Dataset Information

RCT Testing Bystander Effectiveness to Reduce Violence.

ABSTRACT: INTRODUCTION:Bystander-based programs have shown promise to reduce interpersonal violence at colleges, yet limited rigorous evaluations have addressed bystander intervention effectiveness in high schools. This study evaluated the Green Dot bystander intervention to reduce sexual violence and related forms of interpersonal violence in 26 high schools over 5 years. DESIGN:A cluster RCT was conducted. SETTING/PARTICIPANTS:Kentucky high schools were randomized to intervention or control (wait list) conditions. INTERVENTION:Green Dot-trained educators conducted schoolwide presentations and recruited student popular opinion leaders to receive bystander training in intervention schools beginning in Year 1. MAIN OUTCOME MEASURES:The primary outcome was sexual violence perpetration, and related forms of interpersonal violence victimization and perpetration were also measured using anonymous student surveys collected at baseline and annually from 2010 to 2014. Because the school was the unit of analysis, violence measures were aggregated by school and year and school-level counts were provided. RESULTS:A total of 89,707 students completed surveys. The primary, as randomized, analyses conducted in 2014-2016 included linear mixed models and generalized estimating equations to examine the condition-time interaction on violence outcomes. Slopes of school-level totals of sexual violence perpetration (condition-time, p<0.001) and victimization (condition-time, p<0.001) were different over time. During Years 3-4, when Green Dot was fully implemented, the mean number of sexual violent events prevented by the intervention was 120 in Intervention Year 3 and 88 in Year 4. For Year 3, prevalence rate ratios for sexual violence perpetration in the intervention relative to control schools were 0.83 (95% CI=0.70, 0.99) in Year 3 and 0.79 (95% CI=0.67, 0.94) in Year 4. Similar patterns were observed for sexual violence victimization, sexual harassment, stalking, and dating violence perpetration and victimization. CONCLUSIONS:Implementation of Green Dot in Kentucky high schools significantly decreased not only sexual violence perpetration but also other forms of interpersonal violence perpetration and victimization.

SUBMITTER: Coker AL

PROVIDER: S-EPMC5737001 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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RCT Testing Bystander Effectiveness to Reduce Violence.

Coker Ann L AL Bush Heather M HM Cook-Craig Patricia G PG DeGue Sarah A SA Clear Emily R ER Brancato Candace J CJ Fisher Bonnie S BS Recktenwald Eileen A EA

American journal of preventive medicine 20170306 5

<h4>Introduction</h4>Bystander-based programs have shown promise to reduce interpersonal violence at colleges, yet limited rigorous evaluations have addressed bystander intervention effectiveness in high schools. This study evaluated the Green Dot bystander intervention to reduce sexual violence and related forms of interpersonal violence in 26 high schools over 5 years.<h4>Design</h4>A cluster RCT was conducted.<h4>Setting/participants</h4>Kentucky high schools were randomized to intervention o ...[more]

PMID: 28279546

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Project description:BackgroundParenting interventions and conditional cash transfer (CCT) programmes are promising strategies to reduce the risk of violence against children, but evidence of the effectiveness of combining such programmes is lacking for families in low- and middle-income countries with children over two years of age. This study examined the effectiveness of a locally adapted parenting programme delivered as part of a government CCT system to low-income families with children aged two to six years in Metro Manila, Philippines.MethodsParticipants were randomly assigned (1:1) to either a 12-session group-based parenting programme or treatment-as-usual services (N = 120). Participation in either service was required among the conditions for receiving cash grants. Baseline assessments were conducted in July 2017 with one-month post-intervention assessments in January-February 2018 and 12-month follow-up in January-February 2019. All assessments were parent-report (ClinicalTrials.gov: NCT03205449).FindingsOne-month post-intervention assessments indicated moderate intervention effects for primary outcomes of reduced overall child maltreatment (d = -0.50 [-0.86, -0.13]), emotional abuse (d = -0.59 [-0.95; -0.22]), physical abuse (IRR = 0.51 [0.27; 0.74]), and neglect (IRR = 0.52 [0.18; 0.85]). There were also significant effects for reduced dysfunctional parenting, child behaviour problems, and intimate partner violence, and increased parental efficacy and positive parenting. Reduced overall maltreatment, emotional abuse, and neglect effects were sustained at one-year follow-up.InterpretationFindings suggest that a culturally adapted parenting intervention delivered as part of a CCT programme may be effective in sustaining reductions in violence against children in low- and middle-income countries.FundingThis research was supported by UBS Optimus Foundation and UNICEF Philippines, and by the Complexity and Relationships in Health Improvement Programmes of the Medical Research Council MRC UK and Chief Scientist Office (Grant: MC_UU_00022/1 and CSO SPHSU16, MC_UU_00022/3 and CSO SPHSU18).

Project description:IntroductionThe Veterans Health Administration initiated implementation facilitation to integrate intimate partner screening programs in primary care. This study investigates implementation facilitation's impact on implementation and clinical effectiveness outcomes.Study designA cluster randomized, stepped-wedge, hybrid-II implementation-effectiveness trial (January 2021-April 2022) was conducted amidst the COVID-19 pandemic.Setting/participantsImplementation facilitation was applied at 9 Veterans Health Administration facilities, staged across 2 waves. Participants were all women receiving care at participating primary care clinics 3 months before (pre-implementation facilitation n=2,272) and 9 months after initiation of implementation facilitation (implementation facilitation n=5,149).InterventionImplementation facilitation included an operations-funded external facilitator working for 6 months with a facility-funded internal facilitator from participating clinics. The pre-implementation facilitation period comprised implementation as usual in the Veterans Health Administration.Main outcome measuresPrimary outcomes were changes in (1) reach of intimate partner violence (IPV) screening programs among eligible women (i.e., those seen within participating clinics during the assessment period; implementation outcome) and (2) disclosure rates among screened women (effectiveness outcome). Secondary outcomes included disclosure rates among all eligible women and post-screening psychosocial service use. Administrative data were analyzed.ResultsFor primary outcomes, women seen during the implementation facilitation period were nearly 3 times more likely to be screened for IPV than women seen during the pre-implementation facilitation period (OR=2.70, 95% CI=2.46, 2.97). Women screened during the implementation facilitation period were not more likely to disclose IPV than those screened during the pre-implementation facilitation period (OR=1.14, 95% CI=0.86, 1.51). For secondary outcomes, owing to increased reach of screening during implementation facilitation, women seen during the implementation facilitation period were more likely to disclose IPV than those seen during the pre-implementation facilitation period (OR=2.09, 95% CI=1.52, 2.86). Women screened during implementation facilitation were more likely to use post-screening psychosocial services than those screened during pre-implementation facilitation (OR=1.29, 95% CI=1.06, 1.57).ConclusionsFindings indicate that implementation facilitation may be a promising strategy for increasing the reach of IPV screening programs in primary care, thereby increasing IPV detection and strengthening connections to support services among the patient population.Trial registrationThis study is registered at www.Clinicaltrialsgov NCT04106193.

Project description:This study extends prior analyses from a 5-year multisite cluster-randomized controlled trial to examine how the previously reported effects of the Green Dot bystander-based prevention program worked to reduce violence perpetration. Bystander-based interventions are hypothesized to prevent violence by reducing violence acceptance and increasing trained participants' willingness and ability to actively engage others in violence prevention using safe and effective bystander actions to diffuse or avoid potentially violent situations. We tested this hypothesis by examining whether Green Dot worked to reduce violence through two mediators measured over time: reducing violence acceptance and increasing bystander actions. When accounting for changes in these mediators over time, the effect of this intervention on violence perpetration was hypothesized to be attenuated or explained. At baseline (spring 2010) and annually (2011-2014), all students in recruited high schools (13 intervention, 13 control) completed an anonymous survey (response rate = 83.9%). Student responses were aggregated as school-level counts for the analysis. Path analyses estimated direct and indirect effects at specific points in the implementation of the intervention. Longitudinal models were used to determine if changes in violence acceptance and bystander actions could explain or attenuate the effect of the intervention. Time-framed path model analyses indicated that the intervention worked as expected to increase bystander behaviors and reduce violence acceptance; both potential mediators were significantly associated with sexual violence perpetration. In addition, after adjusting intent-to-treat models for the hypothesized mediators, the intervention was no longer associated with violence perpetration. In conclusion, these findings indicate that this bystander intervention worked as hypothesized to reduce sexual violence perpetration by creating theory-based changes in students' violence acceptance and bystander actions.

Project description:BACKGROUND:Men's perpetration of intimate partner violence (IPV) limits gains in health and wellbeing for populations globally. Largely informal, rapidly expanding peri-urban settlements, with limited basic services such as electricity, have high prevalence rates of IPV. Evidence on how to reduce men's perpetration, change social norms and patriarchal attitudes within these settings is limited. Our cluster randomised controlled trial aimed to determine the effectiveness of the Sonke CHANGE intervention in reducing use of sexual and/or physical IPV and severity of perpetration by men aged 18-40?years over 2 years. METHODOLOGY:The theory-based intervention delivered activities to bolster community action, including door-to-door discussions, workshops, drawing on the CHANGE curriculum, and deploying community action teams over 18?months. In 2016 and 2018, we collected data from a cohort of men, recruited from 18 clusters; nine were randomised to receive the intervention, while the nine control clusters received no intervention. A self-administered questionnaire, using audio-computer assisted software, asked about sociodemographics, gender attitudes, mental health, and the use and severity of IPV. We conducted an intention-to-treat analysis at the cluster level comparing the expected risk to observed risk of using IPV while controlling for baseline characteristics. A secondary analysis used latent classes (LCA) of men to see whether there were differential effects of the intervention for subgroups of men. RESULTS:Of 2406 men recruited, 1458 (63%) were followed to 2 years. Overall, we saw a reduction in men's reports of physical, sexual and severe IPV from baseline to endpoint (40.2% to 25.4%, 31.8% to 15.8%, and 33.4% to 18.2%, respectively). Intention-to-treat analysis showed no measurable differences between intervention and control clusters for primary IPV outcomes. Difference in the cluster-level proportion of physical IPV perpetration was 0.002 (95% confidence interval [CI] -?0.07 to 0.08). Similarly, differences between arms for sexual IPV was 0.01 (95% CI -?0.04 to 0.06), while severe IPV followed a similar pattern (Diff?=?0.01; 95% CI -?0.05 to 0.07). A secondary analysis using LCA suggests that among the men living in intervention communities, there was a greater reduction in IPV among less violent and more law abiding men than among more highly violent men, although the differences did not reach statistical significance. CONCLUSION:The intervention, when implemented in a peri-urban settlement, had limited effect in reducing IPV perpetrated by male residents. Further analysis showed it was unable to transform entrenched gender attitudes and use of IPV by those men who use the most violence, but the intervention showed promise for men who use violence less. TRIAL REGISTRATION:ClinicalTrials.gov, NCT02823288. Registered on 30 June 2016.

Project description:IntroductionTeen dating violence is a serious public health problem with few effective prevention strategies. This study examines whether the Dating Matters comprehensive prevention model, compared with a standard of care intervention, prevented negative relationship behaviors and promoted positive relationship behaviors.Study designThis longitudinal, cluster-RCT compared the effectiveness of Dating Matters with standard of care across middle school. Standard of care was an evidence-based teen dating violence prevention curriculum (Safe Dates) implemented in eighth grade.Setting/participantsForty-six middle schools in high-risk urban neighborhoods in four U.S. cities were randomized. Schools lost to follow-up were replaced with new schools, which were independently randomized (71% school retention). Students were surveyed in fall and spring of sixth, seventh, and eighth grades (2012-2016). The analysis sample includes students from schools implementing Dating Matters or standard of care for >2 years who started sixth grade in the fall of 2012 or 2013 and had dated (N=2,349 students, mean age 12 years, 49% female, and 55% black, non-Hispanic, 28% Hispanic, 17% other).InterventionDating Matters is a comprehensive, multicomponent prevention model including classroom-delivered programs for sixth to eighth graders, training for parents of sixth to eighth graders, educator training, a youth communications program, and local health department activities to assess capacity and track teen dating violence-related policy and data.Main outcome measuresSelf-reported teen dating violence perpetration and victimization, use of negative conflict resolution strategies, and positive relationship skills were examined as outcomes. Imputation and analyses were conducted in 2017.ResultsLatent panel models demonstrated significant program effects for three of four outcomes; Dating Matters students reported 8.43% lower teen dating violence perpetration, 9.78% lower teen dating violence victimization, and 5.52% lower use of negative conflict resolution strategies, on average across time points and cohorts, than standard of care students. There were no significant effects on positive relationship behaviors.ConclusionsDating Matters demonstrates comparative effectiveness, through middle school, for reducing unhealthy relationship behaviors, such as teen dating violence and use of negative conflict resolution strategies, relative to the standard of care intervention.Trial registrationThis study is registered at www.clinicaltrials.gov NCT01672541.

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RCT Testing Bystander Effectiveness to Reduce Violence.

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RCT Testing Bystander Effectiveness to Reduce Violence.

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