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RCT evaluation of Skhokho: A holistic school intervention to prevent gender-based violence among South African Grade 8s


Autoři: Rachel Jewkes aff001;  Anik Gevers aff003;  Esnat Chirwa aff001;  Pinky Mahlangu aff001;  Simukai Shamu aff004;  Nwabisa Shai aff001;  Carl Lombard aff005
Působiště autorů: Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa aff001;  School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa aff002;  Independent Consultant, Cape Town, South Africa aff003;  Foundation for Professional Development, Pretoria, South Africa aff004;  Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0223562

Souhrn

We evaluated the effectiveness of the Skhokho interventions (enhanced teaching materials and a parenting programme) in reducing dating and sexual violence. This pragmatic, three-arm cluster randomised controlled trial was conducted in 24 State schools in Grade 8 classes, with all learners invited to participate. The interventions were: i) a schools’ package: A Life Orientation (LO) curriculum workbook for the Grade 8 national curriculum and teacher training; ii) a workshop for caregivers and teenagers, supported by clubs in the second year. Arms were: a no intervention control, the schools’ package, and the combined schools’ and families’ package. Learners were followed up for 18 months. The primary outcomes were the incidence of physical and/or sexual IPV, severe IPV and non-partner rape. At baseline, 3756 (61.8% of total) learners (aged 12–15) were interviewed and 3411 (90.8%) provided end line data. A third of caregivers and learners attended all four families’ intervention workshop sessions. At baseline, 47% of girls and 29% boys were dating and 18% of boys and 2% of girls had had sex. Differences in the primary outcomes between study arms were not statistically significant, however all effects were in the direction of protection from violence and several secondary outcomes were significantly changed. For girls, the incidence of any IPV experience was aIRR 0.84 (95%CI 0.66, 1.07 p = 0.159) for the school’s arm and the incidence of non-partner rape was aIRR 0.84 (95%CI 0.62, 1.14 p = 0.255) for the combined schools and families arm v. control arm. This under-powered pragmatic study’s findings suggest a generally beneficial impact of the Skhokho interventions on a number of outcome measures, when viewed by both adolescents, caregivers and their teachers. These include measures of adolescents’ exposure to violence, improved sexual health and reductions in several IPV risk factors. The intervention warrants further research.

Trial registration

ClinicalTrials.gov NCT02349321.

Klíčová slova:

Learning – Human learning – Teachers – Schools – Child health – Intimate partner violence – Workshops – Rape and sexual assault


Zdroje

1. Machisa M, Jewkes R, Morna C, Rama K. The war at home: Gender Based Violence Indicators Project. Gauteng Research Report. Johannesburg, South Africa: Gender Links & South African Medical Research Council, 2011.

2. Jewkes R, Sikweyiya Y, Morrell R, Dunkle K. The relationship between intimate partner violence, rape and HIV amongst South African men: a cross-sectional study. PLoS ONE 2011, 6(9):e24256. doi: 10.1371/journal.pone.0024256 21935392

3. Wood K, Maforah F, Jewkes R. "He forced me to love him": putting violence on adolescent sexual health agendas. Social Science & Medicine (1982) 1998, 47(2):233–242.

4. Jewkes R, Sikweyiya Y, Morrell R, Dunkle K. The relationship between Intimate Partner Violence, rape and HIV amongst South African men: a cross-sectional study. PLoS ONE 2011, 6(9):e24256. doi: 10.1371/journal.pone.0024256 21935392

5. Jewkes R, Sikweyiya Y, Morrell R, Dunkle K. Gender inequitable masculinity and sexual entitlement in rape perpetration South Africa: findings of a cross-sectional study PLoS ONE 2011, 6(12).

6. Jewkes R, Morrell R, Christofides N. Empowering teenagers to prevent pregnancy: lessons from South Africa. Cult Health Sex. 2009, 11(7):675–688. doi: 10.1080/13691050902846452 19459086

7. Jewkes R, Dunkle K, Nduna M, Levin J, Jama N, Khuzwayo N, et al. Factors associated with HIV sero-status in young rural South African women: connections between intimate partner violence and HIV. Int J Epidemiol. 2006, 35(6):1461–1468. doi: 10.1093/ije/dyl218 17008362

8. Jewkes R, Dunkle K, Koss M, Levin J, Nduna M, Jama N, et al. Rape perpetration by young, rural South African men: Prevalence, patterns and risk factors. Social Science & Medicine 2006, 63:2949–2961.

9. Dunkle KL, Jewkes RK, Nduna M, Levin J, Jama N, Khuzwayo N, et al. Perpetration of partner violence and HIV risk behaviour among young men in the rural Eastern Cape, South Africa. AIDS 2006, 20(16):2107–2114. doi: 10.1097/01.aids.0000247582.00826.52 17053357

10. Fulu E, Jewkes R, Roselli T, Garcia-Moreno C. Prevalence and risk factors for male perpetration of intimate partner violence: findings from the UN Multi-country Study on Men and Violence in Asia and the Pacific. The Lancet Global Health 2013, 1(4): e187–e207. doi: 10.1016/S2214-109X(13)70074-3 25104345

11. Jewkes R, Fulu E, Tabassam Naved R, Chirwa E, Dunkle K, Haardoerfer R, et al. Comparing reports of past year prevalence of intimate partner violence and rape from women and men, and women’s risk factors for IPV: findings from the UN Multi-country Cross–sectional Study on Men and Violence in Asia and the Pacific. PLoS Medicine 2017, 14(9):e1002381.

12. Behrman JA, Peterman A, Palermo T. Does Keeping Adolescent Girls in School Protect Against Sexual Violence? Quasi-Experimental Evidence From East and Southern Africa. Journal of Adolescent Health 2017, 60(2):184–190. doi: 10.1016/j.jadohealth.2016.09.010 27916327

13. Jewkes R, Fulu E, Roselli T, Garcia-Moreno C.Prevalence and risk factors for non-partner rape perpetration: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific. Lancet Global Health 2013, 1(4),e208–18. doi: 10.1016/S2214-109X(13)70069-X 25104346

14. Gallant M, Maticka-Tyndale E. School-based HIV prevention programmes for African youth. Social Science & Medicine 2004, 58:1337–1351.

15. Paul-Ebhohimhen VA, Poobalan A, van Teijlingen E. A systematic review of school-based sexual health interventions to prevent STI/HIV in sub-Saharan Africa. BMC Public Health 2008, 8(4).

16. Harrison A, Newell M-L, Imrie J, Hoddinott G. HIV prevention for South African youth: which interventions work? A systematic review of current evidence. BMC Public Health 2010, 10(102).

17. Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Puren A, et al. Impact of Stepping Stones on incidence of HIV, HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. British Medical Journal 2008, 337:a506. doi: 10.1136/bmj.a506 18687720

18. Mathews C, Eggers SM, Townsend L, Aarø LE, de Vries PJ, Mason-Jones AJ, et al. Effects of PREPARE, a Multi-component, School-Based HIV and Intimate Partner Violence (IPV) Prevention Programme on Adolescent Sexual Risk Behaviour and IPV: Cluster Randomised Controlled Trial. AIDS & Behavior 2016, 20(9):1821–1840.

19. Wolfe DA, Crooks C, Jaffe P, Chiodo D, Hughes R, Ellis W, et al. A school-based program to prevent adolescent dating violence: a cluster randomized trial. Archives of Pediatrics & Adolescent Medicine 2009, 163(8):692–699.

20. Taylor B SN, Woods D, Mumford, E. Shifting Boundaries: Final Report on an Experimental Evaluation of a Youth Dating Violence Prevention Program in New York City Middle Schools. Washington DC: Police Executive Research Forum; 2011.

21. Devries KM, Knight L, Child JC, Mirembe A, Nakuti J, Jones R, et al. The Good School Toolkit for reducing physical violence from school staff to primary school students: a cluster-randomised controlled trial in Uganda. Lancet Global Health 2015, 385:e78–86.

22. Foshee VA, Bauman KE, Ennett ST, Linder GF, Benefield T, Suchindran C. Assessing the long-term effects of the Safe Dates program and a booster in preventing and reducing adolescent dating violence victimization and perpetration. American Journal of Public Health 2004, 94(4):619–624. doi: 10.2105/ajph.94.4.619 15054015

23. Foshee VA, Bauman KE, Greene WF, Koch GG, Linder GF, MacDougall JE. The Safe Dates program: 1-year follow-up results. American Journal of Public Health 2000, 90(10):1619–1622. doi: 10.2105/ajph.90.10.1619 11029999

24. Espelage DL, Low S, Polanin JR, Brown EC. The impact of a middle school program to reduce aggression, victimization, and sexual violence. Journal of Adolescent Health 2013, 52(2):180–186.

25. Jaycox LH, McCaffrey D, Eiseman B, Aronoff J, Shelley GA, Collins RL, et al.: Impact of a school-based dating violence prevention program among Latino teens: Randomized controlled effectiveness trial. Journal of Adolescent Health 2006, 39(5):694–704. doi: 10.1016/j.jadohealth.2006.05.002 17046506

26. Connolly J, Josephson W, Schnoll J, Simkins-Strong E, Pepler D, MacPherson A, et al. Evaluation of a youth-led program for preventing bullying, sexual harassment, and dating aggression in middle schools. The Journal of Early Adolescence 2015, 35(3):403–434.

27. Miller S, Williams J, Cutbush S, Gibbs D, Clinton-Sherrod M, Jones S. Evaluation of the Start Strong initiative: Preventing teen dating violence and promoting healthy relationships among middle school students. Journal of Adolescent Health 2015, 56(2):S14–S19.

28. Sosa-Rubi SG, Saavedra-Avendano B, Piras C, Van Buren SJ, Bautista-Arredondo S. True love: effectiveness of a school-based program to reduce dating violence among adolescents in Mexico City. Prevention Science 2017, 18(7):804–817. doi: 10.1007/s11121-016-0718-4 27738783

29. Taylor BG, Stein N, Burden F. Exploring gender differences in dating violence/harassment prevention programming in middle schools: Results from a randomized experiment. Journal of Experimental Criminology 2010, 6(4):419–455.

30. Puffer ES, Annan J, Sim AL, Salhi C, Betancourt T. The impact of a family skills training intervention among Burmese migrant families in Thailand: a randomized controlled trial. PLoS ONE 2017, 12:e0172611. doi: 10.1371/journal.pone.0172611 28350809

31. Cluver LD, Meinck F, Steinert JI, Shenderovich Y, Doubt J, Herrero-Romero R, et al. Parenting for Lifelong Health: a pragmatic cluster randomised controlled trial of a non-commercialised parenting programme for adolescents and their families in South Africa. BMJ Global Health 2018, 3(1):e000539. doi: 10.1136/bmjgh-2017-000539 29564157

32. Knerr W, Gardner F, Cluver L. Improving Positive Parenting Skills and Reducing Harsh and Abusive Parenting in Low- and Middle-Income Countries: A Systematic Review. Prevention Science 2013, 14(4):252–363.

33. Levey EJ, Gelaye B, Bain P, Rondon MB, Borba CP, Henderson DC, et al. A systematic review of randomized controlled trials of interventions designed to decrease child abuse in high-risk families. Child Abuse & Neglect 2017, 65:48–57.

34. Bloch G: The toxic mix. What's wrong with South Africa's schools and how to fix it. Cape Town: Tafelberg, 2009.

35. Burton P, Leoschut L. School violence in South Africa: Results of the 2012 National School Violence Study. Cape Town: The Centre for Justice and Crime Prevention, 2013.

36. Veriava F. Promoting effective enforcement of the prohibition against corporal punishment in South African schools. Pretoria: University of Pretoria Law Press, 2014.

37. South African Human Rights Commission. Report of the Public Hearing on School-based Violence. Johannesburg: South African Human Rights Commission, 2006.

38. Morrell R, Epstein D, Unterhalter E, Bhana D, Moletsane R. Towards Gender Equality? South African schools during the HIV/AIDS epidemic. Pietermaritzburg: University of KwaZulu-Natal Press; 2009.

39. Jewkes R. Preventing sexual violence: a rights-based approach. Lancet 2002, 360(9339):1092–1093. doi: 10.1016/S0140-6736(02)11135-4 12384005

40. World Health Organisation, London School of Hygiene and Tropical Medicine. Preventing intimate partner and sexual violence against women: taking action and generating evidence. Geneva: World Health Organisation; 2010.

41. Shamu S, Gevers A, Mahlangu P, Jama-Shai N, Chirwa E, Jewkes R. Prevalence and risk factors for intimate partner violence among Grade eight learners in urban South Africa: Baseline analysis from the Skhokho Supporting Success randomised controlled trial Journal of International Health 2015.

42. Hayes RJ, Bennett S. Simple sample size calculation for cluster-randomised trials. International Journal of Epidemiology 1999, 28:319–326. doi: 10.1093/ije/28.2.319 10342698

43. Russell M, Cupp P, Jewkes R, Gevers A, Mathews C, LeFleur-Bellerose C, et al. Intimate Partner Violence among Adolescents in Cape Town, South Africa. Prevention Science 2014, 15(3):283–295. doi: 10.1007/s11121-013-0405-7 23743796

44. Abramsky T, Devries K, Kiss L, Nakuti J, Kyegombe N, Starmann E, et al. Findings from the SASA! Study: a cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduce HIV risk in Kampala, Uganda. BMC Medicine 2014, 12:122. doi: 10.1186/s12916-014-0122-5 25248996

45. Singer JD, Willett J. Applied Longitudinal Data Analysis: Modeling change and event occurrence. Oxford: Oxford University Press; 2003.

46. Kenward MG, Roger J. Small sample inference for linear mixed effects from restricted maximum likelihood. Biometrics 1997, 53:983–997. 9333350

47. Wood K, Jewkes R. 'Dangerous' love: reflections on violence among Xhosa township youth. In: Changing Men in South Africa. edn. Edited by Morrell R. Pietermaritzburg: University of Natal Press, 2001.

48. Ellis WE, Wolfe DA. Bullying Predicts Reported Dating Violence and Observed Qualities in Adolescent Dating Relationships. Journal of Interpersonal Violence 2015, 30(17):3043–3064. doi: 10.1177/0886260514554428 25355858

49. Pronyk P, Hargreaves JR, Kim JC, Morrison LA, Phetla G, Watts C, et al. Effect of a structural intervention for the prevention of intimate partner violence and HIV in rural South Africa: a cluster randomised trial. The Lancet 2006, 368:1973–1983.

50. Jewkes R, Flood M, Lang J. From work with men and boys to changes of social norms and reduction of inequities in gender relations: a conceptual shift in prevention of violence against women and girls. The Lancet 2015, 385(9977):1580–1589.

51. Gevers A, Jewkes R, Mathews C, Flisher A. 'I think it's about experiencing, like, life': a qualitative exploration of contemporary adolescent intimate relationships in South Africa. Cult Health Sex. 2012, 14(10):1125–1137. doi: 10.1080/13691058.2012.723752 22991931

52. Visser M. Rethinking HIV-prevention for school-going young people based on current behaviour patterns. SAHARA 2017, 14(1):64–76.

53. Gevers A, Mathews C, Cupp P, Russell M, Jewkes R. Illegal yet developmentally normative: a descriptive analysis of young, urban adolescents' dating and sexual behaviour in Cape Town, South Africa. BMC Int Health Hum Rights. 2013, 13(1):31.

54. Branson N, Hofmeyer C, Lam D. Progress through school and the determinants of school dropout in South Africa. Cape Town: SALDRU, 2013.


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