Evidence That Classroom-Based Behavioral Interventions Reduce Pregnancy-Related School Dropout Among Nairobi Adolescents

Empowerment Self-Defense Intervention Outcomes: A Descriptive Review of Measures

Global research about empowerment self-defense (ESD)-a sexual assault resistance intervention recommended as a component of a comprehensive sexual assault prevention strategy-continues to emerge, with studies reporting positive effects, including reduced risk of sexual assault victimization. Researchers have suggested ESD may produce additional positive public health outcomes beyond the prevention of sexual violence, but more research is needed to understand the benefits associated with ESD training. However, to conduct high-quality research, scholars have suggested a need for improved measurement tools. To better understand these measurement gaps, the purpose of this study was to identify and review measures used in ESD outcome studies; and in doing so, to determine the range of outcomes previously measured in quantitative studies. Within the 23 articles meeting study inclusion criteria, there were 57 unique scales that measured a range of variables. These 57 measures were grouped into nine construct categories: assault characteristics (n = 1); attitudes and beliefs (n = 6); behavior and behavioral intentions (n = 12); fear (n = 4); knowledge (n = 3); mental health (n = 8); any past unwanted sexual experiences (n = 7); perception of risk and vulnerability (n = 5); and self-efficacy (n = 11). Except for mental health, most scales were developed in the Global North using college student populations, so measures for diverse populations (e.g., diverse in age, culture, ethnicity, geographical origin) are critically needed. Future research should focus on identifying and/or developing standardized tools that measure the full constellation of targeted outcomes. Evaluation of the methodological quality of studies assessing psychometric performance of the tools should also be prioritized.

Empowerment Transformation Training Reduces Rape Among Girls and Young Women in South Sudan and the Kakuma Refugee Camp

PURPOSE

Rape occurs at high rates in South Sudan and Kakuma refugee camps, a region characterized by armed conflict, gender inequity, and economic crisis. To date, we know little about how to prevent rape in this region of the world. As such, the purpose of this study was to examine outcomes of Empowerment Transformation Training (ETT) (an adapted empowerment self-defense program; empowerment self-defense) among female participants in South Sudan and the Kakuma refugee camp.

METHODS

Schools were assigned to the treatment (ETT) condition (n = 7) or control (life skills) condition (n = 9) and used as the unit of analysis given the cluster-randomized design. Female participants anonymously completed a baseline (T1) and 12-month follow-up (T2) paper and pencil survey.

RESULTS

Annual rape victimization rates decreased from 10.7% to 5.5% in the ETT schools (risk ratio [RR] = 0.51); there was no change in the control schools (10.0%-9.0%). Empowerment Transformation Training (ETT) schools had increased confidence at T2 (T1: 42.4%; T2: 75.4%; RR = 1.79) and greater rates of confidence at T2 compared to control schools (54.3%; RR = 1.39). Knowledge of effective self-defense strategies (T2) was greater for ETT schools (47.4%) compared to control schools (30.1%) (RR = 1.57).

DISCUSSION

The ETT program reduced rates of rape, increased confidence, disclosures of rape (among victims), and knowledge of effective self-defense strategies. Empowerment self-defense programs are a critical component to rape prevention across global communities, including those characterized by armed conflict, gender inequity, and economic crisis.

In Their Own Words: Sexual Assault Resistance Strategies Among Kenyan Adolescent Girls Following Participation in an Empowerment Self-Defense Program

The purpose of this study was to examine, via testimonial data, resistance strategies used to thwart a sexual assault among slum-dwelling Kenyan adolescent girls (N  =  678) following their participation in an empowerment self-defense program (IMpower). The majority (58.2%) of perpetrators were strangers; there were no differences in resistance strategies used between strangers versus known perpetrators (83.8% used verbal strategies, 33.2% used resistance strategies, 16.7% ran away, and 7.9% used distraction). Associations between resistance strategies and perpetrator tactics, number of assailants, location of the assault, and the presence of a bystander were also examined.

Young People's Experiences With an Empowerment-Based Behavior Change Intervention to Prevent Sexual Violence in Nairobi Informal Settlements: A Qualitative Study

PURPOSE

Young people in sub-Saharan Africa face one of the world's highest burdens of sexual violence. Previous impact evaluations indicated that a 6-week empowerment-based behavioral intervention in Nairobi informal (slum) settlements can reduce sexual assault. This qualitative study investigated girls' and boys' experiences of the intervention to identify potential mechanisms of change.

METHODS

We conducted a qualitative study in Nairobi slums with students (aged 15-21 years) who had participated in 2 parallel school-based curriculums called IMPower (girls) and Your Moment of Truth (boys) at least 1 year ago. Data were collected via 10 focus group discussions (5 for boys, 5 for girls) with 6-11 participants in each and 21 individual in-depth interviews (11 boys, 10 girls) that explored participants' experiences of the intervention and their suggestions for improvement. Findings were analyzed using thematic network analysis guided by empowerment theory.

RESULTS

Girls described how the intervention enabled them to recognize and resist sexual assault via verbal and physical strategies for self-protection, negotiate sexual consent, and exercise agency. Boys described increased ability to avoid risky behaviors and "bad" peer groups and to understand and respect consent. Girls also described how the intervention strengthened their self-confidence, and boys said that it boosted positive life values and gender-equal attitudes. Skilled facilitators and interactive and relevant content were highlighted as key to intervention success. Areas of improvement included expanding the curriculum to contain more content on sexual and reproductive health and rights and involving out-of-school youth, parents, teachers, and communities.

CONCLUSION

Findings indicate that a relatively short, behavioral school-based intervention can empower both girls and boys to prevent various forms of sexual violence in a low-income setting where it is endemic. Incorporating multilevel support structures, such as involving communities and families, could further enhance young people's long-term safety, health, and well-being.

"I learned that I am worth defending": A process evaluation of a sexual assault prevention program implemented on an Indian reservation

A great deal of programming has been developed to prevent sexual assault (SA) among adolescents. Few studies examine programming implementation among minority groups and present information about program acceptability among participants and community stakeholders. The purpose of the current study was to examine the acceptability of implementing an empowerment SA self-defense program for adolescent girls on an Indian reservation. Data for the study came from posttest surveys of Native American adolescent girls who participated in an SA prevention program (N = 102) and interviews with community stakeholders, including program participants (N = 18). Results showed that acceptability was high among program participants and community stakeholders. Program participants noted that they liked the program overall and liked components of the programming. Participants noted that they disliked pressure to participate, program length, and missing class. Among community stakeholders, all expressed an overall positive impression of the program, felt that the program had a positive impact on program participants, and appreciated that girls learned to use refusal skills. Community stakeholders provided several programming improvement ideas such as incorporating culturally specific content into the program for future implementation. These findings can be used by other researchers, schools, and practitioners implementing prevention programs with Native American girls.

Sexual violence among adolescent girls and young women in Malawi: a cluster-randomized controlled implementation trial of empowerment self-defense training

BACKGROUND

Globally, sexual violence is prevalent, particularly for adolescent women. This cluster-randomized controlled implementation trial examines empowerment self-defense (ESD) for sexual assault risk reduction among school-age women in Malawi.

METHODS

The unit of randomization and analysis was the school (n = 141). Intervention participants received a 12-h intervention over 6 weeks, with refreshers. Primary outcomes were past-year prevalence and incident rate of sexual violence. Secondary outcomes included confidence, self-defense knowledge, and, for those victimized, violence disclosure. Interaction effects on outcomes were evaluated with Poisson models with school-correlated robust variance estimates for risk ratios and incident rate ratios (baseline n = 6644, follow-up n = 4278).

RESULTS

Past-year sexual assault prevalence was reduced among intervention students (risk ratio [RR] 0.68, 95% CI 0.56, 0.82), but not control students (interaction effect p < 0.001). Significant increases in self-defense knowledge were observed solely among intervention students (RR 3.33, 95% CI 2.76, 4.02; interaction effect p < 0.001). Significant changes in sexual violence prevalence and knowledge were observed for both primary and secondary students. Favorable reductions were also observed in sexual violence incident rate among students overall (interaction effect p = 0.01).

CONCLUSIONS

This intervention reduced sexual violence victimization in both primary and secondary school settings. Results support the effectiveness of ESD to address sexual violence, and approach the elimination of violence against women and girls set forth with Sustainable Development Goal #5. Implementation within the education system can enable sustainability and reach.

TRIAL REGISTRATION

Pan African Clinical Trials Registry PACTR201702002028911 . Registered 09 February 2017. Retrospectively registered.

Experiências de estudantes internacionais ao gestar longe do seu país de origem

Objetivo: este estudio pretende comprender las experiencias de madres estudiantes internacionales acerca de quedar embarazada y dar a luz lejos del país de origen.Método: investigación cualitativa, once entrevistas realizadas en profundidad a estudiantes internacionales en una universidad federal en la región del Macizo de Baturité, Ceará (Brasil). Se utilizaron como referenciales teóricos los modelos de adaptación de Roy y el modelo de la universalidad y diversidad del cuidado cultural de Leininger para el análisis, basado en la teoría fundamentada en los datos.Resultados: emergieron las siguientes categorías: 1. Los retos en el embarazo y estudiar lejos de su país; 2. Empoderamiento y superación frente a los desafíos; y 3. Los diferentes cuidados y el choque cultural, que abordó los aspectos relacionados con el contraste cultural con respecto al cuidado.Conclusión: se constata que la vida de las madres estudiantes oriundas de otros países está repleta de desafíos. La mirada diferencial del equipo de salud posibilitaría la adaptación de prácticas para conservar la cultura de cada madre.

A Behavior-Based Intervention That Prevents Sexual Assault: the Results of a Matched-Pairs, Cluster-Randomized Study in Nairobi, Kenya

DESIGN

The study's design was a cluster-randomized, matched-pairs, parallel trial of a behavior-based sexual assault prevention intervention in the informal settlements.

METHODS

The participants were primary school girls aged 10-16. Classroom-based interventions for girls and boys were delivered by instructors from the same settlements, at the same time, over six 2-h sessions. The girls' program had components of empowerment, gender relations, and self-defense. The boys' program promotes healthy gender norms. The control arm of the study received a health and hygiene curriculum. The primary outcome was the rate of sexual assault in the prior 12 months at the cluster level (school level). Secondary outcomes included the generalized self-efficacy scale, the distribution of number of times victims were sexually assaulted in the prior period, skills used, disclosure rates, and distribution of perpetrators. Difference-in-differences estimates are reported with bootstrapped confidence intervals.

RESULTS

Fourteen schools with 3147 girls from the intervention group and 14 schools with 2539 girls from the control group were included in the analysis. We estimate a 3.7 % decrease, p = 0.03 and 95 % CI = (0.4, 8.0), in risk of sexual assault in the intervention group due to the intervention (initially 7.3 % at baseline). We estimate an increase in mean generalized self-efficacy score of 0.19 (baseline average 3.1, on a 1-4 scale), p = 0.0004 and 95 % CI = (0.08, 0.39).

INTERPRETATION

This innovative intervention that combined parallel training for young adolescent girls and boys in school settings showed significant reduction in the rate of sexual assault among girls in this population.