The Good Schools Study: A cluster randomised controlled trial of an intervention to prevent violence against children in Ugandan primary schools

在许多国家，校园暴力侵害儿童是一种普遍做法，《世界暴力侵害儿童问题报告》将预防和治疗方面的研究列为优先事项。在大多数国家，儿童在学校的时间比在家里以外的任何地方都长，他们可能遭受教师和其他学校工作人员以及其他儿童的暴力。尽管如此，在大多数国家，缺乏对这种暴力的发生率、流行病学和后果进行严格研究的证据。现有的研究大多来自北美，那里老师的体罚远不常见。在乌干达，没有严格的、具有代表性的流行数据，但一项调查表明，80%以上的儿童遭受过体罚，如教师的鞭刑和巴掌。目前有更多关于非洲学校女孩遭受的性暴力的研究，定性研究表明，乌干达中学的女孩遭受了来自老师和同学的性暴力和骚扰，但由于害怕报复而无法报告。“好学校工具包”已在乌干达通过发声项目开发和完善了6年。该工具包采取了一种系统的方法，让整个学校都参与到减少暴力和改进教学技术的变革过程中来。该工具包借鉴了跨理论模型，并结合了标准的行为改变技术，如设定目标和制定行动计划，这些技术在改变行为方面是有效的。本研究旨在确定使用“好学校工具包”是否能减少儿童遭受学校工作人员暴力的经历。我们还将研究工具包对儿童心理健康、福祉和教育成果的影响。这项研究将包括一项试验，并辅以一项定性研究、一项过程评价和一项经济评价。我们还将随时间跟踪一组试验参与者。我们将在乌干达Luwero区的42所小学进行一项随机对照试验。一半的学校将获得工具包，另一半学校将被列入等待名单，如果该工具包在研究结束时被证明是有效的，则将获得工具包。在研究开始和结束时，将对学校员工和小学五、六、七年级的儿童（年龄约为11-14岁）进行调查，并将收到工具包的学校与未收到工具包的学校进行比较。还将进行一项定性研究，探讨工具包可能影响暴力、心理健康和教育成果的机制。深入的工作将集中在学校工作人员和儿童如何体验工具包干预，以及它的哪些方面可以改进以更有效。该工具包是专门为低成本实施而设计的，适用于低收入环境。将进行经济评估，以探讨这一干预措施的经济和财政成本，目的是为可能扩大该工具包的规模提供信息。所有小学五年级的学生都将被纵向跟踪，直到后续跟进，届时大部分学生将是小学七年级的学生。这将有助于探索心理健康和教育成果随时间变化的轨迹，以及暴力经历如何影响这一点。随着时间的推移，我们也将能够跟踪学校的工作人员。这次评估的结果将用于向教育和体育部的决策者简要介绍，这些决策者参与制定全国范围内关于学校暴力侵害儿童的政策和做法。

Violence against children in schools is common practice in many countries, and research into prevention and treatment has been outlined as a priority in the World Report on Violence against Children. In most countries, children spend more time at school than anywhere else besides their family home, and can suffer violence from teachers and other school staff, and other children. Despite this, in most countries evidence is lacking from rigorously conducted studies on the prevalence, epidemiology and consequences of this violence. Existing studies tend to come from North America, where corporal punishment from teachers is far less common.In Uganda, no rigorous, representative prevalence data exist, but one survey indicated more than 80% of children have experienced physical punishments such as caning and slapping by teachers. More research exists on sexual violence in schools suffered by girls in African schools, and qualitative studies indicate girls in Ugandan secondary schools experience sexual violence and harassment from teachers and fellow students but are not able to report it for fear of reprisals.The Good School Toolkit has been developed and refined for 6 years in Uganda by Raising Voices. The Toolkit takes a systemic approach, involving an entire school in a process of change to reduce violence and improve teaching techniques. The Toolkit draws on the Transtheoretical Model and incorporates standard behaviour change techniques such as setting a goal and making an action plan, which are effective in modifying behaviour. This study aims to determine whether use of the Good School Toolkit reduces children's experience of violence by school staff. We will also examine the effects of the Toolkit on children's mental health, well-being, and educational outcomes. The study will include a trial, which will be complemented by a qualitative study, a process evaluation, and an economic evaluation. We will also follow a sub-group of trial participants over time.We will conduct a cluster randomised controlled trial in 42 primary schools in Luwero District, Uganda. Half of the schools will receive the Toolkit, and other half will be put on a waiting list to receive the Toolkit at the end of the study if it is shown to be effective. School staff, and children in Primary 5, 6 and 7 will be surveyed (aged about 11-14 years) at the beginning and the end of the study, and schools which received the Toolkit will be compared with those which did not. A qualitative study will also be conducted to explore mechanisms by which the Toolkit might be affecting violence, mental health and educational outcomes. In-depth work will focus on how school staff and children have experienced the Toolkit intervention, and what aspects of it may be refined to be more effective. The Toolkit is specifically designed to be implemented at very low cost, appropriate for low income settings. An economic evaluation will be performed to explore the economic and financial costs of this intervention, with the aim of informing possible scale-up of the Toolkit.All students in Primary 5 at baseline will be followed longitudinally until follow-up, when most will be in Primary 7. This will enable exploration of trajectories of change in mental health and educational outcomes over time, and how violence experience impacts this. We will also be able to follow school staff over time.The results from this evaluation will be used to brief policy-makers within the Ministry of Education and Sports involved in developing country-wide policy and practice around violence against children in schools.