Community activism as a strategy to reduce intimate partner violence (IPV) in rural Rwanda: Results of a community randomised trial
- PMID: 32257154
- PMCID: PMC7125418
- DOI: 10.7189/jogh.10.010406
Community activism as a strategy to reduce intimate partner violence (IPV) in rural Rwanda: Results of a community randomised trial
Abstract
Background: There is considerable interest in community organising and activism as a strategy to shift patriarchal gender norms, attitudes and beliefs and thus reduce intimate partner violence (IPV). Yet there is limited insight into how activism actually translates into reduced violence, including how aspects of programme implementation or cultural context may affect impact. This study evaluates the community activism/mobilisation portion of Indashyikirwa, a multi-component, IPV prevention programme implemented in rural Rwanda. The activism part of Indashyikirwa was based on SASA!, a promising program model from Uganda with demonstrated effectiveness.
Methods: We implemented two separate cross-sectional surveys as part of a larger community randomised controlled trial to assess the impact of the community portion of Indashyikirwa on preventing physical and/or sexual IPV and other secondary outcomes at a community level. The survey consisted of a random household-based sample of 1400 women and 1400 men at both waves. Surveys were conducted before community-level activities commenced and were repeated 24 months later with a new cross-sectional sample. Longitudinal, qualitative data were collected as part of an embedded process evaluation.
Results: There was no evidence of an intervention effect at a community level on any of the trial's primary or secondary outcomes, most notably women's experience of physical and/or sexual IPV from a current male partner in the past 12 months (adjusted odds ratio (aOR) = 1.25; 95% confidence interval (CI) = 0.92-1.70, P = 0.16), or men's perpetration of male-to-female physical and/or sexual IPV (aOR = 1.02; 95% CI = 0.72-1.45, P = 0.89). Process evaluation data suggest that delays due to challenges in adapting and implementing SASA!-style activites in rural Rwanda may account for the trial's failure to measure an effect. Additionally, the intervention strategy of informal activism was not well suited to the Rwandan context and required considerable modification.
Conclusions: Failure to reduce violence when implementing an adaptation of SASA! in rural Rwanda highlights the importance of allowing sufficient time for adapting evidence-based programming (EBP) to ensure cultural appropriateness and fidelity. This evaluation held little chance of demonstrating impact since the project timeline forced endline evaluation only months after certain elements of the programme became operational. Donors must anticipate longer time horizons (5 to 7 years) when contemplating evaluations of novel or newly-adapted programmess for reducing IPV at a population level. These findings also reinforce the value of including embedded process evaluations when investing in rigorous trials of complex phenomena such as community activism.
Trial registration: ClinicalTrials.gov, NCT03477877.
Copyright © 2020 by the Journal of Global Health. All rights reserved.
Conflict of interest statement
Competing interests: The authors completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available upon request from the corresponding author), and declare no conflicts of interest.
Figures
Similar articles
-
Effectiveness of a culturally appropriate intervention to prevent intimate partner violence and HIV transmission among men, women, and couples in rural Ethiopia: Findings from a cluster-randomized controlled trial.PLoS Med. 2020 Aug 18;17(8):e1003274. doi: 10.1371/journal.pmed.1003274. eCollection 2020 Aug. PLoS Med. 2020. PMID: 32810146 Free PMC article. Clinical Trial.
-
Ecological pathways to prevention: How does the SASA! community mobilisation model work to prevent physical intimate partner violence against women?BMC Public Health. 2016 Apr 16;16:339. doi: 10.1186/s12889-016-3018-9. BMC Public Health. 2016. PMID: 27084116 Free PMC article. Clinical Trial.
-
Effective prevention of intimate partner violence through couples training: a randomised controlled trial of Indashyikirwa in Rwanda.BMJ Glob Health. 2020 Dec;5(12):e002439. doi: 10.1136/bmjgh-2020-002439. BMJ Glob Health. 2020. PMID: 33355268 Free PMC article. Clinical Trial.
-
Addressing intimate partner violence and sexual violence among adolescents: emerging evidence of effectiveness.J Adolesc Health. 2015 Jan;56(1 Suppl):S42-50. doi: 10.1016/j.jadohealth.2014.08.012. J Adolesc Health. 2015. PMID: 25528978 Review.
-
A human diversity analysis of culture and gender in Asian American men's intimate partner violence perpetration.J Community Psychol. 2021 Mar;49(2):653-671. doi: 10.1002/jcop.22485. Epub 2020 Dec 3. J Community Psychol. 2021. PMID: 33270922 Review.
Cited by
-
Effectiveness of community mobilisation and group-based interventions for preventing intimate partner violence against women in low- and middle-income countries: A systematic review and meta-analysis.J Glob Health. 2023 Oct 20;13:04115. doi: 10.7189/jogh.13.04115. J Glob Health. 2023. PMID: 37861113 Free PMC article.
-
Strengthening women's empowerment and gender equality in fragile contexts towards peaceful and inclusive societies: A systematic review and meta-analysis.Campbell Syst Rev. 2022 Mar 8;18(1):e1214. doi: 10.1002/cl2.1214. eCollection 2022 Mar. Campbell Syst Rev. 2022. PMID: 36913184 Free PMC article. Review.
-
Pooled analysis of the association between food insecurity and violence against women: Evidence from low- and middle-income settings.J Glob Health. 2023 Mar 10;13:04021. doi: 10.7189/jogh.13.04021. J Glob Health. 2023. PMID: 36896806 Free PMC article.
-
'Our courage has grown': a grounded theory study of enablers and barriers to community action to address violence against women in urban India.BMJ Glob Health. 2023 Jan;8(1):e011304. doi: 10.1136/bmjgh-2022-011304. BMJ Glob Health. 2023. PMID: 36690379 Free PMC article.
-
A summative content analysis of how programmes to improve the right to sexual and reproductive health address power.BMJ Glob Health. 2022 Apr;7(4):e008438. doi: 10.1136/bmjgh-2022-008438. BMJ Glob Health. 2022. PMID: 35443940 Free PMC article.
References
-
- Wagman JA, Gray RH, Campbell JC, Thoma M, Ndyanabo A, Ssekasanvu J, et al. Effectiveness of an integrated intimate partner violence and HIV prevention intervention in Rakai, Uganda: analysis of an intervention in an existing cluster randomised cohort. Lancet Glob Health. 2015;3:e23-33. 10.1016/S2214-109X(14)70344-4 - DOI - PMC - PubMed
Publication types
MeSH terms
Associated data
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous