Effectiveness of a community-based participatory health promotion intervention to address knowledge, attitudes and practices related to intimate partner violence: a quasi-experimental study.

BACKGROUND: Intimate partner violence is the most common form of violence experienced by women. It has detrimental consequences. A range of determinants cause intimate partner violence and to reduce it, effective interventions are required to address the determinants. Health promotion interventions have been recommended as effective to enable people to control over the determinants and to improve health. Hence, a community based participatory health promotion intervention was developed and tested in a selected study setting. The objective was to evaluate the effectiveness of a health promotion intervention in terms of addressing knowledge, attitudes and practices related to intimate partner violence. METHODS: A quasi-experimental study was conducted by recruiting ninety women aged 15 to 49 years separately from two health administrative areas identified as the intervention area and the control area from the Kandy district of Sri Lanka. A pretested interviewer-administered questionnaire was used in both pre- and post-assessments. Selected groups of women from the intervention area were facilitated with a health promotion intervention to improve knowledge, attitudes and practices related to intimate partner violence. To evaluate the effectiveness of the intervention descriptive summaries and bivariate analysis were used. RESULTS: The response rate was 90.9% (N = 90) during the pre-assessment and 87.9% (n = 87) and 82.8% (n = 82) from the intervention and control areas, respectively, during the post-assessment. Statistically significant improvement was reported in the total mean score comprising knowledge, attitudes, practices and identification of determinants from 59.6 to 80.8 in the intervention area [Pre-assessment: Mean = 59.6 (standard deviation-SD) = 17.5; Post-assessment: Mean = 80.8, SD = 19.0; p < 0.001) compared to the improvement in the control area from 62.2 to 63.0 (Pre-assessment: Mean = 62.2, SD = 17.3; Post-assessment: Mean = 63.0, SD = 18.9; p = 0.654). CONCLUSIONS: The intervention was effective to improve knowledge, attitudes and practices related to intimate partner violence. Hence, the present approach can be used in similar contexts to address the knowledge, attitudes and certain practices related to intimate partner violence.

A health promotion intervention to address youth violence among students in a technical college in Sri Lanka guided by the participatory action research approach: a study protocol.

BACKGROUND: Youth violence is a global public health issue and the highest rates are reported in Low and Middle-Income Countries (LMICs). Higher rates of youth violence are reported in Sri Lanka as well. Students who fail to continue higher studies in schools or enter the universities in Sri Lanka, enroll in technical colleges and are associated with a higher number of risk factors of violence. This study aims to empower youth (15-29 years old) of a technical college in Matale district, Sri Lanka, to carry out activities among themselves to improve their knowledge, change perceptions, and violence-related behaviours. METHODS: The Participatory Action Research (PAR) approach will be used. The study participants will be eighty students in a technical college in Matale district, Sri Lanka. The study period will be three years. Study participants will also be collaborators and they will involve actively in all stages of the study. A health promotion intervention will be implemented to identify determinants of youth violence and to design and implement actions while monitoring the changes. The data will be collected mainly through focus group discussions and key informant interviews both before and after the health promotion intervention. Additionally, a self-administered questionnaire will be used and the principal investigator will maintain a reflective diary. The qualitative data will be analysed thematically whereas quantitative data will be analysed using descriptive statistics. Data will be triangulated to increase the rigour of the study. DISCUSSION: According to literature, PAR is not widely used in health promotion. The enabling and empowerment goals of health promotion are fulfilled in PAR. Thus, this will be a novel experience for researchers and this will stimulate discussion on the combination of PAR and health promotion. This study design itself promotes active participant involvement and it may generate effective youth-led, culturally appropriate actions to address youth violence. The findings will describe what works and why it works and will help Sri Lanka and similar LMICs to create safe environments for youth in educational institutes or training colleges.

In this protocol paper, we propose a participatory action research based on the health promotion approach to address youth violence in Sri Lanka which has hitherto not been addressed effectively. We selected this topic in the context where youth violence has become a major public health issue in low and middle-income countries. Since, empowering young people in preventing violence is vital, this study aims to empower the youth of a technical college in Matale district, Sri Lanka to carry out activities among themselves to address youth violence. Thus, we will select eighty students from a Sri Lankan technical college for the study. The students will involve themselves in all stages of the study as research collaborators. We will collectively identify the risk factors of youth violence, design and implement actions to address those risk factors with active youth involvement. The data will be mainly collected before and after the actions to identify the changes in knowledge, perceptions and behaviours that have been taken following the actions. The students who participate in the study will ultimately gain knowledge and skills to address violence in their college and other settings. Further, it will reduce their risk of becoming an offender or a victim of violence. This study is expected to generate effective youth-led, culturally appropriate actions to address youth violence in a selected setting. The findings will be helpful for Sri Lanka and similar low and middle-income countries to create safe environments for youth in educational institutes.

Effectiveness of a health promotion intervention to address determinants of child neglect in a disadvantaged community in Sri Lanka.

BACKGROUND: Child neglect is a form of child maltreatment and it is a neglected area of research. As similar to other forms of maltreatment, neglect also results in negative health outcomes for children. Child neglect is concentrated in disadvantaged communities. The community-centered health promotion approach empowers communities to identify and address determinants of perceived health issues. This study aimed to implement a health promotion intervention to enable a disadvantaged community to address determinants of child neglect and evaluate the effectiveness of the intervention. METHODS: A quasi-experimental study design was used. Two disadvantaged communities in Anuradhapura District, Sri Lanka with similar socio-demographic characteristics were purposively selected as the experimental and control study settings. The mothers who have at least one child in the age range 5-18 years were included in the sample. The sample included 42 mothers from the experimental group and 44 mothers from the control group. The elder children of mothers in the experimental group were selected to be the agents of change. A health promotion intervention was implemented only with the experimental setting. The steps of the intervention included; (1) identifying prevention of child neglect as a goal, (2) understanding the determinants, (3) analyzing determinants and identifying actions and (4) implementing and modifying the actions. The total study duration was 1 year, with the intervention taking an average of 6 months. Data were collected at both pre and post-intervention phases from mothers and children through interviewer-administered questionnaires. RESULTS: Mothers of the experimental group improved their knowledge on child neglect significantly in comparison to the control group (p < 0.05). In the post-intervention phase, there were significant differences in attitudes related to child neglect between experimental and control groups (p < 0.05). Following the health promotion intervention, mothers of the experimental group had significantly improved their practices related to the safety, education, nutrition of children, relationships with the child and social support for child caring (p < 0.05) when compared with the control group. CONCLUSIONS: The health promotion intervention was effective in addressing the selected determinants of child neglect in a disadvantaged community. Children could act as active agents of change to deliver the interventions to their mothers (perpetrators).

Household Expenditure on Tobacco Consumption in a Poverty-Stricken Rural District in Sri Lanka.

Tobacco is a determinant of poverty and a barrier for development. Monaragala, a rural, agricultural district, reports the highest poverty-related indicators in southern Sri Lanka. A cross-sectional study was used to describe the household expenditure on tobacco and its association with food- and education-related expenditures at household level. This study used a 4-stage cluster sampling method to recruit a representative sample of 1160 households. Response rate was 98.6%. Median monthly household income was LKR 20 000 (interquartile range [IQR] = LKR 12 000-30 000). The median monthly expenditure on tobacco was LKR 1000 (IQR = LKR 400-2000) with the highest spending tertile reporting a median of LKR 2700 (IQR = LKR 2000-3600).The proportionate expenditure from the monthly income ranged from 0.0% to 50% with a median of 5.0% (IQR = 2.0-10.0) and a mean of 7.4% (7.6). The poorest reported the highest mean proportionate expenditure (9.8%, SD = 10) from the household income. Household expenditure on tobacco negatively associated with expenditure on education.