Background: An adolescent's school is often the second most important place for his development and education after the home. However, reports highlight the recurrence of the use of violent discipline in schools. There are few school-based interventions that aim at reducing violence at school that have been implemented and evaluated in sub-Saharan Africa. To reduce violent disciplinary measures used at school, we aim to implement and evaluate the feasibility and efficacy of the preventative intervention Interaction Competencies with Children for Teachers (ICC-T). Methods/design: The study will be conducted in six randomly selected districts of the Ankole region in southwestern Uganda. We shall randomly select two mixed-day secondary schools from each district that fulfill our inclusion criteria. Schools will be randomly assigned to the intervention condition, where ICC-T will be implemented, and control schools (no intervention). Sixty students between the ages of 12 and 17 years and at least 15 teachers per school will be included in the trial. We aim to collect pre-assessment data directly before the intervention (t1) and 3 months after the intervention (t2) in both intervention and control schools. Using self-administered questionnaires, we will measure students’ exposure to violence using the Conflict Tactics Scale (CTS), their psychological well-being using the Strengths and Difficulties Questionnaire (SDQ), and teachers’ positive attitudes towards violent disciplining and teachers’ use of violent disciplinary methods (CTS). The implementation feasibility of ICC-T in the cultural context of southwestern Uganda will be assessed with purpose-built measures that follow the guidelines for feasibility studies assessing the demand, applicability, acceptability, and integration of core elements in the daily work. Discussion: The proposed study will allow us to test the feasibility and efficacy of a preventative intervention seeking to reduce violent disciplinary measures in school settings using a scientifically rigorous design. The proposed study provides the opportunity to contribute to the attainment of goal number 16.2 of the United Nations’ Sustainable Development Agenda 2015–2030, which aspires to end all forms of violence against children. Trial registration: ClinicalTrials.gov,
School violence; Students; Behavioral problems; Secondary school; Teachers
Electronic supplementary material The online version of this article (10.1186/s13063-018-2827-9) contains supplementary material, which is available to authorized users.
Violent disciplinary measures refer to the deliberate use of physical force that results in bodily and/or emotional pain with the aim of correcting or regulating a child’s behavior in the school setting [[
Worldwide, the use of physical violence by teachers is legally accepted as a disciplinary measure in 68 countries [[
Despite the legal framework that prohibits physical violence at school, its use continues in many countries. This could be due, for example, to a lack of proper implementation of appropriate laws. Though many countries have enacted laws that forbid physical violence at school, they have failed to stipulate alternative forms of disciplinary procedures applicable in the school setting to guide teachers and students. This contradiction has resulted in teachers’ reliance and continued exclusive use of violent punishment as a disciplinary measure. Furthermore, there are many countries in which violent discipline is still legal [[
Research reports have documented particularly high prevalence rates of violent punishment in sub-Saharan Africa. In total, 27 countries do not fully forbid physical and emotional violence by teachers, which increases the likelihood of students experiencing violence at school [[
Violent disciplinary measures are used when students violate school norms, perform poorly, or make noise in class [[
The use of violence at school in Uganda is prohibited by laws, policies, and guidelines, including the Teachers’ Professional Code of Conduct [[
One survey of 25 schools across five districts in Uganda found that 81% of the children had experienced physical violence at school [[
School violence is a painful experience associated with physical injuries [[
Furthermore, the use of violence in the school leads to chronic fear of violent teachers as well as school avoidance [[
The use of physical violence is further reinforced by sociocultural norms that justify its use as a disciplinary method. Hence, there is a pressing need to reduce children’s exposure to violence, especially in the school setting [[
Human rights activists at the global level have been at the forefront of advocating for the ban of corporal punishment [[
Thus, interventions that aim at preventing violence while changing attitudes and behavior in relation to violence become a necessity, particularly in contexts in which the use of violence is the norm rather than the exception [[
However, there are very few interventions, especially in low-income countries, that have been evaluated for their efficacy. For example, one study in South Africa examined the consistency between the disciplinary approaches used in the schools and the tenets of alternatives to corporal punishment. Generally, the implementation of alternative disciplinary strategies was hindered by the lack of formal training of educators in these methods and inadequate consultations with education stakeholders. Despite the noted challenges, alternatives to physical punishment resulted in better discipline among learners, provided teachers with more non-violent discipline choices, accorded students the opportunity to explain as much as possible for any noted behavioral deviations, and built a school culture based on self-discipline and non-violence [[
In Uganda, the use of violent disciplinary approaches in schools is legally not permitted; however, teachers are not formally provided with alternative disciplinary strategies applicable in the education sector [[
The Good Schools Toolkit intervention designed to prevent physical punishment against students has been evaluated in 42 Ugandan schools [[
To the best of our knowledge, there is as yet no school-based violence prevention intervention that has been implemented and evaluated for its efficacy at the secondary school level in Uganda. The preventative intervention Interaction Competencies with Children (ICC) aims to foster better adult-child interactions while reducing the occurrence of violent discipline. There are currently two versions of ICC, one for caregivers (ICC-C) and one for teachers (ICC-T) [[
Encouraged by these promising initial results, in our current study we aim to evaluate the feasibility and efficacy of ICC-T at the secondary school level in southwestern Uganda. The implementation of ICC-T in Uganda builds upon previous knowledge, because ICC-T focuses on both physical violence and also emotional violence—the most common types of violence that co-occur in the school setting in Uganda [[
The use of violent discipline strategies has continued in Ugandan schools to date despite guidelines that hinder the use of punitive correction approaches. This has been complicated by strong cultural beliefs and support for the use of violence in schools and the general lack of formal alternatives to physical punishment that can help teachers to handle student discipline concerns. To address this challenge, we will implement and evaluate the feasibility and efficacy of ICC-T as a violence prevention approach in secondary schools in southwestern Uganda. With ICC-T our goals are to change teachers’ attitudes concerning the use of violent disciplinary measures, reduce the use of harsh and violent disciplinary measures in schools, and foster better interactions between students and teachers.
In a two-arm cluster randomized controlled trial, 12 secondary schools will be randomly assigned to the intervention group (which will receive the ICC-T intervention training) or the control group (which will receive no training). The study will have two data collection points: pre-assessment and follow-up assessment. See Figs. 1 and 2 and the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist (Additional file 1).
In Uganda, primary school takes 7 years, secondary school (ordinary level) 4 years, and high school (advanced level) 2 years. The education sector in Uganda is divided into 13 regional clusters, with each cluster having seven to 15 districts. Southwestern Uganda has two regional blocks: Ankole and Kigezi. This study will be conducted in Ankole region. Ankole has the third highest student enrollment in Uganda with 134,509 students (50% males), and the majority of the secondary school students (47%; n = 62,807) studying in Senior One and Senior Two (8th and 9th years of formal schooling). The region has 10 districts with each district having 3–20 government-aided secondary schools.
Ankole region was purposefully selected because it has the second largest number of government-aided secondary schools (
The Ministry of Education, Science, Technology and Sports reports that there were only 80 mixed secondary schools that implemented the USE program in the region, which included the number of classes, school enrollment, and number of teachers [[
We plan to include 60 students (30 in 8th year and 30 in 9th year of formal schooling) per school. Based on previous studies in similar settings, we expect a participation rate of approximately 50% [[
Furthermore, as ICC-T intervention is a participatory approach that involves active engagement and practical hands-on learning, we consider ICC-T workshops to be cost-effective with a minimum number of at least 15 participants. That is why we will include only schools that employ at least 15 teachers. Only 41 schools fulfilled these inclusion criteria.
Additionally, we aim to select at least two schools per district in order to randomly assign them into the intervention or control conditions. Eight districts, i.e., Bushenyi, Ibanda, Isingiro, Kiruhura, Mitooma, Ntungamo, Mbarara, and Sheema, have at least two eligible schools. Given that Mbarara district is more like the “regional capital” of the Southwestern region, we purposefully included this district in the study sample. We then randomly selected five districts from the remaining seven districts. In the event that the selected district has two eligible schools, these schools are automatically included in the study sample. From districts that had three to 11 eligible schools, only two schools are randomly selected. As a result, the final sample consists of 12 coeducational secondary schools, from six different districts: Ibanda, Isingiro, Kiruhura, Mitooma, Ntungamo, and Mbarara.
Due to the longitudinal nature of the study which necessitates two data collection points, the focus of this study is on students in the 8th and 9th years of formal schooling. Based on a previous study that used a similar design to test the efficacy of ICC-T in Tanzania [[
All teachers who are officially working in the selected schools will be included in the study sample. Based on the previous study in Tanzania [[
Only selected students aged 12–17 years and teachers in the age range 18–65 years, employed by the selected schools and who will be present during the data collection period, will be included in the study. Teachers will be enrolled in the study if they give their informed consent. Students with parental informed consent and who freely provide assent will be accepted to participate in the study. Students and teachers with acute psychotic symptoms or acute alcohol or drug intoxication will be excluded from the study.
One member of the study team has already visited the selected schools and informally discussed the research with the school administrators. All the selected schools agreed to participate in the study, and the school head teachers provided support for the study. During the subsequent visit to the schools, formal study introduction letters and supporting documents will be provided to the school administrators. The research team members will then explain pertinent study details to the school authorities.
Informed consent will be sought from the teachers before they participate in the study. The relevant details pertaining to the study, including the purpose and significance of the study and ethical concerns including privacy, confidentiality, legal rights, and informed consent, etc., will be explained in detail to the selected participants in English. The research team will also respond to any identified participants’ concerns in relation to the proposed study.
Informed consent from parents and assent from students will be obtained before the students are enrolled in the study. Selected students will be given a parental consent document that they will take home to their parents to sign or thumb-print. The consent document written in English and Runyankole will provide the parents with relevant information about the study including the ethics involved in the study. After obtaining parental consent, the students will assent before they are formally enrolled in the study.
Students in Uganda use English as the medium of instruction throughout the educational cycle. Therefore, the study questionnaire will be administered in English. A pilot study was conducted at one coeducational secondary school in Mbarara district. The pilot test verified the practicality of the data collection procedure and assessed the ease of use of the research instrument.
During the data collection period, the research team will closely supervise the students as they fill in the questionnaire. Research team members will each administer and supervise small groups of about three to five students each as they complete the questionnaire. Previous studies in Africa indicated that children and adolescents provide accurate and reliable information during research [[
A set of questionnaires will be administered to the teachers, too. The research team will be available during the data collection period and will oversee the completion of the questionnaire. Additionally, in case of any clarification or request for more information, the research team will be available to attend to any concerns raised by the selected study participants.
ICC-T intervention is a training workshop, which lasts for 5.5 days, for teachers, with 8 hours spent in training on each full day. ICC-T aims at improving teacher-student relationships, changing teachers’ attitudes and behaviors concerning the use of violent disciplinary measures, and preventing harsh and violent discipline in the school setting. The ICC-T core ideas are based on the childcare guidelines of the American Academy of Pediatrics [[
ICC-T follows core tenets, including incorporating a participative method in which the teachers are encouraged to take an active role during the workshop. Theory and practice are combined during the workshops to enable the teachers to integrate the attained ICC-T skills into the daily work routine at school. During the workshop, confidentiality is emphasized to enable the teachers to freely speak about their work-related tribulations, their desires, and experiences with violent discipline in a trusting and welcoming environment. ICC-T’s sustainability is achieved through rigorous rehearsal of previously learned material, teambuilding events, support supervision, peer consultation, formation of referral networks, and personal reflection on personal behavior. ICC-T ensures that the acquired skills and knowledge will be integrated into the teacher’s everyday school endeavors. Likewise, sustainability is achieved through provision of feedback during the course of the training and through case discussions.
ICC-T is based on five essential components that foster better student-teacher relations and a reduction in school physical punishment. ICC-T training has sessions on teacher-student interactions, maltreatment prevention, effective discipline strategies, identifying and supporting burdened students, and practical implementation of ICC-T aspects in the school setting.
Sessions on teacher-student interactions include topics such as communication skills, instructions and expectations, teachers as role-models, and rules in the classroom. These sessions assist teachers in understanding students’ behavior and highlight teachers’ responsibility as role models for the students. The sessions aim at improving teacher-student relations.
Maltreatment prevention sessions discuss the undesirable outcomes of violent disciplinary measures. Teachers use self-reflection to make a connection between their own childhood experiences of violent punishment, their current use of violent punishment, and its consequences. Discussion topics in this session consist of frequent disciplinary methods, myths about the utility of violent punishment, consequences of violent disciplinary methods, and alternative discipline approaches.
Session on effective discipline strategies intend to equip teachers with non-violent alternatives. Through role-plays teachers will learn how to use non-violent strategies practically, such as privilege removal and reinforcement, to foster desired behavior.
Teachers need to effectively recognize and assist troubled students. This task requires teachers to acknowledge that students may suffer from emotional and behavioral problems. This session will discuss the common internalizing and externalizing behavior problems, developmental delays, and student stress. Afterwards, diverse methods of assisting distressed students will be discussed.
Sessions on ICC-T implementation aim for integrating the learned material into the daily work routine in the school setting. Successful implementation includes collaboration with school staff and peer consultation.
The proposed training strategies include presentations, discussions, question and answer sessions, and supervised practical sessions. The training will be based on the previous success of ICC-T intervention training for teachers in Tanzania. The training was feasible, and first evidence of its effectiveness was found, e.g., a change in teachers’ positive attitudes towards emotional and physical violence and the use of and exposure to physical and emotional violence reported by students and teachers [[
At the randomly selected control schools no intervention will be implemented. However, the study will control for the potential influence of other workshops for teachers that may take place during the course of the study. The school administrations will provide information on all such programs during the course of the study.
Our study intends to test the effects of ICC-T training on the use of violence by teachers at school. This primary outcome measure is assessed by students’ self-reported experiences of violence (emotional and physical violence) as well as teachers’ self-reported use of violence (emotional and physical violence). Secondary outcome measures include teachers’ attitudes towards violence (emotional and physical violence) as well as student’s mental health (see Fig. 2).
All measures selected for the trial have been used in previous studies in East Africa. Further, the reliability coefficients of the instruments in those studies were acceptable [[
The Conflict Tactics Scale (CTS) will assess exposure to common disciplinary measures at school from the students’ perspective. The original CTS assesses diverse disciplinary behaviors including physical assault, emotional and psychological aggression, neglect, and non-violent discipline. For the current trial a modified version of the CTS [[
The Strengths and Difficulties Questionnaire (SDQ) will measure the students’ behavioral problems, namely internalizing and externalizing problems. The 25-item SDQ assesses four problem behaviors: emotional problems, peer problems, conduct problems, and hyperactivity. Each subscale has five items rated on a scale ranging from “not true” (0) to “certainly true” (
The purpose-built measures adapted from Kaltenbach et al. [[
As measures of efficacy we will assess the change in attitudes towards and use of violent disciplinary measures as well as a perceived change in the teacher-student relations (e.g., How did the training influence your understanding of students?). After a 3 months follow-up, integration and implementation of learned ICC-T material into daily work routines will be measured. Attitudes towards emotional and physical violence and actual application of violent discipline strategies in the school will be assessed using items from the modified CTS that have been used previously in Tanzanian studies [[
Moreover, teachers will be asked to report their attitudes towards violent discipline strategies using the 18-item modified CTS. The items are scored on a 4-point Likert scale from “never OK” scored as 0 to “always or almost always OK” scored as 4. Subscale items are summed up to yield scores for physical violence (range 0–52) and emotional violence (range 0–20).
Primary analysis will be carried out based upon the groups as randomized (“intention to treat”). We will use the last-observation-carried-forward approach; i.e., in drop-outs we assume no change from pre-assessment to follow-up. Results will be presented including appropriate effects sizes and a measure of precision (95% confidence intervals).
Our main analysis of the primary outcomes, students’ exposure to and teachers’ use of physical and emotional violence, will be time × group interaction effects using repeated multivariate analysis of variance (MANOVA). In case of a noted cluster effect (intra-cluster correlation coefficient >.10) we shall use multilevel analysis. Multivariate interaction effects and the univariate interaction effect of each outcome variable will be tested first. Paired t test analysis will examine the differences from the pre-assessment to follow-up assessment in the intervention group while the independent t test will examine whether there is a difference between the control group and intervention group at the follow-up assessment. Effect sizes η
Given that the research involves human subjects considered as a vulnerable group, i.e., children [[
Only pre-assigned codes will appear on the questionnaires and consent documents. Data will be stored on a password secured computer accessible to only the study investigators. Data obtained during the research will be kept confidential and will not be disclosed to another person without the participant’s permission or as required by the law. Behavioral intervention studies are minimum risk studies. However, in case of any unexpected adverse effect the researchers will document and report such occurrences to the respective ethical bodies within 1 week. Questions about experiences may evoke upsetting memories in the event that the participant experienced similar events in his or her life. Participants who will experience any psychological distress during the course of the data collection will be provided with psychological support by the research team members. For participants who experience adverse or unexpected events, appropriate referrals and follow-up for specialized services and further management will be made on a case-by-case basis.
Research findings, media reports, and non-governmental organization reports have provided anecdotal evidence about the prevalence, magnitude, and consequences of violence against children in Uganda [[
Our study aim is to implement and evaluate the ICC-T intervention, which aims to reduce violence by teachers at school. The study will adopt a two-arm cluster randomized controlled trial design, with six schools allocated to the intervention group and six control group schools. The study will use a large sample that is representative for the government-aided secondary schools in the southwestern region of Uganda. The experimental design will allow referring of potential interaction effects to the intervention, and it controls for most potential confounds. Additionally, our results may be generalizable to similar school settings in Uganda and the region.
The study takes on a multi-informant approach, as data will be collected from a sample of teachers and students. We shall elicit self-reports from students and teachers in relation to school violence. Hence, the teachers’ self-reports will, in part, be complemented by the viewpoints of students. Furthermore, the instruments adopted for the study have a good theoretical basis and have proven to be reliable in measuring students’ exposure to and teachers’ use of school violence and in screening for mental health problems in East Africa [[
The proposed study results may have implications for schools, teacher training, and policy in Uganda. Teachers’ continued use of violence despite policies that ban its use points to problems with teacher training in Uganda. Intervention approaches, such as ICC-T, that reduce violent disciplinary measures need to be implemented and evaluated at the school level. This may result in the frequent use of non-violent disciplinary methods in schools. Furthermore, regular teacher training needs to be enriched with respect to management of students’ behavior, alternatives to corporal punishment, and fostering of better teacher-student relations. Thus, the results of our study may help the Ministry of Education, Science, Technology and Sports to implement the relevant guidelines and programs that prohibit school violence in a more practical way. Moreover, there is a need to inform education sector stakeholders about the laws that ban the application of violent disciplinary measures in schools, children’s rights, teacher code of conduct, domestic violence laws, and the consequences of violating the applicable laws. Reporting procedures, monitoring guidelines, and review mechanisms must be enshrined in the broader legal implementation plan [[
The proposed study has some limitations. Self-report questionnaires are prone to possible respondent bias and social desirability. Furthermore, the proposed 3-month period between the intervention and follow-up assessment is rather short. The anticipated changes in attitudes and behavior can be regarded as preliminary in nature. Further, the inclusion of relatively few schools limits the generalizability of the study findings. One anticipated problem is the fluctuations in the number of respondents. Teacher attrition can be associated with retirement, routine transfers of civil servants, and resignation, among other causes, while students can drop out of school or transfer to other schools not in the study area. Additionally, there are strong sociocultural factors, attitudes, and beliefs that support the use of violence against children. Nevertheless, involving the teachers in creating the change and formulating their own training may help to promote engagement in the process. Reflections about the teachers’ own experiences of harsh punishment and violent discipline, discussions about consequences of violence for children, and the intensive practice of effective non-violent discipline strategies may facilitate a change of attitude regarding violent discipline. We thus believe that the intervention may enable teachers to visualize the link between violence and the associated negative consequences. This may persuade teachers to embrace alternative disciplinary approaches in schools.
ICC-T is an interactive intervention in which teachers can learn how non-violent discipline measures can be implemented in a real-life school setting in a practical way. It is easily applicable to the school settings in low-income countries and can be scaled up to other government-aided schools in Uganda. Making the school environment a safe place that is free from violence has great potential to contribute to the attainment of Goal Number 16.2 of the United Nations Sustainable Development Goals 2015–2030, which aspires to end all forms of violence against children.
The trial preparation phase is ongoing until July 2018. Intervention pilot test took place in May 2018. Pre-assessment (control and intervention schools) is scheduled from July–November 2018. Interventions are planned from August until December 2018. The follow-up phase will start in December 2018 and end by April 2019.
JS and TH designed the study design and drafted the manuscript. KH and MN made significant contributions to the study design and critically reviewed the manuscript. All authors have read and approved the final manuscript.
Ethical clearance was obtained from the Mbarara University of Science and Technology Research Ethics Committee, the Uganda National Council of Science and Technology, and the University of Konstanz Ethic Review Board. Teachers will be enrolled in the study if they give their informed consent. Students with parental informed consent and who freely provide assent will be accepted to participate in the study.
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
SPIRIT 2013 checklist: Recommended items to address in a clinical trial protocol and related documents. (DOC 120 kb)
The authors would like to thank Thomas Elbert for his continuous support and supervision and Justin Preston for proofreading the manuscript. Joseph Ssenyonga is grateful to the Alexander von Humboldt Foundation for funding his postdoctoral fellowship at the University of Konstanz.
This study is funded by the Alexander von Humboldt Foundation (Jean-Paul-Str. 12, 53173 Bonn, Germany; phone: + 49 (0)228-833-0, fax: + 49 (0)228-833-199), the University of Konstanz, and the Young Scholar Fund of the University of Konstanz (Universitätsstraße 10, 78464 Konstanz, Germany. Phone: + 49 7531 88-0, Fax: + 49 7531 88-3688). The funders had no role in the study design, preparation of the manuscript, or the decision to publish.
The datasets generated and/or analyzed during the current study will be available from the corresponding author on request.
By Joseph Ssenyonga; Katharin Hermenau; Mabula Nkuba and Tobias Hecker