Educational and Skills‐Based Interventions for Preventing Relationship and Dating Violence in Adolescents and Young Adults: A Systematic Review

Relationship and dating violence is a significant problem among adolescents and young adults. Relationship violence includes a range of violent behaviours, from verbal abuse to physical and sexual assault, and from threats to rape and murder. Currently there are many programmes in schools and universities and within community settings that aim to prevent relationship violence. It is important to establish whether these programmes work and whether they result in long‐term reductions in relationship violence. This review looked at the results of 38 studies. The results showed no convincing evidence that the programmes decreased relationship violence, or that they improved participants' attitudes, behaviours and skills related to relationship violence. The results showed that participants' knowledge about relationships improved slightly following the programmes. These results should be interpreted with caution, as individual studies differed in the types of participants and interventions that they used and the ways in which changes were measured. None of the studies looked at the effect of the programmes on physical and mental health. Further studies, which follow participants for a longer period of time and which look at the relationship between attitudes, knowledge, behaviour, skills and the number of times relationship violence occurs, are required to improve our understanding of how well these programmes work. Synopsis/Abstract BACKGROUND Educational and skills‐based interventions are often used to prevent relationship and dating violence among young people. OBJECTIVES To assess the efficacy of educational and skills‐based interventions designed to prevent relationship and dating violence in adolescents and young adults. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PsycINFO, six other databases and a trials register on 7 May 2012. We handsearched the references lists of key articles and two journals (Journal of Interpersonal Violence and Child Abuse and Neglect). We also contacted researchers in the field. SELECTION CRITERIA Randomised, cluster‐randomised and quasi‐randomised studies comparing an educational or skills‐based intervention to prevent relationship or dating violence among adolescents and young adults with a control. DATA COLLECT ION AND ANALYSIS Two review authors independently assessed study eligibility and risk of bias. For each study included in the meta‐analysis, data were extracted independently by GF and one other review author (either CH, JN, SH or DS). We conducted meta‐analyses for the following outcomes: episodes of relationship violence, behaviours, attitudes, knowledge and skills. RESULTS We included 38 studies (15,903 participants) in this review, 18 of which were cluster‐randomised trials (11,995 participants) and two were quasi‐randomised trials (399 participants). We included 33 studies in the meta‐analyses. We included eight studies (3405 participants) in the meta‐analysis assessing episodes of relationship violence. There was substantial heterogeneity (I2 = 57%) for this outcome. The risk ratio was 0.77 (95% confidence interval (CI) 0.53 to 1.13). We included 22 studies (5256 participants) in the meta‐analysis assessing attitudes towards relationship violence. The standardised mean difference (SMD) was 0.06 (95% CI ‐0.01 to 0.15). We included four studies (887 participants) in the meta‐analysis assessing behaviour related to relationship violence; the SMD was ‐0.07 (95% CI ‐0.31 to 0.16). We included 10 studies (6206 participants) in the meta‐analysis assessing knowledge related to relationship violence; the results showed an increase in knowledge in favour of the intervention (SMD 0.44, 95% CI 0.28 to 0.60) but there was substantial heterogeneity (I2 = 52%). We included seven studies (1369 participants) in the meta‐analysis assessing skills related to relationship violence. The SMD was 0.03 (95% CI ‐0.11 to 0.17). None of the included studies assessed physical health, psychosocial health or adverse outcomes. Subgroup analyses showed no statistically significant differences by intervention setting or type of participants. The quality of evidence for all outcomes included in our meta‐analysis was moderate due to an unclear risk of selection and detection bias and a high risk of performance bias in most studies. AUTHORS' CONCLUSIONS Studies included in this review showed no evidence of effectiveness of interventions on episodes of relationship violence or on attitudes, behaviours and skills related to relationship violence. We found a small increase in knowledge but there was evidence of substantial heterogeneity among studies. Further studies with longer‐term follow‐up are required, and study authors should use standardised and validated measurement instruments to maximise comparability of results. Plain language summary INTERVENTIONS TO PREVENT RELATIONSHIP AND DATING VIOLENCE IN ADOLESCENTS AND YOUNG PEOPLE Relationship and dating violence is a significant problem among adolescents and young adults. Relationship violence includes a range of violent behaviours, from verbal abuse to physical and sexual assault, and from threats to rape and murder. Currently there are many programmes in schools and universities and within community settings that aim to prevent relationship violence. It is important to establish whether these programmes work and whether they result in long‐term reductions in relationship violence. This review looked at the results of 38 studies. The results showed no convincing evidence that the programmes decreased relationship violence, or that they improved participants' attitudes, behaviours and skills related to relationship violence. The results showed that participants' knowledge about relationships improved slightly following the programmes. These results should be interpreted with caution, as individual studies differed in the types of participants and interventions that they used and the ways in which changes were measured. None of the studies looked at the effect of the programmes on physical and mental health. Further studies, which follow participants for a longer period of time and which look at the relationship between attitudes, knowledge, behaviour, skills and the number of times relationship violence occurs, are required to improve our understanding of how well these programmes work.