Browsing by Author "Tanton, Clare"

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    Adapting a complex violence prevention intervention: a case study of the Good School Toolkit in Uganda
    (BioMed Central Ltd, 2024-02) Grundlingh, Heidi; Kyegombe, Nambusi; Namy, Sophie; Nakuti, Janet; Laruni, Yvonne; Nanyunja, Barbrah; Muluusi, Hassan; Nakiboneka, Mastula; Mukuwa, Aggrey; Tanton, Clare; Knight, Louise; Naker, Dipak; Devries, Karen
    Abstract BACKGROUNDAdaptation 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.METHODSWe 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.RESULTSWe 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.CONCLUSIONSBased 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. MEDLINE - Academic
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    Good School Toolkit-Secondary Schools to prevent violence against students: protocol for a pilot cluster randomised controlled trial
    (British Medical Journal Publishing Group, 2024-02) Devries, Karen; Tanton, Clare; Knight, Louise; Nakuti, Janet; Nanyunja, Barbrah; Laruni, Yvonne; Amollo, Mathew; Apota, John; Opobo, Timothy; Pearlman, Jodie; Allen, Elizabeth; Bonell, Chris; Naker, Dipak
    IntroductionNo whole-school interventions which seek to reduce physical, sexual and emotional violence from peers, intimate partners and teachers have been trialled with adolescents. Here, we report a protocol for a pilot trial of the Good School Toolkit-Secondary Schools intervention, to be tested in Ugandan secondary schools. Our main objectives are to (1) refine the intervention, (2) to understand feasibility of delivery of the intervention and (3) to explore design parameters for a subsequent phase III trial.Methods and analysisWe will conduct a pilot cluster randomised controlled trial, with two arms and parallel assignment. Eight schools will be randomly selected from a stratified list of all eligible schools in Kampala and Wakiso Districts. We will conduct a baseline survey and endline survey 18 months after the baseline, with 960 adolescents and 200 teachers. Qualitative data and mixed methods process data collection will be conducted throughout the intervention. Proportion of staff and students reporting acceptability, understanding and implementing with fidelity will be tabulated at endline for intervention schools. Proportions of schools consenting to participation, randomisation and proportions of schools and individual participants completing the baseline and endline surveys will be described in a Consolidated Standards of Reporting Trials diagram.Ethics and disseminationThe ethical requirements of our project are complex. Full approvals have been received from the Mildmay Ethics Committee (0407-2019), the Uganda National Council for Science and Technology (SS 6020) and the London School of Hygiene & Tropical Medicine (16212). Results of this study will be published in peer-reviewed academic journals, and shared with public bodies, policy makers, study participants and the general public in Uganda.Trial registration numberPACTR202009826515511.
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    Menstrual health intervention and school attendance in Uganda (MENISCUS-2): a pilot intervention study
    (BMJ Open, 2020) Kansiime, Catherine; Hytti, Laura; Nalugya, Ruth; Nakuya, Kevin; Namirembe, Prossy; Nakalema, Shamirah; Neema, Stella; Tanton, Clare; Alezuyo, Connie; Namuli Musoke, Saidat; Torondel, Belen; Francis, Suzanna C.; Ross, David A.; Bonell, Christopher; Seeley, Janet; Weiss, Helen Anne
    Achieving good menstrual health and hygiene (MHH) is a public health challenge and there is little evidence to inform interventions. The aim of this study was to pilot test an intervention to improve MHH and school attendance in Uganda, in preparation for a future cluster-randomised trial. Design Longitudinal study with pre–post evaluation of a pilot intervention. Setting Two secondary schools in Entebbe, Uganda. Participants Of the 473 eligible students in secondary 2 (S2) at baseline, 450 (95.1%; 232 girls and 218 boys) consented/assented. 369 students (188 girls; 81.0%; and 181 boys; 83.0%) participated in the endline survey. Intervention The intervention comprised training teachers to improve delivery of government guidelines for puberty education, training in use of a menstrual kit and pain management, a drama skit, provision of analgesics and improvements to school water and sanitation hygiene facilities. Primary and secondary outcome measures Feasibility and acceptability of delivering the intervention. Baseline and endline quantitative surveys were conducted, with qualitative interviews conducted at endline. School attendance was assessed using self-completed daily diaries among a nested cohort of 100 female students. Results There were high levels of uptake of the individual and behavioural intervention components (puberty education, drama skit, menstrual hygiene management (MHM) kit and pain management). The proportion of girls reporting anxiety about next period decreased from 58.6% to 34.4%, and reported use of effective pain management increased from 76.4% to 91.4%. Most girls (81.4%) reported improved school toilet facilities, which improved their comfort managing menstruation. The diary data and qualitative data indicated a potential intervention impact on improving menstrual-related school absenteeism. Conclusions The pilot study showed that the multicomponent MHM intervention was acceptable and feasible to deliver, and potentially effective in improving menstruation knowledge and management. A cluster-randomised trial is needed to evaluate rigorously the intervention effects on MHM and school attendance.
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    Self-Collection of Vaginal Swabs Among Adolescent Girls in a School-Setting in East Africa
    (Sexually transmitted diseases, 2019) Francis, Suzanna C.; Miiro, George; Nakuya, Kevin; Rutakumwa, Rwamahe; Nakiyingi-Miiro, Jessica; Nabaggala, Grace; Musoke, Saidat; Namakula, Juliet; Tanton, Clare; and On behalf of the MENISCUS project team
    Few studies have evaluated the acceptability of self-collected vaginal swabs among young women in sub-Saharan Africa, including in school settings. We evaluated the acceptability of 2 conditions for the self-collection of swabs in secondary schools in Entebbe, Uganda.Assenting girls with parental consent from 3 secondary schools were provided instructions for sampling, and randomly allocated to self-collection of vaginal swabs with or without nurse assistance to help with correct placement of the swab. Swabs were tested for bacterial vaginosis by Gram stain. Participants were followed up after 1 to 2 days and 1 to 2 weeks and invited for a qualitative interview.Overall 96 girls were enrolled (median age, 16 years; interquartile range, 15–17 years). At the first follow-up visit, participants in both arms reported that instructions for sample collection were easy to understand, and they felt comfortable with self-collection. Girls in the nurse assistance arm reported feeling less relaxed (27% vs. 50%, P = 0.02) than those in the arm without nurse assistance, but more confident that they collected the sample correctly (96% vs. 83%, P = 0.04). About half (47%) of participants agreed that self-sampling was painful, but almost all (94%) would participate in a similar study again. Qualitative data showed that participants preferred self-collection without nurse assistance to preserve privacy. Bacterial vaginosis prevalence was 14% (95% confidence interval, 8–22).In this setting, self-collection of vaginal swabs in secondary schools was acceptable and feasible, and girls preferred self-collection without nurse assistance. Self-collection of swabs is an important tool for the detection, treatment and control of reproductive tract infections in girls and young women.
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    Self-Collection of Vaginal Swabs Among Adolescent Girls in a School-Setting in East Africa
    (Sexually transmitted diseases, 2019) Francis, Suzanna C.; Miiro, George; Nakuya, Kevin; Rutakumwa, Rwamahe; Nakiyingi-Miiro, Jessica; Nabaggala, Grace; Musoke, Saidat; Namakula, Juliet; Tanton, Clare; Torondel, Belen; Ross, David A.; Weiss, Helen A.
    Few studies have evaluated the acceptability of self-collected vaginal swabs among young women in sub-Saharan Africa, including in school settings. We evaluated the acceptability of 2 conditions for the self-collection of swabs in secondary schools in Entebbe, Uganda. Methods: Assenting girlswith parental consent from3 secondary schools were provided instructions for sampling, and randomly allocated to selfcollection of vaginal swabs with or without nurse assistance to help with correct placement of the swab. Swabs were tested for bacterial vaginosis by Gram stain. Participants were followed up after 1 to 2 days and 1 to 2 weeks and invited for a qualitative interview. Results: Overall 96 girls were enrolled (median age, 16 years; interquartile range, 15–17 years). At the first follow-up visit, participants in both arms reported that instructions for sample collection were easy to understand, and they felt comfortablewith self-collection.Girls in the nurse assistance arm reported feeling less relaxed (27% vs. 50%, P = 0.02) than those in the armwithout nurse assistance, but more confident that they collected the sample correctly (96% vs. 83%, P = 0.04). About half (47%) of participants agreed that self-sampling was painful, but almost all (94%) would participate in a similar study again. Qualitative data showed that participants preferred self-collection without nurse assistance to preserve privacy. Bacterial vaginosis prevalence was 14% (95% confidence interval, 8–22). Conclusions: In this setting, self-collection of vaginal swabs in secondary schools was acceptable and feasible, and girls preferred self-collection without nurse assistance. Self-collection of swabs is an important tool for the detection, treatment and control of reproductive tract infections in girls and young women.