Why, how and in what circumstances do school-based gender-based violence interventions work in LMICs? A realist review.

BACKGROUND: Gender-based violence (GBV), a human rights violation, disproportionately affects women and girls in low- and middle-income countries (LMICs). School settings are important platforms for GBV prevention interventions. OBJECTIVE: This paper employs realist synthesis to understand the mechanisms underlying how and why school-based interventions in LMICs generate GBV-related outcomes. METHODS: Database searches yielded 6235 papers - 31 were included, describing 28 different interventions, mostly multilevel and mixed-sex interventions. Grounded theory was used to analyse important contexts, mechanisms, outcomes, and to create explanatory configurations. RESULTS: The predominant contexts are fixed patriarchal sociocultural norms condoning violence, resource availability, and organisational partnerships. Mechanisms, the underpinning forces of the interventions that lead to outcomes, are interdependent and commonly involve knowledgeable facilitators, safe spaces, and enhancing individuals' "power to" and "power within". Changes in GBV knowledge and attitudes are the most frequently reported outcomes. Whilst knowledgeable facilitators are the main vehicle to triggering other enabling mechanisms, the context in terms of sociocultural norms, resource availability, and organisational support needs to be assessed for its capacity to trigger other mechanisms that enable intervention goals. The facilitator mechanism can then trigger individual-level "power to" or "power within" mechanisms; however, these alone are insufficient to improve outcomes. CONCLUSIONS: Multilevel, mixed-sex interventions with increased access to and distribution of resources are important for improving GBV outcomes, particularly those with family and community involvement.