Community activism as a strategy to reduce intimate partner violence (IPV) in rural Rwanda: Results of a community randomised trial.
Background: There is considerable interest in community organising and activism as a strategy to shift patriarchal gender norms, attitudes and beliefs and thus reduce intimate partner violence (IPV). Yet there is limited insight into how activism actually translates into reduced violence, including...
| Publicado en: | Journal of Global Health Vol. 10; no. 1; pp. 1 - 18 |
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| Autores principales: | , , , |
| Formato: | research tables/charts randomized controlled trial Journal Article |
| Publicado: |
Edinburgh University Global Health Society
2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=144276779&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 144276779 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 20472978 DBQG jtl: Journal of Global Health issn: 20472978 maglogo: N pubinfo: dt: 2020 vid: 10 iid: 1 pid: 72708 pub: Edinburgh University Global Health Society artinfo: ui: 144276779 144276779 NLM32257154 144276779 10.7189/jogh.10.010406 NLM32257154 144276779 ppf: 1 ppct: 17 formats: fmt: @attributes: type: P tig: atl: Community activism as a strategy to reduce intimate partner violence (IPV) in rural Rwanda: Results of a community randomised trial. aug: au: Chatterji, Sangeeta Stern, Erin Dunkle, Kristin Heise, Lori affil: Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA sug: subj: Rural Population Intimate Partner Violence Prevention and Control Sexual Partners Education Health Promotion Community Role Community Programs Rwanda Outcomes of Education Evaluation Human Adolescence Adult Middle Age Cross Sectional Studies Male Female Rwanda Comparative Studies Evaluation Research Questionnaires Randomized Controlled Trials Program Implementation Random Sample Qualitative Studies Life Experiences Odds Ratio Confidence Intervals Descriptive Statistics Culture Adaptation, Psychological Random Assignment Data Analysis Software Multivariate Analysis Sex Factors Socioeconomic Factors Funding Source Adolescent: 13-18 years Adult: 19-44 years Middle Aged: 45-64 years Male Female ab: Background: There is considerable interest in community organising and activism as a strategy to shift patriarchal gender norms, attitudes and beliefs and thus reduce intimate partner violence (IPV). Yet there is limited insight into how activism actually translates into reduced violence, including how aspects of programme implementation or cultural context may affect impact. This study evaluates the community activism/mobilisation portion of Indashyikirwa, a multi-component, IPV prevention programme implemented in rural Rwanda. The activism part of Indashyikirwa was based on SASA!, a promising program model from Uganda with demonstrated effectiveness.Methods: We implemented two separate cross-sectional surveys as part of a larger community randomised controlled trial to assess the impact of the community portion of Indashyikirwa on preventing physical and/or sexual IPV and other secondary outcomes at a community level. The survey consisted of a random household-based sample of 1400 women and 1400 men at both waves. Surveys were conducted before community-level activities commenced and were repeated 24 months later with a new cross-sectional sample. Longitudinal, qualitative data were collected as part of an embedded process evaluation.Results: There was no evidence of an intervention effect at a community level on any of the trial's primary or secondary outcomes, most notably women's experience of physical and/or sexual IPV from a current male partner in the past 12 months (adjusted odds ratio (aOR) = 1.25; 95% confidence interval (CI) = 0.92-1.70, P = 0.16), or men's perpetration of male-to-female physical and/or sexual IPV (aOR = 1.02; 95% CI = 0.72-1.45, P = 0.89). Process evaluation data suggest that delays due to challenges in adapting and implementing SASA!-style activites in rural Rwanda may account for the trial's failure to measure an effect. Additionally, the intervention strategy of informal activism was not well suited to the Rwandan context and required considerable modification.Conclusions: Failure to reduce violence when implementing an adaptation of SASA! in rural Rwanda highlights the importance of allowing sufficient time for adapting evidence-based programming (EBP) to ensure cultural appropriateness and fidelity. This evaluation held little chance of demonstrating impact since the project timeline forced endline evaluation only months after certain elements of the programme became operational. Donors must anticipate longer time horizons (5 to 7 years) when contemplating evaluations of novel or newly-adapted programmess for reducing IPV at a population level. These findings also reinforce the value of including embedded process evaluations when investing in rigorous trials of complex phenomena such as community activism.Trial Registration: ClinicalTrials.gov, NCT03477877. pubtype: Academic Journal doctype: research tables/charts randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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