Interrupting the intergenerational cycle of violence: protocol for a three-generational longitudinal mixed-methods study in South Africa (INTERRUPT_VIOLENCE)

Abstract IntroductionViolence is a global social and human rights issue with serious public health implications across the life-course. Interpersonal violence is transmitted across generations and there is an urgent need to understand the mechanisms of this transmission to identify and inform interventions and policies for prevention and response. 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 sub-Saharan Africa. The study has three aims: 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. Methods and analysisINTERRUPT_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 and possible future waves, the original participants (now young adults), their oldest child (aged 6+), and their former primary caregiver will be recruited. Quantitative surveys will be carried out followed by qualitative in-depth interviews with a subset of 30 survey families. Adults will provide informed consent, while children will be invited to assent following adult consent for child participation. Stringent distress and referral protocols will be in place for the study. Triangulation will be used to deepen interpretation of findings. Qualitative data will be analysed thematically, quantitative data using advanced longitudinal modelling. Ethics and disseminationEthical approval was granted by the University of Edinburgh, University of the Witwatersrand, North-West University, and the Provincial Department of Health Mpumalanga. Results will be published in peer-reviewed journals, at scientific meetings, and policy briefs. Article summaryStrengths and limitations of this studyThis is the first study on intergenerational violence transmission in a three-generational longitudinal sample in Southern AfricaIt measures not only violence against children (physical abuse, emotional abuse, sexual abuse, neglect and exposure to domestic violence), but also intimate partner violence experience and perpetration, non-partner sexual violence experience and perpetration, bullying experience and perpetration, community violence experience, witnessing and perpetration, and structural violence experience in addition to risk and protective factors on all levels of the socio-ecological modelThe study will employ a mixed-methods approach to develop the first empirically generated theoretical framework to transform our understanding of causes, effects, and prevention of violence transmission in Southern AfricaThe proposed study represents a major scientific advance in understanding the transmission and prevention of violence and will impact a critically important societal and public health challenge of our timeWhile the study involves a large eligible sample, challenges with tracing and attrition 10 years after the original data collection may reduce sample size substantially