Stepping Stones and Creating Futures Intervention to Prevent Intimate Partner Violence Among Young People: Cluster Randomized Controlled Trial

Gibbs, Andrew; Washington, Laura; Abdelatif, Nada; Chirwa, Esnat; Willan, Samantha; Shai, Nwabisa; Sikweyiya, Yandisa; Mkhwanazi, Smanga; Ntini, Nolwazi; Jewkes, Rachel

doi:10.1016/j.jadohealth.2019.10.004

Cited by 87 publications

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“…However, there is little literature around the effect of interventions addressing the interrelated risks of substance use and IPV in developing country contexts. Previous evidence suggests that the Stepping Stones program, targeting enhanced sexual health for young men and women in South Africa, led to a significant reduction in alcohol use among men but not women [ 17 ], a finding that was replicated in a more recent evaluation of Stepping Stones in conjunction with a livelihood-strengthening intervention [ 18 ]. The Raising HIV Awareness in Non-HIV-Infected Indian Wives (RHANI) Wives intervention targeted women in urban Mumbai experiencing IPV and heavy spousal alcohol use, and the intervention included a focus on alcohol as a point of spousal conflict; however, changes in substance use patterns were not measured or reported [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

An intimate partner violence prevention intervention for men, women, and couples in Ethiopia: Additional findings on substance use and depressive symptoms from a cluster-randomized controlled trial

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Background Intimate partner violence (IPV) is linked to substance use by male perpetrators and is associated with an increased risk of depression for women who experience violence. Unite for a Better Life (UBL) is a gender-transformative intervention delivered to men, women, and couples in Ethiopia; previous evidence demonstrated the intervention significantly reduced experience of and perpetration of IPV when delivered to men and led to more equitable household task-sharing when delivered to men and couples. The aim of this analysis is to assess engagement in the UBL intervention and to examine the relationship between random assignment to the intervention and men’s past-year substance use and women’s reported depressive symptoms as measured at the individual level. Methods and findings A sample of 64 villages in Gurague zone, Ethiopia, was randomly allocated to 4 arms (men’s UBL, women’s UBL, couples’ UBL, or control). In each village, 106 households were randomly sampled, and households in the intervention arms were invited to participate in UBL, consisting of 14 sessions delivered by trained facilitators. Households in the control arm were offered a short educational session on IPV. Descriptive data on participant engagement in the intervention are reported, and outcomes assessed in an intention-to-treat (ITT) analysis include male use of substances (alcohol and khat) and women’s depressive symptoms as measured by the Patient Health Questionnaire (PHQ-9). Results from both adjusted and unadjusted specifications are reported, the latter adjusting for baseline covariates including age, education level, marriage length, polygamy, socioeconomic status, months between intervention and endline, and the baseline level of the outcome variable. The baseline sample includes 6,770 respondents surveyed in 2014–2015, and follow-up data were available from 88% of baseline respondents surveyed in 2017–2018; the majority of respondents report no education, and 61% are Muslim. Respondents reported high attendance rates and engagement in the intervention. In addition, there was evidence of a significant reduction in frequent past-year alcohol intoxication self-reported by men (adjusted odds ratio [AOR] = 0.56, 95% CI 0.36–0.85, p = 0.007), and a significant increase in the probability of frequent khat use self-reported by men (AOR = 3.09, 95% CI 1.37–6.96, p = 0.007), both observed in the couples’ UBL arm at 24 months’ follow-up relative to the control arm. There was a significant increase in symptoms of moderate depression among women in the women’s UBL arm only (AOR = 1.65, 95% CI 1.13–2.41, p = 0.010), again relative to the control arm. There was no evidence of shifts in symptoms of mild or severe depression. The primary limitation of this study is the reliance on self-reported data around sensitive behaviors. Conclusions The findings suggest that the UBL intervention ...

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Section: Introductionmentioning

confidence: 99%

An intimate partner violence prevention intervention for men, women, and couples in Ethiopia: Additional findings on substance use and depressive symptoms from a cluster-randomized controlled trial

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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. This analysis identified three violence trajectories among men: a low-flat trajectory (60%–67% of men), a high-start with large reduction trajectory (19%–24%) and high-start with slight increase trajectory (10%–21%), suggesting these interventions may have had the greatest impact on those who were more violent at baseline ( Gibbs, Dunkle, et al, 2020 ). We did not find any study that examined the differential impact of an IPV intervention on primary versus secondary prevention for men (The SASA evaluation interviewed only women).…”

Section: Introductionmentioning

confidence: 99%

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

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Gibbs

et al. 2020

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Currently, most efforts to evaluate programmes designed to reduce intimate partner violence (IPV) assume that they affect all people similarly. Understanding whether interventions are more or less effective for different subgroups of individuals, however, can yield important insights for programming. In this study, we conducted subgroup analyses to assess whether treatment effects vary by baseline reporting of IPV experience among women or perpetration among men. Results indicated that for both men and women, the Indashyikirwa intervention in Rwanda was more successful at reducing or stopping ongoing IPV than it was at preventing its onset. The SS-CF intervention in South Africa, by contrast, was more successful at preventing men from starting to perpetrate IPV than it was in reducing the intensity of men's perpetration or stopping it entirely. These results indicate that the prevention field needs to better understand the extent to which IPV interventions may have differential impacts on primary versus secondary prevention. It also emphasizes the importance of distinguishing between intervention strategies that prevent the onset of IPV versus those that reduce or stop ongoing IPV.

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“…15 Main IPV trial outcomes In the main analysis, men in the SS-CF intervention reported significantly less physical IPV (adjusted ORs (aOR)0.71, 95% CI: 0.51 to 0.97, p=0.032), and a marginal reduction in sexual IPV (aOR0.74, 95% CI: 0.54 to 1.03, p=0.072) perpetration at 24 months, with similar levels of reduction seen at 12 months. 19 sonke CHAnge trial Intervention The Sonke CHANGE trial worked with men (18-40 years) in peri-urban settlements in Gauteng, South Africa, to reduce IPV through community activism and mobilisation approaches to transforming harmful gender attitudes and norms. The intervention comprised door-to-door activities, 2-day workshops drawing on the Sonke CHANGE curriculum, which sought to encourage reflection around gender norms and the use of violence, mini-workshops (3-4 hours), community murals and deploying community action teams over 18 months.…”

Section: Methodsmentioning

confidence: 99%

“…31 In addition, men in the intervention in SS-CF started working more by end-line compared with the control arm. 19 It could be that because SS-CF provided a therapeutic group space, and supporting young men to work more, SS-CF helped reduce these symptoms of depression, enabling men to reduce their self-blame and in turn reduce their use of IPV. The differences between the high-reducing trajectory, and high-increasing trajectory, may be linked to the different drivers of depression, and the extent to which depression was a marker of more entrenched mental health challenges, or driven by contextual factors.…”

Section: Multinomial Models Comparing All Three Trajectoriesmentioning

confidence: 99%

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

et al. 2020

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IntroductionEmerging evidence suggests working with men to prevent intimate partner violence (IPV) perpetration can be effective. However, it is unknown whether all men benefit equally, or whether different groups of men respond differentially to interventions.MethodsWe conducted trajectory modelling using longitudinal data from men enrolled in intervention arms of three IPV trials in South Africa and Rwanda to identify trajectories of IPV perpetration. We then use multinomial regression to describe baseline characteristics associated with group allocation.ResultsIn South Africa, the Stepping Stones and Creating Futures (SS-CF) trial had 289 men and the CHANGE trial had 803 men, and in Rwanda, Indashyikirwa had 821 men. We identified three trajectories of IPV perpetration: a low-flat (60%–67% of men), high with large reduction (19%–24%) and high with slight increase (10%–21%). Baseline factors associated men in high-start IPV trajectories, compared with low-flat trajectory, varied by study, but included higher poverty, poorer mental health, greater substance use, younger age and more childhood traumas. Attitudes supportive of IPV were consistently associated with high-start trajectories. In separate models comparing high-reducing to high-increasing trajectories, baseline factors associated with reduced IPV perpetration were depressive symptoms (relative risk ratio, RRR=3.06, p=0.01 SS-CF); living separately from their partner (RRR=2.14, p=0.01 CHANGE); recent employment (RRR=1.85, p=0.04 CHANGE) and lower acceptability of IPV (RRR=0.60, p=0.08 Indashyikirwa). Older aged men had a trend towards reducing IPV perpetration in CHANGE (p=0.06) and younger men in Indashyikirwa (p=0.07).ConclusionsThree distinct groups of men differed in their response to IPV prevention interventions. Baseline characteristics of past traumas and current poverty, mental health and gender beliefs predicted trajectory group allocation. The analysis may inform targeting of interventions towards those who have propensity to change or guide how contextual factors may alter intervention effects.Trial registration numbersNCT03022370; NCT02823288; NCT03477877.

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Stepping Stones and Creating Futures Intervention to Prevent Intimate Partner Violence Among Young People: Cluster Randomized Controlled Trial

Cited by 87 publications

References 33 publications

An intimate partner violence prevention intervention for men, women, and couples in Ethiopia: Additional findings on substance use and depressive symptoms from a cluster-randomized controlled trial

An intimate partner violence prevention intervention for men, women, and couples in Ethiopia: Additional findings on substance use and depressive symptoms from a cluster-randomized controlled trial

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

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

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