Re-orientating systematic reviews to rigorously examine what works, for whom and how: example of a realist systematic review of school-based prevention of dating and gender violence
Conventional systematic reviews offer few insights into for whom and how interventions work. 'Realist reviews' examine such questions but are insufficiently rigorous in how evidence is identified, assessed and synthesised. We developed ‘realist systematic reviews’, addressing similar questions to realist reviews but using rigorous methods. We applied this to synthesising evidence on school-based prevention of dating and relationship violence (DRV) and gender-based violence (GBV). This paper reflects on overall methods and findings. We identified three initial mechanisms via which these interventions might work: ‘school-transformation’ (preventing violence by changing school environments); ‘basic-safety’ (stopping violence by emphasising its unacceptability) or ‘positive-development’ (developing students’ broader skills and relationships). We used various innovative analyses to test and augment these hypothesised mechanisms. Overall, interventions were effective in reducing long-term DRV but not GBV or short-term DRV. DRV prevention occurred most effectively via the ‘basic-safety’ mechanism. ‘School-transformation’ mechanisms were more effective in preventing GBV but only in high-income countries. Our method provided novel insights and should be useful to policy-makers seeking the best interventions for their contexts and the most information to inform implementation.
Chris Bonell, LSHTM
Chris Bonell is Professor of Public Health & Sociology in PHES/PHP. His main areas of interest are evaluation and evidence synthesis, adolescent health, and sexual health. He has previously worked at UCL, Oxford University and the Social Exclusion Unit. With colleagues he has developed various methods for building on realist methods in evaluation and evidence synthesis while still employing randomised trial and systematic review designs
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