Co-development of online violence against women and girls prevention interventions with school-going adolescents

Abstract

Background: Violence against women and girls (VAWG)amongst adolescents remains a global public health problem. Globally, an estimated 24 per cent of girls aged 15-19 are reported to have experienced VAWG before the age of 20. Experience of VAWG has far reaching health and educational consequences. Thus, the prevention of VAWG needs to be a priority. In recent years, there has been an increase in web-based or online violence prevention interventions. However, these interventions are either secondary prevention interventions, or primary prevention interventions, focused on emergency or protective solutions. Current evidence indicates that group-based participatory violence prevention interventions are an important approach to the primary prevention of VAWG but there remains a gap in understanding if these interventions can be delivered online. Further, it remains unclear if co-development of group-based participatory violence prevention interventions with young people – which has been proposed to enhance contextualisation of interventions – can occur online. Goal and specific objectives: This study aimed to explore and understand the feasibility of co-developing an online group-based participatory VAWG prevention intervention for adolescents. The specific objectives of this study were (i) from the perspective of experts understand the feasibility, acceptability and challenges of a group-based participatory VAWG prevention intervention developed and delivered online, (ii) from the perspective of adolescents, understand the feasibility, acceptability and challenges of a group-based participatory VAWG prevention intervention developed and delivered online and (iii) Undertake an online co-development process of an online group-based participatory VAWG prevention intervention with adolescents. ix Methods: This qualitative study was conducted in Gqeberha (formerly known as Port Elizabeth), in the Nelson Mandela Bay municipality, Eastern Cape Province of South Africa. The study was guided by the intervention development framework: 6 Essential Steps for Quality Intervention Development (6SQuID). Data were collected online using in-depth semi-structured interviews, with 20 experts sampled through convenience and snowball strategies and 18 purposively sampled adolescents, to achieve objectives one and two. This was then followed by a co-development process with high school-going adolescents (ages 18- 19 years) to achieve objective three. In the co-development process, the candidate worked with a small group of adolescents (four adolescents) for five sessions online, over a period of two weeks. In these sessions, the co-development team engaged in discussions on sexual violence, which resulted in creation of a problem tree and populated a theory of change table. Data were transcribed in English, verbatim and analysed using thematic network analyses. Findings: Findings for the first objective about understanding from the perspective of experts the feasibility, acceptability and challenges of a group-based participatory VAWG prevention intervention developed and delivered online, showed experts identified several opportunities for these. Specifically, experts identified the potential of bringing these interventions to scale, which has been a challenge for in-person interventions, as well as accessing hard to reach groups, such as people in conflict settings, those on the move and people with limited mobility. However, experts felt there were many complex questions in the development of an online VAWG prevention intervention that needed resolving. Some of the challenges raised by experts included concerns of achieving privacy, trust, and safety online, which are central to achieving transformative communication. Experts also struggled to grapple with how a sense of community could be achieved online. There were also concerns amongst experts about material challenges such as access to devices, access to data and poor connectivity. x Interestingly, younger experts were more open to online participatory interventions than the more experienced experts. Findings for objective two “from the perspective of adolescents, understand the feasibility, acceptability and challenges of a group-based participatory VAWG prevention intervention developed and delivered online”, young people reported they were keen and open to the idea of online group-based participatory VAWG prevention interventions. They discussed how they enjoyed engaging in online groups and often experienced a sense of belonging in these groups. Yet, like the experts, school-going adolescents were concerned about safety, privacy, and trust in online groups. These concerns shaped adolescents’ willingness to disclose sensitive information online and ability to engage in open dialogue. Concern over privacy, trust and safety online also influenced adolescents’ choices over which apps to engage with, and with whom. Young people were active in thinking through and addressing how they dealt with safety, privacy and trust issues online. The third objective was “to undertake an online co-development process of an online group-based participatory VAWG prevention intervention with adolescents”, which was done over two weeks. A range of positive outcomes were identified. Firstly, young people enjoyed the level of autonomy and their depth of involvement in the process. They had come into the process anticipating being lectured to and were pleasantly surprised to find that their role was central, and they would drive the process. Secondly, adolescents were eager to be involved and appreciated being ‘heard’. This allowed for a more extensive exploration of their understanding on the topic, and development of the intervention activities that emerged. Thirdly, young people found it easy to build rapport online, both amongst each other, and with the facilitator, which made communication in the group easier. Importantly, this group of adolescents had their own laptops, or cell phones to use, and the project provided data for the young people to participate. However, there were also challenges to the process of coxi development. The central challenge was that young people and facilitator often slipped into a form of teacher-learner communication, driven by their prior histories of didactic education, which led the adolescents to ‘fearing’ to give ‘wrong’ responses. The facilitator also struggled on how to maintain adolescents’ autonomy of thought, while also incorporating ‘scientific evidence’ in the emerging intervention activities. Furthermore, the more talkative school-going adolescents took the centre stage in the discussions, with the quieter ones remaining quiet. Conclusions: The findings of this study showed that the feasibility of taking group-based participatory interventions online are possible, but this is shaped by a complex set of factors, that impact on the possibilities for transformative communication, and on the creation of safe social spaces – such as trust, privacy, safety. The central question is whether the theoretical constructs of transformative communication and safe social spaces are achievable online. A significant step in moving towards enabling transformative communication online will be addressing the issues of privacy, safety and trust. Careful training of facilitators around skills to facilitate group-based participatory VAWG prevention interventions online is also recommended. The complexities of delivering online participatory interventions require careful consideration, and this needs to be developed and thought about in conjunction with school-going adolescents (the target group), to ensure that interventions resonate with their needs and requirements. Future directions in this research field are provided.Thesis (PhD) -- Faculty of Health Sciences, 202