Evaluation of the rural response system intervention to prevent violence against women: findings from a community-randomised controlled trial in the Central Region of Ghana

Abstract

Background: Intimate partner violence (IPV) affects one in three women globally and undermines women's human rights, social and economic development, and health, hence the need for integrated interventions involving communities in its prevention. Objective: This community-randomised controlled trial evaluated the Rural Response System (RRS) intervention, which uses Community Based Action Teams to prevent IPV by raising awareness and supporting survivors, compared to no intervention. Methods: Two districts of the Central Region of Ghana were randomly allocated to each arm. Data were collected by repeated, randomly sampled, household surveys, conducted at baseline (2000 women, 2126 men) and 24 months later (2198 women, 2328 men). The analysis used a difference in difference (DID) approach, adjusted for age and exposure to violence in childhood. Results: In intervention communities, women's past year experience of sexual IPV reduced from 17.1% to 7.7% versus 9.3% to 8.0% in the control communities (DID = −9.3(95%CI; −17.5,−1.0), p = 0.030). The prevalence of past-year physical IPV among women in the intervention communities reduced from 16.5% to 8.3% versus 14.6% to 10.9% in the controls (DID = −4.2(−12,3.6), p = 0.289). The prevalence of severe IPV experienced by women reduced from 21.2% to 11.6% in intervention versus 17.3% to 11.4% in controls (DID = −3.7(−12.5,5.1), p = 0.408). The direction of impact of the intervention on violence perpetrated by men was more towards a reduction but changes were not statistically significant. Emotional IPV perpetration was significantly lower (DID = −15.0(−28.5, −1.7), p = 0.031). Women's depression scores and reports of male partner controlling behaviour significantly also reduced in the intervention arm compared to those in the control arm (DID = −4.8(−8.0,−1.5), p = 0.005; DID = −2.7(−3.3,−1.0), p = 0.002, respectively). Conclusion: Our findings indicate that the RRS intervention reduced women's experiences of IPV, depression, and partner controlling behaviour and some evidence of men's reported reductions in the perpetration of IPV. The RRS intervention warrants careful scale-up in Ghana and further research.

Should female community health volunteers (FCHVs) facilitate a response to gender-based violence (GBV)? A mixed methods exploratory study in Mangalsen, Nepal

“…Further capacity building on gender transformative dialogues and community mobilisation can enhance this work. Studies in Ghana and the United States have demonstrated the effectiveness of interventions to reduce intimate partner violence by raising awareness about violence, counselling couples experiencing violence, conducting safety planning, and providing referrals (Ogum Alangea et al, 2020;Sarin & Lunsford, 2017). However, these interventions involved considerable investments in training and support and raise concerns about overburdening FCHVs with too many responsibilities.…”

“…More recently, two randomised controlled trials have demonstrated that CHWs can play an effective role in preventing intimate partner violence through community sensitisation and facilitating access to services. In Ghana, physical violence reported by women decreased in communities where community-based action teams led dialogues at local events on women's economic rights, equitable household practices, and non-violence and also counselled couples (Ogum Alangea et al, 2020). In the United States, study areas showed significant, sustained decreases in intimate partner violence in response to home visits to pregnant women during which a CHW or nurse reviewed information on the cycle of violence, danger assessments, safety planning, and available resources (Sharps et al, 2016).…”

Community-level spillover effects of an intervention to prevent intimate partner violence and HIV transmission in rural Ethiopia

“…3 A growing body of literature has evaluated interventions designed to prevent and reduce IPV and shift gender norms by targeting women, [6][7][8][9] men, 7 10 11 couples [12][13][14] or communities. [15][16][17][18] In general, these interventions entail intensive interactions over a defined period with a particular set of participants. These individuals may be those beneficiaries who are explicitly sampled for and invited to participate in the programme, or, in the case of community-level interventions, those beneficiaries who are effectively reached by the mobilisation process.…”

“…6 19 The published community-level IPV intervention trials reported community-level effects without separately analysing effects for beneficiaries directly reached by the programme (eg, programme activists or participants), vis-à-vis community members who are exposed indirectly to programme messages. [15][16][17][18] By contrast, a much larger literature has demonstrated spillover effects of other public health interventions including vaccines, infectious disease interventions, and water and sanitation interventions. 20 21 Unite for a Better Life (UBL) is a gender-transformative intervention designed to reduce physical and sexual IPV and HIV risk behaviours and promote healthier, more equitable relationships.…”

“…This paper is among the first to report robust and meaningful spillover effects of an IPV prevention intervention among indirect beneficiaries, as previous evidence from IMAGES and Stepping Stones found little direct evidence of diffusion from programme participants to other indirect beneficiaries. 6 19 Other major interventions, such as SASA!, Indashyikirwa and SHARE were targeted at the community level and thus there is no clear distinction between direct and indirect beneficiaries, [15][16][17][18] though in the case of SASA! a follow-up analysis examined patterns of diffusion.…”