A protocol for a cluster-randomized controlled trial testing an empowerment intervention to prevent sexual assault in upper primary school adolescents in the informal settlements of Nairobi, Kenya

Clea Sarnquist, Jennifer Lee Kang, Mary Amuyunzu-Nyamongo, Gabriel Oguda, Dorothy Otieno, Benjamin Mboya, Nancy Omondi, Duncan Kipkirui, Michael Baiocchi, Clea Sarnquist, Jennifer Lee Kang, Mary Amuyunzu-Nyamongo, Gabriel Oguda, Dorothy Otieno, Benjamin Mboya, Nancy Omondi, Duncan Kipkirui, Michael Baiocchi

Abstract

Background: Sexual violence against adolescents is prevalent worldwide and results in significant physical and mental injuries as well as loss of economic and personal potential. Urban informal settlements such as those around Nairobi, Kenya have been shown to have especially high incidences of violence. Research has shown that empowerment interventions for female adolescents can reduce sexual assault. However, these interventions have had limited testing in urban informal settlements, with young adolescents, or in coordination with complementary programs for male adolescents.

Methods/design: This study was a two-arm, parallel, cluster-randomized trial testing a combination of a previously-tested girls' intervention, IMPower, and a newly revised boys' intervention, Source of Strength. Clusters were defined as schools within the informal settlements; participants were adolescent girls and boys in class 6, generally between the ages of 10-14 at baseline. Data collection began in January 2016 and continued through December 2018. The primary outcome was the change in incidence of self-reported sexual assault among girls from baseline, compared to a life skills standard of care intervention. Secondary outcomes included experiences of physical and emotional violence, as well as determining the effects of the intervention on self-efficacy, self-esteem, and gender attitudes and beliefs, and how those effects led to changes in experience of sexual assault. For the primary outcome and several of the secondary outcomes, we used an intention to treat estimand.

Discussion: This was the first randomized controlled trial with longitudinal follow-up of an empowerment self-defense approach to violence prevention for adolescents in informal settlements. The large size and rigorous design supported analysis to understand multiple subgroup experiences in the hypothesized reduction in sexual assault. The study was also unique in its focus on young (10-14 years of age) adolescents and in engaging both boys and girls in separate but coordinated curriculums. The focus on a highly vulnerable and understudied population will make it a significant contribution to the literature on violence prevention.

Trial registration: Clinical Trials.gov # NCT02771132 . Version 3.1 registered May 2017, first participant enrolled January 2017. Retrospectively registered.

Keywords: Adolescent; Intervention; Kenya; Protocol; Violence against woman and girls.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. UNICEF: Hidden in plain sight: a statistical analysis of violence against children. UNICEF; 2014. .
    1. García-Moreno C, Jansen HA, Ellsberg M, Heise L, Watts C: WHO multi-country study on women's health and domestic violence against women: initial results on prevalence, health outcomes and women's responses: World Health Organization; 2005.
    1. UNICEF: Violence against Children in Kenya: Findings from a 2010 National Survey. Summary Report on the Prevalence of Sexual, Physical and Emotional Violence, Context of Sexual Violence, and Health and Behavioral Consequences of Violence Experienced in Childhood. In. Nairobi, Kenya: United Nations Children’s Fund Kenya Country Office, Division of Violence Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, and the Kenya National Bureau of Statistics; 2012.
    1. Macro, ICF. Kenya demographic and health survey 2008-2009. Calverton; 2010. .
    1. Sarnquist C, Omondi B, Sinclair J, Gitau C, Paiva L, Mulinge M, Cornfield DN, Maldonado Y. Rape prevention through empowerment of adolescent girls. Pediatrics. 2014;133(5):e1226–e1232. doi: 10.1542/peds.2013-3414.
    1. Baiocchi M, Omondi B, Langat N, Boothroyd DB, Sinclair J, Pavia L, Mulinge M, Githua O, Golden NH, Sarnquist C. A behavior-based intervention that prevents sexual assault: the results of a matched-pairs, cluster-randomized study in Nairobi, Kenya. Prev Sci. 2016:1–10.
    1. Stockl H, March L, Pallitto C, Garcia-Moreno C, Team WHOM-cS Intimate partner violence among adolescents and young women: prevalence and associated factors in nine countries: a cross-sectional study. BMC Public Health. 2014;14:751. doi: 10.1186/1471-2458-14-751.
    1. Gupta N, Mahy M. Sexual initiation among adolescent girls and boys: trends and differentials in sub-Saharan Africa. Arch Sex Behav. 2003;32(1):41–53. doi: 10.1023/A:1021841312539.
    1. Singh Susheela. Adolescent Childbearing in Developing Countries: A Global Review. Studies in Family Planning. 1998;29(2):117. doi: 10.2307/172154.
    1. Klein JD. Adolescent pregnancy: current trends and issues. Pediatrics. 2005;116(1):281–286. doi: 10.1542/peds.2005-0999.
    1. Krug EG, Mercy JA, Dahlberg LL, Zwi AB. The world report on violence and health. Lancet. 2002;360(9339):1083–1088. doi: 10.1016/S0140-6736(02)11133-0.
    1. Brown D, Riley L, Butchart A, Meddings D, Kann L, Harvey A. Exposure to physical and sexual violence and adverse health behaviours in African children: results from the global school-based student health survey. Bull World Health Organ. 2009;87(6):447–455. doi: 10.2471/BLT.07.047423.
    1. Brown DS, Fang X, Florence CS. Medical costs attributable to child maltreatment a systematic review of short- and long-term effects. Am J Prev Med. 2011;41(6):627–635. doi: 10.1016/j.amepre.2011.08.013.
    1. Ellsberg Mary, Arango Diana J, Morton Matthew, Gennari Floriza, Kiplesund Sveinung, Contreras Manuel, Watts Charlotte. Prevention of violence against women and girls: what does the evidence say? The Lancet. 2015;385(9977):1555–1566. doi: 10.1016/S0140-6736(14)61703-7.
    1. Corburn Jason, Riley Lee. 1. From the Cell to the Street: Coproducing Slum Health. In: Corburn Jason, Riley Lee., editors. Slum Health. Berkeley: University of California Press; 2019. pp. 11–37.
    1. Jewkes R, Gibbs A, Jama-Shai N, Willan S, Misselhorn A, Mushinga M, Washington L, Mbatha N, Skiweyiya Y. Stepping stones and creating futures intervention: shortened interrupted time series evaluation of a behavioural and structural health promotion and violence prevention intervention for young people in informal settlements in Durban, South Africa. BMC Public Health. 2014;14:1325. doi: 10.1186/1471-2458-14-1325.
    1. Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Puren A, Duvvury N. Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. Bmj. 2008;337:a506. doi: 10.1136/bmj.a506.
    1. Abramsky T, Devries K, Kiss L, Nakuti J, Kyegombe N, Starmann E, Cundill B, Francisco L, Kaye D, Musuya T, 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 Med. 2014;12(1):122. doi: 10.1186/s12916-014-0122-5.
    1. Wagman JA, Gray RH, Campbell JC, Thoma M, Ndyanabo A, Ssekasanvu J, Nalugoda F, Kagaayi J, Nakigozi G, Serwadda D, et al. Effectiveness of an integrated intimate partner violence and HIV prevention intervention in Rakai, Uganda: analysis of an intervention in an existing cluster randomised cohort. Lancet Glob Health. 2015;3(1):e23–e33. doi: 10.1016/S2214-109X(14)70344-4.
    1. Pronyk PM, Hargreaves JR, Kim JC, Morison LA, Phetla G, Watts C, Busza J, Porter JD. Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial. Lancet. 2006;368(9551):1973–1983. doi: 10.1016/S0140-6736(06)69744-4.
    1. Jordan J, Mossman E. “Back off buddy, this is my body, not yours”: empowering girls through self-defense. Violence Against Women. 2018;24(13):1591–1613. doi: 10.1177/1077801217741217.
    1. Brenick Alaina, Shattuck Julie, Donlan Alice, Duh Shinchieh, Zurbriggen Eileen L. Empowering children with safety-skills: An evaluation of the Kidpower Everyday Safety-Skills Program. Children and Youth Services Review. 2014;44:152–162. doi: 10.1016/j.childyouth.2014.06.007.
    1. Senn CY, Eliasziw M, Barata PC, Thurston WE, Newby-Clark IR, Radtke HL, Hobden KL. Efficacy of a sexual assault resistance program for university women. N Engl J Med. 2015;372(24):2326–2335. doi: 10.1056/NEJMsa1411131.
    1. Rozee P, Koss M. Rape: a century of resistance. Psychol Women Q. 2001;25(4):295–311. doi: 10.1111/1471-6402.00030.
    1. Gidycz CA, Dardis CM. Feminist self-defense and resistance training for college students: a critical review and recommendations for the future. Trauma Violence Abuse. 2014;15(4):322–333. doi: 10.1177/1524838014521026.
    1. Hollander JA. Does self-defense training prevent sexual violence against women? Violence Against Women. 2014;20(3):252–269. doi: 10.1177/1077801214526046.
    1. Dank M, Ziv Y: Evaluation of the effect of El Havel IMPACT programs on participants. Research for Social Impact 2015.
    1. Sinclair J, Sinclair L, Otieno E, Mulinge M, Kapphahn C, Golden NH. A self-defense program reduces the incidence of sexual assault in Kenyan adolescent girls. J Adolesc Health. 2013;53(3):374–380. doi: 10.1016/j.jadohealth.2013.04.008.
    1. Keller Jennifer, Mboya Benjamin O., Sinclair Jake, Githua Oscar W., Mulinge Munyae, Bergholz Lou, Paiva Lee, Golden Neville H., Kapphahn Cynthia. A 6-Week School Curriculum Improves Boys’ Attitudes and Behaviors Related to Gender-Based Violence in Kenya. Journal of Interpersonal Violence. 2016;32(4):535–557. doi: 10.1177/0886260515586367.
    1. Imai K, King G, Nall C. The essential role of pair matching in cluster-randomized experiments, with application to the Mexican universal health insurance evaluation. Stat Sci. 2009;24(1):29–53. doi: 10.1214/08-STS274.
    1. Rotondi M. CRTSize: sample size estimation functions for cluster randomized trials. In: R package version 02. 2011.
    1. Paiva L. IMpower girls: upper primary (UP). In. San Francisco; 2014.
    1. Paiva L, Bergholz L. IMpower boys: sources of strength (SOS) in. San Francisco; 2015.
    1. United Nations Children’s Fund Kenya Country Office, Division of Violence Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, and the Kenya National Bureau of Statistics. Violence against Children in Kenya: Findings from a 2010 National Survey. Summary Report on the Prevalence of Sexual, Physical and Emotional Violence, Context of Sexual Violence, and Health and Behavioral Consequences of Violence Experienced in Childhood. Nairobi; 2012. .
    1. Jewkes R, Nduna M, Jama-Shai N. Stepping stones South Africa: a training manual for sexual and reproductive health communication and relationship skills. Pretoria: MRC; 2010.
    1. Muris P. A brief questionnaire for measuring self-efficacy in youths. J Psychopathol Behav Assess. 2001;23:145–149. doi: 10.1023/A:1010961119608.
    1. Rosenberg M: Society and the adolescent self-image. Princeton, NJ: Princeton University Press; 1965.
    1. Frangakis C, Rubin D. Principal stratification in causal inference. Biometrics. 2002;58(1):21–29. doi: 10.1111/j.0006-341X.2002.00021.x.
    1. Brumback BA, He Z, Prasad M, Freeman MC, Rheingans R. Using structural-nested models to estimate the effect of cluster-level adherence on individual-level outcomes with a three-armed cluster-randomized trial. Stat Med. 2014;33(9):1490–1502. doi: 10.1002/sim.6049.
    1. Guest G, MacQueen K, Namey E: Applied thematic analysis. Thousand Oaks, CA: Sage Publishing; 2012.
    1. Jewkes R, Dartnall E, Sikweyiya Y: Ethical and safety recommendations for research on perpetration of sexual violence. Pretoria: Sexual Violence Research Initiative 2012.
    1. World Health Organization: Putting women first: ethical and safety recommendations for research on domestic violence against women. Geneva, Switzerland: World Health Organization; 2001.
    1. Sikweyiya Y, Jewkes R. Perceptions about safety and risks in gender-based violence research: implications for the ethics review process. Cult Health Sex. 2011;13(9):1091–1102. doi: 10.1080/13691058.2011.604429.
    1. Sikweyiya Y, Jewkes R: Potential research participants’ motivations and perceived risks in research participation: reflections on the implications of ethics in health research. PLoS One in press.
    1. Amin A, Chandra-Mouli V. Empowering adolescent girls: developing egalitarian gender norms and relations to end violence. Reprod Health. 2014;11(1):75. doi: 10.1186/1742-4755-11-75.
    1. Brecklin LR, Ullman SE. Self-defense or assertiveness training and Women’s responses to sexual attacks. J Interper Violence. 2005;20(6):738–762. doi: 10.1177/0886260504272894.
    1. Brecklin LR. Evaluation outcomes of self-defense training for women: a review. Aggress Violent Behav. 2008;13(1):60–76. doi: 10.1016/j.avb.2007.10.001.
    1. Menning C, Holtzman M. Combining primary prevention and risk reduction approaches in sexual assault programming. J Am Coll Heal. 2015(just-accepted:00–0.
    1. University V: REDCap In, vol 617.1; 2016.
    1. Office UNCsFKC, CDC US, Statistics KNBo: Violence Against Children in Kenya: Findings from a 2010 national surey. In. Nairobi, Kenya; 2012.
    1. Martin CL, Ruble DN. Patterns of gender development. Annu Rev Psychol. 2010;61:353–381. doi: 10.1146/annurev.psych.093008.100511.
    1. Habitat U: Slum Almanac 2015/16. In. Naiorib, Kenya; 2016.
    1. Moynihan MM, Banyard VL, Cares AC, Potter SJ, Williams LM, Stapleton JG. Encouraging responses in sexual and relationship violence prevention: what program effects remain 1 year later? J Interpers Violence. 2014;30(1):110–132. doi: 10.1177/0886260514532719.
    1. Dworkin SL, Fleming PJ, Colvin CJ. The promises and limitations of gender-transformative health programming with men: critical reflections from the field. Culture Health Sexuality. 2015;17(sup2):128–143. doi: 10.1080/13691058.2015.1035751.
    1. Jewkes R, Nduna M, Jama-Shai N, Chirwa E, Dunkle K. Understanding the relationships between gender inequitable Behaviours, childhood trauma and socio-economic status in single and multiple perpetrator rape in rural South Africa: structural equation modelling. PLoS One. 2016;11(5):e0154903. doi: 10.1371/journal.pone.0154903.
    1. UNICEF: UNICEF data: monitoring the situation of children and women in.; 2015.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj