A systematic review and equity analysis of school-based violence prevention interventions evaluated in randomised controlled trials

BACKGROUND: Experiencing violence in school is a violation of a child’s rights and can increase school absence, affect academic achievement, employment prospects, and later-life health. Effective school-based violence prevention interventions are crucial, however, most are universally targeted. It is less clear if current interventions to prevent violence in schools ensure subgroups of children benefit equitably. METHODS: We conducted a systematic review. We drew on professional networks and searched Medline, Cochrane Library, Embase, Global Health, PsycINFO, and Web of Science to identify systematic reviews (n = 29) which included randomised controlled trials (RCTs) of school-based violence prevention interventions. Reviews conducted searches until December 2023. We screened all included articles within the final review sample to identify all RCTs of universal school-based violence prevention interventions. We examined what sociodemographic characteristics were measured, assessed intervention effectiveness by subgroups, and applied criteria to assess equity. RESULTS: Out of 160 articles of RCTs evaluating violence prevention interventions in schools, we identified 19 articles reporting on 16 trials that reported effects by the following subgroups: sex (n = 16), disability (n = 1), sexuality (n = 1), race/ethnicity (n = 1) and socioeconomic status (n = 1). Subgroup and moderation analysis found mixed results of intervention effectiveness by subgroups, with some evidence of heterogeneity. CONCLUSIONS: Most trials of school-based violence prevention interventions do not report whether they are effective for subgroups of minoritised children, or children at higher risk of experiencing violence, and therefore may not contribute to advancing health equity. Ensuring a commitment to equity in the design, delivery, and impact of school-based violence prevention is essential to achieving the Sustainable Development Goals. REVIEW REGISTRATION: PROSPERO: CRD42023463384.