Preventing violence against women and girls - what works: effective investments summary

3. What works to transform attitudes, beliefs and norms?

3.1 School-based programmes promoting equal relationships: promising

Programmes promoting equal relationships – often among young people^[36] – are informed by an awareness that partner abuse and sexual violence among adolescents can "place them on a lifelong trajectory of violence, either as victims or perpetrators" (Lundgren and Amin, 2015: 542).

Kovalenko et al.'s (2020:7) systematic review on effective interventions to prevent youth violence^[37] notes that programme content should be "underpinned by evidence-based theories and appropriately tailored to the culture and needs of target audiences". They also identify that effective dating and relationship violence programmes involved:

• peer education
• use of drama and poster activities
• education on legislation, personal safety, consequences, health and sexuality, gender roles, healthy relationships, and the role of bystanders
• focus on conflict resolution, problem-solving, sexual decision making and dealing with pressure
• programmes should be incorporated into school policies
• these programmes must define terms such as aggression, rape, and dating violence clearly and potentially in a gender specific way^[38] (see also De Koker et al., 2014)

Moreover, a WHO (2010:83) report entitled Preventing intimate partner and sexual violence against women reports that dating programmes are more effective when they involve delivery across "multiple sessions over time (rather than in a single session) and if they aim to change attitudes and norms rather than simply provide information".

Likewise, De Koker et al. (2014:12) reported that interventions aimed at reducing intimate partner violence (IPV) among adolescents showed that: "the most effective interventions had the most comprehensive programs, including individual-level curricula and community-based components". In particular, they cite Safe Dates, The Fourth R^[39] and Shifting Boundaries as effective in preventing the perpetration and/or victimisation of IPV among students.

A long-term evaluation of Safe Dates using a RCT^[40] to examine the effects of the programme over time involved the completion of questionnaires by adolescents^[41] participating in the programme and control groups. These questionnaires were conducted in school at baseline, 1 month, 1 year, 2 years, 3 years and 4 years after the programme was completed (Foshee et al. 2005). Results showed that:

adolescents who were exposed to Safe Dates in the eighth or ninth^[42] grade, as compared to those who were not, reported less psychological, moderate physical, and sexual dating violence perpetration and less moderate physical dating violence victimization at all four follow-up periods (Foshee et al. 2005:255).

As noted in De Koker et al.'s (2014:12) research, Safe Dates uses a gender-neutral approach as they "do not view violence as primarily perpetrated by males, but also by females". Results from a Safe Dates evaluation "showed that there was no statistically significant interaction between gender and the intervention outcomes", rather it was equally effective for males and females (De Koker et al. 2014:12; Coker et al. 2000; Stith et al. 2010).

Foshee et al. (2005:256) identify within their evaluation of Safe Dates that:

Consistent and long-term effects may have been realized because Safe Dates was offered at the beginning of the adolescent's dating careers (eighth and ninth grades) and included information and skills that could be incorporated into individual dating practices that continued through the high school years.

The Safe Dates programme is therefore an example of effective early intervention with young people to prevent VAWG perpetration that demonstrated programme effects as many as 3 years post-intervention (Foshee et al. 2005). It was also noted that there was no evidence that booster sessions were effective to further reduce adolescent relationship abuse reductions (Taylor et al. 2017).

De La Rue et al. (2014) note that evidence on sexual assault prevention has shown that programmes focused solely on educational or attitudinal components may not be effective in changing behaviour. In this context, they argue that "the skill building component of Safe Dates is a crucial component of the chain of events that can lead to positive outcomes" (De La Rue et al. 2014:11; see also De La Rue et al. 2017).

Key findings for service delivery and practice:

• Interventions should be theory driven, evidence based and delivered with fidelity.
• Features that will help to make programmes effective include: engaging peers; using a range of activities like drama and poster design; and focusing on developing skills for conflict resolution, problem-solving, sexual decision making, alongside skills for dealing with pressure.
• To facilitate open and clear dialogue, practitioners should define terms.

3.2 Education as a sexual violence prevention strategy: mixed

One approach to reducing sexual violence against women in higher education settings has been rape reduction programmes. These programmes involve education on "sexual assault laws, the extent to which rape occurs, the context in which it is likely to occur, and the availability of victimization-related health care and other social services (e.g. contact information for either a rape crisis center or a campus/local sexual assault coordinator)" (Daigle et al., 2009:400).

Vladutiu et al. (2011) highlight the practices that influence the effectiveness of measures around education as a sexual violence prevention approach: "the effectiveness of college- or university-based sexual violence prevention programs varies depending on the type of audience, facilitator, format, and program content".

Education as a sexual violence prevention strategy: higher education settings

There are robust empirical findings about what sexual assault prevention program components and characteristics work most effectively for college and university students^[43]:

• effective sexual assault prevention programs are professional-facilitated, targeted at single-gender audiences, and offered at various times throughout students' time in college/university
• effective sexual assault prevention programs are workshop-based or offered as classroom courses with frequent and extended sessions
• workshop and classroom-based sexual assault prevention programs should be supplemented with campus-wide mass media and public service announcements"

However, rape prevention programmes "have less effect on men at a higher risk of committing rape" (Jewkes et al., 2015:1583). Therefore, available evidence emphasizes the importance of early interventions to prevent GBV and SV through universal approaches with younger people.

In a Scottish context, The Equally Safe in Higher Education (ESHE) toolkit developed and funded by the University of Strathclyde and the Scottish Government^[44] provides a range of resources that can be used to encourage trauma-informed approaches, primary prevention strategies, examples of good practice, tools for research on GBV and more within higher education settings (Donaldson et al. 2018). Donaldson et al. (2018:16) note that this "whole-system approach to prevention presents opportunities for curriculum-based GBV education and prevention work". While drawing upon evidence-based primary interventions, the toolkit itself, launched in April 2018 and thereafter rolled out to colleges and universities, has not yet been evaluated.

Following their systematic review of primary prevention strategies, DeGue et al., (2014: 359) call for a shift in approaches to sexual violence prevention that:

• moves away from low-dose educational programming in adulthood
• moves towards investment in the development and rigorous evaluation of more comprehensive, multi-level strategies (e.g. including individuals, parents, and peers)
• moves towards strategies that target younger populations and seek to modify community and contextual support

Education as sexual violence prevention strategy: school-based settings

An evaluation of Rape Crisis Scotland'sNational Sexual Violence Prevention Projectfound that the programme had a clear impact on young people's knowledge and attitudes towards sexual violence (McNeish and Scott, 2015). As a result of attending three workshops run by local rape crisis centres across Scotland, the vast majority of young people^[45] increased their knowledge of how sexual violence and abuse can affect people, what the law says sexual violence is and where people who have been raped or sexually assaulted can go for support. For example, prior to the workshops 53% of young people agreed or strongly agreed with the statement "I know what the law says sexual violence is", but afterwards 89% did so and the 'not sures' had decreased from 39% to 10%.

The evaluation of the National Sexual Violence Prevention Project also reported that the workshop sessions were successful in raising young people's awareness of sexual violence, the importance of equality and consent in healthy relationships, and that the responsibility for sexual violence lies with perpetrators rather than victims-survivors (McNeish and Scott, 2015). It also showed that in most cases boys were more likely to change their opinions than girls. In most instances, this was partly because boys had more distance to travel from their pre-workshop views to those most consistent with the messages of the workshops. There is evidence of promising results in terms of intermediate outcomes (such as increasing knowledge, changing attitudes and raising awareness) within this research. However, their impact on violent behaviours has not been evaluated.

The Equally Safe at School programme has been introduced as a pilot to two schools in Scotland. This whole-school approach to complement the work of the National Sexual Violence Prevention Project. While an evaluation is not yet available^[46], the six central components of this model are^[47]:

• a whole school assessment
• action group(s)
• staff training
• curricular enhancement
• policy review and development
• student-led projects

Key findings for service delivery and practice:

• Delivering effective sexual violence education interventions requires professional facilitation, and are workshop based or offered over multiple, longer sessions, as opposed to short one-off interventions.
• Ideally, educational sessions should be supplemented through reinforcement of messages in surrounding media and environment.
• These interventions may be most effective when targeted at single-gender groups.

3.3 Awareness campaigns and edutainment: inconclusive

Aimed at preventing violence, awareness campaigns and edutainment can be targeted at different demographics (e.g. younger people) with a focus on changing and challenging social or gender norms. Awareness campaigns,sometimes conducted through mass media approaches "intend[s] to modify individual behaviour directly through informative messages, media campaigns can also affect behaviour indirectly by stimulating changes in perceptions of social or cultural norms through social interaction. Here, a change in perception of norms provides additional motivation for a change in individual behaviour" (WHO, 2010a:103).

Edutainment aims to "impart knowledge and bring about social change through television soap operas and other popular forms of entertainment. By achieving strong audience identification with television characters who are positive role models, edutainment can contribute to help improve cultural and social norms" (WHO, 2010a:103).

There is limited evidence about the effectiveness of interventions that aim to prevent violence through raising awareness via awareness campaigns, and targeting people through education and entertainment via so-called 'edutainment' (WHO, 2009; Heise, 2011). The UK Government's anti-domestic violence campaign - This is Abuse – ranbetween 2010-2012 but the success of it has not been publicly evaluated (Gadd et al. 2014).

Awareness campaigns are understood as "among the most visible and ubiquitous of all strategies for preventing intimate partner and sexual violence". However, as WHO (2010:57) states:

Even where evaluations have been undertaken, these have typically measured changes in attitudes and beliefs rather than in the occurrence of the violent behaviours themselves, making it difficult to draw firm conclusions on their effectiveness in actually preventing intimate partner and sexual violence.

Moreover, Brooks' (2018) research shows that with regards to sexual violence awareness campaigns targeted at young women barriers included:

• advice that was either not practical to implement or it was at odds with their desire to enjoy a social life
• some young women resisted and resented (potentially victim-blaming) safety messages targeted at them rather than at men who may perpetrate sexual violence

Brooks (2018:283) also suggests that sexual violence safety campaigns can "inadvertently compound the normalisation of male violence and harassment experienced by women by presenting it as an innate aspect of male behaviour alongside the presentation of safekeeping strategies for women as 'common sense'.

Ellsberg et al., (2015: 1556) note that despite limited empirical evidence on preventing VAWG through use of edutainment; "a small, but promising, body of evidence shows either significant or highly promising positive effects in reductions or prevention". There is some evidence to suggest that edutainment can be impactful "by achieving strong audience identification with television characters who are positive role models, edutainment can contribute to help improve cultural and social norms" (WHO, 2009:9).

Key findings for service delivery and practice:

• Although evidence on awareness campaigns and edutainment in and of themselves is limited, it has been noted earlier in this report that the media and environmental reinforcement of messages can help other interventions to be effective. Services and practitioners may wish to utilise awareness campaigns to strengthen the messaging in the environments where they work with participants.
• Practitioners should be aware of major campaigns or relevant events in popular media, as both potential triggers for people they work with, and as opportunities to start conversations with them.
• Women need advice and support that they can implement within their existing social lives, and that do not inadvertently blame them.