Comprehensive sexuality education may help prevent intimate partner violence, but few evaluations of sexuality education courses have measured this. Here we explore how such a course that encourages critical reflection about gendered social norms might help prevent partner violence among young people in Mexico. We conducted a longitudinal quasi-experimental study at a state-run technical secondary school in Mexico City, with data collection including in-depth interviews and focus groups with students, teachers, and health educators. We found that the course supported both prevention of and response to partner violence among young people. The data suggest the course promoted critical reflection that appeared to lead to changes in beliefs, intentions, and behaviors related to gender, sexuality, and violence. We identify four elements of the course that seem crucial to preventing partner violence. First, encouraging participants' reflection about romantic relationships, which helped them question whether jealousy and possessive behaviors are signs of love; second, helping them develop skills to communicate about sexuality, inequitable relationships, and reproductive health; third, encouraging care-seeking behavior; and fourth, addressing norms around gender and sexuality, for example demystifying and decreasing discrimination towards sexually diverse populations. The findings reinforce the importance of schools for violence prevention and have implications for educational policy regarding sexuality education. The results suggest that this promising and relatively short-term intervention should be considered as a school-based strategy to prevent and respond to partner violence.
BackgroundRigorous evaluations of health sector interventions addressing intimate partner violence (IPV) in low- and middle-income countries are lacking. We aimed to assess whether an enhanced nurse-delivered intervention would reduce IPV and improve levels of safety planning behaviors, use of community resources, reproductive coercion, and mental quality of life.MethodsWe randomized 42 public health clinics in Mexico City to treatment or control arms. In treatment clinics, women received the nurse-delivered session (IPV screening, supportive referrals, health/safety risk assessments) at baseline (T1), and a booster counselling session after 3 months (T2). In control clinics, women received screening and a referral card from nurses. Surveys were conducted at T1, T2, and T3 (15 months from baseline). Our main outcome was past-year physical and sexual IPV. Intent-to-treat analyses were conducted via three-level random intercepts models to evaluate the interaction term for treatment status by time.ResultsBetween April and October 2013, 950 women (480 in control clinics, 470 in treatment clinics) with recent IPV experiences enrolled in the study. While reductions in IPV were observed for both women enrolled in treatment (OR, 0.40; 95% CI, 0.28–0.55; P < 0.01) and control (OR, 0.51; 95% CI, 0.36–0.72; P < 0.01) clinics at T3 (July to December 2014), no significant treatment effects were observed (OR, 0.78; 95% CI, 0.49–1.24; P = 0.30). At T2 (July to December 2013), women in treatment clinics reported significant improvements, compared to women in control clinics, in mental quality of life (β, 1.45; 95% CI, 0.14–2.75; P = 0.03) and safety planning behaviors (β, 0.41; 95% CI, 0.02–0.79; P = 0.04).ConclusionWhile reductions in IPV levels were seen among women in both treatment and control clinics, the enhanced nurse intervention was no more effective in reducing IPV. The enhanced nursing intervention may offer short-term improvements in addressing safety planning and mental quality of life. Nurses can play a supportive role in assisting women with IPV experiences.Trial RegistrationClinicaltrials.gov (NCT01661504). Registration Date: August 2, 2012Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0880-y) contains supplementary material, which is available to authorized users.
BackgroundIntimate partner violence (IPV) victimization is a prevalent issue among women residing in Mexico City. Comprehensive and integrated health care provider (HCP) delivered programs in clinic-settings are needed, yet few have been evaluated in Latin America, including Mexico. In addition, there has been minimal attention to interventions among lower income women presenting at settings outside of antenatal care clinics. The current randomized controlled trial seeks to increase midlevel HCPs’ capacity, specifically nurses, who are often the first point of contact in this setting, to identify women presenting at health clinics with experiences of IPV and to assist these women with health risk mitigation. Specific outcomes include changes in past-year IPV (physical and/or sexual), reproductive coercion, safety planning, use of community resources, and quality of life.Methods/DesignForty-two public health clinics in Mexico City were randomized to treatment or control clinics. Nurses meeting eligibility criteria in treatment groups received an intensive training on screening for IPV, providing supportive referrals, and assessing for health and safety risks. Nurses meeting eligibility criteria at control clinics received the standard of care which included a one-day training focused on sensitizing staff to IPV as a health issue and referral cards to give to women. Women were screened for eligibility (currently experiencing abuse in a heterosexual relationship, 18-44 years of age, non-pregnant or in first trimester) by research assistants in private areas of waiting rooms in health clinics. Consenting women completed a baseline survey and received the study protocol for that clinic. In treatment clinics, women received the nurse delivered session at baseline and received a follow-up counseling session after three months. Surveys are conducted at baseline, three months, and fifteen months from baseline.DiscussionThis study will provide important insight into whether a nurse-delivered program can assist women currently experiencing abuse in a Latin American context. Findings can be used to inform IPV programs and policies in Mexico City’s public health clinics.Trial registrationNCT01661504
A pilot randomized controlled trial (RCT) was conducted in El Salvador of an intervention ('Thula Sana') previously shown to enhance maternal sensitivity and infant security of attachment in a South African sample. In El Salvador, trained community workers delivered the intervention from late pregnancy to 6 months postpartum as part of a home-visiting programme. The sample comprised 64 pregnant adolescent women, aged 14-19 years, living in predominantly rural settings. They were randomised to receive either the intervention or normal care. Demographic information was collected at baseline and, immediately post-intervention, blind assessments were made of parental sensitivity and infant emotion regulation. The intervention was found to have a substantial positive impact on maternal sensitivity. Further, compared to control group, infants in the intervention group showed more regulated behaviour: in a social challenge task they showed more attempts to restore communication, and in a non-social challenge task they showed more social and goal-directed behaviour. This replication and extension of the South African findings in a small El Salvador sample shows promise and justifies the conduct of a large-scale RCT in a Central or South American context.
Evaluating social change programs requires methods that account for changes in context, implementation, and participant experience. We present a case study of a school-based partner violence prevention program with young people, where we conducted 33 repeat interviews with nine participants during and after an intervention and analyzed participant trajectories. We show how repeat interviews conducted during and after a social change program were useful in helping us understand how the intervention worked by providing rich contextual information, elucidating gradual shifts among participants, and identifying aspects of the intervention that appear to influence change. Long-term effects of social change interventions are very hard to quantify or measure directly. We argue that a qualitative longitudinal approach provides a way to measure subtle changes that can serve as proxies for longer term impacts.
Qualitative longitudinal research may help understand people’s changing experiences during interventions: dynamics which are often overlooked in evaluations. We present a case study of a partner violence prevention program where we conducted 33 repeat interviews every one to two months with nine participants, and analyzed participant trajectories. We found that participants’ relationship-related beliefs and intentions changed, promoting self-reflection that in turn helped alter their relationship dynamics. Our qualitative longitudinal approach allowed us to detect and track specific examples of change, identify influential elements of the program, and gather contextualized data about participants’ lived experiences. Qualitative longitudinal research provided evidence of gradual shifts on the pathways to violence prevention. Long term effects of violence prevention interventions are very hard to measure directly. We argue that a qualitative longitudinal approach provides a way to measure subtle changes that can serve as proxies for longer term impacts.
Comprehensive sexuality education may help prevent intimate partner violence, but few evaluations of sexuality education courses have measured this. Here we explore how such a course that encourages critical reflection about gendered social norms might help prevent partner violence among young people in Mexico. We conducted a longitudinal quasi-experimental study at a state-run technical secondary school in Mexico City, with data collection including in-depth interviews and focus groups with students, teachers and health educators. We found that the course supported both prevention of and response to partner violence among young people. The data suggest the course promoted critical reflection that appeared to lead to changes in beliefs, intentions and behaviors related to gender, sexuality and violence. We identify four elements of the course that seem crucial to preventing partner violence. First, encouraging participants’ reflection about romantic relationships, which helped them question whether jealousy and possessive behaviors are signs of love; second, helping them develop skills to communicate about sexuality, inequitable relationships and reproductive health; third, encouraging care-seeking behavior; and fourth, addressing norms around gender and sexuality, for example demystifying and decreasing discrimination towards sexually diverse populations. The findings reinforce the importance of schools for violence prevention and have implications for educational policy regarding sexuality education. The results suggest that this promising and relatively short-term intervention should be considered as a school-based strategy to prevent and respond to partner violence.
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