The Good School Toolkit–Secondary to prevent violence against students: a pilot cluster randomised controlled trial

Pearlman et al. BMC Public Health (2025) 25:3802 https://doi.org/10.1186/s12889-025-23913-8 BMC Public Health Open Access RESEARCH The Good School Toolkit–Secondary to prevent violence against students: a pilot cluster randomised controlled trial Jodie Pearlman1*, Mathew Amollo1,2, Clare Tanton1, John Bosco Apota2, Yvonne Laruni3, Janet Nakuti3, Charles Opondo1, Elizabeth Allen1, Chris Bonell1, Tvisha Nevatia3, Devin Faris3 and Karen Devries1 Abstract Background Schools provide a unique opportunity to address multiple forms of violence against adolescents. Yet, few whole-school interventions to comprehensively address physical, sexual and emotional violence against adolescents from multiple perpetrators have been evaluated in the Global South. We report results of a pilot trial of the Good School Toolkit–Secondary (GST-S), an intervention for secondary schools in Uganda. The trial aimed to determine whether criteria for progression to a phase 3 trial were met based on pre-specified implementation and research feasibility criteria. Methods We conducted a pilot cluster randomised controlled trial with two arms and parallel assignment. The trial was conducted in eight secondary schools, varying by faith status and urban or rural setting, randomly selected from a list of all eligible registered schools in Kampala and Wakiso Districts. Schools were randomised to control or intervention arms and aware of their allocation. The primary outcome was to determine whether criteria for progression to a phase 3 trial were met based on pre-specified criteria regarding fidelity, acceptability and understanding of GST-S, and research feasibility. Outcomes were measured using cross-sectional baseline and endline surveys among eligible school students and staff, and routine monitoring data collected during implementation. Results Overall, seven of eight schools agreed to participate in the baseline survey, randomisation and endline survey, with three randomised to the control and four to the intervention group. The endline survey included 837 students (response rate: control, 100%; intervention, 99.4%) and 98 staff (response rate: control, 91.1%; intervention, 95.0%). There were delays to the trial due to Covid-19 and an Ebola outbreak. Despite this, all pre-specified implementation and feasibility criteria were met. The intervention was acceptable and understandable to students and staff, was delivered with fidelity, and the trial demonstrated good research feasibility. Conclusions We present the first evidence that it is feasible to deliver a whole-school intervention aiming to address physical, sexual and emotional violence against adolescents from multiple perpetrators including peers, teachers and intimate partners in sub-Saharan Africa. Based on our results, we recommend progression to a phase 3 trial with minor refinements to the research methods and intervention. *Correspondence: Jodie Pearlman Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Pearlman et al. BMC Public Health (2025) 25:3802 Page 2 of 19 Trial registration Pan African Clinical Trials Registry, PACTR202009826515511, 16/09/20. Keywords Violence, Schools, Adolescents, Pilot trial, Uganda Background Estimates suggest that one billion children globally experience emotional, physical or sexual violence each year [1]. Evidence shows that experiencing violence in childhood increases the risk of adverse social, health and economic outcomes, including poorer physical and mental health, sexual risk behaviours, behaviour disorders, substance abuse, lower educational attainment, worse employment outcomes and perpetration of violence [2– 7]. Ending violence against children is an important part of the 2030 Sustainable Development Goals, where it is included as a specific target and in relation to goals for quality education and gender equality [8]. In Uganda, a national survey in 2015 found that over three-quarters of young men and women reported experiencing at least one type of violence during childhood. The survey found that 59% of young women and 68% of young men reported experience of physical violence, 34% of young women and 36% young men reported experience of emotional violence, and 35% of young women and 17% of young men reported experience of sexual violence during their childhoods [9]. The survey also found that teachers, peers and romantic partners were common perpetrators of violence, all of whom are likely to interact with students in schools. Ending violence against children is a key priority area within the Uganda National Child Policy [10]. Yet, analysis of the Ugandan government’s budget allocation showed that the child protection sector is not being allocated sufficient funds despite identification of child protection as a national priority [11]. Despite the burden of violence and commitment to reducing it, there is a lack of effective interventions aiming to address violence in adolescence that have been evaluated in the Global South [12–14]. Most interventions aiming to prevent violence against adolescents in the Global South aim to address only one type of violence, most commonly violence from peers [15–17]. Very few interventions aim to address physical, sexual or emotional violence perpetrated by teachers towards students [18], and only three interventions that aim to reduce both teacher and peer violence against children have been evaluated in randomised controlled trials and shown to be effective in the Global South [19–21]. However, these were all in pre-primary or primary schools, with limited evidence for interventions in secondary schools. Schools provide a unique opportunity to address multiple forms of violence against adolescents and the World Health Organisation (WHO) recommends whole-school approaches to prevent violence [22, 23]. By bringing together a range of important individuals in an adolescent’s life, including teachers, peers, administrative staff, parents and the community, these approaches have the potential to reduce multiple forms of violence that adolescents may experience. The Good School (...truncated)