Impact of the Change Starts at Home Trial on Women's experience of intimate partner violence in Nepal

Cari Jo Clark, Binita Shrestha, Gemma Ferguson, Prabin Nanicha Shrestha, Collin Calvert, Jhumka Gupta, Brian Batayeh, Irina Bergenfeld, J Michael Oakes, Cari Jo Clark, Binita Shrestha, Gemma Ferguson, Prabin Nanicha Shrestha, Collin Calvert, Jhumka Gupta, Brian Batayeh, Irina Bergenfeld, J Michael Oakes

Abstract

Intimate partner violence (IPV) affects 1 in 3 women worldwide. Research in low- and middle-income countries suggests that multicomponent interventions incorporating media, group work, and community mobilization may be effective at changing social norms that enable such violence. Our study aimed to evaluate the impact of a radio programme plus community engagement versus radio programming alone on the 12-month prevalence of IPV. Using a cluster randomized, repeat cross-sectional, single-blinded approach, thirty-six village communities were pair-matched within three districts in Nepal and randomly assigned to either control or intervention. Both groups were exposed to social behaviour change communication through radio programming. In addition, weekly listening and discussion groups (LDGs) were formed in intervention communities to meet and discuss radio programming over the 40-week intervention period. Participants were also exposed to other community mobilization activities such as street theatre and messaging from local leaders who were engaged in intervention programming. IPV was measured at baseline, 12 months post-baseline at program conclusion, and 28 months post-baseline using a simple random sample of 40 married women per cluster (n = approximately 1440 at each time point) along with 382 women who participated in the LDGs. Although control and intervention groups were demographically similar, baseline rates of IPV were higher in control areas. The trend in IPV for both groups was nonlinear, largely declining at midline (control condition) and rising again at endline (control and intervention conditions), possibly reflecting greater reporting due to awareness-raising activities. Significant differences between the two groups were largely absent at endline. Higher LDG attendance was associated with decreases in several forms of IPV, some of which persisted to endline. These findings suggest that intensive community engagement over longer timespans or social network measurement may be necessary to detect significant changes at the community level (NCT02942433).

Keywords: Domestic violence; Intimate partner violence; Prevention; Randomized trial.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

© 2019 The Authors.

Figures

Fig. 1
Fig. 1
Research design.
Fig. 2
Fig. 2
Change starts at home flow diagram.
Fig. 3a
Fig. 3a
Cluster level Primary and Secondary violence Outcomes by Time and Condition (N = 36).
Fig. 3b
Fig. 3b
Cluster level Other Secondary Outcomes by Time and Condition (N = 36).

References

    1. Abramsky T., Devries K., Kiss L., Nakuti J., Kyegombe N., Starmann E. Findings from the SASA! Study: A cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduce HIV risk in kampala, Uganda. BMC Medicine. 2014;12:122.
    1. Abramsky T., Devries K.M., Michau L., Nakuti J., Musuya T., Kiss L. Ecological pathways to prevention: How does the SASA! community mobilisation model work to prevent physical intimate partner violence against women? BMC Public Health. 2016;16:339.
    1. Abramsky T., Devries K.M., Michau L., Nakuti J., Musuya T., Kyegombe N. The impact of SASA!, a community mobilisation intervention, on women's experiences of intimate partner violence: Secondary findings from a cluster randomised trial in kampala, Uganda. Journal of Epidemiology & Community Health. 2016;70(8):818–825.
    1. Alkire S. University of Oxford; Oxford: 2008. Concepts and meausres of agency. Oxford poverty and human development initiative working paper 9.
    1. Atteraya M.S., Gnawali S., Song I.H. Factors associated with intimate partner violence against married women in Nepal. Journal of Interpersonal Violence. 2015;30(7):1226–1246.
    1. C-Change . C‐Change/FHI 360; Washington, DC: 2012. (C-modules: A learning package for social and behavior change communication (SBCC)).
    1. Chatterji S., Stern E., Dunkle K., Heise L. 2019. Community activism as a strategy to reduce intimate partner violence (IPV) in rural Rwanda: Results of a community randomised trial. (in press)
    1. Christofides N., Hatcher A.E., Rebombo, McBride B., Munshi, Pino L.G. 2019. Effectiveness of a multi-level intervention to reduce men's perpetration of intimate partner violence: A cluster randomised controlled trial. (in press)
    1. Cislaghi B., Denny E.K., Cisse M., Gueye P., Shrestha B., Shrestha P.N. Changing social norms: The importance of “organized diffusion” for scaling up community health promotion and women empowerment interventions. Prevention Science. 2019 Aug;20(6):936–946.
    1. Clark C.J., Cheong Y.F., Gupta J., Ferguson G., Shrestha B., Shrestha P.N. Intimate partner violence in Nepal: Latent patterns and associations with depressive symptoms. SSM-Population Health. 2019 Dec 9:100481.
    1. Clark C.J., Ferguson G., Shrestha B., Shrestha P.N., Batayeh B., Bergenfeld I. Mixed methods assessment of women's risk of intimate partner violence in Nepal. BMC Women's Health. 2019;19(1):20.
    1. Clark C.J., Spencer R.A., Shrestha B., Ferguson G., Oakes J.M., Gupta J. Evaluating a multicomponent social behaviour change communication strategy to reduce intimate partner violence among married couples: Study protocol for a cluster randomized trial in Nepal. BMC Public Health. 2017;17(1):75.
    1. Creswell J.W., Fetters M.D., Plano Clark V.L., Morales A. Mixed methods intervention trials. Mixed methods research for nursing and the health sciences. 2009:161–180.
    1. Devries K.M., Mak J.Y., Garcia-Moreno C., Petzold M., Child J.C., Falder G. Global health. The global prevalence of intimate partner violence against women. Science. 2013;340(6140):1527–1528.
    1. Doyle K., Levtov R.G., Barker G., Bastian G.G., Bingenheimer J.B., Kazimbaya S. Gender-transformative Bandebereho couples' intervention to promote male engagement in reproductive and maternal health and violence prevention in Rwanda: Findings from a randomized controlled trial. PLoS One. 2018;13(4)
    1. Ellsberg M., Arango D.J., Morton M., Gennari F., Kiplesund S., Contreras M. Prevention of violence against women and girls: What does the evidence say? Lancet. 2015;385(9977):1555–1566.
    1. Enders C.K. The Guilford Press; New York: 2010. Applied missing data analysis.
    1. Ernst F.A. Speaking of health: Assessing health communication, strategies for diverse populations. Journal of the National Medical Association. 2005;97(6):846.
    1. Fulu E., Warner X., Miedema S., Liou C. UNDP. UNFPA, UN Women and UNV; Bangkok: 2013. Toolkit for replicating the UN multi-country study on men and violence: Understanding why some men use violence against women and how we can prevent it.
    1. García-Moreno C., Jansen H.A., Ellsberg M., Heise L., Watts C. World Health Organization; 2005. WHO multi-country study on women's health and domestic violence against women: Initial results on prevalence, health outcomes and women's responses.
    1. Hannan P.J. Experimental social epidemiology-controlled community trials. In: Oakes J.M., Kaufman J.S., editors. Methods in social epidemiology. Jossey-Bass; San Francisco, CA: 2006. pp. 341–369.
    1. Heise L.L. STRIVE Research Consortium, London School of Hygiene and Tropical Medicine; London, UK: 2011. What works to prevent partner violence? An evidence overview. (p. xvii+108 pp.)
    1. Hellen Keller International, USAID . 2015. Suaahara good nutrition project II. (not stated)
    1. Jewkes R., Nduna M., Levin J., Jama N., Dunkle K., Puren A. Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: Cluster randomised controlled trial. BMJ. 2008;337:a506.
    1. Karpowitz C.F., Mendelberg T. Princeton University Press; Princeton, New Jersey: 2014. The silent sex: Gender, deliberation, and institutions.
    1. Kim J.C., Watts C.H., Hargreaves J.R., Ndhlovu L.X., Phetla G., Morison L.A. Understanding the impact of a microfinance-based intervention on women's empowerment and the reduction of intimate partner violence in South Africa. American Journal of Public Health. 2007;97(10):1794–1802.
    1. McGhee S., Shrestha B., Ferguson G., Shrestha P.N., Bergenfeld I., Clark C.J. J Interpers Violence. 2019 Mar 28 886260519839422. [Epub ahead of print]PMID: 30917734.
    1. Ogum-Alangea D., Addo-Lartey A., Chirwa E.D., Sikweyiya Y., Coker-Appiah D., Jewkes R. 2019. The rural response system to reduce intimate partner violence in the central region of Ghana: Findings from a cluster-randomized trial. (in press)
    1. Paluck E., Ball L. International Rescue Committee; New York: 2010. Social norms marketing aimed at gender based violence: A literature review and critical assessment.
    1. Pulerwitz J., Barker G. Measuring attitudes toward gender norms among young men in Brazil: Development and psychometric evaluation of the GEM scale. Men and Masculinities. 2008;10(3)
    1. Pulerwitz J., Barker G., Segundo M., Nascimento M. Population Council; Washington, DC: 2006. Promoting gender equity among young Brazilian men ad an HIV prevention strategy.
    1. Silliman J. In: Communications and technology for violence prevention: Workshop summary. Blakeslee K.M., Patel D.M., Simon M.A., editors. The National Academies Press; Washington, DC: 2012.
    1. United Nations . Voices Project; Impact Assessment: 2010. Trust fund support of actions to eliminate violence against women, & women. U. N. D. F. f.
    1. Usdin S., Scheepers E., Goldstein S., Japhet G. Achieving social change on gender-based violence: A report on the impact evaluation of soul city's fourth series. Social Science & Medicine. 2005;61(11):2434–2445.
    1. Wagman J.A., Gray R.H., Campbell J.C., Thoma M., Ndyanabo A., Ssekasanvu J. Effectiveness of an integrated intimate partner violence and HIV prevention intervention in Rakai, Uganda: Analysis of an intervention in an existing cluster randomised cohort. Lancet Glob Health. 2015;3(1):e23–33.
    1. What Works to Prevent Violence Against Women and Girls Programme . UKaid; 2019. What works to prevention violence: A global programme to prevent violence aginast women and Girls.
    1. What Works to Prevent Violence Global Program . 2015. Standard outcomes for assessment of intimate partner violence.
    1. World Health Organization . World Health Organization; Geneva: 2005. WHO multi-country study on women's health and domestic violence against women: Summary report of initial results onprevalence, health outcomes and women's responses.
    1. World Health Organization . 2007. Engaging men and boys in changing gender-based inequity in health: Evidence from programme interventions. (Geneva)
    1. World Health Organization . World Health Organization; Geneva: 2016. Ethical and safety recommendation for intervention research on violence against women: Building on lessons from the WHO publication Putting women first: Ethical and safety recommendations for resaerch on domestic violence against women.
    1. Yoshikawa K., Shakya T.M., Poudel K.C., Jimba M. Acceptance of wife beating and its association with physical violence towards women in Nepal: A cross-sectional study using couple's data. PLoS One. 2014;9(4)

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다