Effectiveness of a multi-level intervention to reduce men’s perpetration of intimate partner violence: a cluster randomised controlled trial

Abstract

Background: Men's perpetration of intimate partner violence (IPV) limits gains in health and wellbeing for populations globally. Largely informal, rapidly expanding peri-urban settlements, with limited basic services such as electricity, have high prevalence rates of IPV. Evidence on how to reduce men's perpetration, change social norms and patriarchal attitudes within these settings is limited. Our cluster randomised controlled trial aimed to determine the effectiveness of the Sonke CHANGE intervention in reducing use of sexual and/or physical IPV and severity of perpetration by men aged 18-40 years over 2 years. Methodology: The theory-based intervention delivered activities to bolster community action, including door-to-door discussions, workshops, drawing on the CHANGE curriculum, and deploying community action teams over 18 months. In 2016 and 2018, we collected data from a cohort of men, recruited from 18 clusters; nine were randomised to receive the intervention, while the nine control clusters received no intervention. A self-administered questionnaire, using audio-computer assisted software, asked about sociodemographics, gender attitudes, mental health, and the use and severity of IPV. We conducted an intention-to-treat analysis at the cluster level comparing the expected risk to observed risk of using IPV while controlling for baseline characteristics. A secondary analysis used latent classes (LCA) of men to see whether there were differential effects of the intervention for subgroups of men.

Which men change in intimate partner violence prevention interventions? A trajectory analysis in Rwanda and South Africa

“…16 Main outcomes for IPV In the main analysis, men in the CHANGE trial showed no difference in the cluster-level proportion past year physical IPV (diff=0.002, 95% CI=−0.07-0.08) or sexual IPV (diff=0.01, 95% CI=−0.04-0.06ß) at endline after adjusting for sociodemographic characteristics and baseline IPV perpetration. 20 Severe IPV followed a similar pattern (diff=0.01; 95% CI=−0.05-0.07).…”

“…In the Sonke CHANGE trial, there was a steep decrease in past year physical and/or sexual IPV in the intervention arm from 45.7% at baseline, to 39.0% midline and 26.9% at endline (though overall the intervention showed no impact because of similar patterns in the control arm 20 ). Two-thirds (66.0%) of men were in the flat-low trajectory, one-fifth (19.1%) were in the high decreasing trajectory and 14.8% were in the high slightly increasing trajectory (figure 2 and online supplementary table 1).…”

“…This somewhat substantiates another analysis of the Sonke CHANGE trial, which suggested that it may have reduced men's violence among those who were moderately violent at baseline and more amenable to light-touch interventions, but had no impact on those most violent, with attendant overlapping issues of poor mental health and substance misuse. 20 In Rwanda, men in the high-reducing trajectory were less accepting of IPV compared with the high with slight increase trajectory. The finding around attitudes towards IPV suggests that these men may have already been more amenable to change, and that IPV was partly driven by pressure from social norms to discipline their wives 35 and that the intervention provided men with alternative strategies of communication.…”

Exploring differential impacts of interventions to reduce and prevent intimate partner violence (IPV) on sub-groups of women and men: A case study using impact evaluations from Rwanda and South Africa

“…Indeed, this analysis highlights the possibility that interventions may work to different extents for different sub-populations and may have differential impacts on primary versus secondary prevention. Prior subgroup analyses also suggest that interventions may work differently for perpetrators who were report low versus high levels of violence at baseline ( Christofides et al, 2020 ; Gibbs, Dunkle, et al, 2020 ). These results suggest that IPV prevention programs need to be tailored to suit the needs of different subpopulations.…”

“…Two additional studies have explored the differential impacts of IPV prevention programming on different categories of men. A study using latent class analysis found that the Sonke CHANGE intervention in South Africa may have been more effective at reducing IPV perpetration among men who were less violent and reported lower non-partner sexual violence perpetration as compared to anti-social and hypermasculine men who reported high levels of violence at baseline ( Christofides et al, 2020 ). Another study used group-based trajectory analyses to identify trajectories of violence perpetration among men enrolled in the intervention arms of three separate IPV prevention trials in Africa—the Sonke CHANGE trial in a peri-urban area of Johannesburg; the Stepping Stones/Creating Futures trial among young men in Durban; and the Indashykirwa trial among cohabiting couples in Rwanda.…”