This qualitative study examined the "drivers" of intimate partner violence (IPV) against women in displacement to identify protective factors and patterns of risk. Qualitative data were collected in three refugee camps in South Sudan, Kenya, and Iraq ( N = 284). Findings revealed interrelated factors that triggered and perpetuated IPV: gendered social norms and roles, destabilization of gender norms and roles, men's substance use, women's separation from family, and rapid remarriages and forced marriages. These factors paint a picture of individual, family, community and societal processes that exacerbate women's risk of IPV in extreme conditions created by displacement. Implications for policy and practice are indicated.

IntroductionInterpersonal violence is a critical public health concern in humanitarian contexts, but evidence of effective violence prevention programmes targeting adolescent girls is lacking. We investigated the efficacy of a life skills and safe spaces programme to reduce adolescent girls’ experiences of interpersonal violence in a refugee setting.MethodsIn this two-arm, single-blinded, cluster randomised controlled trial, we recruited 919 Sudanese and South Sudanese girls ages 13–19 years residing in refugee camps in Ethiopia. Girls were divided into 31 clusters, with 457 and 462 participants assigned to the intervention and control arms, respectively. Intervention clusters received 30 life skills sessions delivered in safe spaces and 8 complementary sessions for caregivers. The primary outcome was exposure to sexual violence in the previous 12 months. Secondary outcomes included disaggregated forms of sexual violence, physical violence, emotional violence, transactional sex, child marriage, feelings of safety, attitudes around rites of passage and perceptions of social support. Intent-to-treat analysis was used.ResultsAt 12-month follow-up, the intervention was not significantly associated with reduction in exposure to sexual violence (adjusted OR =0.96, 95%  CI 0.59 to 1.57), other forms of violence, transactional sex or feelings of safety. The intervention was associated with improvements in attitudes around rites of passage and identified social supports. Additionally, the intervention showed a decrease in reported child marriage among girls who were married at baseline.ConclusionWhile the intervention impacted key markers along the causal pathway to violence reduction, further research and programmatic adaptations are needed to prevent violence towards adolescents in humanitarian contexts.Trial registrationNCT02506543.

BackgroundViolence against adolescent girls in humanitarian settings is of urgent concern given their additional vulnerabilities to violence and unique health and well-being needs that have largely been overlooked by the humanitarian community. In order to understand what works to prevent violence against adolescent girls, a multi-component curriculum-based safe spaces program (Creating Opportunities through Mentorship, Parental involvement and Safe Spaces – COMPASS) will be implemented and evaluated. The objectives of this multi-country study are to understand the feasibility, acceptability and effectiveness of COMPASS programming to prevent violence against adolescent girls in diverse humanitarian settings.Methods/designTwo wait-listed cluster-randomized controlled trials are being implemented in conflict-affected communities in eastern Democratic Republic of Congo (N = 886 girls aged 10–14 years) and in refugee camps in western Ethiopia (N = 919 girls aged 13–19 years). The intervention consists of structured facilitated sessions delivered in safe spaces by young female mentors, caregiver discussion groups, capacity-building activities with service providers, and community engagement. In Ethiopia, the research centers on the overall impact of COMPASS compared to a wait-list group. In DRC, the research objective is to understand the incremental effectiveness of the caregiver component in addition to the other COMPASS activities as compared to a wait-list group. The primary outcome is change in sexual violence. Secondary outcomes include decreased physical and emotional abuse, reduced early marriage, improved gender norms, and positive interpersonal relationships, among others. Qualitative methodologies seek to understand girls’ perceptions of safety within their communities, key challenges they face, and to identify potential pathways of change.DiscussionThese trials will add much needed evidence for the humanitarian community to meet the unique needs of adolescent girls and to promote their safety and well-being, as well as contributing to how multi-component empowerment programming for adolescent girls could be adapted across humanitarian settings.Trial registrationClinical Trials NCT02384642 (Registered: 2/24/15) & NCT02506543 (Registered: 7/19/15).

Adolescent girls are at an increased risk of sexual violence, abuse, exploitation, and forced or early marriage across humanitarian contexts. In the past few years, prominent initiatives, organizations, and working groups have started to highlight the targeted needs and issues facing adolescent girls and have developed programmatic responses such as safe spaces for adolescent girls to protect and empower girls and reduce their vulnerabilities to violence or exploitation. A systematic review of academic and grey literature was conducted in September 2015 to examine the evidence base for programming that seeks to reduce violence against adolescent girls in humanitarian contexts. The authors used a Boolean search procedure to find and review 5830 records from academic journal databases, resource-hosting websites and relevant organizational websites. The inclusion criteria left us with three adolescent girl program evaluations from humanitarian settings to examine, all of which were pre/post-test evaluations that looked at changes in indicators such as social assets, self-esteem, decision making, livelihood skills and financial assets, gender norms, and feelings of safety. While these three evaluations showed promising results, overall, this systematic review demonstrates a significant gap in currently available rigorous research. Evidence is urgently needed to guide programming decisions to ensure that the emerging programs provide the level and depth of protection that adolescent girls need in humanitarian settings.

In Canada, public health agencies often employ fact sheets or brochures as means of communicating injury prevention messaging to target groups; these are used because they are cost-effective and can reach large segments of the population. Unfortunately, the design of these instruments rarely reflects an evidence-based process, lacks theoretical grounding, and communication effectiveness is rarely assessed. In collaboration with Safe Kids Canada, we devised a methodological template for the development and evaluation of fact sheets targeting parental safety behaviours. This project involved the development of fact sheets targeting parents of infants at two ages (0–6, 6–12 months). The process employed a rigorous program evaluation framework, including a logic model, grounded in social cognitive theories and existing evidence that resulted in a focus on injury-prevention attitudes, self efficacy, and beliefs about vulnerability and severity of infant injury. Focus group testing with parents allowed us to compare the impact of alternative wording and images on cognitions, emotional reactions and parents injury-prevention beliefs and attitudes. Evidence drawn from these focus groups guided the final development of the fact sheets. A report was produced detailing evidence and recommendations as well as the process of developing and evaluating fact sheets, providing a template for future instrument development.