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

Abstract

BackgroundThe 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.MethodsImplementation 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.ResultsSchool 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.ConclusionsOur 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 registrationThe trial is registered at clinicaltrials.gov, NCT01678846, August 24th 2012.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5462-1) contains supplementary material, which is available to authorized users.

Precarious transition: a mortality study of South African ex-miners

“…whether employment was by the mining company or via a third party (“contractor”). The latter group merits particular attention because of their increased vulnerability [7, 17]. However, exploratory analysis of the distribution between company employees and contractors suggested considerable misclassification or other error.…”

“…Only 81.2% of this ex-miner population had an employment duration of 10 years or less, a period within which silicosis is uncommon, whether detected radiologically [31] or at autopsy [32]. This sample therefore reflected a high turnover of relatively short service workers, a phenomenon likely to have been be accelerated by shrinkage of the gold mining industry as well as the growing engagement of short-service “contractors” [7]. The lack of an employment duration effect may reflect a healthy survivor phenomenon in which the distribution of those “leaving sick”, particularly due to HIV and TB, is weighted towards shorter service workers.…”

“…The changing role of TEBA and of the representativeness of its database have been described in detail elsewhere [7]. In summary, the TEBA database is likely to represent a very high proportion of miners employed in the gold mining industry during this period, a substantial proportion of platinum miners and a minority of coal miners.…”

“…No health, behavioural or cause of death information is available on the TEBA database. Also, while gold and platinum recruitment is believed to be reasonably well represented on the TEBA database during this period, recruitment into the coal industry is underrepresented [7]. …”

“…Between 1973 and 2012, 1.64 million miners, mostly internal or foreign migrants, were recruited through the primary regional recruitment agency, TEBA Ltd. (“TEBA”), of whom 27% were from countries outside South Africa [7]. …”