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

学校暴力侵害儿童行为是许多国家的普遍做法，《世界暴力侵害儿童问题报告》已将预防和治疗研究列为优先事项。在大多数国家，儿童在学校的时间比其他任何地方都长，除了他们的家庭，而且可能遭受来自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，缺乏关于这种暴力的流行率、流行病学和后果的严格研究的证据。现有的研究倾向于来自北美，那里的教师体罚远没有那么常见。在乌干达，没有严格的、有代表性的流行数据，但一项调查显示，超过80%的儿童经历过教师的体罚，如鞭打和耳光。关于非洲学校女孩在学校遭受的性暴力问题，有更多的研究，定性研究表明，乌干达中学的女孩遭受教师和同学的性暴力和骚扰，但由于害怕报复，无法报告。乌干达通过提高声音开发和完善好学校工具包已有6年。该工具包采取了一种系统的方法，让整个学校参与到减少暴力和改进教学技术的变革过程中。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。这项研究旨在确定良好学校工具包的使用是否减少了学校工作人员对儿童的暴力体验。我们还将研究工具包对儿童心理健康、福祉和教育结果的影响。这项研究将包括一项试验，并将辅之以定性研究、过程评估和经济评估。我们还将随着时间的推移跟踪试验参与者的子组。我们将在乌干达卢韦罗地区的42所小学进行一项整群随机对照试验。一半的学校将收到工具包，另一半的学校将在研究结束时被列入等待接收工具包的名单，如果它被证明是有效的。在研究开始和结束时，将对学校教职员工以及小学5、6和7年级的儿童(年龄约11-14岁)进行调查，并将收到工具包的学校与没有接受工具包的学校进行比较。还将进行一项定性研究，以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教职员工和儿童如何经历工具包干预，以及可以改进哪些方面以使其更有效。该工具包是专门为以非常低的成本实施而设计的，适合低收入环境。将进行一项经济评估，以探索这一干预措施的经济和财务成本，目的是告知可能扩大工具包的规模。将对基线的所有五年级学生进行纵向跟踪，直到跟进，届时大多数学生将在七年级。这将使人们能够探索心理健康和教育结果随时间的变化轨迹，以及暴力经历如何影响这一点。我们还将能够随着时间的推移跟踪学校工作人员。这次评估的结果将用于向教育和体育部内参与制定关于校园暴力侵害儿童行为的全国政策和实践的政策制定者介绍情况。

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.