The Good School Toolkit-Secondary to prevent violence against students: a pilot cluster randomised controlled trial

Schools provide a unique opportunity to address multiple forms of violence against adolescents. Yet, few whole-school interventions to comprehensively address physical, sexual and emotional violence against adolescents from multiple perpetrators have been evaluated in the Global South. We report results of a pilot trial of the Good School Toolkit-Secondary (GST-S), an intervention for secondary schools in Uganda. The trial aimed to determine whether criteria for progression to a phase 3 trial were met based on pre-specified implementation and research feasibility criteria.

We conducted a pilot cluster randomised controlled trial with two arms and parallel assignment. The trial was conducted in eight secondary schools, varying by faith status and urban or rural setting, randomly selected from a list of all eligible registered schools in Kampala and Wakiso Districts. Schools were randomised to control or intervention arms and aware of their allocation. The primary outcome was to determine whether criteria for progression to a phase 3 trial were met based on pre-specified criteria regarding fidelity, acceptability and understanding of GST-S, and research feasibility. Outcomes were measured using cross-sectional baseline and endline surveys among eligible school students and staff, and routine monitoring data collected during implementation.

Overall, seven of eight schools agreed to participate in the baseline survey, randomisation and endline survey, with three randomised to the control and four to the intervention group. The endline survey included 837 students (response rate: control, 100%; intervention, 99.4%) and 98 staff (response rate: control, 91.1%; intervention, 95.0%). There were delays to the trial due to Covid-19 and an Ebola outbreak. Despite this, all pre-specified implementation and feasibility criteria were met. The intervention was acceptable and understandable to students and staff, was delivered with fidelity, and the trial demonstrated good research feasibility.

We present the first evidence that it is feasible to deliver a whole-school intervention aiming to address physical, sexual and emotional violence against adolescents from multiple perpetrators including peers, teachers and intimate partners in sub-Saharan Africa. Based on our results, we recommend progression to a phase 3 trial with minor refinements to the research methods and intervention.

Pan African Clinical Trials Registry, PACTR202009826515511, 16/09/20.