Home > Characteristics of public health approaches for youth violence prevention.

Walsh, Colm and Razey, Kelly and Scott, David and Sheehan, Katie and Farrington, Christopher and Hazelden, Claire and Anderson, Phil and Caldwell, Frances (2023) Characteristics of public health approaches for youth violence prevention. Belfast: Queen's University Belfast.

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Violence is a significant concern that disproportionally affects young people and that contributes to a range of individual and community-level harms. Decades of evidence has shown that prevalence and impact are complex and multifaceted. Both are associated with a range of negative outcomes impacting greatly on public health. Since the 1980’s there have been increasing calls for a science-based approach that recognises the complexity, but also that demonstrates the promise of prevention. Public health for violence prevention (PH-VP) has emerged as a leading paradigm and one that has both conceptually and operationally helped to facilitate community coalitions around a common goal. Despite this increasing interest, few studies have sought to capture the central characteristics of such an approach, thus inhibiting its wider application and refinement. 

Understanding potential variation in how PH-VP is conceptualised and how it is applied is important for prevention. Thus, the primary aim of the current study is to synthesise the evidence around the characteristics of PH-VP in real-world settings. From a total of 754 sources identified, 101 sources were retrieved for full appraisal. After a further 41 were excluded on the basis that there were either the wrong population or the wrong focus a total of 60 sources were included in the current review (see fig. 2). Following analysis, a number of overarching themes emerged as key chrematistics of PH-VP. These included: priorities; principles, polices, practices and programmes-summarised here as ‘the five P’s of public health for violence prevention (PH-VP)’. 

The review found that across the literature, public health for violence prevention publications appear to have remained fairly dogmatic since the 1980’s, providing few opportunities to critically engage with the structure, content and impact, and thus tempering opportunities to enhance them further. Despite a number of descriptive overviews, for the most part, the implementation factors that have been implicated in increasing the feasibility and acceptability of evidence supported responses, such as ‘adaptability’ (the ability of the new organisation to be understand the various levels of change needed in order to successfully replicate the chosen programme), and ‘compatibility’ (the contextual appropriateness of the host agency selecting a particular programme to address a well-defined problem) are largely missing from the literature. 

Evidence from this review also found that communities often struggle to understand how a package of evidence-based programs can fit together to create a strategic, sustainable, evidence-based comprehensive approach. They are challenged with: collecting and using data to make decisions about programme selection and impact; achieving consensus on the prioritized problems and the solutions; how to implement the programs with fidelity; how to create environments for evidence based programmes to survive; and, when this approach involves multiple sectors and agencies (e.g., community, academia, justice, health, education), who has the authority and responsibility for ensuring its success. As evidence has advanced, this combined literature included as part of this review suggests that there is likely to be a need to be more specific and conscious with regard to the approach to implementation and that the dogmatically accepted four-step sequential process model does not sufficiently capture the complexity of prevention responses. While comparisons have been made between disease containment and violence prevention, one stark difference is that violence does not have an easily identified ‘patient zero’. Rather than an index case the proximal antecedents of any incident of violence is likely to be significantly more complicated with multiple and interacting factors not as easily understood with reference to the public health fourstep model. Despite the current consensus, and some degree of excitement, an implementation perspective is required, and that with further reflection, the true utility of these approaches may become more apparent.

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