RCT of the Effectiveness of the WfWI Intervention in Afghanistan

Individually Randomised Control Trial Evaluation of the Effectiveness of the Women for Women International (WfWI) Intervention in Afghanistan for Intimate Partner Violence Prevention Among Married Women

This is an individually randomised control trial to assess the effectiveness of a livelihoods and social empowerment intervention, delivered by Women for Women International, on married women's experiences of intimate partner violence in Afghanistan. It has a 22 month follow up.

Study Overview

• Status: Unknown
• Conditions: Depressive Symptoms; Domestic Violence; Livelihoods
• Intervention / Treatment: Behavioral: Women for Women International Intervention

• Study Type: Interventional
• Enrollment (Actual): 1461
• Phase: Phase 3

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 45 years (Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Women should be in the lowest economic level (earning less than US$1.25/day)
• Unemployed
• No in education/school
• Not involved in a similar programme
• Able to provide informed consent

Exclusion Criteria:

• Not mentally incapacitated, so as unable to provide informed consent
• Already been part of the WfWI intervention previously

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control
Experimental: WfWI Intervention; Women receive the WfWI intervention. This comprises of three main components. First, a social empowerment and health intervention. Second a livelihood strengthening intervention, including numeracy training, and vocational training. Third, a cash transfer conditional on attendance at the intervention to cover costs of attendance and provide start-up capital. The intervention is delivered over 12 months.	Behavioral: Women for Women International Intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Any past year physical intimate partner violence experienced amongst currently married women	Physical intimate partner violence is assessed using five items based on the WHO VAW scale. A positive response to any item leads to a person being classified as experiencing in the past year.	22 months post baseline
Past year severe physical intimate partner violence experience amongst currently married women	Severe physical intimate partner violence experience is assessed using 5 items. Past year severe physical IPV is assessed as positive if a person responds to two (or more) items as once, or one item as few (or more), essentially creating a more than once categorization.	22 months post baseline
Depressive symptomology	Past week depressive symptomology is assessed by the Centre for Epidemiological Studies Depression (CESD) scale, with the full twenty items. A mean score will be calculated.	22 months post baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Household food insecurity in past four weeks	Three items ask about household level food insecurity in the past 4 weeks. A mean score is calculated.	22 months post baseline
Financial shock resilience	One item assesses ability to mobilise cash in an emergency.	22 months post baseline
Monthly earnings	A single item assesses women's past month earnings	22 months post baseline
Total savings	A single item assesses women's total savings	22 months post baseline
Life satisfaction	Life satisfaction is assessed using four-items derived from the Satisfaction With Life Scale. A mean score is produced.	22 months post baseline
Suicidal ideation in past 4 weeks	A single item assesses thoughts about suicide in past week.	22 months post baseline
Gender attitudes	11 questions assess women's gender attitudes. A mean score is created.	22 months post baseline
Married women's participation in household decision-making	Five items are asked about women's ability to participate in household decisions. A mean score is created.	22 months post baseline
Any emotional abuse in the past year amongst currently married women	Seven items assess emotional abuse in the past year. A mean score is calculated.	22 months post baseline
Perceptions of husband cruelty amongst currently married women	Five items ask about married women's perceptions of her husband and his attitudes and relationship towards her. A mean score is created	22 months post baseline
Mother-in-law or abuse in the past 12 months amongst currently married women	A single item assesses whether mother-in-laws have hit the woman in the past 12 months and another item assesses whether siblings have hit the woman in the past 12 months, an affirmative response to either item would indicate abuse.	22 months post baseline
Perceptions of mother-in-law cruelty amongst currently married women	For married women, six items ask about their relationship and the mother-in-laws attitudes towards her	22 months post baseline

Collaborators and Investigators

• Sponsor: Medical Research Council, South Africa
• Collaborators: Women for Women International (WfWI)
• Investigators: Principal Investigator: Rachel Jewkes, PhD, Director Gender and Health Research Unit

Publications and helpful links

General Publications

• Gibbs A, Corboz J, Chirwa E, Mann C, Karim F, Shafiq M, Mecagni A, Maxwell-Jones C, Noble E, Jewkes R. The impacts of combined social and economic empowerment training on intimate partner violence, depression, gender norms and livelihoods among women: an individually randomised controlled trial and qualitative study in Afghanistan. BMJ Glob Health. 2020 Mar 16;5(3):e001946. doi: 10.1136/bmjgh-2019-001946. eCollection 2020.
• Gibbs A, Said N, Corboz J, Jewkes R. Factors associated with 'honour killing' in Afghanistan and the occupied Palestinian Territories: Two cross-sectional studies. PLoS One. 2019 Aug 8;14(8):e0219125. doi: 10.1371/journal.pone.0219125. eCollection 2019.
• Gibbs A, Corboz J, Jewkes R. Factors associated with recent intimate partner violence experience amongst currently married women in Afghanistan and health impacts of IPV: a cross sectional study. BMC Public Health. 2018 May 3;18(1):593. doi: 10.1186/s12889-018-5507-5.
• Gibbs A, Corboz J, Shafiq M, Marofi F, Mecagni A, Mann C, Karim F, Chirwa E, Maxwell-Jones C, Jewkes R. An individually randomized controlled trial to determine the effectiveness of the Women for Women International Programme in reducing intimate partner violence and strengthening livelihoods amongst women in Afghanistan: trial design, methods and baseline findings. BMC Public Health. 2018 Jan 22;18(1):164. doi: 10.1186/s12889-018-5029-1.

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2016
• Primary Completion (Anticipated): November 1, 2018
• Study Completion (Anticipated): November 1, 2018

Study Registration Dates

• First Submitted: July 28, 2017
• First Submitted That Met QC Criteria: July 28, 2017
• First Posted (Actual): August 2, 2017

Study Record Updates

• Last Update Posted (Actual): August 2, 2017
• Last Update Submitted That Met QC Criteria: July 28, 2017
• Last Verified: July 1, 2017

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavioral Symptoms; Depression
• Other Study ID Numbers: EC034-11-2015

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No