Which men change in intimate partner violence prevention interventions? A trajectory analysis in Rwanda and South Africa

Abstract

IntroductionEmerging evidence suggests working with men to prevent intimate partner violence (IPV) perpetration can be effective. However, it is unknown whether all men benefit equally, or whether different groups of men respond differentially to interventions.MethodsWe conducted trajectory modelling using longitudinal data from men enrolled in intervention arms of three IPV trials in South Africa and Rwanda to identify trajectories of IPV perpetration. We then use multinomial regression to describe baseline characteristics associated with group allocation.ResultsIn South Africa, the Stepping Stones and Creating Futures (SS-CF) trial had 289 men and the CHANGE trial had 803 men, and in Rwanda, Indashyikirwa had 821 men. We identified three trajectories of IPV perpetration: a low-flat (60%–67% of men), high with large reduction (19%–24%) and high with slight increase (10%–21%). Baseline factors associated men in high-start IPV trajectories, compared with low-flat trajectory, varied by study, but included higher poverty, poorer mental health, greater substance use, younger age and more childhood traumas. Attitudes supportive of IPV were consistently associated with high-start trajectories. In separate models comparing high-reducing to high-increasing trajectories, baseline factors associated with reduced IPV perpetration were depressive symptoms (relative risk ratio, RRR=3.06, p=0.01 SS-CF); living separately from their partner (RRR=2.14, p=0.01 CHANGE); recent employment (RRR=1.85, p=0.04 CHANGE) and lower acceptability of IPV (RRR=0.60, p=0.08 Indashyikirwa). Older aged men had a trend towards reducing IPV perpetration in CHANGE (p=0.06) and younger men in Indashyikirwa (p=0.07).ConclusionsThree distinct groups of men differed in their response to IPV prevention interventions. Baseline characteristics of past traumas and current poverty, mental health and gender beliefs predicted trajectory group allocation. The analysis may inform targeting of interventions towards those who have propensity to change or guide how contextual factors may alter intervention effects.Trial registration numbersNCT03022370; NCT02823288; NCT03477877.

Exploring differential impacts of interventions to reduce and prevent intimate partner violence (IPV) on sub-groups of women and men: A case study using impact evaluations from Rwanda and South Africa

“…Both trials had their own limitations as described in their primary outcomes papers ( Dunkle et al, 2020 ; Gibbs, Washington, et al, 2020 ) which remain valid for the secondary analyses conducted in this current study. For instance, all measures rely on self-report, making them subject to reporting bias.…”

“…Results from the main trial analysis found that men in the SS-CF intervention reported significantly less perpetration of severe physical and/or sexual IPV (aOR:0.70, 95% CI: 0.52, 0.94, p < 0.05), physical IPV (aOR:0.71, 95% CI: 0.51, 0.97, p < 0.05) and a non statistically significant reduction in perpetration of sexual IPV (aOR:0.74, 95% CI: 0.54, 1.03, p = 0.07) at 24 months. There was no evidence of an intervention effect on women's experiences of physical and/or sexual IPV ( Gibbs, Washington, et al, 2020 ).…”

“…A total of 676 women and 674 men were recruited and endline retention was 74.9% (n = 505) for men and 80.6% (n = 545) for women. More details on the study rationale, setting, methods and intervention are available elsewhere ( Gibbs, Washington, et al, 2020 ). Results from the main trial analysis found that men in the SS-CF intervention reported significantly less perpetration of severe physical and/or sexual IPV (aOR:0.70, 95% CI: 0.52, 0.94, p < 0.05), physical IPV (aOR:0.71, 95% CI: 0.51, 0.97, p < 0.05) and a non statistically significant reduction in perpetration of sexual IPV (aOR:0.74, 95% CI: 0.54, 1.03, p = 0.07) at 24 months.…”

“…Both trials used an intention-to-treat analysis approach and we used the same models for subgroup analyses. In the SS-CF trial, outcomes were analyzed using generalized estimating equation models accounting for the clustered nature of the data ( Gibbs, Washington, et al, 2020 ). The analysis for the Indashyikirwa trial included a generalized linear mixed effects model with a logit link function to compare the effect of the intervention between the 2 study arms for all binary variables and a negative binomial link function for count data.…”

“…Secondary ethics approval was also obtained from the South Africa Medical Research Council (EC033-10/2015). In both trials, written consent was obtained from all participants; illiterate participants could have the form read to them by study personnel or a trusted person of their choosing ( Dunkle et al, 2020 ; Gibbs, Washington, et al, 2020 ).…”