PDF(Pubmed)
Abstract：
BACKGROUND: Adaptation is a key strategy to extend the reach of evidence-based interventions to prevent violence in new populations, but there is a dearth of practical case examples. The Good School Toolkit was developed by Ugandan NGO Raising Voices for use in primary schools (GST-P). We describe our systematic approach to adapting the GST-P for use in secondary schools in Uganda, and reflect on the utility of the process as well as limitations of existing adaptation frameworks.
METHODS: We adapted the GST-P in four phases, which included: I) clarifying the logic model and core intervention components using a streamlined process; II) conducting formative research (cross-sectional survey, focus groups, etc.) to understand the new population; III) selecting and preparing new intervention components and modifying existing intervention components; and IV) pretesting new intervention components with teachers and students in Uganda.
RESULTS: We identified core components using a logic model. Formative research showed results largely in line with our apriori hypotheses. Teacher violence remained highly prevalent in secondary versus primary schools (> 65% of secondary students reported past year exposure), while peer violence significantly increased (secondary = 52% vs. primary girls = 40%, P < 0.001; secondary = 54% vs. primary boys = 44%, P = 0.009) in secondary versus primary schools. Significantly more secondary girls (51%) than secondary boys (45%) reported past year dating/intimate partner violence (P = 0.03). Inequitable, gendered educational practices emerged as a salient theme, perceived to heighten female students\' vulnerability to violence. In light of these findings, we made several adjustments to the adapted intervention. We strengthened existing teacher and peer violence intervention components. We also developed, pretested and revised new program components to prevent dating violence and promote \'gender fairness in schools\'. Finally, original activities were modified to support engagement with school administration and promote increased student agency in secondary schools.
CONCLUSIONS: Based on our experience, it was difficult to apply mechanistic models to clarify the intervention logic of the GST-P, a complex multicomponent intervention, and simpler methods may be sufficient. Our team had high levels of contextual knowledge before the adaptation, and formative research to understand the new target population provided only limited additional insight. In similar situations, a simplified approach to mapping the core intervention components, qualitative research to understand the new target population, and pre-testing of new intervention components may be the most informative elements of systematic adaptation processes.
METHODS: We adapted the GST-P in four phases, which included: I) clarifying the logic model and core intervention components using a streamlined process; II) conducting formative research (cross-sectional survey, focus groups, etc.) to understand the new population; III) selecting and preparing new intervention components and modifying existing intervention components; and IV) pretesting new intervention components with teachers and students in Uganda.
RESULTS: We identified core components using a logic model. Formative research showed results largely in line with our apriori hypotheses. Teacher violence remained highly prevalent in secondary versus primary schools (> 65% of secondary students reported past year exposure), while peer violence significantly increased (secondary = 52% vs. primary girls = 40%, P < 0.001; secondary = 54% vs. primary boys = 44%, P = 0.009) in secondary versus primary schools. Significantly more secondary girls (51%) than secondary boys (45%) reported past year dating/intimate partner violence (P = 0.03). Inequitable, gendered educational practices emerged as a salient theme, perceived to heighten female students\' vulnerability to violence. In light of these findings, we made several adjustments to the adapted intervention. We strengthened existing teacher and peer violence intervention components. We also developed, pretested and revised new program components to prevent dating violence and promote \'gender fairness in schools\'. Finally, original activities were modified to support engagement with school administration and promote increased student agency in secondary schools.
CONCLUSIONS: Based on our experience, it was difficult to apply mechanistic models to clarify the intervention logic of the GST-P, a complex multicomponent intervention, and simpler methods may be sufficient. Our team had high levels of contextual knowledge before the adaptation, and formative research to understand the new target population provided only limited additional insight. In similar situations, a simplified approach to mapping the core intervention components, qualitative research to understand the new target population, and pre-testing of new intervention components may be the most informative elements of systematic adaptation processes.
摘要：
背景：适应是扩大基于证据的干预措施的范围以防止新人群中的暴力的关键策略，但是缺乏实际案例。良好学校工具包是由乌干达非政府组织“提高声音”开发的，用于小学（GST-P）。我们描述了我们的系统方法来调整GST-P在乌干达的中学使用，并反思该过程的效用以及现有适应框架的局限性。
方法：我们分四个阶段对GST-P进行了调整，其中包括：I）使用简化的流程阐明逻辑模型和核心干预组件；II）进行形成性研究（横断面调查，焦点小组,等。）了解新人口；III）选择和准备新的干预组件并修改现有的干预组件；IV）与乌干达的老师和学生一起对新的干预组件进行预先测试。
结果：我们使用逻辑模型确定了核心组件。形成性研究表明，结果与我们的先验假设基本一致。教师暴力在中学和小学中仍然非常普遍(>65%的中学生报告去年接触过)，而同伴暴力显著增加(次要=52%vs.小学女生=40%,P<0.001；次级=54%vs.小学男孩=44%，中学与小学的P=0.009）。去年，中学女孩（51％）比中学男孩（45％）报告了约会/亲密伴侣暴力（P=0.03）。不公平的，性别教育实践成为一个突出的主题，认为这加剧了女学生对暴力的脆弱性。根据这些发现,我们对适应性干预进行了一些调整。我们加强了现有的教师和同伴暴力干预组件。我们还开发了,预先测试和修订的新计划组成部分，以防止约会暴力和促进“学校性别公平”。最后,对原有活动进行了修改，以支持与学校管理部门的接触，并促进中学增加学生代理。
结论：根据我们的经验，很难应用机械模型来阐明GST-P的干预逻辑，复杂的多成分干预，和更简单的方法可能就足够了。我们的团队在适应之前有高水平的背景知识，和形成性研究以了解新的目标人群仅提供了有限的额外见解。在类似的情况下,映射核心干预组件的简化方法，定性研究以了解新的目标人群，和预测新的干预组件可能是系统适应过程中信息最丰富的元素。
方法：我们分四个阶段对GST-P进行了调整，其中包括：I）使用简化的流程阐明逻辑模型和核心干预组件；II）进行形成性研究（横断面调查，焦点小组,等。）了解新人口；III）选择和准备新的干预组件并修改现有的干预组件；IV）与乌干达的老师和学生一起对新的干预组件进行预先测试。
结果：我们使用逻辑模型确定了核心组件。形成性研究表明，结果与我们的先验假设基本一致。教师暴力在中学和小学中仍然非常普遍(>65%的中学生报告去年接触过)，而同伴暴力显著增加(次要=52%vs.小学女生=40%,P<0.001；次级=54%vs.小学男孩=44%，中学与小学的P=0.009）。去年，中学女孩（51％）比中学男孩（45％）报告了约会/亲密伴侣暴力（P=0.03）。不公平的，性别教育实践成为一个突出的主题，认为这加剧了女学生对暴力的脆弱性。根据这些发现,我们对适应性干预进行了一些调整。我们加强了现有的教师和同伴暴力干预组件。我们还开发了,预先测试和修订的新计划组成部分，以防止约会暴力和促进“学校性别公平”。最后,对原有活动进行了修改，以支持与学校管理部门的接触，并促进中学增加学生代理。
结论：根据我们的经验，很难应用机械模型来阐明GST-P的干预逻辑，复杂的多成分干预，和更简单的方法可能就足够了。我们的团队在适应之前有高水平的背景知识，和形成性研究以了解新的目标人群仅提供了有限的额外见解。在类似的情况下,映射核心干预组件的简化方法，定性研究以了解新的目标人群，和预测新的干预组件可能是系统适应过程中信息最丰富的元素。
