Skhokho Supporting Success: A Cluster RCT of a Multi-faceted, School-based IPV Prevention Intervention in South Africa

Skhokho Supporting Success: A Cluster Randomised Controlled Trial of a Multi-faceted, School-based Intimate Partner Violence Primary Prevention Intervention in Gauteng, South Africa

Development and evaluation of a multi-faceted school-based intervention to prevent intimate partner violence among Grade 8 high school students in South Africa

Study Overview

• Status: Completed
• Conditions: Partner of Victim of Physical Abuse
• Intervention / Treatment: Behavioral: Skhokho Supporting Success for Schools; Behavioral: Skhokho Supporting Success for Families

Detailed Description

Primary prevention of intimate partner violence among young men and women requires an intervention which addresses the underlying driving factors of such violence operating at different ecological levels.That is, interventions need to address factors impacting directly on youth and their family relationships, school as an institutional setting. In the school, holistic interventions strengthen the curriculum and teaching, but also the broader environment of learning, including addressing positive discipline and the culture of the school. In order to prevent violence, interventions need to build gender equality, challenge the normative use of violence in schools and homes (e.g., corporal punishment), strengthen teen-adult relationships and communication, and build negotiation and conflict resolution skills, as well as addressing stress and coping.

A three-arm, cluster randomised controlled trial based in high schools in Gauteng, South Africa is evaluating such a multi-faceted primary prevention intervention. This intervention includes school strengthening components for learners and educators, which includes providing a teaching materials for the grade 8 life orientation (LO) curriculum (which covers gender and violence), training teachers in LO teaching, training staff on positive discipline and establishing learner clubs. A second intervention seeks to strengthen families and is a workshop based intervention delivered over 4 day long sessions for a parent or caregiver and their grade 8 adolescent.

The intervention is being evaluated in a three arm randomised controlled trial, with school-level randomisation involving 24 schools. One is a delayed intervention control arm, two arms have the school strengthening intervention and one arm additionally have the family strengthening intervention.

The outcomes will be addressed using qualitative and quantitative methods with data collected from Grade 8 learners (the primary outcome group), school educators and administrators, and parents/caregivers of Grade 8s. These measures will be conducted pre-intervention and at 6, 12, and 18 month follow up periods. In addition, an economic costing evaluation will be conducted.

• Study Type: Interventional
• Enrollment (Anticipated): 3192
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• LEARNER/TEEN PARTICIPANTS: enrolled in Grade 8 in one of the study schools; informed consent from parent/guardian to participate in study
• EDUCATOR PARTICIPANTS: currently employed/working as an educator (of any group of learners) at one of the study schools
• PARENT/CAREGIVER PARTICIPANTS: the male or female parent/caregiver/guardian of a Grade 8 learner in Arm 2 schools

Exclusion Criteria:

NONE

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: School Strengthening; Skhokho Supporting Success for Schools: (a) Full year Grade 8 Life Orientation Learner Workbook (following the national curriculum), Educator Guide, and LO Educator support workshops; (b) Educator workshops including values, positive discipline skills, adolescent development, and stress and coping; (c) Learner club workshops (Grade 8s-11s) including creating change for a safe and vibrant school community, human rights at school, communication and conflict resolution skills, and stress and coping.	Behavioral: Skhokho Supporting Success for Schools; All information describing each facet of the intervention are included in the arm/group descriptions.
Experimental: School + Family Strengthening; Skhokho Supporting Success for Schools: See description above. Skhokho Supporting Success for Families: Participatory four-day workshop for parents/caregivers and their young adolescent children including parallel and joint dialogue sessions. This workshop aims to promote supportive, open relationships between parents/caregivers and their teens and includes communication, negotiation and conflict resolution skills; positive discipline skills; challenging traditional gender constructions; understanding the impact of child abuse; stress and coping.	Behavioral: Skhokho Supporting Success for Schools; All information describing each facet of the intervention are included in the arm/group descriptions.; Behavioral: Skhokho Supporting Success for Families; All information describing each facet of the intervention are included in the arm/group descriptions.
No Intervention: Arm 3: Control (Delayed Intervention); This group will continue with "treatment as usual" (i.e: school services, activities, and textbooks without specialised intervention). At the end of primary data collection, these schools will be eligible to receive the Schools Strengthening Intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The incidence of IPV (perpetration of physical or sexual IPV for boys and victimisation for girls)	Any participant who responds affirmatively to any one of the five questions on physical intimate partner violence or one question on sexual intimate partner violence at the 6, 12 or 18 month data collection points will be deemed to be an incident case of IPV victimisation (if female) or perpetration (if male).	Over 18 months of the study
The incidence of severe physical and sexual IPV	Any participant who responds affirmatively to more than one of the five questions on physical intimate partner violence and/or one question on sexual intimate partner violence at the 12 or 18 month data collection points will be deemed to be an incident case of severe IPV victimisation (if female) or perpetration (if male).	Over the last 12 months of the study

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Child-caregiver communication scores	difference in scores derived through summing 5 questions	18 month follow up
Childhood trauma scale scores	Difference in scores derived through summing 15 items	18 month follow up
The incidence of non-partner rape victimisation and perpetration	Any participant who responds affirmatively to any of the non-partner rape questions (2 for girls and 4 for boys) will be deemed to be an incident case of non-partner rape victimisation (if female) and perpetration (if male)	Over 18 months of the study
Childhood trauma exposure incidence	Positive affirmation of teens and environment at home Emotional neglect Physical abuse Sexual abuse	18 month follow up
Bullying at school score	Comparison of scores across 3 items	18 month follow up
Score for communication with girlfriend/boyfriend	Difference in scores measured through summing responses to 5 items	18 month follow up
The incidence of emotional Intimate Partner Violence perpetration (for boys) and victimisation (for girls)	Any participant who responds affirmatively to any one of the three questions on emotional intimate partner violence at the 6, 12 or 18 month data collection points will be deemed to be an incident case of emotional IPV victimisation (if female) or perpetration (if male).	18 months follow up
the incidence of delinquency	Any participant who responds affirmatively to any one of five questions on delinquency at the 6, 12 or 18 months data collection points will be deemed to be an incident case of delinquency	18-month follow up
Depression and anxiety score measured on the Child Depression Inventory	The difference in scores	18-month follow up
Gender attitudes score measured across 5 items	the difference in scores	18-month follow up

Collaborators and Investigators

• Sponsor: Medical Research Council, South Africa
• Investigators: Principal Investigator: Rachel Jewkes, MD, SA Medical Research Council; Principal Investigator: Anik Gevers, PhD, SA Medical Research Council

Publications and helpful links

General Publications

• Jewkes R, Gevers A, Chirwa E, Mahlangu P, Shamu S, Shai N, Lombard C. RCT evaluation of Skhokho: A holistic school intervention to prevent gender-based violence among South African Grade 8s. PLoS One. 2019 Oct 29;14(10):e0223562. doi: 10.1371/journal.pone.0223562. eCollection 2019.
• Shamu S, Gevers A, Mahlangu BP, Jama Shai PN, Chirwa ED, Jewkes RK. Prevalence and risk factors for intimate partner violence among Grade 8 learners in urban South Africa: baseline analysis from the Skhokho Supporting Success cluster randomised controlled trial. Int Health. 2016 Jan;8(1):18-26. doi: 10.1093/inthealth/ihv068. Epub 2015 Dec 5.

Study record dates

Study Major Dates

• Study Start (Actual): February 9, 2013
• Primary Completion (Actual): September 30, 2013
• Study Completion (Actual): May 30, 2016

Study Registration Dates

• First Submitted: January 16, 2015
• First Submitted That Met QC Criteria: January 23, 2015
• First Posted (Estimate): January 28, 2015

Study Record Updates

• Last Update Posted (Actual): August 1, 2017
• Last Update Submitted That Met QC Criteria: July 28, 2017
• Last Verified: July 1, 2017

More Information

Terms related to this study

• Keywords: adolescents; South Africa; parenting; primary prevention; randomised controlled trial; school; physical or sexual intimate partner violence
• Other Study ID Numbers: ECO22-9