Abstract
BackgroundIntimate partner violence (IPV) against women is a global public health concern. While community-level gender norms and attitudes to IPV are recognised drivers of IPV risk, there is little evidence on how interventions might tackle these drivers to prevent IPV at the community-level. This secondary analysis of data from the SASA! study explores the pathways through which SASA!, a community mobilisation intervention to prevent violence against women, achieved community-wide reductions in physical IPV.MethodsFrom 2007 to 2012 a cluster randomised controlled trial (CRT) was conducted in eight communities in Kampala, Uganda. Cross-sectional surveys of a random sample of community members, aged 18–49, were undertaken at baseline (n = 1583) and 4 years post intervention implementation (n = 2532). We used cluster-level intention to treat analysis to estimate SASA!’s community-level impact on women’s past year experience of physical IPV and men’s past year perpetration of IPV. The mediating roles of community-, relationship- and individual-level factors in intervention effect on past year physical IPV experience (women)/perpetration (men) were explored using modified Poisson regression models.ResultsSASA! was associated with reductions in women’s past year experience of physical IPV (0.48, 95 % CI 0.16–1.39), as well as men’s perpetration of IPV (0.39, 95 % CI 0.20–0.73). Community-level normative attitudes were the most important mediators of intervention impact on physical IPV risk, with norms around the acceptability of IPV explaining 70 % of the intervention effect on women’s experience of IPV and 95 % of the effect on men’s perpetration. The strongest relationship-level mediators were men’s reduced suspicion of partner infidelity (explaining 22 % of effect on men’s perpetration), and improved communication around sex (explaining 16 % of effect on women’s experience). Reduced acceptability of IPV among men was the most important individual-level mediator (explaining 42 % of effect on men’s perpetration).ConclusionsThese results highlight the important role of community-level norm-change in achieving community-wide reductions in IPV risk. They lend strong support for the more widespread adoption of community-level approaches to preventing violence.Trial registrationClinicalTrials.gov, NCT00790959. Registered 13th November 2008.The study protocol is available at: http://www.trialsjournal.com/content/13/1/96Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3018-9) contains supplementary material, which is available to authorized users.
Highlights
Intimate partner violence (IPV) against women is a global public health concern
Community- and societallevel factors shown empirically to be linked to women’s risk of experiencing or men’s risk of perpetrating IPV include norms relating to the acceptability of wife beating [8,9,10,11,12] and male authority over female behaviour [9], norms granting men economic and decision-making power in the household [13], low levels of autonomy among women [14], lack of easy access to divorce for women [13], low literacy rates [15], low levels of female education [9, 11], high levels of poverty and unemployment [16], and lack of community sanctions against IPV [17]. These contexts in turn engender many of the individual- and relationship-level factors associated with increased risk of IPV, such as childhood experience of abuse or exposure to violence between parents, attitudes accepting of violence against women, low levels of education, harmful use of alcohol or drugs, economic stress, conflict or dissatisfaction in a relationship, male dominance in the family, and men having multiple partners [7, 18,19,20]
We recently reported the results of the SASA! Study, a cluster randomised controlled trial to assess the community level impacts of SASA!, a community mobilisation intervention to prevent violence against women and reduce HIV-risk behaviours in Kampala, Uganda [27]
Summary
Intimate partner violence (IPV) against women is a global public health concern. While communitylevel gender norms and attitudes to IPV are recognised drivers of IPV risk, there is little evidence on how interventions might tackle these drivers to prevent IPV at the community-level. Community- and societallevel factors shown empirically to be linked to women’s risk of experiencing or men’s risk of perpetrating IPV include norms relating to the acceptability of wife beating [8,9,10,11,12] and male authority over female behaviour [9], norms granting men economic and decision-making power in the household [13], low levels of autonomy among women [14], lack of easy access to divorce for women [13], low literacy rates [15], low levels of female education [9, 11], high levels of poverty and unemployment [16], and lack of community sanctions against IPV [17] These contexts in turn engender many of the individual- and relationship-level factors associated with increased risk of IPV, such as childhood experience of abuse or exposure to violence between parents, attitudes accepting of violence against women, low levels of education, harmful use of alcohol or drugs, economic stress, conflict or dissatisfaction in a relationship, male dominance in the family, and men having multiple partners [7, 18,19,20]. To date, there is little evidence on how interventions might engage with community-level drivers of IPV-risk in order to achieve community-wide reductions in violence
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