Community activism as a strategy to reduce intimate partner violence (IPV) in rural Rwanda: Results of a community randomised trial

Abstract

Community activism as a strategy to reduce intimate partner violence (IPV) in rural Rwanda: Results of a community randomised trial 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

Effective prevention of intimate partner violence through couples training: a randomised controlled trial ofIndashyikirwain Rwanda

“…They were active collaborators on our accompanying qualitative research and process evaluations, including validating the analysis and formulating recommendations. 13 14 21 25–28 The Indashyikirwa programme and the impact evaluation were overseen by a programme advisory committee chaired by the Rwandan Ministry of Gender and Family Planning (MIGEPROF), with active engagement of civil society representatives. Findings presented here were workshopped in Rwanda with stakeholders from civil society, government, multilateral agencies and research organisations before submission for publication.…”

“…A separate manuscript presents findings from the results from repeat cross-sectional surveys of the communities before and after the three other components of Indashyikirwa, as well as insights from the detailed process evaluation that accompanied the rollout. 13 The full Indashyikirwa 'Agents of Change' programme included four interlocking components: a 21-session couples' curriculum; community outreach by trained community activists; the creation of an enabling environment through training and active involvement of key opinion leaders; and provision of support to victims through the creation of women's 'safe spaces'. 13 14 The Couples Curriculum drew on Journeys of Transformation (JoT)-a 17-session participatory curriculum implemented by CARE Rwanda, the Rwandan Men's Resource Centre (RWAMREC) and Promundo-to foster men's support of their partners' participation in CARE's village savings and loan associations (VSLA).…”

“…Findings from this aspect of Indashyikirwa are described in detail elsewhere. 13 To assess the impact of the Indashyikirwa couples' programme, we conducted a community randomised controlled trial (cRCT). Outcomes for participants in the couples' training were assessed at the individual level.…”

“…A separate manuscript presents findings from the results from repeat cross-sectional surveys of the communities before and after the three other components of Indashyikirwa , as well as insights from the detailed process evaluation that accompanied the rollout. 13 …”

“…The full Indashyikirwa ‘Agents of Change’ programme included four interlocking components: a 21-session couples’ curriculum; community outreach by trained community activists; the creation of an enabling environment through training and active involvement of key opinion leaders; and provision of support to victims through the creation of women’s ‘safe spaces’. 13 14 The Couples Curriculum drew on Journeys of Transformation (JoT)—a 17-session participatory curriculum implemented by CARE Rwanda, the Rwandan Men’s Resource Centre (RWAMREC) and Promundo—to foster men’s support of their partners’ participation in CARE’s village savings and loan associations (VSLA). A small mixed-method evaluation found that the JoT curriculum reduced household-level poverty and had a positive impact on partners’ collaboration around household and care work, family relations and decision-making, but had an unclear impact on IPV.…”