A community mobilisation intervention to prevent violence against women and reduce HIV/AIDS risk in Kampala, Uganda (the SASA! Study): study protocol for a cluster randomised controlled trial

Abstract

BackgroundGender based violence, including violence by an intimate partner, is a major global human rights and public health problem, with important connections with HIV risk. Indeed, the elimination of sexual and gender based violence is a core pillar of HIV prevention for UNAIDS. Integrated strategies to address the gender norms, relations and inequities that underlie both violence against women and HIV/AIDS are needed. However there is limited evidence about the potential impact of different intervention models. This protocol describes the SASA! Study: an evaluation of a community mobilisation intervention to prevent violence against women and reduce HIV/AIDS risk in Kampala, Uganda.Methods/DesignThe SASA! Study is a pair-matched cluster randomised controlled trial being conducted in eight communities in Kampala. It is designed to assess the community-level impact of the SASA! intervention on the following six primary outcomes: attitudes towards the acceptability of violence against women and the acceptability of a woman refusing sex (among male and female community members); past year experience of physical intimate partner violence and sexual intimate partner violence (among females); community responses to women experiencing violence (among women reporting past year physical/sexual partner violence); and past year concurrency of sexual partners (among males). 1583 women and men (aged 18–49 years) were surveyed in intervention and control communities prior to intervention implementation in 2007/8. A follow-up cross-sectional survey of community members will take place in 2012. The primary analysis will be an adjusted cluster-level intention to treat analysis, comparing outcomes in intervention and control communities at follow-up. Complementary monitoring and evaluation and qualitative research will be used to explore and describe the process of intervention implementation and the pathways through which change is achieved.DiscussionThis is one of few cluster randomised trials globally to assess the impact of a gender-focused community mobilisation intervention. The multi-disciplinary research approach will enable us to address questions of intervention impact and mechanisms of action, as well as its feasibility, acceptability and transferability to other contexts. The results will be of importance to researchers, policy makers and those working on the front line to prevent violence against women and HIV.Trial registrationClinicalTrials.Gov NCT00790959

Increased Reporting of Cases of Gender-Based Violence: A Retrospective Review of a Prevention Programme in Dharavi, Mumbai

“…Study, a pair-matched cluster randomised controlled trial, who listed out appropriate actions that were encouraged by the intervention. 23 Primary prevention activities raise expectations and as a result community members identify and inform about cases where women are facing violence in their homes without taking the consent of that woman. Our thrust on eliciting community member's participation and contribution has led to difficulties in maintaining confidentiality of the case.…”

A Process Review of the Indashyikirwa Couples Curriculum to Prevent Intimate Partner Violence and Support Healthy, Equitable Relationships in Rwanda

“…A rigorous evaluation indicated that SASA! generated significant shifts in gender norms related to IPV, and found a 52% reduction in past-year experience of physical IPV among women (Abramsky et al 2012;Kyegombe et al 2014).…”

“…Interventions responding to IPV have traditionally sought to establish support services for victims and improve the criminal and health sector responses (Abramsky et al 2012), Yet, there has been a more recent emphasis on interventions that prevent IPV. A promising IPV prevention approach is participatory group education to support individuals to identify the risk factors and consequences of IPV, and gain self-efficacy to prevent and respond to IPV (Campbell et al 2013).…”

“…This is a limitation given the increasing recognition of the need to address the interplay of personal, situational and socio-cultural factors influencing IPV (Heise 2011;Abramsky et al 2012;Kyegombe et al 2014). Community mobilization strategies to prevent IPV are critical as when significant masses of people change their beliefs and behaviors, social norms can change, which reinforces the behaviour changes of individuals and families.…”

“…Community mobilization strategies to prevent IPV are critical as when significant masses of people change their beliefs and behaviors, social norms can change, which reinforces the behaviour changes of individuals and families. Moreover, without ongoing activism around IPV prevention, social norms that condone IPV or regulate it to the private domain, are likely to be maintained (Abramsky et al 2012). SASA!…”