Improving family functioning and reducing violence in the home in North Kivu, Democratic Republic of Congo: a pilot cluster-randomised controlled trial of Safe at Home

Abstract

ObjectiveTo test the effectiveness of the Safe at Home programme which was developed to improve family well-being and prevent multiple forms of violence in the home.DesignWaitlisted pilot cluster randomised controlled trial.SettingNorth Kivu, Democratic Republic of Congo.Participants202 heterosexual couples.InterventionThe Safe at Home programme.Primary and secondary outcome measuresThe primary outcome was family functioning, with secondary outcomes of past-3 month co-occurring violence, intimate partner violence (IPV) and harsh discipline. Pathway mechanisms assessed included attitudes related to acceptance of harsh discipline, gender equitable attitudes, positive parenting skills and power sharing within the couple.ResultsNo significant improvements in family functioning were documented for women (β=1.49; 95% CI: −2.75 to 5.74; p=0.49) and men (β=1.09; 95% CI: −3.13 to 4.74; p=0.69). However, women in Safe at Home reported a OR=0.15 (p=0.000), OR=0.23 (p=0.001) and OR=0.29 (p=0.013) change in co-occurring IPV and harsh discipline; physical/sexual/emotional IPV by their partner and use of physical and/or emotional harsh discipline against their child, respectively, as compared with women in the waitlisted group. Men participating in Safe at Home reported a OR=0.23 (p=0.005) change in perpetration of co-occurring violence, OR=0.26 (p=0.003) change in any form of IPV perpetration and OR=0.56 (p=0.19) change in use of harsh discipline against their child as compared with the waitlist arm. Positive changes were also noted in pathway variables around attitudes, skills and behaviours within couples.ConclusionThis pilot trial demonstrated the Safe at Home programme to be highly effective in preventing multiple forms of violence in the home and improving equitable attitudes and skills in couples. Future research should assess longitudinal impact and implementation at scale.Trial registration numberNCT04163549.

Drivers of men’s use of intimate partner violence in conflict-affected settings: learnings from the Democratic Republic of Congo

“…Interventions focused on the relationship between men’s experiences of interpersonal violence and men’s use of IPVAW in conflict-affected settings are relatively rare. One recent exception is Safe at Home, a discussion group intervention in DRC, that explicitly recognized shared structural drivers for IPV and harsh parenting [ 19 ], thereby addressing multiple interpersonal violence exposures (e.g., child abuse and witnessing IPVAW) that could contribute to IPVAW use in the present and subsequent generations.…”

“…Dedicated attention to gender norms and attitudes in IPV interventions in conflict-affected settings is critical. Although interventions focusing on gender inequitable attitudes and related social norms have shown mixed effects in controlled studies, some studies have observed robust effects [ 19 ] or changes in factors that may precede IPV, including changes in attitudes toward violence 12. Our findings suggest targeting gender inequitable attitudes alongside mental health may be a useful strategy.…”

“…Perhaps consequently, few IPVAW interventions engaging men have proven efficacious. Among ten studies engaging men to reduce IPVAW in conflict and post-conflict settings [ 10 – 19 ], three have shown a statistically significant reduction in any type of IPVAW when compared to a control group: community-based dialogue groups [ 19 ], gender dialogue groups added to group savings [ 10 ], and trauma-informed psychotherapy [ 17 ].…”

Impacts of an abbreviated personal agency training with refugee women and their male partners on economic empowerment, gender-based violence, and mental health: a randomized controlled trial in Rwanda

“…Another approach to addressing GBV shown to successfully reduce rates of IPV outside of humanitarian settings includes adapting programs that used group learning and engaged partners through community gender dialogues [ 12 , 13 ]. Recent evidence from the ‘safe at home’ trial in the Democratic Republic of Congo (DRC) finds that single-sex discussion groups for couples significantly reduced the risk of IPV for women and harsh discipline for children [ 14 ]. However, in another study amongst conflict affected populations in the DRC, similar gender dialogue trainings with men alone have not been found to reduce IPV [ 11 ].…”

“…Moreover, engaging men led to no promising impacts on women’s economic empowerment and did not address NPV. These interventions are also extremely resource and time intensive and require participants to attend upto 29 weekly sessions over a period of 6–8 months [ 14 ].…”