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Devries K, Tanton C, Knight L, Nakuti J, Nanyunja B, Laruni Y, Amollo M, Apota J, Opobo T, Pearlman J, Allen E, Bonell C, Naker D. Good School Toolkit-Secondary Schools to prevent violence against students: protocol for a pilot cluster randomised controlled trial. BMJ Open 2024; 14:e077788. [PMID: 38346875 PMCID: PMC10862314 DOI: 10.1136/bmjopen-2023-077788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/22/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION No whole-school interventions which seek to reduce physical, sexual and emotional violence from peers, intimate partners and teachers have been trialled with adolescents. Here, we report a protocol for a pilot trial of the Good School Toolkit-Secondary Schools intervention, to be tested in Ugandan secondary schools. Our main objectives are to (1) refine the intervention, (2) to understand feasibility of delivery of the intervention and (3) to explore design parameters for a subsequent phase III trial. METHODS AND ANALYSIS We will conduct a pilot cluster randomised controlled trial, with two arms and parallel assignment. Eight schools will be randomly selected from a stratified list of all eligible schools in Kampala and Wakiso Districts. We will conduct a baseline survey and endline survey 18 months after the baseline, with 960 adolescents and 200 teachers. Qualitative data and mixed methods process data collection will be conducted throughout the intervention. Proportion of staff and students reporting acceptability, understanding and implementing with fidelity will be tabulated at endline for intervention schools. Proportions of schools consenting to participation, randomisation and proportions of schools and individual participants completing the baseline and endline surveys will be described in a Consolidated Standards of Reporting Trials diagram. ETHICS AND DISSEMINATION The ethical requirements of our project are complex. Full approvals have been received from the Mildmay Ethics Committee (0407-2019), the Uganda National Council for Science and Technology (SS 6020) and the London School of Hygiene & Tropical Medicine (16212). Results of this study will be published in peer-reviewed academic journals, and shared with public bodies, policy makers, study participants and the general public in Uganda. TRIAL REGISTRATION NUMBER PACTR202009826515511.
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Affiliation(s)
- Karen Devries
- London School of Hygiene & Tropical Medicine, London, UK
| | - Clare Tanton
- London School of Hygiene & Tropical Medicine, London, UK
| | - Louise Knight
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Mathew Amollo
- Africhild Centre, Makerere University, Kampala, Uganda
| | - John Apota
- Africhild Centre, Makerere University, Kampala, Uganda
| | - Timothy Opobo
- Africhild Centre, Makerere University, Kampala, Uganda
| | - Jodie Pearlman
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Chris Bonell
- Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Abramsky T, Harvey S, Mosha N, Mtolela G, Gibbs A, Mshana G, Lees S, Kapiga S, Stöckl H. Longitudinal inconsistencies in women's self-reports of lifetime experience of physical and sexual IPV: evidence from the MAISHA trial and follow-on study in North-western Tanzania. BMC Womens Health 2022; 22:120. [PMID: 35428296 PMCID: PMC9013096 DOI: 10.1186/s12905-022-01697-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/05/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) against women is pervasive throughout the world, with profound consequences for women's health. Research to understand the extent, causes and consequences of IPV relies on self-reported data on violence, and yet there is a paucity of research into the consistency with which women report lifetime IPV over time. METHODS We use data from the control group of the cluster randomised trial and a follow-on longitudinal study in Tanzania to examine discrepancies in women's reported experience of lifetime physical IPV and sexual IPV over three time-points (T0, T29, T53 months). Among those reporting lifetime history of IPV at T0, we calculate the proportion who subsequently report no lifetime history at T29 and/or T53 ('discrepant' reporting). We use logistic regression to explore associations between discrepant reporting and respondent baseline characteristics, the nature of their IPV experiences at baseline, and situational factors at T53. RESULTS Complete IPV data were available for 301 women. At T0, 154 (51%) women reported lifetime history of physical IPV, of whom 62% gave a discrepant 'never' report in a subsequent round. Among 93 (31%) with lifetime history of sexual IPV at T0, 73% provided a subsequent discrepant report. 73% of women reported lifetime physical IPV, and 55% lifetime sexual IPV in at least one survey round. For both IPV outcomes, women were less likely to provide discrepant reports if they had recent IPV at baseline, poor mental health (T53) and poor communication with partner (T53). For physical IPV only, reduced discrepant reporting was also associated with baseline household-level financial hardship and more severe or extensive experience of IPV. CONCLUSIONS A large proportion of women provided discrepant reports over the course of the study. Prevalence estimates of lifetime IPV from one-off cross-sectional surveys are likely to be underestimates, biased towards more recent and severe cases. To improve the stability of IPV measures, researchers should explicitly clarify the meaning of reference periods such as 'ever', consider using shorter reference periods (e.g. past-year), and avoid filter questions that use positive reports of lifetime IPV as a gateway to asking about more recent experiences. TRIAL REGISTRATION Maisha CRT01 registered at ClinicalTrials.gov #NCT02592252, registered retrospectively (13/08/2015).
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Affiliation(s)
- Tanya Abramsky
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Sheila Harvey
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
- Mwanza Intervention Trials Unit, PO Box 11936, Mwanza, Tanzania
| | - Neema Mosha
- Mwanza Intervention Trials Unit, PO Box 11936, Mwanza, Tanzania
| | - Grace Mtolela
- Mwanza Intervention Trials Unit, PO Box 11936, Mwanza, Tanzania
| | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, 491 Peter Mokaba Road, Durban, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Gerry Mshana
- Mwanza Intervention Trials Unit, PO Box 11936, Mwanza, Tanzania
- National Institute for Medical Research, Isamilo Road, Mwanza, Tanzania
| | - Shelley Lees
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, PO Box 11936, Mwanza, Tanzania
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Heidi Stöckl
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377 München, Germany
- Pettenkofer School of Public Health, Elisabeth-Winterhalter-Weg 6, 81377 München, Germany
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Bowers M, Francis T, Baker-Henningham H. The Irie Classroom Toolbox: Mixed method assessment to inform future implementation and scale-up of an early childhood, teacher-training, violence-prevention programme. Front Public Health 2022; 10:1040952. [PMID: 36582373 PMCID: PMC9792689 DOI: 10.3389/fpubh.2022.1040952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Violence against children (VAC) is a violation of child rights, has high prevalence in low- and middle-income countries, is associated with long-term negative effects on child functioning, and with high economic and social costs. Ending VAC at home and at school is thus a global public health priority. Methods In Jamaica, we evaluated an early childhood, teacher-training, violence-prevention programme, (the Irie Classroom Toolbox), in a cluster-randomised trial in 76 preschools. The programme led to large reductions to teachers' use of VAC, although the majority of teachers continued to use VAC at times. In this paper, we describe a mixed-method evaluation of the Irie Classroom Toolbox in the 38 Jamaican preschools that were assigned to the wait-list control group of the trial. In a quantitative evaluation, 108 preschool teachers in 38 preschools were evaluated at pre-test and 91 teachers from 37 preschools were evaluated at post-test. One preschool teacher from each of these 37 preschools were randomly selected to participate in an in-depth interview as part of the qualitative evaluation. Results Preschool teachers were observed to use 83% fewer instances of VAC across one school day after participating in the programme, although 68% were observed to use VAC at least once across two days. The qualitative evaluation confirmed these findings with all teachers reporting reduced use of violence, but 70% reporting continued use of VAC at times. Teachers reported that the behaviour change techniques used to deliver the intervention increased their motivation, knowledge and skills which in turn led to improved child behaviour, improved relationships and improved professional well-being. Direct pathways to reduced use of VAC by teachers were through improved child behaviour and teacher well-being. The main reasons for continued use of VAC were due to barriers teachers faced using positive discipline techniques, teachers' negative affect, and child behaviours that teachers perceived to be severe. Discussion We describe how we used the results from the mixed-method evaluation to inform revisions to the programme to further reduce teachers' use of VAC and to inform the processes of training, supervision and ongoing monitoring as the programme is scaled-up through government services.
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Affiliation(s)
- Marsha Bowers
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Taja Francis
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Helen Baker-Henningham
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica.,School of Human and Behavioural Sciences, Bangor University, Bangor, United Kingdom
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Devries K, Balliet M, Thornhill K, Knight L, Procureur F, N'Djoré YAB, N'Guessan DGF, Merrill KG, Dally M, Allen E, Hossain M, Cislaghi B, Tanton C, Quintero L. Can the 'Learn in peace, educate without violence' intervention in Cote d'Ivoire reduce teacher violence? Development of a theory of change and formative evaluation results. BMJ Open 2021; 11:e044645. [PMID: 34758988 PMCID: PMC8587474 DOI: 10.1136/bmjopen-2020-044645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To gather evidence on whether a brief intervention (Apprendre en paix et éduquer sans violence, developed by the Ivorian Ministry of Education and Graines de Paix) to promote peace in primary schools by reducing teacher violence perpetration and improving pedagogical techniques was acceptable to teachers and affected change in intermediate outcomes. DESIGN Mixed-methods formative research. SETTING Primary schools in Tonkpi region, Cote d'Ivoire. PARTICIPANTS 160 teachers participating in the peace training, surveyed three times during implementation; qualitative in-depth interviews with 19 teachers and teacher-counsellors. INTERVENTIONS Learn in peace, educate without violence-a brief intervention with primary school teachers designed to promote peace in primary schools. OUTCOMES For survey data, we generated composite measures of intermediate outcomes (teachers' awareness of consequences of violence, self-efficacy in applying positive classroom management methods, acceptance of physical discipline practices in school) and used random intercept linear mixed-effects models to compare responses over time. Qualitative research included open-ended questions about acceptability and perceived need for such an intervention. A framework analysis was undertaken. RESULTS Four-months post-training (vs pretraining), teachers had higher self-efficacy in applying positive classroom management methods (pre-mean=26.1; post-mean=27.5; p<0.001) and borderline lower acceptance of physical discipline practices (premean=4.2; postmean=3.6; p=0.10). We found no change in teacher awareness of the consequences of violence. Qualitatively, teachers found the intervention acceptable and understandable, perceiving it as useful because it provided methods for non-violent discipline. Teachers had mixed views about whether the techniques improved classroom dynamics. CONCLUSIONS Data suggest that the intervention is acceptable and leads to change in intermediate outcomes for teachers. Further evaluation in a randomised controlled trial is warranted.
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Affiliation(s)
- Karen Devries
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Manuela Balliet
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Kerrie Thornhill
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Louise Knight
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Fanny Procureur
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Katherine G Merrill
- Bloomburg School of Public Health Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Mazeda Hossain
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare Tanton
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Fabbri C, Rodrigues K, Leurent B, Allen E, Qiu M, Zuakulu M, Nombo D, Kaemingk M, De Filippo A, Torrats-Espinosa G, Shayo E, Barongo V, Greco G, Tol W, Devries KM. The EmpaTeach intervention for reducing physical violence from teachers to students in Nyarugusu Refugee Camp: A cluster-randomised controlled trial. PLoS Med 2021; 18:e1003808. [PMID: 34606500 PMCID: PMC8489723 DOI: 10.1371/journal.pmed.1003808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND School-based violence prevention interventions offer enormous potential to reduce children's experience of violence perpetrated by teachers, but few have been rigorously evaluated globally and, to the best of our knowledge, none in humanitarian settings. We tested whether the EmpaTeach intervention could reduce physical violence from teachers to students in Nyarugusu Refugee Camp, Tanzania. METHODS AND FINDINGS We conducted a 2-arm cluster-randomised controlled trial with parallel assignment. A complete sample of all 27 primary and secondary schools in Nyarugusu Refugee Camp were approached and agreed to participate in the study. Eligible students and teachers participated in cross-sectional baseline, midline, and endline surveys in November/December 2018, May/June 2019, and January/February 2020, respectively. Fourteen schools were randomly assigned to receive a violence prevention intervention targeted at teachers implemented in January-March 2019; 13 formed a wait-list control group. The EmpaTeach intervention used empathy-building exercises and group work to equip teachers with self-regulation, alternative discipline techniques, and classroom management strategies. Allocation was not concealed due to the nature of the intervention. The primary outcome was students' self-reported experience of physical violence from teachers, assessed at midline using a modified version of the ISPCAN Child Abuse Screening Tool-Child Institutional. Secondary outcomes included student reports of emotional violence, depressive symptoms, and school attendance. Analyses were by intention to treat, using generalised estimating equations adjusted for stratification factors. No schools left the study. In total, 1,493 of the 1,866 (80%) randomly sampled students approached for participation took part in the baseline survey; at baseline 54.1% of students reported past-week physical violence from school staff. In total, 1,619 of 1,978 students (81.9%) took part in the midline survey, and 1,617 of 2,032 students (79.6%) participated at endline. Prevalence of past-week violence at midline was not statistically different in intervention (408 of 839 students, 48.6%) and control schools (412 of 777 students, 53.0%; risk ratio = 0.91, 95% CI 0.80 to 1.02, p = 0.106). No effect was detected on secondary outcomes. A camp-wide educational policy change during intervention implementation resulted in 14.7% of teachers in the intervention arm receiving a compressed version of the intervention, but exploratory analyses showed no difference in our primary outcome by school-level adherence to the intervention. Main study limitations included the small number of schools in the camp, which limited statistical power to detect small differences between intervention and control groups. We also did not assess the test-retest reliability of our outcome measures, and interviewers were unmasked to intervention allocation. CONCLUSIONS There was no evidence that the EmpaTeach intervention effectively reduced physical violence from teachers towards primary or secondary school students in Nyarugusu Refugee Camp. Further research is needed to develop and test interventions to prevent teacher violence in humanitarian settings. TRIAL REGISTRATION clinicaltrials.gov (NCT03745573).
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Affiliation(s)
- Camilla Fabbri
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Katherine Rodrigues
- International Rescue Committee, New York, New York, United States of America
| | - Baptiste Leurent
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Elizabeth Allen
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mary Qiu
- Innovations for Poverty Action, Dar es Salaam, Tanzania
| | | | - Dennis Nombo
- International Rescue Committee, New York, New York, United States of America
| | - Michael Kaemingk
- Behavioral Insights Team, New York, New York, United States of America
| | | | | | - Elizabeth Shayo
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Vivien Barongo
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Giulia Greco
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wietse Tol
- University of Copenhagen, Copenhagen, Denmark
| | - Karen M. Devries
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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