Abstract
BackgroundInterpersonal violence can significantly reduce adolescents’ opportunities for becoming happy and healthy adults. Central America is the most violent region in the world and it is estimated that adolescents are involved in 82% of all homicides in this region. Family skills training programmes have been designed to prevent interpersonal violence in adolescents. Several studies in high-income countries suggest they are effective. However, there are no published trials assessing effectiveness of these programmes in low- and middle-income countries (LMIC). The aim of this study is to test the effectiveness of the Strengthening Families Programme 10–14 (SFP 10–14 or “Familias Fuertes”) in Panama, a LMIC in Central America. An embedded process evaluation will examine the extent to which the intervention is delivered as intended, variation across trial sites, influences on implementation and intervention-context interactions. Cost-effectiveness will also be assessed.MethodsThis is a cluster randomised controlled trial. The 28 townships with the highest homicide rates in Panama will be randomly allocated to implementation of SFP 10–14 alongside services-as-usual or to services-as-usual only. Approximately 30 families will be recruited in each township, a total sample of 840 families. Families will be assessed at baseline, approximately eight weeks after baseline (i.e. post intervention), six months and 12 months after. The primary outcome measure will be the parent reported externalising subscale of the Child Behaviour Checklist at T3 (i.e., which is approximately 12 months after baseline). For the process evaluation, recruitment, attendance, fidelity and receipt will be measured. Qualitative interviews with facilitators, trainers, parents and adolescents will explore barriers/facilitators to implementation and intervention receipt. For the cost-effectiveness analysis, service use information will be gathered from parents and adolescents with a three-month recall period. Costs and consequences associated with implementation of the intervention will be identified.DiscussionThis trial will be the first to evaluate SFP 10–14 in a LMIC. Results have the potential to guide public policies for the prevention of interpersonal violence in Central America and beyond.Trial registrationISRCTN Registry, 14023111. Registered on 13 July 2017.
Highlights
Interpersonal violence can significantly reduce adolescents’ opportunities for becoming happy and healthy adults
We will allow for missing outcome data under the Missing At Random (MAR) assumption and check the sensitivity of treatment effect estimates to departures from MAR
Costs It may not be possible to measure all of the costs and benefits associated with SFP 10–14, but we aim to provide a full identification of the most important ones
Summary
Interpersonal violence can significantly reduce adolescents’ opportunities for becoming happy and healthy adults. There are no published trials assessing effectiveness of these programmes in low- and middle-income countries (LMIC). According to the 2014 report ‘Health for the World’s Adolescents’, interpersonal violence is the leading cause of adolescent mortality and morbidity in Central America [3]. Those aged < 29 years in upper-middle income countries, such as Panama and Costa Rica, are involved in 82% of all homicides [3]. Short- and long-term health consequences of interpersonal violence harm individuals, families and communities, compromise economic development of countries in Central America, and place a great burden on international aid from high-income countries [2].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
