Handbook for the Documentation of Interpersonal Violence Prevention Programmes

This study evaluated the effect of Students for Peace, a multi-component violence-prevention intervention, on reducing aggressive behaviours among students of eight middle schools randomly assigned into intervention or control conditions. The intervention, based on Social Cognitive Theory, included the formation of a School Health Promotion Council, training of peer mediators and peer helpers, training of teachers in conflict resolution, a violence-prevention curriculum, and newsletter for parents. All students were evaluated in the spring of 1994, 1995 and 1996 (approximately 9 000 students per evaluation). Sixth graders in 1994 were followed through seventh grade in 1995 or eighth grade in 1996, or both (n = 2 246). Cohort and cross-sectional evaluations indicated little to no intervention effect in reducing aggressive behaviours, fights at school, injuries due to fighting, missing classes because of feeling unsafe at school or being threatened to be hurt. For all variables, the strongest predictors of violence in eighth grade were violence in sixth grade and low academic performance. Although ideal and frequently recommended, the holistic approach to prevention in schools in which teachers, administrators and staff model peaceful conflict resolution is difficult to implement, and, in this case, proved ineffective. The Students for Peace experience suggests that interventions begin prior to middle school, explore social environmental intervention strategies, and involve parents and community members. (Health Education Research, 2000, Vol 15(1): 45–58) Box 2.2 ■ Protecting school girls against sexual exploitation: a guardian programme in Mwanza, Tanzania Authors Zaida Mgalla, Dick Schapink, J Ties Boerma Abstract This paper presents a study in 1996 of a guardian programme in primary schools in two districts in Mwanza region, Tanzania, whose aim was to protect adolescent girls against sexual exploitation, which is thought to be common within educational institutions in Africa. The guardians were women teachers whose role was to help in cases of sexual violence or harassment, and act as counsellors on sexual health problems. About half of the girls in the highest three classes of these primary schools (mean age 15) had had sex. Sexual exploitation of schoolgirls by schoolboys, young men in their teens and 20s and teachers was common. The guardian programme has been well accepted and has already generated considerable public debate. One of the most important initial effects is that sexual abuse is less hidden, and abuse by teachers may have become more difficult than in the past. However, most guardians and other teachers were opposed to any sexual activity among girls, which limited their potential to encourage contraceptives use and preventing of STDs and HIV. In this context, the guardian programme should be only one component of a much broader effort to address the issue of adolescent sexuality.This paper presents a study in 1996 of a guardian programme in primary schools in two districts in Mwanza region, Tanzania, whose aim was to protect adolescent girls against sexual exploitation, which is thought to be common within educational institutions in Africa. The guardians were women teachers whose role was to help in cases of sexual violence or harassment, and act as counsellors on sexual health problems. About half of the girls in the highest three classes of these primary schools (mean age 15) had had sex. Sexual exploitation of schoolgirls by schoolboys, young men in their teens and 20s and teachers was common. The guardian programme has been well accepted and has already generated considerable public debate. One of the most important initial effects is that sexual abuse is less hidden, and abuse by teachers may have become more difficult than in the past. However, most guardians and other teachers were opposed to any sexual activity among girls, which limited their potential to encourage contraceptives use and preventing of STDs and HIV. In this context, the guardian programme should be only one component of a much broader effort to address the issue of adolescent sexuality. (Reproductive Health Matters, 1998, Vol 6(12): 19–30) 18 HANDBOOK FOR THE DOCUMENTATION OF INTERPERSONAL VIOLENCE PREVENTION PROGRAMMES information may range from case histories, self-reports, focus group discussions, interviews, documents and reports. In Table 2.1 three examples of prevention programmes are analysed in terms of the logical stages followed in prevention programmes. The first is the DESEPAZ-programme in Colombia (see Box 1.1); the second is a multi-component violence prevention programme for school children in Texas, USA (Box 2.1, Orpinas et al., 2000); and the third is a guardian proTABLE 2.1 STAGES IN PREVENTION PROGRAMME PLANNING AND IMPLEMENTATION: THREE CASE STUDIES DESEPAZ Programme: Violence Prevention Guardian Programme: Colombia Programme: USA Tanzania (see Box 1.1) (see Box 2.1) (see Box 2.2) 1. Problem statement Theory/philosophy Explicit: public health Explicit: social cognitive Implicit: feminist theory approach theory Information to motivate High homicide rate Results from evaluated Research findings and study Police, coroner and programmes and theory Information from TANESA – hospital-based and research on project on HIV/STDs in information behaviour change Tanzania 2. Programme plan Aims and objectives Evaluate effects of ban on Evaluate effect of multiIntervention to protect carrying firearms and component intervention adolescent girls against alcohol consumption on aggressive behaviour sexual exploitation Interventions Education on civil rights Violence prevention Training of guardians TV advertising on tolerance curriculum Forming of guardian and self-control Peer mediation committees Interpersonal conflicts : programme schools, families Training of teachers Restrictions on alcohol School Health promotion sales Council Ban on carrying handguns Newsletters to parents Target population General public School students Schoolgirls 3. Implementation P R O C E S S R E C O R D E D I N D E T A I L 4. Effects, outcomes Decline in homicide rate Little/no effect in reducing Generated public debate aggressive behaviours Sexual abuse less hidden Conscientization process 5. The evidence Sources of information Preand post-intervention Data from a randomized Case history reports used surveillance data control trial gramme to protect schoolgirls against sexual exploitation in Tanzania (Box 2.2, Mgalla et al. ,1998). These examples illustrate how the programme logic, on which the evaluation of a programme is based, shapes practical evaluation efforts. It demonstrates the importance of systematic documentation and shows the value of putting in place even basic measures of impact. 2. CONCEPTUAL FRAMEWORK AND PROGRAMME DOCUMENTATION CRITERIA 19 2.4 How to identify interpersonal violence prevention programmes The definitions of violence and prevention given in Chapter 1 and the overviews of the public health approach in this chapter enable specification of the ecological model, principles of evaluation and criteria for identifying interpersonal violence prevention programmes. Such programmes: — are identified by local experts as programmes for preventing interpersonal violence; — have clearly defined goals and objectives based on existing knowledge to explain the extent and nature of the problem; — are aimed at primary and/or secondary prevention; — are designed to address clearly identified risk factors at one or more different levels of the ecological model; — are informed by a logical framework for prevention (e.g. the public health approach); — are focused on clearly identified target populations (e.g. women, youth aged 15–24, the general population); — have an administrative and logistic infrastructure. Because of the multifaceted nature of violence and the complexity of its root causes, interpersonal violence prevention programmes can manifest great diversity in the number and type of risk factors they address. Some programmes may focus directly on one or two risk factors, such as the DESEPAZ-programme with its focus on alcohol consumption and carrying of firearms. Other programmes may have the prevention of violence as one among many aims, such as community empowerment programmes that focus on self-efficacy, autonomy and the development of skills for dealing with aggressive behaviour. Programmes such as pre-school enrichment programmes may not concentrate on violence prevention per se, but have been demonstrated to be effective in reducing youth violence or risk factors for youth violence (Krug et al., 2002). 2.5 Programme characteristics Programme characteristics refer to the common dimensions on which different programmes can be described and compared to one another. Factors included in the classification of programme characteristics are: ■ Scope – whether the programme is deployed locally, nationally or internationally. ■ Geographical location – specific particulars of where the programme takes place. ■ Setting of the target population – whether the programme operates in a rural, urban or peri-urban context. ■ Socioeconomic variables – these are known risk factors for interpersonal violence (for example poverty) and it is therefore important to document them. ■ Type and nature of interpersonal violence – information on the type of violence identifies whether the programme deals with child abuse and neglect, intimate partner violence, elder abuse, acquaintance violence and stranger violence, and whether the violence is of a physical, sexual or psychological nature, or involving deprivation and neglect. ■ Theoretical/philosophical orientation – information about the programme’s conceptual framework. ■ Nature and level of intervention and prevention – whether the interventions are targeted at one or more levels of the ecological model (individual, relationship, community, society), and whether the interventions are at the primary or secondary level of prevention. ■ Target populations – identify the populations that the programme aims to benefit in terms of characteristics such as age and sex, and whether they are victims, perpetrators or the general public. ■ Sites and settings – identify in what settings the programme takes place, such as schools, neighbourhoods, workplaces, old age homes and so on. 20 HANDBOOK FOR THE DOCUMENTATION OF INTERPERSONAL VIOLENCE PREVENTION PROGRAMMES ■ Programme information – general information about the programme will include whether it is a single or multiple site intervention, whether the programme focuses explicitly on violence or not, and details about resources used, for instance staff and physical resources available to the programme. ■ Information on the programme plan, implementation and outcomes – this section includes information on the relevance of and support for the programme, methods of documenting the programme and its interventions, and on the outcomes and whether the programme has been evaluated. How information is disseminated should also be noted. It is likely that the majority of programmes identified for documentation using this handbook will not, at the time of documentation, have been subject to a formal scientific evaluation. Accordingly, few will be able to provide empirical evidence of outcome and impact effectiveness. In such instances the documentation procedure will be limited to describing if and how such programmes are attempting to measure their effects and effectiveness.