions in the classroom.

To improve the readability of the booklet and PowerPoint presentation slides, the researcher increased the font size, made the sentences more concise and reduced the words and increased the number of images, diagrams and tables in the booklet and PowerPoint presentation. To support the comprehension of the learning contents of the booklet, the researcher also created a recording of a summary of each chapter of the booklet that teachers can listen to while reading the booklet’s contents. The recording of the summary was uploaded on YouTube for easy access for teachers.

Addressing RQ1, the present study found with a teacher focus group that the learning contents of online teacher training programs presented in the self-paced learning booklet and PowerPoint slides for the live online interactive session are mostly suitable for stimulating the interest of Japanese teachers and engaging teachers in learning. All teachers agreed that the contents are interesting and relevant for Japanese teachers. The present study found with a teacher focus group that the contents of an online teacher training program for providing neuroscience-informed mental health intervention would be effective for improving teachers’ knowledge and skills for delivering mental health intervention and promoting the adoption of neuroscience-informed mental health intervention. Teachers reported that a range of practical mental health intervention strategies described in the content of the online teacher training program would be empowering for teachers to provide mental health intervention to students, especially because they currently have limited breadth and depth of knowledge and skills in mental health intervention grounded on scientific evidence. Teachers also agreed that the checklist included in the self-paced learning booklet would help provide mental health intervention because they currently have limited knowledge for assessing the mental health needs of students.

However, the study’s teacher focus group revealed that Japanese teachers have limited time to plan mental health interventions due to their academic teaching, teaching preparation and other extra duties. To effectively promote the implementation of neuroscience-informed mental health interventions, teachers suggested that the online teacher training program needs to provide a more detailed guideline that helps teachers easily implement a range of intervention strategies. In response to this feedback, the researcher made necessary revisions to the contents of online teacher training program. The researcher created a sheet summarizing a detailed guideline for implementing each regulation strategy presented in the self-paced learning booklet and presentation slides. Additionally, the researcher developed intervention sheets that teachers can use in the classroom with students. The guideline sheet and intervention sheet were developed based on materials from established group mental health intervention programs, such as SST, group CBT and stress management education, to ensure consistency and effectiveness (Matsumoto et al., 2020; Yamamoto et al., 2017). To guarantee successful implementation, the researcher opted to offer follow-up consultations via email, phone and online video conferencing after teachers participated in the online live interactive sessions. These adjustments ensured that the co-designed online teacher training program was tailored to meet the specific needs of Japanese educators.

Addressing RQ2, the present study found with a teacher focus group that the learning format of online teacher training in the self-paced learning booklet and live online interactive session are suitable format for Japanese teachers. Japanese teachers agreed that the overall volume of the self-paced learning booklet (90 pages) is appropriate. Japanese teachers also agreed that two weeks would be an appropriate time for teachers to complete a self-paced learning booklet before attending an online live interactive session. Teachers also agreed that the volume of PowerPoint slides (45 slides) would allow teachers to focus on the contents of learning on each slide and provide opportunities for questions and discussions without rushing through content in 90 min of the online live interactive session. Teachers agreed that the online teacher training format without face-to-face contact is suitable to avoid the risk of COVID-19 infection. Teachers agreed that simple online live interactive session that only involves listening and speaking would be ideal for Japanese teachers because, while Japanese teachers have more opportunities to attend online teacher training, many of them are still not used to using complicated online technologies for online training (e.g., breakout rooms). All teachers agreed that the booklet for the online teacher training program has a suitable format, featuring diagrams and photos that enhance their understanding of the training content, including neurobiological mechanisms of mental health issues. Teachers also agreed that the booklet’s exercises and case studies can enable teachers to apply the knowledge learned in the workshop to improve their own mental health and that of their students in the classroom.

The study found that although teachers were comfortable with the online teacher training program format, they had difficulty reading the small font size, wordy sentences and lack of images and diagrams in the self-paced learning booklet and PowerPoint slides. This difficulty in reading may potentially demotivate Japanese teachers from learning and reduce the effectiveness of the training. Teachers suggested that they would be more engaged in the self-paced learning booklet and online live interactive session if there were more images and diagrams. In response to the feedback, the researcher made necessary revisions to the format of online teacher training program. The researcher revised the format of the self-paced learning booklet and PowerPoint slides by increasing the font size, making sentences more concise and adding more images and diagrams. To further enhance comprehension, the researcher created audio recordings summarizing each chapter of the booklet. These recordings were uploaded to YouTube for easy access by teachers. These revisions ensured that the online teacher training has suitable format for Japanese teachers.

Japanese teachers who participated in the focus group were not randomly selected. The researcher invited Japanese teachers who expressed willing to join the focus group. Therefore, the input of teachers from the focus group may not represent the entire opinions of Japanese teachers in the school. Furthermore, teacher training developed in the present study was designed to meet the needs of Japanese teachers in a single public primary school in Western Japan. Hence, teacher training developed in this study may not be suitable for Japanese teachers in other Japanese schools in rural areas. Furthermore, although co-researchers validated the identified themes’ appropriateness, only the primary author was responsible for coding and identifying themes from the teacher focus group data. No other researcher conducted an independent parallel thematic analysis. Consequently, the reliability of the identified themes may be somewhat compromised due to the lack of inter-rater verification.

This study co-designed a tailored online teacher training program for delivering neuroscience-informed mental health interventions, specifically formatted and content-rich for Japanese teachers in rural settings, by integrating feedback from rural Japanese teachers and a panel of expert advisors. The developed teacher training is expected to enhance the knowledge and skills of rural Japanese teachers in effectively providing mental health interventions to Japanese children. The next step would be to evaluate the effectiveness of the developed online training program in delivering neuroscience-informed mental health interventions and promoting the mental health of Japanese primary school students in rural areas. Future studies evaluating the effectiveness of online teacher training programs for delivering NIMHI may collect feedback from students and teachers to inform further program development.

Authors would like to thank the Japanese primary school teachers and students who provided the opportunity to conduct this research.

Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Conflict of interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Author contributions: YT contributed to the design and implementation of the research, to the analysis of the results and to the writing of the manuscript. MB, HT and SE contributed to the design of the research, to the analysis of the results and to the writing of the manuscript.

Data availability statement. The raw data supporting the conclusions of this article will be made available by the corresponding author, YT, upon reasonable request.