Violence Prevention: The Evidence

This set of seven briefings from the World Health Organization (WHO) and the Centre for Public Health, Liverpool John Moores University, aims to cover what works to prevent interpersonal violence (including against women and girls) and self-directed violence. The seven strategies include: "(1) increasing safe, stable and nurturing relationships between children and their parents and caregivers; (2) developing life skills in children and adolescents; (3) reducing availability and harmful use of alcohol; (4) reducing access to guns, knives and pesticides; (5) promoting gender equality; (6) changing cultural norms that support violence; and (7) victim identification, care and support." [Footnotes have been removed by the editor.]

Based upon evidence, the briefings provide directions for how funders, policymakers, and programme implementers "can boost the impact of their violence prevention efforts for women and girls, men and boys." According to the document, studies demonstrate that "violence can be prevented and its impact reduced, in the same way that public health efforts have prevented and reduced pregnancy-related complications, workplace injuries, infectious diseases and illness resulting from contaminated food and water in many parts of the world."

Table 1 on page 4 shows interventions for which there is well-supported or emerging evidence of effectiveness against various types of violence, including child maltreatment, intimate partner violence, sexual violence, youth violence, elder abuse, and suicide. Child- and youth-related examples include:

1. Developing safe, stable and nurturing relationships between children and their parents and caregivers - Strong evidence: Parent training, including nurse home visitation; Emerging evidence: Parent-child programmes
2. Developing life skills in children and adolescents - Emerging evidence: Preschool enrichment programmes; Strong evidence: Social development programmes
3. Other communication-related suggestions, not specifically for children and youth, include: school-based programmes to address gender norms and attitudes; microfinance combined with gender equity training; life-skills interventions; social marketing to modify social norms; advocacy support programmes; and psychosocial interventions.

According to the publisher, more specifically, four types of programmes can help to develop nurturing relationships: "Parenting programmes (e.g. the Positive Parenting Program or Triple P) provide information and support to help parents. Parent and child programmes (e.g. Early Head Start) provide both parents and their children with family support, preschool education, child care and health and community services. Social support groups (e.g. Parents Anonymous) help parents build social networks to provide peer support and reduce social isolation. Media interventions (e.g. the television series “Families”) aim to educate all parents to increase their knowledge and strengthen awareness of child maltreatment....High-quality evidence has shown, for instance, that the Nurse Family Partnership home-visiting programme and the Triple P in the United States of America reduce child maltreatment. Findings also suggest that parenting and parent and child programmes can reduce problematic aggressive, disruptive and defiant behaviour in children in the short term, and arrests, convictions and violent acts in adolescence and early adulthood."

Because, as stated here, poor social skills, low academic achievement, impulsiveness, truancy, and poverty can fuel violence, developing the life skills of young children can work to prevent violent behaviours. "Life skills are cognitive, emotional, interpersonal and social skills that enable individuals to deal effectively with the challenges of everyday life. Evidence shows that preschool enrichment and social development programmes, which target children early in life, can prevent aggression, improve social skills, boost educational achievement and improve job prospects....The benefits of high-quality programmes of this type can also be sustained into adulthood....The effects of academic enrichment programmes, incentives to complete schooling and vocational training programmes on violence prevention demand further research, though studies have found positive effects on behavioural outcomes. These may be short-lived, however, and some programmes for adolescents have even shown detrimental effects."

Expectations of behaviour (norms) within a cultural or social group can encourage or discourage violence. "Interventions that challenge cultural and social norms supportive of violence can prevent acts of violence and have been widely used." For example, social marketing campaigns against intimate partner violence have included a theatre presentation addressing socialisation; male peer-to-peer education; posters, flyers, and mass media pre-tested messaging; and a helpline with associated counselling referrals. For adolescents, reinforcing positive attitudes can include: "[c]reating opportunities for adolescents and parents to learn positive forms of behaviour for relationships; [e]ncouraging adolescents, parents, caregivers and teachers to choose to treat themselves and others with respect; [i]ncreasing adolescents’ ability to recognize and prevent unhealthy, violent relationships; and [p]romoting ways for a variety of audiences to get information and other tools to prevent dating abuse. In Nicaragua, a "national weekly soap opera television series (Sexto Sentido [Sixth Sense]); a nightly radio talk show, in which callers could discuss the issues raised by the television series; and community-based activities such as youth leadership training."

According to the document, successful mass media campaigns on violence can use messages about legal penalties for non-compliant behaviour and fresh information (i.e., a new recommended behaviour to solve a health problem). They must try to reach a large proportion of the intended audience and be tailored to audience segments "using social marketing principles and creating a supportive environment that enables the intended audience to make changes - e.g. by mobilizing communities in support of the campaign. To develop effective campaigns, it is also important to use research, such as interviews with key stakeholders and focus groups with members of the target audience, to determine existing attitudes and beliefs and ways of motivating people to change their behaviour...", including pre-tested messages.

The document states that intervention evaluations need to be rigorous and take into account: confounding factors such as concurrent interventions, use of rates of violence as a measurement for comparison, equivalent comparison groups, and an understanding of key terms and underlying mechanisms " through which altering social and cultural norms changes behaviour. "