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Indian Journal of Youth and Adolescent Health Volume 1, Issue 2, 2014 ISSN: 2349–2880 2880

Pilot study for Process Evaluation of SchoolSchool based LifeLife skills Education Program for Prevention of Violence in Adolescents Dr. Drishti#, Dr. Jugal Kishore, Kishore Dr. Nandini Sharma, Dr. Anshul Shukla Department of Community Medicine, Maulana Azad Medical College, New Delhi #

E- mail Id of Corresponding Author: [email protected] Abstract

Introduction: Violence has far reaching effects on behavioral and psychological aspects of youth in addition to the resultant death and injury. Life skills are abilities for adaptive and positive behavior that enable individuals to deal effectively with the demands and the challenges lenges of everyday life, in this case, case violence. Objective: Effect of school based universal life skills training program on interpersonal violence among adolescents is intended to be assessed. assessed Results of the pilot test are presented. Method: Process evaluation to assess the success of implementation of lifelife skills education program was conducted from April to July 2013. Change in violence related behavior was measured using pre- tested, semisemi structured, self- administered questionnaire. User views were collected from teachers and students using interviews and a feedback dback questionnaire. questionnaire Results: The total of 22 participants (14 boys, 8 girls) filled the baseline information. 17 out of these attended the four weekly life skills sessions over a month and also completed the post intervention violence assessment questionnaire. questionn Mean age of the participants was 13.27 + 0.70 years and all the participants were Muslims as the school selected for pilot testing was a minority status Government recognized school. The program was successfully implemented and is to be followed up for 6 months. The mean attendance of the sessions was 25.75students and 45% participants completed homework assignments on an average. User feedback got 4.49 point average over four sessions on a five point Likert ikert scale for achieving the objectives. © ADR Journals 2014.. All Rights Reserved

Page 12


Qualitative research as collected from 10 students and 5 teachers indicated convincing appreciation of the service. The intervention didn’t ’t bring significant change on violent behavior but a significant improvement in protective behavior (Life appreciation) was seen. Conclusion: Universal School based Life skills Education ducation is helpful in improving positive skills (particularly ‘life appreciation’) that protect from violence like behavior. behavior The program suggests that action towards violence prevention is acceptable by the school authorities, authorities teachers and students; the demand is felt for such intervention intervention to curb youth yout violence. The non- randomized controlled intervention study should be carried out to find out the effectiveness of the program.

Keywords: Adolescents, violence, life skills, violence prevention program, evaluation program. knowledge,

INTRODUCTION

attitudes,

thoughts

about

violence olence and skill deficits such as poorly Violence by young people is one of the most visible forms of violence in the society. Almost everywhere, the t main victims tims and perpetrators of such violence are themselves adolescents and young people. Adolescence is a critical time in life. The he experiences, knowledge and skills acquired quired in this time have important

developed veloped communication skills, drug and alcohol abuse, having witnessed wit or been victimized by interpersonal violence and access weapons

to [2]

firearms

and

other

.This study focuses on physical

and emotional aspects of peer group or sibling related interpersonal

violence

among adolescents.

implications cations for an individual’s prospects in adulthood. Violence involving young

Violence prevention research is intended

people adds to the cost of health and

to

welfare fare services, reduces productivity,

immediate

decreases creases the value of property, disrupts

studies determine how well these programs

the range of essential services

and

work and their impact.. This information is

generally undermines the fabric of the

crucial in effective implementation of its

society[1] Interpersonal terpersonal violence can be

prevention

attributed to

communities

different factors

© ADR Journals 2014.. All Rights Reserved

viz.

have

practical

implications

and

relevance. Evaluation

programs [3]

in

schools

and

.Although Although not developed Page 13


specifically as an approach to violence

irrespective of their risk and past history of

prevention, life skills training can be an

violent

important tool of successful conflict

with relevant vant literature, literature search school

resolution

[2]

behavior were included [4].Along

.Thee paper presents the results

authorities, teachers, public health experts

of the evaluation of one such intervention

and life-skills skills trainers were consulted

program. The assessment sessment would ascertain

during the development of

the following-

intervention

i) Whether the program was successfully implemented.

[5-7]

module for

.Weekly eekly sessions over a

month, a total off four and each of 120 minutes duration, were planned to ensure sufficient

time

allocation

for

skill

ii) The effects perceived by students and

development. The appropriate attendance

teachers,

for each session was initially decided as

iii) The changes in violence related behavior

among

the

young

people

10- 12 discussion

participants but after a participants, with

representatives

from

education department, feasibility of such

involved.

sessions

appeared doubtful. Hence,

It was undertaken as preliminary work

sessions were designed for complete class

needed before progressing to assess the

(30 students) so that the school curriculum

effectiveness

remains undisturbed. A smaller class size

by

non-

randomized

controlled intervention study.

is known to help in

participation and effective learning of

METHOD

skills among adolescents of

Development Phase Life Skills training sessions pertaining to application of life skills for dealing with social and emotional challenges leading to violence were designed keeping SAFE (Sequential, Active, Focused and Explicit) [4]

practices in mind . The program was for

universal

[4]

.The package

intervention used a sequenced

step- by- step training

planned

better

incorporating

active

approach forms

of

learning and focused on giving sufficient time me on skill development aided by explicit cit learning goals.

The skills that

foster development of interinter related sets of behavioral competencies were planned to be imparted using modes like role play,

implementation, i.e., all the students © ADR Journals 2014.. All Rights Reserved

Page 14


discussions,

video

display,

team

sheet about the pilot study along with

activities, story- telling, poster making,

consent forms were sent to the parents for

information pamphlet and games. Session

their approval. On the day assigned for

moderators received training in imparting

baseline estimation tion of violence related

life skills from experts.

behavior, 22 students dents were present. Assent was sought from the study participants

Study Design & Participants

before any assessment. sessment. The eligibility for

A quasi experimental design was chosen

participants to be included in analysis was

for pilot testing the intervention. A

completion of entire 4 sessions session of the

government

training module dule and completion of pre and

recognized recognized,

minority

approved co- educational school in the

post

intervention tion

questionnaires.

The

urban area of New Delhi was selected for

number of

the study. One middle school section (8th

successfully completed the program was

standard) was selected. The sample was

17. Flow of participants is represented in

that of convenience. The entire class (29

figure 1.

participants who

students) was selected and information Total students in the selected section=29

Students present on the day of baseline evaluation=22

Number of consent onsent forms sent home=29. Number of students who got the consent forms filled=29

Pre-intervention intervention questionnaire administered to 22 students. Number of students absent=7 Life Skills Education, 4 sessions Post- intervention int Questionnaire

Students who were able to complete the pre and post intervention questionnaire and attended all four sessions of Life Skills Education=17

Students who either missed one of the sessions or did not fill either of the questionnaire= 5

Figure 1.Flowchart chart showing recruitment of participants and flow of participants through phases of study © ADR Journals 2014.. All Rights Reserved

Page 15


added to the bridge bridg and previous

Life Skills Education Program

sessions revised [7]. Our program aims to develop life skills which will help the adolescents to deal

•

activities, games, storystory telling

with their day to day challenges in dealing

sessions, role- plays were used to

with physical, verbal and emotional aspect of violence.

build up the skill base of the

Following the SAFE

strategy in implementing the t violence prevention program,, investigators fixed a

participants. •

academic time each

week

required participation ticipation of parents). parents •

Feedback- via semisemi structured forms

for four

about

the

collected from the

consecutive weeks. A room in the school premises was allotted for

announcement.

(Homework assignments usually

skills education and the participants were

school agreed to devote 120 minutes of

Revision of entire session and homework

weekday (Tuesday in this case) for life

pre- informed ed about the schedule. schedule The

Circle exercises, discussions, group

at

intervention.

the

end

of

session

was

participants each

session.

Feedback regarding whether the

Each session had following activities: activities

session achieved its said objectives •

•

Meeting up – It included different

was marked by the participants on

warm up exercises e.g. clapping,

a 5 point Likert scale, with ‘0’

foot

being ‘disagree’ and ‘5’ being

tapping

with

changing

commands.

‘completely agree’. It also sought

Revision of rules- A set of rules

suggestions and comments if any.

were formedd by the participants

A question box was available all

based on social skills required to

the time during sessions for the

maintain an ambient environment

participants to share their queries.

for learning. •

•

About Violence- A bridge model

The four training sessions were divided with th the following learning themes:

was used to overcome the problem i.e. river called violence. Each week, planks of life skills were


i)

Self- awareness and creative thinking

Page 16


ii)

iii)

iv)

Understanding and managing

views regarding the extent to which the

emotions (anger management)

objectives were achieved on the Likert

and critical thinking

scale from 1 to 5, 5 being ‘completely

Empathy, communication skills

agree’. Their views on improving the

and social skills

sessions and other suggestions along with

Responsible decision making

what they liked most during durin the session

and conflict management.

were also gathered in the feedback.

Two trained life skill trainers (one male

A purposive sample of 10 students and 5

and one female) were present during each

teachers was chosen and interviewed one

of the

month

sessions for facilitation. Incentives

after

the

completion

of

like ke chocolates and pens were used u to

intervention. tion. Face to face interviews were

encourage

conducted by first author

participation and practice practic

of life- skills.

(also involved

in formulation of intervention and was one of the trainers) in the school

Evaluation process

premises in

a separate room in complete privacy. privacy Each

The evaluation was based on the process

interview

evaluation

user

minutes. The interviewed students s and

feedback and change hange in violence related

teachers were queried about the need of

behavior. The he process evaluation measures

such a

included session wise attendance which

quizzed on whether the method selected

was maintained by the investigators. It also

was likely to bring any change, whether

took into account completed homework

they felt any change post program

submissions by the students, and student

completion and the ways in which the

and teacher views through interviews. We

program could be further ther improved. Video

expected to have at least 70% students

recordings along with field notes were

complete

recorded during all the interviews.

of

the

implementation implementation,

entire

program;

and

approximately proximately 60% students to complete their homework assignments. User feedback back structured

was

collected

using

semi semi-

questionnaire after the end of

each session. It was used to ascertain their © ADR Journals 2014.. All Rights Reserved

took

approximately

15

program. Moreover, Moreover they were

The quantitative outcome measured measure the change in violence related behavior (using Illinois Bully scale: with subscales sub viz. physical and emotional perpetration of Page 17


violence and

victimization) was

Statistical Analysis

measured using a pre- designed, prepre tested,

semi-

structured

and

self-

administered tered questionnaire. It was derived from the Centers of Disease Control and Prevention’s Compendium of assessment tools for measuring bullying, victimization vi perpetration and bystander stander experiences

[8]

.

It measures frequency of violent acts done over 30 days with point values assigned as

The analysis of the data was done using R version-2.15.1.

The

means,

standard

deviations ations and proportions were calculated as appropriate. The means of pre and post intervention

recording of behavior were

compared using Wilcoxon Signed Rank Test.

Ethical Approval Process

never=0, 0, 1 or 2 times=1, 3 or 4 times = 2, 5 or 6 times = 3 and 7 or more times = 4. It can be used as a continuous scale and can be dichotomized based on values greater than or equal to one standard deviation.

Authorities in the selected school were w explained about the nature and procedure of the study. Information sheets and consent forms for the students were sent to their parents informing them of the study

Another

outcome

was

the

violence violence-

and asking for their permission for their

protective behavior.. For this outcome

children dren to participate in this study. Those

measure

who didn’t wish to enroll their ward were

Adolescent Healthy Life

Questionnaire’s re’s

life life-

requested to contact the investigator by

appreciation (Self- awareness and selfself

phone call. Confidentiality of information

management agement related questions) and socialsocial

was taken care of. Ethical approval was

support port were chosen. Both the subscales

received

were scored as continuous variables

Committee mittee of Maulana Azad Medical

[9]

subscales

viz.,

.Youth risk behavior survey was used to

measure [10, 11]

from

Institutiona Institutional

Ethics

College, New Delhi.

violence related risk behaviors

.

Results

The questionnaire also contained items to

The study pilot tested the acceptability,

assess demographic data (age, gender and

comprehension

socio- economic status, educational status

intervention. It started in April 2013 and

and occupational status of the parents).

was followed lowed up till July. At baseline, the

and

delivery

of

violence related behavior was assessed in © ADR Journals 2014.. All Rights Reserved

Page 18


22 students. Four sessions on weekly basis

family ily income correctly. Out of those who

for four weeks were then conducted

reported the same, majority ajority i.e., i six were

followed by evaluation.

in Upper middle class, three in Lower middle and one participant in each Upper

Baseline data

lower and Upper class, class using modified

The mean age of students (table 1)

Kuppuswamy

recruited in the program was 13.27 +

ranges of year 2012)[12]. In addition to this,

0.70years, years, 14 of the 22 students (64%)

the baseline data showed that 2 of the 22

were boys and as the school has minority

participants had carried weapons to the

status the entire class had

Muslim

school premises and 5 had history of being

participants. ticipants. Mean number of siblings

injured severe enough to be treated by a

were measured to be 2.54 + 1.11 and mean

doctor or a nurse owing to acts of violence. violence

number of members in the family were 5.7

The mean violence related behavior at

+

baseline ne is represented by the graph

1.42..

Questions

related

to

socio

economic nomic status were asked but only 11

scale

(updated

income

(figure.2).

out of 22 students could recall the monthly Socio demographic factor

Value*

Mean Age

13.27(0.70)

Gender •

Male

64(14)

•

Female

36(8)

Religion •

100(22)

Muslim

Mean Number of siblings

2.54(1.11)

Mean Number of family members

5.7(1.42)

*Mean (Standard deviation) except male gender and religion where the measure is percentage (number)

Table 1.Characteristics Characteristics of the students of middle school section selected (n=22) as measured at baseline


Page 19


Process Evaluation of the ImplementaImplementa

violence is a

tion

adolescents. cents.

Mean participant attendance during the sessions was 25.75 (+ 2.25) students. At least two trainers were present in all the sessions. None of the school staff was required quired to be present during the sessions. On an average, 45% participants participa submitted the

completed

homework

in

the

subsequent sessions. Out of the 29 recruited in the study, 17 (59%) completed the four life skills sessions and filled the pre and post intervention questionnaire. Interviews with five teachers and ten students dents

revealed

that

common problem among Bullying,

calling, use of abusive

fighting,

name

language and

social exclusion sion of some students was common occurrences as observed by interviewees. All agreed that violence led to physical and mental harm and reduced school performance mance as well. The life skill based program gram was appreciated by the teachers and three of them expressed their interest to attend some of the t sessions. Furthermore, teachers

suggested a

session exclusively sively for teachers on the measures to control violence focusing on methods to teach students about life- skills.

interpersonal

Figure 2.Boxplots showing baseline measure of primary outcome measures


Page 20


One of the teachers reported reduction in

the

verbal abuse after one month from the

understand and state whether the objective

completion of the program. Rest didn’t

of the class was achieved or not. The class

report any apparent difference; though

average age came out to be 4.49 4. + 0.05 on 5

they did show their belief that such

point Likert scale (range 11 5).

changes occur cur over time and slowly. They also

acknowledged

that

changing

behavior is difficult because of various

parts

which

were

difficult

to

The prominent suggestions from the feedback forms were: •

other factors at play like family and educational status of parents.

The

participants

should

be

provided vided with reading material about violence.

Students felt that the program helped them •

control their anger and improved their concentration in academic activities. They

should be included.

suggested that such classes should be

•

arranged weekly throughout the year. They

The homework should be defined clearly and should be given in

approved of all the sessions and suggested

writing.

that the sessions should be followed by some jotter notes to revise the various

More videos and more games

Change in Violence related behavior

skills later. They also suggested that microphone could be used as some

The violence related behavior as measured by Illinois Bully Scale was plotted on QQ

students speak out softly.

plots

(Quantile-

Quantile

plots)

and

One month post- intervention, intervention when asked

Shapiro- Wilk ilk test was applied to test the

about the change they perceived in their

normality. The

behavior, the majority reported reduction

normal distribution hence non parametric

in

tests were applied to test the difference

physical

violence

and

emotional

violence more than verbal violence.

User feedback

subscales didn’t follow

between the two measurements. The violence related behavior as measured one month after the completion of life skills

Participants were asked to fill feedback

training sessions showed that perpetration

forms at the end of each session to find out

of


emotional violence increased from Page 21


mean value of 3.32 (2.15)) to 5.06 (3.97),

from 2.82 (2.22) to 2.65 (1.99), though

perpetration of physical violence increased

none of the changes were significant after

from 2.73 (1.75) to 3.35 (4.72 4.72) and self-

comparison of means by Wilcoxon signed

reported victimization score decreased

rank test (table 2) [13].

Violence Subscale

Baseline Score

Post- test score

(range)

Mean(SD)

Mean(SD)

2.35) 3.41(2.35

5.06 (3.97)

0.3308

2.77(1.64 1.64)

3.35(4.72)

0.4918

2.82 (2.22) (2.22

2.65(1.99)

1

Emotional Perpetration(0- 32) Physical

Perpetra-

tion(0- 20) Victimization(0- 16)

P- value

Table 2.Violence Violence subscale values as measured at baseline and after intervention using Wilcoxon signed rank test

The second outcome compared between

positive life style factor measured and

baseline

compared

measurement

intervention tion

found

and a

post

statistically

was

social

sup support

which

showed a non- significant nificant change from

significant cant change in life appreciation from

3.14 (2.49) to 4.18 (3.00 3.00).

7.77 (1.97) to 11 (1.27). ). The other Protective factor

Life-

Appreciation

score Social support

Baseline Score

Post- test score

P- value

Mean(SD)

Mean(SD)

7.77(1.97) (1.97)

11(1.27)