Preventing violence against women and girls - what works: evidence summary

What works to transform attitudes, beliefs and norms?

Key findings

This section considers interventions that centre on changing attitudes and behaviours that can prevent and challenge social norms around VAWG. Overall, social and emotional learning programmes can address some of the risk factors for later GBV (e.g. through assisting individuals to develop emotional awareness, responsible decision-making, relationships, self-management, and self-awareness according to Crooks et al. 2019:31)

Programmes promoting equal relationships (in secondary school settings):

• There is evidence that school-based programmes which seek to prevent violence in dating and intimate partner relationships (through developing life skills, improving knowledge of abuse, and challenging social norms and gender stereotypes that increase the risk of violence) are promising
• Of these programmes, there is strong evidence that the Safe Dates programme is effective

Education as a sexual violence prevention strategy (in higher education settings):

• There is mixed evidence about the effectiveness of education as a sexual violence prevention strategy in higher education
• For example, there is limited robust evidence that looks at rape prevention programmes in both the short-term and longitudinally

Awareness campaigns and edutainment:

• 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). As such, it has been classified as inconclusive.

School-based programmes promoting equal relationships

Classification: Promising (GBV/DA/SV)

Background

Programmes promoting equal relationships – often among young people^[89] – 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).

While the evidence outlined below indicates that these programmes are promising^[90], an example of an effective programme for preventing VAWG is the US school-based Safe Dates programme (see Foshee et al., 2004). This is “a school and community initiative that targets eighth and ninth grade girls and boys (13-15 years-old). It includes a ten-session educational curriculum^[91], structured around 45-minute sessions in school with additional school and community components (Crooks et al. 2019). Safe Dates focuses upon both preventing and reducing violence perpetration and victimisation. In doing so, this programme involves: “a theatre production, a poster contest, training for providers of community services and support services for affected adolescents” (WHO, 2010:43).

The goals of Safe Dates^[92] are to:

• raise awareness of healthy and abusive dating relationships
• raise awareness of the causes and consequences of dating abuse
• equip students with the skills and resources to help themselves or friends in abusive dating relationships^[93]
• teach students skills to develop healthy dating relationships

(Crooks et al., 2019:32)

These programmes, such as Safe Dates, are often undertaken by children, teenagers and young adults in educational settings such as schools and colleges (Wood et al. 2010:3). As Wood et al (2010:3) note, these programmes for early adolescents often involve:

• discussion about gender stereotypes and equality
• education about violence in relationships
• the development of skills for healthy relationships, such as good communication and negotiation skills

Overall, these programmes are based on the “assumption that these healthy attitudes and skills will carry through as they transition into later adolescent years and form long-term intimate relationships” (Lundgren and Amin, 2015: 546).

Available evidence

The WHO (2010:43) reports that evaluations of safe dating interventions show:

• These programmes increase knowledge about dating violence and improve attitudes towards it
• Their effectiveness appears promising at reducing levels of abuse towards females
• However, results have not been consistently demonstrated and evaluations have mainly focused on short-term outcomes

As noted within a forthcoming Scottish Government report (written by the Scottish Violence Reduction Unit) on What Works to Prevent and Reduce Youth Violence, the effectiveness of the interventions remains uncertain as it is not yet possible to generate clear conclusions based on the evidence that is currently available see also White 2019). For example, very few evaluations have measured dating violence perpetration as an explicit outcome.

A recent systematic review (Kovalenko et al., 2020), identified 11 reviews of school based programmes that aimed to prevent physical, emotional, or sexual violence within adolescents’ intimate peer relationships. Overall, there was inconsistent evidence that adolescent relationship violence prevention programmes were effective in reducing the number of young people being exposed to or perpetrating VAWG within the context of an intimate partner relationship. Whilst these interventions appear effective in improving attitudes and knowledge, the evidence on behavioural outcomes is less clear (White 2019).

Safe Dates programme

While some evidence regarding this intervention type suggests they show promise in preventing VAWG, the Safe Dates programme has been shown to be effective. According to Crooks et al (2019:34): “Safe Dates is one of the few effective primary prevention approaches for reducing sexual violence perpetration”. In particular, the WHO (2010:44) notes that Safe Dates:

was found to have had a greater impact upon primary prevention as opposed to preventing re-abuse among those with a history of previous abuse.

A long-term evaluation of Safe Dates using a RCT^[94] to examine the effects of the programme over time involved the completion of questionnaires by adolescents^[95] 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^[96] 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).

Moreover, Crooks et al. (2019) highlight that research on the efficacy of Safe Dates shows that it can impact on other types of violence. They note that:

• these diversified outcomes are important in promoting both the update and the sustainability of the programme as schools can “prevent a range of negative outcomes with one comprehensive approach” (Crooks et al. 2019:36).
• Safe Dates is also one of the few effective primary prevention approaches for reducing sexual violence perpetration (Crooks et al. 2019; DeGue et al., 2014).

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”.

Efficacy according to gender

The WHO (2009:5) report on Violence Prevention: The Evidence suggest that there is evidence that “for men, programmes presented to mixed male and female groups are less effective in changing attitudes than those presented to all-male group”.

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).

Similarly, Wolfe et al. (2009) conducted a cluster randomized trial^[97] to determine the effectiveness of a Canadian school programme focused on promoting healthy relationships and preventing adolescent dating violence[1]; an adapted version of the Safe Dates Project (see Foshee et al., 2004).

Wolfe et al.’s (2009) evaluation of over 1700 participants showed that teaching young people “about healthy relationships as part of their required health curriculum reduced physical dating violence”^[98] (Wolfe et al., 2009: 692). The results of this study demonstrated “significant reductions in both perpetration and victimisation of dating violence in both boys and girls in the intervention groups compared with the control groups” (Ellsberg et al., 2015: 1557).

The Fourth R programme

The Fourth R is another example of a programme with promising evidence that it can promote equal relationships and reduces physical dating violence for programme participants. This intervention takes a gender-specific approach and has been developed for school and community settings and has been used across Canada, in some US states, and internationally (Crooks et al. 2019:31). These programmes:

• differ with respect to age and secondary school grade level in its format (ranging from grade 9 to 12^[99])
• are based on the theory that relationship skills can be taught in a similar way to academic or athletic skills; through breaking down into steps, and using guided practice
• take a gender-specific approach to dating violence by emphasizing gender-specific patterns and factors and matching activities accordingly; therefore, the curriculum content is slightly different for boys and girls.

A study evaluating The Fourth R programme involved a cluster RCT with Grade 9^[100] programme participants, including 20 schools and over 1,700 students (Crooks et al. 2019). The results of Crook et al.’s (2019:31) Fourth R evaluations over time showed that:

• physical dating violence was about 2.5 times greater among control (i.e. standard health education) versus intervention participants at two and a half year follow-up
• the impact of the intervention was greater for boys than girls
• the intervention improved condom use in sexually active boys compared with their control condition counterparts
• there was an increase in effective peer resistance skills among Fourth R participants compared with control group

Broadly, Lundgren and Amin (2015: 546) reported that school-based interventions^[101] targeting younger adolescents show:

• emerging evidence for improving gender-equitable attitudes
• evidence for increasing self-reported likelihood to intervene in situations of bullying and partner violence
• most evaluations saw minimal changes in girls’ perceived ability to cope with sexual violence
• creating enabling environments to make violence unacceptable may be more effective than placing the burden on girls to protect themselves by teaching them self-protection skills

Moderating factors

While not explicitly linked to interventions that promote healthy relationships, Crooks et al. (2019) suggest that it is important to consider bullying prevention programmes alongside such interventions. They argue that adopting these programmes for younger people can offer an opportunity to challenge power dynamics in relationships and develop healthy relationship skills (Crooks et al., 2019).

Crooks et al., (2019:31) also highlight evidence that bullying behaviours may predict future sexual violence perpetration; noting that it can be “difficult to draw the line between bullying and GBV”, particularly where bullying behaviours become gender-based.

Potential facilitators

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).

Kovalenko et al.’s (2020:7) systematic review on effective interventions to prevent youth violence^[102] 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^[103] (see also De Koker et al., 2014)

Moreover, WHO (2010:83) notes 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^[104] (IPV) among adolescent showed that: “the most effective interventions had the most comprehensive programs, including individual-level curricula and community-based components”^[105]. In particular, they cite Safe Dates, The Fourth R and Shifting Boundaries^[106] as interventions with strong evidence of effectiveness in preventing the perpetration and/or victimisation of IPV among secondary school students.

UK evaluations of these school-based programmes that seek to promote equal relationships have explored young people’s responses and feedback in depth through qualitative methods. These evaluations:

highlighted some of the challenges in terms of service delivery and suggestions for good practice, such as what should be taught (i.e. programme content), how it should be taught (e.g. teaching methods) and who should deliver it (e.g. teachers or external organisations) (Fox et al., 2014).

As such, using qualitative methods in evaluations of prevention-focused interventions can provide different and in depth reflections and challenges (Fox et al., 2014). Future research evaluations may need to account for this, as well as longitudinal research to understand the effects and impacts of these interventions.

Potential barriers

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).

A report by the Early Intervention Foundation (2014:60) suggest that additional research is required to:

• determine the ability of programmes to sustain change (whether attitudinal or behavioural) over the medium term
• to demonstrate that programmes such as Safe Dates, which has been found to improve attitudes in relation to domestic violence and abuse, can have a long term impact on perpetration behaviour
• conduct rigorous longitudinal evaluation of programme effectiveness on young people’s levels of perpetration and victimisation in relation to domestic violence and abuse into young adulthood, including measurement of domestic violence and abuse through observational measurement

A WHO (2010:45) evidence review on preventing forms of VAWG^[107] also identifies that additional research is required to:

evaluate the effectiveness of dating violence prevention programmes in the longer term, when integrated with programmes for the prevention of other forms of violence, and when delivered outside North America and in resource-poor settings.

Education as a sexual violence prevention strategy in higher education and school-based settings

Classification: Mixed (SV/GBV)

Background

Within US colleges the prevalence of sexual assault has been well documented (see McCaughey and Cermele, 2017). One of the approaches to reducing sexual violence against women in this context 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).

In a Scottish context, Equally Safe in Higher Education (ESHE) toolkit developed and funded by the University of Strathclyde and the Scottish Government^[108] 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.

Available evidence

Education as a sexual violence prevention strategy: higher education settings

Brooks et al. (2014) note that there is limited robust evidence that critically evaluates the effectiveness of rape prevention programmes, both in the short-term and longitudinally. They suggest that:

Some evidence has been found that short-term positive changes occur in rape-supportive attitudes and rape-myth understandings within prevention programme participants, and findings suggest that both men and women leave the programme with a better understanding of rape, its legal definition, and the effects of rape.

However, little is known about long-term effects of such programmes, and in particular whether attitudinal changes result in behavioural changes, or if they contribute to a reduction in rapes” (Brooks et al., 2014:6).

Similarly, Vladutiu et al.’s (2011:67) review of evaluated US programmes indicates that the effectiveness of college- or university-based sexual violence prevention programmes can vary depending on the:

• type of audience
• facilitator
• format
• programme content

As Daigle et al. (2009:398) note within the context of colleges in the USA: “evaluations suggest that most rape reduction programs improve students’ knowledge and attitudes about rape but do not produce large, lasting reductions in sexual victimization”. Likewise, Jewkes et al. (2015:1583) suggest that research from rape prevention programmes attended by men in college in the USA shows that these programmes “have less effect on men at a higher risk of committing rape”. Similarly, in relation to challenging ‘rape myths’^[109], Daigle et al. (2009:401) note that “little evidence suggests that changes in rape myths and rape-supportive attitudes are related to actual behavioral change or a reduction in sexual victimization”.

Education as sexual violence prevention strategy: school-based settings

An evaluation of Rape Crisis Scotland’s National Sexual Violence Prevention Project found 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^[110] 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%.

This evaluation 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^[111], the six central components of this model are^[112]:

• A whole school assessment
• Action group
• Staff training
• Curricular enhancement
• Policy review and development
• Student-led projects

Moderating factors

Potential facilitators

Flood (2006) emphasises the effectiveness of longer term education programmes for preventing sexual violence (see Meyer & Stein, 2004), although he notes the practical and financial constraints of these approaches.

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
• there are robust empirical findings about what sexual assault prevention program components and characteristics work most effectively for college and university students^[113]
• 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

Within their research on what works in USA college settings, Daigle et al., (2009:400) suggest that:

although what ‘works’ in reducing repeat sexual victimization remains somewhat unclear, research suggests the importance of considering sexual victimization history and risk of subsequent sexual victimization in the development and evaluation of risk-reduction programs.

Moreover, according to Davis et al., (2006:15) it is vital to change norms around safe behaviours, and “support healthy, equitable and safe relationships” at a community level. They suggest that “the community has a stake in preventing sexual violence and all members have a valuable role to play”.

Following their systematic review of primary prevention strategies for sexual violence perpetration, 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
• towards investment in the development and rigorous evaluation of more comprehensive, multi-level strategies (e.g. including individuals, parents, and peers)
• towards strategies that target younger populations and seek to modify community and contextual support

Likewise, research by Kilimnik and Humphreys (2018:205) suggests that education about sexual violence should not be the only strategy. Instead, they advocate for use of multiple approaches, or a holistic approach to preventing and reducing sexual violence.

More broadly, Flood (2006:27) argues that effective strategies for reducing sexual violence against women should involve:

• education-focused interventions that challenge the “beliefs, values and discourses which support violence”
• the promotion of “alternative constructions of masculinity, gender and selfhood which foster non-violence and gender justice”

Potential barriers

There are limitations to the available evidence on the effectiveness of violence prevention education as it is often under-evaluated, or shows mixed results (Flood, 2006).

As noted above, 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.

Awareness campaigns and edutainment

Classification: Inconclusive (GBV)

Background

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^[114]:

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).

Awareness campaigns have been highlighted as a form of primary intervention to prevent GBV. According to Fulu et al. (2014:6):

awareness campaigns may aim to raise awareness or increase knowledge about a service, a law or about violence against women as an issue in general.

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, 2010: 103).

Available evidence

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).

Awareness campaigns

Awareness campaigns are understood as “among the most visible and ubiquitous of all strategies for preventing intimate partner and sexual violence”. However, there is limited evidence about the effectiveness of awareness campaigns upon altering cultural and social norms, including norms around GBV (WHO 2010b). 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.

One example of an awareness campaign cited by WHO (2010b) was based in New South Wales in Australia. This campaign was entitled ‘Violence against women: it’s against all the rules’ and was targeted at men aged 21 to 29 years old. In aiming to influence their attitudes, this campaign involved sporting celebrities conveyed the messages that VAWG was unacceptable, and that “a masculine man is not a violent man” (WHO 2010b:56). The campaign also aimed to increase the capacity of communities more broadly to challenge and address VAWG. A post-campaign survey showed some positive results:

• 83% of the respondents reported that the message of the campaign was that violence against women is “not on”
• 59% of respondents could recall the campaign slogan
• However, 91% of the target group reported that the issue was not one they would talk about with their peers, irrespective of the campaign

However, like other evaluated campaigns, this campaign evaluation did not focus upon the prevention of VAWG through behavioural change as an outcome.

Edutainment

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).

For both awareness campaigns and edutainment Fulu et al. (2014) note that there is little evidence that these interventions have impact upon the prevalence or incidence of VAWG. They note that:

This is partly because existing evaluations have not measured violence as an outcome, and because it is difficult to attribute changes to media campaigns. However, it is likely that single-component communications campaigns are seldom intensive enough or sufficiently theory-driven to transform norms or change actual behaviours (Fulu et al al. 2014:7) .

Likewise, Davis et al., (2006: 9) note that although mass media campaigns have been shown to “increase awareness, change attitudes, and build support for successful implementation of prevention policies” it is “not clear how effective this approach is for directly reducing sexual violence”.

Moderating factors

Gadd et al.’s (2014:3) suggest that the efficacy of social marketing^[115] (through targeted mass media, awareness campaigns, and edutainment): “remains debated, with most measures of effectiveness being somewhat crude”. For example, the UK Government’s anti-domestic violence campaign - This is Abuse – ran between 2010-2012 but the success of it has not been publicly evaluated (Gadd et al. 2014).

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 SV.

Moreover, Brooks (2018:283) suggests that SV 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’.

Following limited evidence and unclear links between these awareness-raising interventions and behaviours, it is not clear whether these interventions are effective in preventing and/or reducing various forms of VAWG. Consequently these interventions have been classified as inconclusive due to insufficient evidence.