Comprehensive sexuality education may help prevent intimate partner violence, but few evaluations of sexuality education courses have measured this. Here we explore how such a course that encourages critical reflection about gendered social norms might help prevent partner violence among young people in Mexico. We conducted a longitudinal quasi-experimental study at a state-run technical secondary school in Mexico City, with data collection including in-depth interviews and focus groups with students, teachers, and health educators. We found that the course supported both prevention of and response to partner violence among young people. The data suggest the course promoted critical reflection that appeared to lead to changes in beliefs, intentions, and behaviors related to gender, sexuality, and violence. We identify four elements of the course that seem crucial to preventing partner violence. First, encouraging participants' reflection about romantic relationships, which helped them question whether jealousy and possessive behaviors are signs of love; second, helping them develop skills to communicate about sexuality, inequitable relationships, and reproductive health; third, encouraging care-seeking behavior; and fourth, addressing norms around gender and sexuality, for example demystifying and decreasing discrimination towards sexually diverse populations. The findings reinforce the importance of schools for violence prevention and have implications for educational policy regarding sexuality education. The results suggest that this promising and relatively short-term intervention should be considered as a school-based strategy to prevent and respond to partner violence.
Despite calls for evaluation practice to take a complex systems approach, there are few examples of how to incorporate complexity into real-life evaluations. This article presents the case for using a complex systems approach to evaluate a school-based intimate partner violence-prevention intervention. We conducted a post hoc analysis of qualitative evaluation data to examine the intervention as a potential system disruptor. We analysed data in relation to complexity concepts particularly relevant to schools: ‘diverse and dynamic agents’, ‘interaction’, ‘unpredictability’, ‘emergence’ and ‘context dependency’. The data—two focus groups with facilitators and 33 repeat interviews with 14–17-year-old students—came from an evaluation of a comprehensive sexuality education intervention in Mexico City, which serves as a case study for this analysis. The findings demonstrate an application of complex adaptive systems concepts to qualitative evaluation data. We provide examples of how this approach can shed light on the ways in which interpersonal interactions, group dynamics, the core messages of the course and context influenced the implementation and outcomes of this intervention. This gender-transformative intervention appeared to disrupt pervasive gender norms and reshape beliefs about how to engage in relationships. An intervention comprises multiple dynamic and interacting elements, all of which are unlikely to be consistent across implementation settings. Applying complexity concepts to our analysis added value by helping reframe implementation-related data to focus on how the ‘social’ aspects of complexity influenced the intervention. Without examining both individual and group processes, evaluations may miss key insights about how the intervention generates change, for whom, and how it interacts with its context. A social complex adaptive systems approach is well-suited to the evaluation of gender-transformative interventions and can help identify how such interventions disrupt the complex social systems in which they are implemented to address intractable societal problems.
Adolescent abuse is an important and understudied issue in society. The objective of this study was to examine the epidemiology of physical injuries due to maltreatment among adolescents aged 10-19 years. Subjects came from seven hospitals/trauma centres in Washington DC that were involved in the Washington DC Initiative to Reduce Infant Mortality and Prevention of Childhood Injuries Study. From 1996-1998, information was gathered about all injuries to adolescents aged 10-19 years that resulted in a visit to a participating emergency department. This paper focuses on the subset 178 adolescents aged 10-19 years who presented with physical injuries due to maltreatment. It was found that 55% of victims of abuse were female. Abuse victims were more likely to be female than those with unintentional injury. The most common injuries were contusions to the extremities (29%). Mothers were the most common perpetrators (48%). A total of 64% of victims were assaulted with an object/weapon and the most common object used was a belt. There are some similarities and some important differences between patterns of maltreatment in adolescents vs. younger children. Increased awareness of maltreatment among older children is a critical step in increasing and improving screening and prevention practices among health-care professionals.
Comprehensive sexuality education may help prevent intimate partner violence, but few evaluations of sexuality education courses have measured this. Here we explore how such a course that encourages critical reflection about gendered social norms might help prevent partner violence among young people in Mexico. We conducted a longitudinal quasi-experimental study at a state-run technical secondary school in Mexico City, with data collection including in-depth interviews and focus groups with students, teachers and health educators. We found that the course supported both prevention of and response to partner violence among young people. The data suggest the course promoted critical reflection that appeared to lead to changes in beliefs, intentions and behaviors related to gender, sexuality and violence. We identify four elements of the course that seem crucial to preventing partner violence. First, encouraging participants’ reflection about romantic relationships, which helped them question whether jealousy and possessive behaviors are signs of love; second, helping them develop skills to communicate about sexuality, inequitable relationships and reproductive health; third, encouraging care-seeking behavior; and fourth, addressing norms around gender and sexuality, for example demystifying and decreasing discrimination towards sexually diverse populations. The findings reinforce the importance of schools for violence prevention and have implications for educational policy regarding sexuality education. The results suggest that this promising and relatively short-term intervention should be considered as a school-based strategy to prevent and respond to partner violence.
Background: Missing and inconsistent data are common problems when researching young people’s sexual health. Complete and high-quality data are needed to inform effective programming. To inform improvements, we examine different techniques for collecting school-based data about young people’s sexuality, relationships and partner violence.Methods: We use empirical data from a school-based programme evaluation in Mexico City as a case study. The evaluation sought data on sexuality and relationships using self-administered questionnaires, observation, focus groups, and in-depth interviews. We explore the advantages and disadvantages of different data collection methods in practice, comparing data from questionnaires and interviews to examine data quality and identifying challenges to collecting and interpreting data from different methods and sources. We used descriptive statistics, reviewed field notes, and conducted thematic analysis, drawing on research team and participant perspectives. Results: Data collection was influenced by earthquakes and extreme weather, social aspects of the data collection setting, and the sensitive nature of the data. There was variation in data quality by group, timepoint, gender, and topic. Women had a higher proportion of complete responses than men at most timepoints. Intervention group men were the only group to increase their proportion of complete responses from baseline to endline. Items about sexual activity had the lowest proportions of complete responses. Participants varied in their willingness to share personal information. Data from different sources and timepoints sometimes appeared contradictory, creating challenges with interpretation. Conclusions: This analysis can inform methodological choice for school-based sexual health research. Our experience highlights the difficulties of anticipating – and correcting for – the many interacting real-world challenges threats to data quality and interpretation challenges that can arise. It is vital that results for all types of analysis are accompanied by a reflexive discussion of data collection conditions and challenges that might impact on data quality.
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