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Interrupting the intergenerational transmission of violence: a mixed-methods longitudinal study in South Africa

Periodic Reporting for period 2 - INTERRUPT_VIOLENCE (Interrupting the intergenerational transmission of violence: a mixed-methods longitudinal study in South Africa)

Reporting period: 2022-01-01 to 2023-06-30

Violence is a global social and human rights issue with serious public health implications across the life-course. Violence is transmitted across generations but there is an urgent need to understand the mechanisms of this transmission to identify and inform interventions and policies for prevention and response. Ending violence is one of the targets of the United Nations Sustainable Development Goals; however, we lack an evidence-base for understanding the underlying mechanisms of the intra- and intergenerational transmission of violence as well as potential for intervention, particularly in regions with high rates of interpersonal violence such as South Africa.

This study is using a mixed-methods approach to develop the first known empirically generated theoretical framework to transform our understanding of the causes, effects and potential prevention of the transmission of violence in South Africa. INTERRUPT_VIOLENCE is a mixed-methods three-generational longitudinal study. It builds on a two-wave existing cohort study of 1665 adolescents in South Africa interviewed in 2010/11 and 2011/12. For wave three, the original participants (now young adults), their oldest child (aged 6+), and their former primary caregiver are recruited. Quantitative surveys are carried out followed by qualitative in-depth interviews with a subset of 30 survey families, 15 of whom will be qualitatively re-interviewed a second time. Adults provide informed consent, while children are invited to assent following adult consent for child participation. Stringent distress and referral protocols are in place for the study. Triangulation will be used to deepen interpretation of findings.

The main objectives for the study are: 1) to identify mechanisms of violence transmission across generations and by gender through quantitative and qualitative methods; 2) to examine the effect of multiple violence experience on health outcomes, victimisation and perpetration; 3) to investigate the effect of structural risk factors on violence transmission; and 4) to examine protective interventions and policies.
The study represents a major scientific advance in understanding the transmission of violence and its prevention and will impact a critically important societal and public health challenge of our time.
The study set out to investigate the mechanisms of intergenerational violence transmission, the effects of multiple violence experience on health outcomes, victimisation and perpetration and to investigate structural risk factors and protective interventions and policies for violence transmission through a) a longitudinal quantitative survey of men and women, b) a quantitative three-generational survey including the longitudinal dataset of young men and women, the oldest child in their care and their former primary caregiver, c) in-depth qualitative interviews with family members across three generations, and d) a second in-depth interview with family members across three generations.

The study has completed the following activities for each component:

a) Out of the planned 1665 young men and women who participated in the wave 1 and wave 2 interviews, 1190 have been traced (602 in urban site/ 537 in rural site). In total 719 young men and women have been interviewed for a third time. In total 32 young adults thus far have refused participation and 21 have passed away.
b) Out of 200eligible children thus far, 122 have been interviewed. One child refused, 36 young adults refused for their child to be interviewed, and 12 eligible children have passed away. Out of 557 eligible former primary caregivers thus far, 349 have been interviewed. In total, 90 young adults refused for their former primary caregiver to be contacted, 29 caregivers refused to participate, and 82 former primary caregivers have passed away.
c) Qualitative in-depth interviews were conducted with 14 families, including 22 young adults, 11 children and 13 former primary caregivers (n = 46). Ongoing analyses are looking at a) intersections of violence, mental health and HIV on parenting, b) risks for intergenerational violence transmission across generations, c) protective factors against violence transmission across generations among violence exposed participants.
d) Plans for the follow-up interviews with 15 families will be finalised once the first stage of the qualitative interviews has been completed.

In addition, we conducted an in-depth pilot study July to October 2021 to investigate the feasibility of participant recruitment, consent, and interviewing; length and burden of the study questionnaires; appropriateness and acceptability of the measures used; and young children’s (age 4–7) ability to comprehend the measures and participate meaningfully in interviews asking about violence.

The project has also reached the final write up stage for two realist reviews, one on the underlying mechanisms of the intergenerational transmission of violence victimisation and one on violence perpetration. Findings have been presented at the ISPCAN 2022 congress, by the PI and research fellow.
This project is currently in the middle of data collection and well within its projected timeline.

There are four main achievements and developments we want to mention at this point:
• The PI has successfully obtained additional funding from the Scottish Graduate School of Social Sciences for a fully-funded PhD student who will conduct analyses on the longitudinal dataset investigating associations between childhood adversity and poor adult mental health and potential beneficial effects of government social protection.
• The PI and members of the research team were contracted by the Sexual Violence Research Initiative to develop an online course for researchers new to violence against children research: Measuring Violence Against Children: From Concept to Action.
• The PhD fellow at University of the Witwatersrand is conducting analyses of qualitative data which go beyond the scope of the plan of action on the intersections of HIV, mental health and intimate partner violence and their impact on parenting in female caregivers.
• The project has developed a highly successful capacity building strategy where motivated qualitative interviewers are trained to code and analyse qualitative interviews.
• The qualitative methods include three arts-based approaches: river of life, Kinetic Family Drawing and sandboxing. The study is exploring the value of the different methods; and the feasibility and acceptability of the methods in a rural and peri-urban setting with different age groups.