Findings from a cluster randomized controlled trial to assess the impact of a multi-level SBCC intervention in South Africa to reduce men's perpetration of intimate partner violence against women

Summary:

Background: Men's perpetration of intimate partner violence (IPV) limits health and wellbeing globally. Peri-urban settlements have very high prevalence of IPV and evidence on how to reduce men's perpetration is very limited. Our C-RCT evaluated the effectiveness of the Sonke CHANGE intervention in reducing use of sexual and/or physical IPV by men aged 1840 years over 2-years. Methodology: The theory-based intervention delivered activities to mobilize communities. We collected data from a cohort of men, recruited from 18 clusters, 9 were randomized to receive the intervention. A self-administered questionnaire was completed at two timepoints. We conducted an intention-to-treat analysis at the cluster level comparing the proportions of IPV while controlling for baseline characteristics. A sub-analysis used latent classes (LCA) of men to see differential effects of the intervention for sub-groups of men. Results: Of 2,406 men recruited, 1458 (63%) were followed to 2-years. We found no measurable differences between intervention and control clusters for primary IPV outcomes; differences in cluster-level proportions of IPV use was 0.002 (95%CI=-0.07-0.08). A sub-analysis suggested a greater reduction in IPV among more law-abiding men than more highly violent men. Conclusion: The intervention, implemented in a peri-urban settlement, had limited effect in reducing IPV perpetrated by male residents. Further analysis showed it was unable to transform entrenched gender attitudes and use of IPV by men who used the most violence, but the intervention showed promise for men who use violence less.

Background/Objectives:

Background: Men's perpetration of intimate partner violence (IPV) limits gains in health and well-being for populations globally. Peri-urban settlements have very high prevalence rates of IPV and evidence on how to reduce men's perpetration, change social norms and patriarchal attitudes here is very limited. Our cluster randomized 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 1840 years over 2-years.

Description Of Intervention And/or Methods/Design:

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, 9 were randomized to receive the intervention. A self-administered questionnaire, using audio-computer-assisted software, asked about socio-demographics, 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 sub-analysis used latent classes (LCA) of men to see whether there were differential effects of the intervention for sub-groups of men.

Results/Lessons Learned:

Results: Of 2,406 men recruited, 1458 (63%) were followed to 2-years. Overall, we saw a reduction in men's reports of physical, sexual and severe IPV from baseline to endline (40.2% to 25.4%, 31.8% to 15.8% and 33.4% to 18.2%). Intention-to-treat analysis showed no measurable differences between intervention and control clusters for primary IPV outcomes. Difference in the cluster-level proportion of physical IPV perpetration was 0.002 (95%CI=-0.07-0.08). Similarly, differences between arms for sexual IPV was 0.01 (95%CI=-0.04-0.06). While severe IPV followed a similar pattern (Diff=0.01; 95%CI=-0.05-0.07). LCA suggested that among the men living in intervention communities there was a greater reduction in IPV among less violent and more law abiding men than among more highly violent men, although the differences did not reach statistical significance.

Discussion/Implications For The Field:

Discussion: The intervention, when implemented in a peri-urban settlement, had limited effect in reducing IPV perpetrated by male residents. Further analysis showed it was unable to transform entrenched gender attitudes and use of IPV by those men who use the most violence, but the intervention showed promise for men who use violence less.

Abstract submitted by: 

Nicola Christofides - University of the Witwatersrand 

Abigail  Hatcher - University of the Witwatersrand 

Dumisani Rebombo - Yanani Community Project

Ruari-Santiago McBride - North Tipperary Development

Shehnaz Munshi - University of the Witwatersrand