Development and validation of an intervention for childhood trauma and exposure to violence in Vhembe District, South Africa
PMCID: PMC10978521
PMID:
Abstract
Most strategies are implemented; however, South Africa needs to evaluate and develop trauma interventions. The study aims to develop, test and validate childhood trauma exposure intervention in the Vhembe district, Limpopo province. Donabedian's structure-process-outcome model will guide the study. The study will employ multiphase mixed methods with five phases. Phase 1 will be a thorough systematic evaluation of literature on childhood trauma and exposure to violence interventions to describe existing interventions. Phase 2, stage 1: Will explore the experiences of children exposed to trauma and violence regarding their experiences of the treatment they received, using semi-structured qualitative interviews. Non-probability purposeful sampling techniques will be used to select participants. The Thoyondou Victim Empowerment's database will select participants. The researchers will conduct semi-structured and unstructured interviews with youngsters exposed to violence and trauma. Stage 2 will be a qualitative study of trauma centre managers and personnel sampled from the contact record. IPA will analyze data. Phase 3 will conceptualize Phase 1 and the empirical phase into Donabedian's SPO framework for Phase 4. Phase 4 develops the intervention using Phase 3′s conceptual framework and tests and validates it. Graphical abstract Image, graphical abstract
Full Text
The SPO model recommends that healthcare quality concerning trauma be evaluated using the following: the structure will refer to (characteristics of the healthcare facility setting), the process (clinical processes performed in the healthcare facility setting), and outcome (ultimate status of the patient following trauma-informed care interventions). According to this model, improvements in the structure of care in TVEP facilities will improve clinical processes and patient outcomes. Donabedian structure process model is the more flexible framework to be applied in this study. It will serve as a framework to analyse the underlying mechanisms contributing to trauma management [1].
Child: According to South African law, a child means a person under the age of 18 years [2]. For this research study, a child is a person aged 6–17 years.
Trauma: According to the APA, trauma is defined as any distressing experience, such as rape, war and or witnessing a murder, that brings about significant fear, confusion, and disruptive feeling intense enough to have a long-lasting negative effect. These negative effects range from negative behaviour and attitudes and affect other aspects of an individual [3]. In this research study, trauma will be conceptualized as a significant event that transpired to a child or witnessed by a child and has caused significant emotional distress and mental effects resulting in fear, helplessness, behavioural problems and emotional dysregulation.
Violence: Violence is an act, whether direct or indirect, used to injure or abuse a person, group or community [4]. In this study, violence will be conceptualized as an act that is intended to cause harm to a child or a community to which a child belongs.
The study design of stage 1 will be qualitative exploratory, descriptive methods. According to Stebbins [5], exploratory research aims to provide insights into and an understanding of the problem identified by the researcher. Previous studies suggest that descriptive research, on the other hand, aims at describing something, mainly functions and characteristics [6]. Qualitative research focuses on obtaining relevant, comprehensive and specific information about a phenomenon in a natural environment [7].
Non-probability purposive sampling will be used to select children who have been exposed to domestic violence and childhood trauma aged between 9 and 17 years. A homogeneous sample from the TVEP centre will hold some relevance and personal significance to respondents and enable researchers to capture details on a specific group of participants who have experienced a particular phenomenon. Data saturation will determine the sample size for the study phase. Data saturation refers to the point in a research study where researchers have gathered sufficient information, such that any more data collected does not yield new insights or knowledge [8].
Interpretative phenomenological analysis (IPA) will be used for data analysis in this phase. IPA is chosen as a method of data analysis because, according to Noon and Hallam, analysis for IPA goes beyond thematic analysis, furthermore, it is multidirectional and allows the researcher to adapt it following the objectives [9].
This study will sample all the trauma centre's employees, managers, and health care providers (clinical psychologists, registered trauma counsellors), both in the public and private sectors. The sample size will be determined by data saturation. Data saturation refers to the point in a research study where researchers have gathered sufficient information, such that any more data collected does not yield new insights or knowledge [8].
In this phase, the researcher will conceptualize the findings for phases 1 and 2 into the Structure-Process -Outcome (SPO) model. The structure will be characteristics of the healthcare facility setting, the process will be clinical processes performed in the healthcare facility setting, and the outcome will be the ultimate status of the patient following trauma-informed care interventions. See Fig. 1.
The Donabedian structure process model [1].
In this phase, the researchers will use the conceptualized findings in phase 3 to develop and test the intervention. To achieve that, the researchers will follow Wight et al.’s six steps to develop an intervention [10]. The first step is defining and understanding the problem and its causes [10]. This study will conduct individual interviews to understand the problems and their causes. The second step is identifying modifiable causal or contextual factors with the greatest scope for change and who would benefit most. In this study, the researchers will identify modifiable causes or contextual factors, such as techniques and activities. The third step is deciding on the mechanisms of change. Thus, the information acquired from the interview sessions will decide the mechanisms of change. The fourth step is clarifying how these will be delivered. This study will deliver the mechanisms for change through a hard copy as an intervention for change. The fifth step is testing and adapting the intervention. In this study, the last step is for the researcher to collect sufficient evidence of effectiveness to ensure the rigorous evaluation/implementation of the trauma intervention collecting sufficient evidence of effectiveness to proceed to a rigorous evaluation. To ensure the intervention's rigour, the following steps will be taken to ensure usability and adaptability. In this study Fig. 2 below is summarizing the overall research strategy that will be followed in this study.
The researcher will treat all the private information collected about the participants as highly confidential. The collected data, audio recordings, and field notes will be stored in a locked room with good ventilation [[10], [11]]. The principal researcher, supervisor and co-supervisor will be the only people accessing the collected data. Should the researcher involve facilitators, discussion and signing confidentiality and privacy forms will be made available to them to ensure that they are aware of the obligation of not discussing the content or identifying particulars of the participants.
This principle emphasizes that all the participants must be treated as human beings to respect their human dignity. These principles will ensure that the researcher and participants respect the right to human dignity, the right to full disclosure, and the right to self-determination [12].
Sections
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It will serve as a framework to analyse the underlying mechanisms contributing to trauma management [1].\"}, {\"pmc\": \"PMC10978521\", \"pmid\": \"\", \"reference_ids\": [\"bib0002\"], \"section\": \"Definition of concepts\", \"text\": \"Child: According to South African law, a child means a person under the age of 18 years [2]. For this research study, a child is a person aged 6\\u201317 years.\"}, {\"pmc\": \"PMC10978521\", \"pmid\": \"\", \"reference_ids\": [\"bib0003\"], \"section\": \"Definition of concepts\", \"text\": \"Trauma: According to the APA, trauma is defined as any distressing experience, such as rape, war and or witnessing a murder, that brings about significant fear, confusion, and disruptive feeling intense enough to have a long-lasting negative effect. These negative effects range from negative behaviour and attitudes and affect other aspects of an individual [3]. 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According to Stebbins [5], exploratory research aims to provide insights into and an understanding of the problem identified by the researcher. Previous studies suggest that descriptive research, on the other hand, aims at describing something, mainly functions and characteristics [6]. Qualitative research focuses on obtaining relevant, comprehensive and specific information about a phenomenon in a natural environment [7].\"}, {\"pmc\": \"PMC10978521\", \"pmid\": \"\", \"reference_ids\": [\"bib0008\"], \"section\": \"Sample and sampling\", \"text\": \"Non-probability purposive sampling will be used to select children who have been exposed to domestic violence and childhood trauma aged between 9 and 17 years. A homogeneous sample from the TVEP centre will hold some relevance and personal significance to respondents and enable researchers to capture details on a specific group of participants who have experienced a particular phenomenon. Data saturation will determine the sample size for the study phase. Data saturation refers to the point in a research study where researchers have gathered sufficient information, such that any more data collected does not yield new insights or knowledge [8].\"}, {\"pmc\": \"PMC10978521\", \"pmid\": \"\", \"reference_ids\": [\"bib0009\"], \"section\": \"Data analysis\", \"text\": \"Interpretative phenomenological analysis (IPA) will be used for data analysis in this phase. IPA is chosen as a method of data analysis because, according to Noon and Hallam, analysis for IPA goes beyond thematic analysis, furthermore, it is multidirectional and allows the researcher to adapt it following the objectives [9].\"}, {\"pmc\": \"PMC10978521\", \"pmid\": \"\", \"reference_ids\": [\"bib0008\"], \"section\": \"Sample and sampling\", \"text\": \"This study will sample all the trauma centre's employees, managers, and health care providers (clinical psychologists, registered trauma counsellors), both in the public and private sectors. The sample size will be determined by data saturation. Data saturation refers to the point in a research study where researchers have gathered sufficient information, such that any more data collected does not yield new insights or knowledge [8].\"}, {\"pmc\": \"PMC10978521\", \"pmid\": \"\", \"reference_ids\": [\"fig0001\"], \"section\": \"Phase 3 conceptualization of phase 1 and 2 findings into a conceptual framework\", \"text\": \"In this phase, the researcher will conceptualize the findings for phases 1 and 2 into the Structure-Process -Outcome (SPO) model. The structure will be characteristics of the healthcare facility setting, the process will be clinical processes performed in the healthcare facility setting, and the outcome will be the ultimate status of the patient following trauma-informed care interventions. See Fig. 1.\"}, {\"pmc\": \"PMC10978521\", \"pmid\": \"\", \"reference_ids\": [\"bib0001\"], \"section\": \"\", \"text\": \"The Donabedian structure process model [1].\"}, {\"pmc\": \"PMC10978521\", \"pmid\": \"\", \"reference_ids\": [\"bib0010\", \"bib0010\", \"fig0002\"], \"section\": \"Design\", \"text\": \"In this phase, the researchers will use the conceptualized findings in phase 3 to develop and test the intervention. To achieve that, the researchers will follow Wight et al.\\u2019s six steps to develop an intervention [10]. The first step is defining and understanding the problem and its causes [10]. This study will conduct individual interviews to understand the problems and their causes. The second step is identifying modifiable causal or contextual factors with the greatest scope for change and who would benefit most. In this study, the researchers will identify modifiable causes or contextual factors, such as techniques and activities. The third step is deciding on the mechanisms of change. Thus, the information acquired from the interview sessions will decide the mechanisms of change. The fourth step is clarifying how these will be delivered. This study will deliver the mechanisms for change through a hard copy as an intervention for change. The fifth step is testing and adapting the intervention. In this study, the last step is for the researcher to collect sufficient evidence of effectiveness to ensure the rigorous evaluation/implementation of the trauma intervention collecting sufficient evidence of effectiveness to proceed to a rigorous evaluation. To ensure the intervention's rigour, the following steps will be taken to ensure usability and adaptability. In this study Fig. 2 below is summarizing the overall research strategy that will be followed in this study.\"}, {\"pmc\": \"PMC10978521\", \"pmid\": \"\", \"reference_ids\": [\"bib0010\", \"bib0011\"], \"section\": \"Confidentiality privacy\", \"text\": \"The researcher will treat all the private information collected about the participants as highly confidential. The collected data, audio recordings, and field notes will be stored in a locked room with good ventilation [[10], [11]]. The principal researcher, supervisor and co-supervisor will be the only people accessing the collected data. Should the researcher involve facilitators, discussion and signing confidentiality and privacy forms will be made available to them to ensure that they are aware of the obligation of not discussing the content or identifying particulars of the participants.\"}, {\"pmc\": \"PMC10978521\", \"pmid\": \"\", \"reference_ids\": [\"bib0012\"], \"section\": \"Respect for human dignity\", \"text\": \"This principle emphasizes that all the participants must be treated as human beings to respect their human dignity. These principles will ensure that the researcher and participants respect the right to human dignity, the right to full disclosure, and the right to self-determination [12].\"}]"
Metadata
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