{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T19:15:46Z","timestamp":1789154146965,"version":"build-2803163510"},"reference-count":43,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2022,5,6]],"date-time":"2022-05-06T00:00:00Z","timestamp":1651795200000},"content-version":"unspecified","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"This study is funded by the Wellsprings Philanthropic Fund.","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,4,22]]},"published-print":{"date-parts":[[2022,5]]},"abstract":"\n Introduction<\/jats:title>\n National violence against children (VAC) surveys in Tanzania and Kenya reported that approximately three-quarters of children in Tanzania experienced physical violence while 45.9% of women and 56.1% of men experienced childhood violence in Kenya. In response to VAC, Investing in Children and their Societies\u2014Strengthening Families & Protecting Children (ICS-SP) developed the whole school approach (WSA) for reducing VAC in and around schools. Objectives of this evaluation are to: (1) determine intervention\u2019s feasibility and (2) the extent to which the WSA reduces prevalence and incidence of VAC in and around schools in Kenya and Tanzania; (3) gain insights into changes in stakeholders\u2019 knowledge, attitudes and practices in relation to VAC following intervention implementation and (4) provide evidence-based recommendations for refining intervention content, delivery and theory of change (ToC).<\/jats:p>\n <\/jats:sec>\n \n Methods and analysis<\/jats:title>\n The study is a mixed-methods, controlled before-and-after, quasi experimental pilot designed to assess the delivery and potential changes in knowledge, attitudes, behaviours and VAC prevalence and incidence in and around schools following the WSA intervention implementation in Kenya and Tanzania. The preintervention phase will entail stakeholder enhancement of the WSA ToC and baseline cross-sectional surveys of teaching and non-teaching staff and parents (knowledge, attitude and practices), pupils (VAC incidents and school climate) and school safety audits. The WSA intervention implementation phase will include an intervention delivery process assessment and random school visits. In the postintervention phase, end-line surveys will be conducted similarly to baseline. Focus group discussions and in-depth interviews will be held with ICS-SP staff, training facilitators, teachers, parents and pupils to gain insights into acceptability, delivery and potential intervention effects. Quantitative and qualitative data will be analysed using SPSS V.25 and NVIVO V.12, respectively.<\/jats:p>\n <\/jats:sec>\n \n Ethics and dissemination<\/jats:title>\n Ethics approvals were received from Amref Health Africa in Kenya (AMREF-ESRC P910\/2020) and National Health Research Ethics Committee (NatHREC) in Tanzania (NIMR\/HQ\/R.8a\/Vol.IX\/3655). Dissemination will be through research reports.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-055231","type":"journal-article","created":{"date-parts":[[2022,5,6]],"date-time":"2022-05-06T12:29:27Z","timestamp":1651840167000},"page":"e055231","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Assessment of whole school approach intervention to reduce violence affecting children in and around schools in Kenya and Tanzania: protocol for a before-and-after, mixed-methods pilot study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1506-1132","authenticated-orcid":false,"given":"Cynthia Khamala","family":"Wangamati","sequence":"first","affiliation":[{"name":"Center for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahimu","family":"Mdala","sequence":"additional","affiliation":[{"name":"General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Ogutu","sequence":"additional","affiliation":[{"name":"ICS-SP Africa, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kudely","family":"Sokoine","sequence":"additional","affiliation":[{"name":"ICS-SP Africa, Shinyanga, United Republic of Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moureen","family":"Ochieng","sequence":"additional","affiliation":[{"name":"ICS-SP Africa, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Majikata","sequence":"additional","affiliation":[{"name":"ICS-SP Africa, Shinyanga, United Republic of Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian Bernard","family":"Ochieng","sequence":"additional","affiliation":[{"name":"LVCT Health, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan A.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Global Health & Childhoods, Independent Consultant, Mwanza, United Republic of Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,5,6]]},"reference":[{"key":"2025120520111465000_12.5.e055231.1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015-4079"},{"key":"2025120520111465000_12.5.e055231.2","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2015-205860"},{"key":"2025120520111465000_12.5.e055231.3","unstructured":"UNICEF Tanzania, CDC USC for DC and P, Muhimbili MU of H and AS . Violence against children in Tanzania: findings from a national survey, 2009 summary report on the prevalence of sexual, physical and emotional violence, context of sexual violence, and health and behavioural consequences of violence experienced in Childh. Dar es Salaam, 2011."},{"key":"2025120520111465000_12.5.e055231.4","unstructured":"Ministry of Labour and Social Protection of Kenya D of CS . Violence against children in Kenya: findings from a national survey, 2019, 2019. Available: https:\/\/www.unicef.org\/kenya\/media\/1516\/file\/2019 Violence Against Children Survey (VACS).pdf"},{"key":"2025120520111465000_12.5.e055231.5","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1080\/13548506.2016.1153679","article-title":"The enduring impact of violence against children","volume":"22","author":"Hillis","year":"2017","journal-title":"Psychol Health Med"},{"key":"2025120520111465000_12.5.e055231.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.chiabu.2013.11.007"},{"key":"2025120520111465000_12.5.e055231.7","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-016-0828-3","article-title":"Harsh discipline relates to internalizing problems and cognitive functioning: findings from a cross-sectional study with school children in Tanzania","volume":"16","author":"Hecker","year":"2016","journal-title":"BMC Psychiatry"},{"key":"2025120520111465000_12.5.e055231.8","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.socscimed.2017.03.008","article-title":"How did the good school toolkit reduce the risk of past week physical violence from teachers to students? qualitative findings on pathways of change in schools in Luwero, Uganda","volume":"180","author":"Kyegombe","year":"2017","journal-title":"Soc Sci Med"},{"key":"2025120520111465000_12.5.e055231.9","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-2007"},{"key":"2025120520111465000_12.5.e055231.10","doi-asserted-by":"publisher","DOI":"10.1177\/1524838014523336"},{"key":"2025120520111465000_12.5.e055231.11","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1017\/S0022278X00020462","article-title":"Women and the changing urban household economy in Tanzania","volume":"27","author":"Tripp","year":"1989","journal-title":"J Mod Afr Stud"},{"key":"2025120520111465000_12.5.e055231.12","first-page":"96","article-title":"Family and child welfare in relation to urbanization","volume":"13","author":"El Mahi","year":"2013","journal-title":"Sudan J Paediatr"},{"key":"2025120520111465000_12.5.e055231.13","unstructured":"Invocavity J . The effects of corporal punishment on discipline among students in Arusha secondary schools. Open University of Tanzania, 2014."},{"key":"2025120520111465000_12.5.e055231.14","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1179\/2046905513Y.0000000071","article-title":"Perceptions of child discipline and its contributions to child abuse in a low-income community in Nairobi, Kenya","volume":"33","author":"Mudany","year":"2013","journal-title":"Paediatr Int Child Health"},{"key":"2025120520111465000_12.5.e055231.15","doi-asserted-by":"crossref","first-page":"90","DOI":"10.5430\/wje.v4n6p90","article-title":"Perceptions of teachers on the ban of corporal punishment in Pre-Primary institutions in Kenya","volume":"4","author":"Mwai","year":"2014","journal-title":"WJE"},{"key":"2025120520111465000_12.5.e055231.16","first-page":"2320","article-title":"Utilitarian view on persistent use of corporal punishment in secondary schools in Kisii central sub County, Kenya","volume":"5","author":"Okone","year":"2015","journal-title":"IOSR J Res Method Educ"},{"key":"2025120520111465000_12.5.e055231.17","unstructured":"Tao S . Corporal punishment, capabilities and well-being: Tanzanian primary school teachers\u2019 perspectives. In: Comparative and. Toronto, CANADA: International Education Society Conference, 2014."},{"key":"2025120520111465000_12.5.e055231.18","unstructured":"Kelly SA . Exploring the Space Between: community perspectives and experiences of child disclipline and the relationship with the discourse of children\u2019s rights in northwest Tanzania. London School of Hygiene and Tropical Medicine, 2020."},{"key":"2025120520111465000_12.5.e055231.19","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1080\/17450128.2018.1476746","article-title":"A socioecological approach to children\u2019s experiences of violence: Evidence from Young Lives","volume":"13","author":"Pells","year":"2018","journal-title":"Vulnerable Child Youth Stud"},{"key":"2025120520111465000_12.5.e055231.20","unstructured":"United Nations Girls Education Initiative . A whole school approach to prevent school-related gender-based violence: minimum standards and monitoring framework. Available: https:\/\/www.ungei.org\/sites\/default\/files\/A-whole-school-approach-to-prevent-school-related-gender-based-violence-Minimum-Standards-and-Monitoring-Framework-2019-eng.pdf"},{"key":"2025120520111465000_12.5.e055231.21","unstructured":"World Health Organization . School-Based violence prevention: a practical Handbook. Journal of school Violence2019. Geneva, 2019."},{"key":"2025120520111465000_12.5.e055231.22","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1080\/02796015.2004.12086267","article-title":"The effectiveness of whole-school antibullying programs: a synthesis of evaluation research","volume":"33","author":"Smith","year":"2004","journal-title":"School Psych Rev"},{"key":"2025120520111465000_12.5.e055231.23","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1057\/cpcs.2011.6","article-title":"Schooled in democracy? promoting Democratic values as a whole-school approach to violence prevention","volume":"13","author":"Holt","year":"2011","journal-title":"Crime Prev Community Saf"},{"key":"2025120520111465000_12.5.e055231.24","doi-asserted-by":"crossref","unstructured":"Maxwell C , Aggleton P . Preventing Violence Against Women and Girls: A whole- school approach. In: Ellis J , Thiara RK , eds. Prevenitng violence against women and girls: educational work with children and young people. Bristol & Chicago: Policy Press, 2014: 103\u201320.","DOI":"10.46692\/9781447307327.007"},{"key":"2025120520111465000_12.5.e055231.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.childyouth.2017.01.018"},{"key":"2025120520111465000_12.5.e055231.26","doi-asserted-by":"crossref","DOI":"10.1002\/cl2.1120","article-title":"Interventions for reducing violence against children in low\u2010and middle\u2010income countries: an evidence and gap MAP","volume":"16","author":"Pundir","year":"2020","journal-title":"Campbell Syst Rev"},{"key":"2025120520111465000_12.5.e055231.27","doi-asserted-by":"crossref","first-page":"e378","DOI":"10.1016\/S2214-109X(15)00060-1","article-title":"The good school toolkit for reducing physical violence from school staff to primary school students: a cluster-randomised controlled trial in Uganda","volume":"3","author":"Devries","year":"2015","journal-title":"Lancet Glob Health"},{"key":"2025120520111465000_12.5.e055231.28","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0201362","article-title":"Reducing violence by teachers using the preventative intervention interaction competencies with children for teachers (ICC-T): a cluster randomized controlled trial at public secondary schools in Tanzania","volume":"13","author":"Nkuba","year":"2018","journal-title":"PLoS One"},{"key":"2025120520111465000_12.5.e055231.29","unstructured":"Heise LL . What works to prevent partner violence? an evidence overview. London, 2011: 85\u20132.doi:ISBN: 978 0 902657 85 2"},{"key":"2025120520111465000_12.5.e055231.30","unstructured":"Krug EG , Dahlberg LL , Mercy JA , et al . World report on violence and health. Geneva, 2002. Available: http:\/\/whqlibdoc.who.int\/publications\/2002\/9241545615_eng.pdf?ua=1 [Accessed 9 May 2018]."},{"key":"2025120520111465000_12.5.e055231.31","unstructured":"Fergus L . Prevention of violence against women and girls, UN women, 2012. Available: https:\/\/www.fokuskvinner.no\/aktuelt\/saker\/what-causes-violence-against-women-an-update-on-the-research\/ [Accessed 9 May 2018]."},{"key":"2025120520111465000_12.5.e055231.32","unstructured":"Fergus L . What causes violence against women, FOKUS, 2013. Available: http:\/\/www.fokuskvinner.no\/Nyheter\/2013\/What-causes-violence-against-women\/ [Accessed 9 May 2018]."},{"key":"2025120520111465000_12.5.e055231.33","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.jogn.2019.01.005","article-title":"What is a pilot study?","volume":"48","author":"Lowe","year":"2019","journal-title":"J Obstet Gynecol Neonatal Nurs"},{"key":"2025120520111465000_12.5.e055231.34","unstructured":"Raising Voices . Good school toolkit, 2020. Available: https:\/\/raisingvoices.org\/good-school\/"},{"key":"2025120520111465000_12.5.e055231.35","unstructured":"Life skills promoters . An integrated life skills approach to behaviour change series. Available: https:\/\/lifeskills.or.ke\/publications\/"},{"key":"2025120520111465000_12.5.e055231.36","doi-asserted-by":"crossref","unstructured":"Lachman JM , Wamoyi J , Spreckelsen TS . Combining economic strengthening and parenting programmes to reduce violence against children in rural Tanzania\u202f: A cluster randomised controlled trial. Lancet Global Health 2020.doi:10.1136\/bmjgh-2020-00234","DOI":"10.2139\/ssrn.3514670"},{"key":"2025120520111465000_12.5.e055231.37","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.chiabu.2018.06.007","article-title":"Effects of a violence prevention intervention in schools and surrounding communities: secondary analysis of a cluster randomised-controlled trial in Uganda","volume":"84","author":"Merrill","year":"2018","journal-title":"Child Abuse Negl"},{"key":"2025120520111465000_12.5.e055231.38","doi-asserted-by":"crossref","unstructured":"Liamputtong P . Focus group methodology: introduction and history. Focus Gr Methodol Princ Pract 2011;224.doi:10.4135\/9781473957657.n1","DOI":"10.4135\/9781473957657"},{"key":"2025120520111465000_12.5.e055231.39","unstructured":"UNICEF . Survey on Professional groups\u2019 knowledge, attitudes, practices and social norms associated with violence against children, 2017. Available: https:\/\/www.unicef.org\/northmacedonia\/media\/4251\/file\/MK_KAPProfessionals_Report_ENG.pdf"},{"key":"2025120520111465000_12.5.e055231.40","unstructured":"UNICEF . Survey on Parents\u2019 and Caregivers\u2019 Knowledge, Attitudes, Practices and Social Norms Associated with Violence Against Children, 2017. Available: https:\/\/www.unicef.org\/northmacedonia\/media\/4236\/file\/MK_KAPonVAC_Report_ENG.pdf"},{"key":"2025120520111465000_12.5.e055231.41","doi-asserted-by":"crossref","unstructured":"Frick PJ . The Alabama parenting questionnaire. 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