We find several challenges facing schools including high workload for teaching staff and inadequate school-based referral structures for cases of abuse. In addition, we find divided views on the use of corporal punishment at schools from teachers and parents, with many supporting its use despite the recent ban. Our findings suggest there is an opportunity for the intervention to play an important role in supporting teachers to move towards alternative discipline strategies, through recognisable structures and teaching methods, such as manuals and school committees. Findings suggest these familiar methods of teaching will not only serve to support already overburdened staff but will also help integrate the intervention within the existing school structure. ZCBC’s systems expertise and pre-established relationships with the Church, schools and ministries (MoPSE) will be critical to developing this familiar approach and in easing the intervention acceptability amongst these stakeholders, which our findings suggest will play an important role.
However, our findings suggest that additional training may be needed to equip intervention actors and existing change agents within schools with appropriate content, ethical and safety skills relevant to violence prevention. For instance, findings highlighted the need for intervention content to be more child-friendly, and to not perpetuate harmful ideas, such as blaming children for abuse, as explore elsewhere (40). In addition, qualitative findings, alongside prior literature (30, 31), highlighted the challenges with the wider referral system in Zimbabwe and the difficulties of integrating this with a school-based referral system. The current mechanisms within schools faced challenges, including poorly handled cases and negative outcomes. Although strengthening the referral mechanisms was part of the initial intervention design, these were not piloted. The current challenges, alongside the limited content expertise, highlighted the need for this aspect of the intervention to be carefully considered in the intervention refinements.
Given the current challenges within and around schools explored in this paper, the findings suggest the intervention will need to align closely with existing school, child protection and religious systems to be successful. However, the ToC workshop discussions highlighted the need for the intervention to have clear boundaries around its intended content, or intervention messages could become diffuse, and may overlap with existing structures in the schools. Balancing between aligning the intervention within existing systems and setting clear boundaries around it will also be essential to successful delivery and acceptability by intervention beneficiaries and stakeholders.
Comparison to other literature
Relatively few studies document how violence prevention interventions are conceptualised, designed and developed, and along with previous work (4), we provide learning for future evaluation approaches and impact analysis. In violence prevention, interventions are often designed by or in consultation with behaviour change or topic specialists, NGOs or academics (19–22). These interventions are then tested in randomised controlled trials which are often carefully controlled, documented, and delivered by well-resourced and/or specialised organisations. Few interventions evaluated in RCTs have been designed from within national or local education authorities, yet, contextually-informed, well-linked interventions may well have the potential to be more sustainable or scalable. Interventions designed by these system experts or ‘insiders’ may face fewer barriers to implementation and are likely to be or perceived to be in alignment with key stakeholders priorities, due to existing relationships, knowledge of the system and the ability to enact changes. There may be particular challenges working within hierarchical organisations, however, such as the Church or within the wider education context, where power dynamics interplay and the intervention will need to be responsive to these.
Sustainability, defined as a continuation of “program components and activities for the continued achievement of desirable program and population outcomes” (43) (p. 2060), is often the final step in intervention development, after design and evaluation but integrating sustainability within the initial design process is crucial (44–46). Several frameworks exist to guide the evaluation of intervention implementation which refer to concepts of scale implementation and sustained delivery (47, 48), but neither these frameworks nor empirical evidence provides consideration of how design stage factors may influence scalability and sustainability. Within the Safe Schools Programme, design stage factors including community engagement with the Church, school leadership training, and school wide safeguarding policy implementation may be key enablers to achieving sustainability, as indicated by prior research (49) (50). Many of these elements are responsive to the context explored in the research findings, including the need for religion to play a role in Safeguarding (4).
Scale-up involves efforts to expand the impact of successful public health interventions or innovations to benefit more people and create lasting policies and programmes (51). Within broader implementation research, evidence on scaling up child-focused interventions is small but growing, with recent research on scaling social norms interventions (52), early childhood development (53), and parenting interventions (54). Complex interventions may prove difficult to simplify for scale-up without altering the effective aspects of the intervention (55). For example, interventions that rely on specialist change agents can be challenging to adapt at scale due to limited expertise or geographical constraints. Interventions initiated and designed to be embedded within existing education, religious or child protection systems may provide a solution to these challenges. In the Safe Schools Programme, for instance, as ZCBC manage many of the schools that will be part of the intervention, there are opportunities for embedding at a school level, including: new safeguarding staff will be appointed by ZCBC, teachers will act as change agents and will be trained by senior internal ZCBC staff, and exisiting lesson structures can be utilised for the intervention curriculum. Designing referral structures within schools to align with the wider child protection structures could also be key to future scale-up and achieving sustainability. Prior research has found the wider policy context may be crucial to sustainability of school-based interventions (50) and given the changing child protection landscape discussed above, this presents an opportunity to position the intervention alongside these changes. Given these factors, structuring the intervention to align with these exisiting systems could be important to achieving scale-up and sustainability if the intervention is found to be effective.
Strengths and Limitations
There are several strengths and limitations in our approach. The three ToC workshops and subsequent ToC discussion, along with the qualitative research studies, was a lengthy process, allowing ample time for reflection and discussion between the research partners and implementation team. This also meant that throughout the intervention design process, the content was refined in response to contextually-informed research and stakeholder discussions. This process has led to a stronger intervention with the potential for sustainability. The research, however, was limited by small sample sizes, and due to the challenges of COVID-19 and subsequent school closures, adaptations to the design that meant interviews with children were delayed. In addition, the research was limited to a few areas of Zimbabwe which may be distinct and a not representative of the wider school context. The qualitative research alongside the intervention pilot was conducted at one-time point.