Caroline Farmer, Naomi Shaw, Noreen Orr, Vashti Berry, and G. J. Melendez-Torres are with the Faculty of Health and Life Sciences, University of Exeter, Exeter, UK. Andrew J. Rizzo is with the College of Health and Human Performance, University of Florida, Gainesville. Annah Chollet is with the Department of Social Policy and Intervention, University of Oxford, Oxford, UK. Ann Hagell and Emma Rigby are with the Association for Young People's Health, London, UK. Honor Young is with the Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK. Chris Bonell is with the Department of Public Health Environments and Society, London School of Hygiene and Tropical Medicine, London, UK.
Am J Public Health. 2023 Mar;113(3):320-330. doi: 10.2105/AJPH.2022.307153.
Schools are sites of dating and relationship violence (DRV) and of gender-based violence (GBV) victimization and perpetration. School-based interventions can reach a broad range of students, targeting both individual and group processes that may underpin DRV and GBV. Considering DRV and GBV jointly is important because of their shared etiologies. Comparing the effectiveness of interventions using network meta-analysis (NMA) can support decision-making on optimal resource use. To evaluate the comparative effectiveness of school-based interventions for children aged 5 to 18 years on DRV and GBV victimization, perpetration, and related mediators. We searched 21 databases in July 2020 and June 2021, alongside extensive supplementary search methods, including gray literature searches, forward and backward citation chasing, and searches on first and last author names. We included randomized-controlled trials of interventions for children of compulsory school age implemented within the school setting, and either partially or wholly aimed at changing DRV or GBV outcomes. Pairwise meta-analyses using random-effects robust variance estimation considered intervention effectiveness on DRV and GBV victimization and perpetration using odds ratios, and on mediators (e.g., knowledge and attitudes) using standardized mean differences. Effects were divided into short-term (< 12 months postbaseline) and long-term (≥ 12 months postbaseline). NMAs on victimization and perpetration outcomes compared interventions categorized by breadth of mechanism and complexity of delivery and implementation. Meta-regression tested sensitivity to percentage of girls in the trial sample and country context. Our analysis included 68 trials. Evidence was stronger overall for effects on DRV than for GBV, with significant long-term impacts on DRV victimization (odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.68, 0.99) and DRV perpetration (OR = 0.78; 95% CI = 0.64, 0.94). Knowledge and attitudinal effects were predominantly short-term (e.g., for DRV-related violence acceptance, = 0.16; 95% CI = 0.08, 0.24). NMAs did not suggest the superiority of any intervention type; however, most analyses for GBV outcomes were inconsistent. A higher proportion of girls in the sample was associated with increased effectiveness on long-term victimization outcomes. Evidence is stronger for DRV than for GBV, despite considerable heterogeneity. Certainty of findings was low or very low overall. Violence reductions may require more than 1 school year to become apparent. More extensive interventions may not be more effective. A possible reason for stronger effectiveness for DRV is that whereas GBV is ingrained in school cultures and practices, DRV is potentially more open to change via addressing individual knowledge and attitudes. (. 2023;113(3):320-330. https://doi.org/10.2105/10.2105/AJPH.2022.307153).
学校是约会和关系暴力（DRV）以及基于性别的暴力（GBV）受害和施暴的场所。基于学校的干预措施可以覆盖广泛的学生群体，针对可能构成 DRV 和 GBV 基础的个人和群体过程。考虑到 DRV 和 GBV 具有共同的病因，将它们放在一起比较是很重要的。使用网络荟萃分析（NMA）比较干预措施的效果可以支持关于最佳资源利用的决策。评估面向 5 至 18 岁儿童的基于学校的干预措施对 DRV 和 GBV 受害、施暴和相关中介因素的比较有效性。我们于 2020 年 7 月和 2021 年 6 月检索了 21 个数据库，并结合了广泛的补充检索方法，包括灰色文献检索、前向和后向引文追踪，以及对第一和最后作者姓名的检索。我们纳入了在学校环境中实施的、针对儿童强制性学校年龄的干预措施的随机对照试验，这些干预措施部分或全部旨在改变 DRV 或 GBV 结果。使用随机效应稳健方差估计的成对荟萃分析考虑了使用优势比（OR）衡量的 DRV 和 GBV 受害和施暴干预效果，以及使用标准化均数差（SMD）衡量的中介因素（例如知识和态度）。效应分为短期（基线后<12 个月）和长期（基线后≥12 个月）。对受害和施暴结果的 NMAs 比较了按机制广度和交付及实施复杂性分类的干预措施。元回归检验了试验样本中女孩比例和国家背景的敏感性。我们的分析包括 68 项试验。DRV 的证据总体上比 GBV 更有力，长期对 DRV 受害（OR=0.82；95%置信区间 [CI]：0.68，0.99）和 DRV 施暴（OR=0.78；95% CI：0.64，0.94）有显著影响。知识和态度影响主要是短期的（例如，DRV 相关暴力接受度，SMD=0.16；95% CI：0.08，0.24）。NMAs 并没有表明任何一种干预类型具有优势；然而，对大多数 GBV 结果的分析不一致。样本中女孩比例较高与长期受害结果的有效性增加有关。尽管存在相当大的异质性，但 DRV 的证据强于 GBV。总体而言，证据确定性为低或极低。暴力减少可能需要超过 1 学年才能显现。更广泛的干预措施可能并不更有效。DRV 更有效的一个可能原因是，虽然 GBV 根植于学校文化和实践中，但 DRV 通过解决个人知识和态度，更有可能发生变化。（2023 年；113（3）：320-330. https://doi.org/10.2105/10.2105/AJPH.2022.307153）。
