Social norms increasingly are the focus of intimate partner violence (IPV) prevention strategies but are among the least examined contextual factors in quantitative violence research. This study assesses the within-community, between-community, and contextual effect of a new measure of social norms (PVNS: Partner Violence Norms Scale) on women's risk of IPV. Data come from baseline surveys collected from 1435 female, married, reproductive-age participants, residing in 72 wards in three districts (Chitwan, Kapilvastu, Nawalparasi) in Nepal who were enrolled in a cluster randomized trial testing the impact of a social behavioral change communication intervention designed to prevent IPV. Results of unconditional multilevel logistic regression models indicated that there was cluster-level variability in the 12-month prevalence of physical (ICC = 0.07) and sexual (ICC = 0.05) IPV. Mean PVNS scores also varied across wards. When modeled simultaneously, PVNS scores aggregated to the ward-level and at the individual-level were associated with higher odds of physical (OR = 1.12, CI = 1.04, 1.20; OR = 1.40, CI = 1.15, 1.72) and sexual (OR = 1.15, CI = 1.08, 1.24; OR = 1.47, CI = 1.24, 1.74) IPV. The contextual effect was significant in the physical (0.23, se = 0.11, t = 2.12) and sexual (0.24, se = 0.09, t = 2.64) IPV models, suggesting that the ward-level association was larger than that at the individual-level. Adjustment for covariates slightly attenuated the ward-level association and eliminated the contextual association, suggesting that individual perceptions and the collective community phenomena were equally strong predictors of women's risk of IPV and should be taken into consideration when planning interventions. PVNS is a promising measure of social norms underpinning women's risk of IPV and warrants further psychometric testing.

BackgroundIntimate partner violence (IPV) is a significant public health issue that affects one in three women globally and a similarly large number of women in Nepal. Although important policy and programmatic steps have been taken to address violence against women in Nepal over the past decade, there is still a gap on IPV research in Nepal, particularly with regard to social norms.MethodsThis mixed-methods study used in-depth interviews with women and their husbands as well as baseline survey data from a cluster randomized trial testing a primary prevention intervention for IPV to examine the prevalence and risk factors for IPV. Baseline survey data included 1800 women from Nawalparasi, Chitwan, and Kapilvastu districts in Nepal. Multivariate regression was used to identify risk and protective factors for exposure to physical and / or sexual IPV in the prior 12 months. Case-based analysis was used to analyze one of 18 pairs of in-depth interviews to examine risk and protective factors within marriages.ResultsOf 1800 eligible participants, 455 (25.28%) were exposed to IPV. In multivariate analyses, low caste, wife employment, income stress, poor marital communication, quarrelling, husband drunkenness, exposure to IPV as a child, in-law violence, and gender inequitable normative expectations were associated with IPV. The selected case interview represented common themes identified in the analysis including the wife’s exposure to violence as a child, husband alcohol use, and marital quarrelling.ConclusionsGender inequitable norms in the community and the intergenerational transmission of attitudes and behaviors supportive of IPV are important to address in intervention measures.

Approximately 54% of women in rural Nepal report lifetime physical or sexual violence. The Change Starts at Home project is a primary prevention strategy to reduce and prevent marital intimate partner violence (IPV). This study analyzed in-depth interviews with 17 married couples (n = 34 individuals) at intervention midline and end line. Case-based analysis and thematic summaries were used to assess change, couple concordance, and gendered reporting patterns at midline. Individual changes included husband's alcohol use and roaming tendencies. Relationship-level changes comprised labor roles, communication, decision making, conflict resolution, and experience of IPV. End line interviews were analyzed to understand sustenance of change within these same individual and relationship dynamics. Results indicate promising shifts in men's individual behavior and marital dynamics, which underpin IPV risk.

Although intimate partner violence (IPV) is the most common form of violence against women, there is limited understanding of best practices to prevent IPV through working directly with couples and supporting quality of relationships. There are valid concerns of safely conducting research and programming with couples. Yet couples programming responds to the fact that many couples may want to stay together but require support and skills to manage violence. This article compares evaluation data of two programs in Nepal and Rwanda that worked with couples to support relationship quality. The Indashyikirwa program in Rwanda implemented a 5-month curriculum with couples to support equitable, nonviolent relationships. Approximately 25% of trained partners of couples were further supported as community activists for an additional 2 years. Change Starts at Home in Nepal implemented a 9-month couples’ curriculum to promote equitable and violence free relationships through fostering mutual respect and understanding, alongside a weekly radio program. The last 3 months of the curriculum focused on community outreach and awareness. This article draws on longitudinal qualitative interviews conducted separately with 28 partners of couples before, immediately after and 1 year following the couples’ curriculum in Rwanda, and with 36 partners of couples before, 6 months into the curriculum, and at the end of the intervention in Nepal. Thematic analysis of couples’ accounts was conducted and compared across the two studies. Despite the different interventions and settings, the cross-comparative analysis suggests similar pathways of change among couples, including enhanced relationship quality and skills as mediators to prevent IPV. This article considers how both programs supported greater communication and conflict resolution skills and a sense of unity and shared power among couples. The findings suggest the value of couples programming within the context of an enabling environment, highly trained facilitators, and strong referral networks.

Husband-perpetrated intimate partner violence (IPV) against wives is highly prevalent in rural Nepal. Social inequities experienced by women and girls, compounded by norms characterized by male dominance increase risk of IPV. To address this problem, the Change Starts at Home Project employs a social behavior change communication strategy (SBCC) to shift behavior and norms related to IPV in 36 Village Development Committees in three districts (Chitwan, Kapilvastu, Nawalparasi) in Nepal. The project is being evaluated with a cluster randomized trial (NCT02942433). Data for the manuscript come from baseline surveys of reproductive-aged women randomly selected from the intervention and control communities (N=1440) and female intervention enrollees (N=360). Descriptive statistics were used to identify differences across and within intervention arms and among intervention enrollees and randomly selected participants from the same communities. A total of 1982 individuals were assessed for eligibility resulting in a response rate of 72.65%. The cooperation rate was 84.16%. Results indicate broad sociodemographic similarities on most variables, although a higher percentage of intervention participants were unemployed and a lower percentage had love marriages compared to both study conditions. A smaller percentage of women in the intervention communities reported physical and / or sexual IPV in the prior 12 months (23.89%) than control communities (31.81%) or intervention participants (15.00%). Participants reported favorably to questions inquiring about whether their rights as participants were upheld, however, a minority felt they could discontinue at any time suggesting the need for greater consideration of this aspect of participation in subsequent data collection.