Absence of conflict of interest.
Citation
Mert, K., & Kadioglu, H. (2016). Nursing interventions to help prevent children from working on the streets. International Nursing Review 63, 429–436. doi:10.1111/inr.12301
Highlights
- The study’s objective was to assess the impact of a program developed to prevent children under 18 years of age from working on the street.
- The study was an interrupted time series design conducted in one neighborhood in the city of Izmit, Turkey. The authors compared the outcomes for mothers and their children before, immediately after, and three months after participating in The Streets are Not the Solution program.
- The study found that participating in the program was associated with a 44 percentage point decrease from pretest to posttest in the percentage of children who worked on the streets. However, the study did not include tests of statistical significance.
- The quality of causal evidence presented in this report is low because the authors did not account for trends in outcomes before the intervention. This means we are not confident that the effects are attributable to the Streets are Not the Solution program; other factors are likely to have contributed.
Intervention Examined
The Streets are Not the Solution
Features of the Intervention
The Streets are Not the Solution is a program developed by the study authors to (1) increase interactions between children and parents, (2) develop mothers' problem solving skills, and (3) enhance the mother's social support to ultimately prevent children from working on the streets. Program sessions included group discussions, role playing, oral presentations, individual counseling, a jewelry-making class for adults, and other activities Mothers and their children attended nine educational sessions, each lasting 40 minutes. Sessions were held at the neighborhood primary school. Food and drinks were served at each session, and children and mothers received a participation certificate at the end of the program.
Features of the Study
The study was an interrupted time series design conducted in one neighborhood in the city of Izmit, in the Kocaeli province of Turkey. Children working on the street were required to register at a children and youth center. Using these records, the authors recruited 44 children and their mothers (n=40) to participate in the study. Eight mothers withdrew from the study, which resulted in 32 mothers and 36 children included in the analyses. Two types of child labor were measured—selling tissues and weighing passers-by on scales. Child labor was measured through observation, but the authors do not provide information about when and how these observations occurred. The authors compared the labor outcomes of children before, immediately after, and three months after participating in the program.
Findings
Employment/Child labor
- At baseline, 28 percent of children were always working on the street and 72 percent were working on the street from time-to-time. Immediately after the program, 17 percent of children were “always” working on the street, 39 percent were working on the street from time-to-time, and 44 percent were not working on the street.
- Three months after the program ended, 14 percent of children were always working on the street, 44 percent were working on the street from time-to-time, and 42 percent were not working on the street.
- The study authors did not include statistical tests to assess differences in child labor participation.
Considerations for Interpreting the Findings
The authors compared the outcomes of participants measured before, immediately after, and three months after they participated in the program. For these types of designs, the authors must observe outcomes for multiple periods of time before the intervention to rule out the possibility that participants had increasing or decreasing trends in the outcomes before enrollment in the program. That is, if participants who were already decreasing their participation working on the streets tended to enroll in the program, we would anticipate further decreases over time, even if they did not participate in the program. Without knowing the trends before program enrollment, we cannot rule this out. Therefore, the study receives a low causal evidence rating.
Causal Evidence Rating
The quality of causal evidence presented in this report is low because the authors did not account for trends in outcomes before the intervention. This means we are not confident that the effects are attributable to the Streets are Not the Solution program; other factors are likely to have contributed.