Implementation of the Good School Toolkit in Uganda: a quantitative process evaluation of a successful violence prevention program

Abstract

Background: The Good School Toolkit, a complex behavioural intervention designed by Raising Voices a Ugandan NGO, reduced past week physical violence from school staff to primary students by an average of 42% in a recent randomised controlled trial. This process evaluation quantitatively examines what was implemented across the twenty-one intervention schools, variations in school prevalence of violence after the intervention, factors that influence exposure to the intervention and factors associated with students' experience of physical violence from staff at study endline.

Methods: Implementation measures were captured prospectively in the twenty-one intervention schools over four school terms from 2012 to 2014 and Toolkit exposure captured in the student (n = 1921) and staff (n = 286) endline cross-sectional surveys in 2014. Implementation measures and the prevalence of violence are summarised across schools and are assessed for correlation using Spearman's Rank Correlation Coefficient. Regression models are used to explore individual factors associated with Toolkit exposure and with physical violence at endline.

Results: School prevalence of past week physical violence from staff against students ranged from 7% to 65% across schools at endline. Schools with higher mean levels of teacher Toolkit exposure had larger decreases in violence during the study. Students in schools categorised as implementing a 'low' number of program school-led activities reported less exposure to the Toolkit. Higher student Toolkit exposure was associated with decreased odds of experiencing physical violence from staff (OR: 0.76, 95%CI: 0.67-0.86, p-value< 0.001). Girls, students reporting poorer mental health and students in a lower grade were less exposed to the toolkit. After the intervention, and when adjusting for individual Toolkit exposure, some students remained at increased risk of experiencing violence from staff, including, girls, students reporting poorer mental health, students who experienced other violence and those reporting difficulty with self-care.

Conclusions: Our results suggest that increasing students and teachers exposure to the Good School Toolkit within schools has the potential to bring about further reductions in violence. Effectiveness of the Toolkit may be increased by further targeting and supporting teachers' engagement with girls and students with mental health difficulties.

Trial registration: The trial is registered at clinicaltrials.gov , NCT01678846, August 24th 2012.

Keywords: Children; Corporal punishment; Process evaluation; Schools; Uganda; Violence.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the London School of Hygiene and Tropical Medicine Ethics Committee (6183) and the Uganda National Council for Science and Technology (SS2520). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written voluntary informed consent was obtained from all individual participants included in the study. Headteachers provided consent for schools to participate in the study. Parents were notified and could opt children out of participation in survey data collection. Children themselves provided consent for participation. Staff provided consent for participation in survey data collection.

Competing interests

Dipak Naker developed the Good School Toolkit and is a Co-director of Raising Voices and Sophie Namy is the Raising Voices Learning Coordinator. Angel Mirembe and Janet Nakuti are employed in Raising Voices monitoring and evaluation division, but were managed by LSHTM staff during the study. No other author declared competing interests.

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Figures

Fig. 1

Summarises process evaluation objectives and specific questions addressed in this paper Legend for Fig. 1: Figure 1 summarises the four process evaluation objectives and the specific questions addressed in this paper. The left hand panel describes the school-level intervention and outcome, and lists the process measures explored in this analysis. The right hand panel describes exploratory analysis of factors associated with Toolkit exposure and the violence outcome

Fig. 2

Figure 2a: Delivery, implementation, adoption and reach in the intervention schools. Figure 2b: Student Toolkit exposure questions and factor groupings Notation: IQR: Interquartile range, range: full range

Fig. 3

Prevalence of physical violence in intervention schools at baseline and endline Legend: Intervention school-level of physical violence from staff in the last week, reported by students, graph presenting baseline and end-line school means and 95% confidence intervals.