Effective prevention of intimate partner violence through couples training: a randomised controlled trial of Indashyikirwa in Rwanda. Issue 12 (22nd December 2020)

• Record Type: Journal Article
• Authors: Dunkle, Kristin; Stern, Erin; Chatterji, Sangeeta; Heise, Lori
• Is Part Of: BMJ global health. Volume 5:Issue 12(2020)
• Publication Date: 2020-12-22
• Subjects: health education and promotion -- prevention strategies -- public health -- Cluster randomised trial; World health -- Periodicals; 362.105
• DOI: 10.1136/bmjgh-2020-002439
• Languages: English
• ISSNs: 2059-7908

Abstract

Abstract : Background: Between 2015 and 2018, three civil society organisations in Rwanda implemented Indashyikirwa, a four-part intervention designed to reduce intimate partner violence (IPV) among couples and within communities. We assessed the impact of the programme's gender transformative curriculum for couples. Methods: Sectors (n=28) were purposively selected based on density of village savings and loan association (VLSA) groups and randomised (with stratification by district) to either the full community-level Indashyikirwa programme (n=14) or VSLA-only control (n=14). Within each sector, 60 couples recruited from VSLAs received either a 21-session curriculum or VSLA as usual. No blinding was attempted. Primary outcomes were perpetration (for men) or experience (for women) of past-year physical/sexual IPV at 24 months post-baseline, hypothesised to be reduced in intervention versus control (ClinicalTrials.gov: NCT03477877 ). Results: We enrolled 828 women and 821 men in the intervention sectors and 832 women and 830 men in the control sectors; at endline, 815 women (98.4%) and 763 men (92.9%) in the intervention and 802 women (96.4%) and 773 men (93.1%) were available for intention-to-treat analysis. Women in the intervention compared with control were less likely to report physical and/or sexual IPV at 24 months (adjusted relative risk (aRR)=0.44, 95% CI 0.34 to 0.59). Men in the intervention compared with control were also significantly less likely to report perpetration of physical and/or sexual IPV at 24 months (aRR=0.54, 95% CI 0.38 to 0.75). Additional intervention benefits included reductions in acceptability of wife beating, conflict with partner, depression, and corporal punishment against children and improved conflict management, communication, trust, self-efficacy, self-rated health, household earnings, food security and actions to prevent IPV. There were no study-related harms. Conclusions: The Indashyikirwa couples' training curriculum was highly effective in reducing IPV among male/female couples in rural Rwanda. Scale-up and adaptation to similar settings should be considered.