Gender and Health Research Unit, South African Medical Research Council, Private Bag x385, 0001, Pretoria, South Africa; Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, 4th Floor, George Campbell Building West Wing, Howard College Campus, Durban, South Africa.
Biostatistics Unit, South African Medical Research Council, PO Box 70380, 4091 Overport, Durban, South Africa.
Soc Sci Med. 2020 Nov;265:113538. doi: 10.1016/j.socscimed.2020.113538. Epub 2020 Nov 19.
Working with men to prevent their perpetration of intimate partner violence and non-partner sexual violence is increasingly recognised as effective. However, in any given context there are a multiplicity of masculinities, each of which has a different association with violence perpetration. There remains lack of clarity about whether such interventions impact all men and masculinities equally. We undertook a post-hoc analysis of men involved in the successful Stepping Stones and Creating Futures cluster randomized control trial in Durban, South Africa, to assess: i) whether there were different groups of men, ii) the factors associated with group allocation, and iii) whether the intervention had a differential impact on these groups in terms of violence perpetration. We used Latent Class Analysis (LCA) to identify masculinity classes, based on fit statistics and theoretical plausibility, and then used descriptive statistics (numbers, percentages, means) and p-values and multinomial models (95% confidence intervals, p-values) to assess factors associated with allocation to each class. To assess intervention impact by group, we used an intention-to-treat analysis, comparing men in each masculinity class, by intervention and control arm, using generalized estimating equations reporting unadjusted and adjusted odds ratios (aORs). In total 674 were recruited at baseline, and the LCA identified three classes of men: high violence (29% of men), medium violence (50% of men) and low violence (21% of men). Multinomial models showed those in more violent classes were more supportive of violence, had more adverse experiences, more depression and had worked more. By masculinity class, the impact of SS-CF showed reductions among the most violent men, with significant reductions in past year physical IPV (aOR0.59, p = 0.014), emotional IPV (aOR0.44, p = 0.044) and economic IPV (aOR0.35, p = 0.004), with non-significant reductions among other classes of men. This analysis suggests intensive group-based interventions can have significant impacts on the most violent men in communities.
与男性合作，防止其实施亲密伴侣暴力和非伴侣性暴力，已日益被视为有效措施。然而，在任何特定情况下，都存在多种男性气质，每一种男性气质与暴力实施都有不同的关联。目前尚不清楚此类干预措施是否会对所有男性和男性气质产生同等影响。我们对南非德班成功实施的“踏脚石”和“创造未来”群组随机对照试验中的男性进行了事后分析，以评估：i）是否存在不同类型的男性；ii）与分组相关的因素；iii）干预措施在暴力实施方面对这些群体是否具有不同影响。我们使用潜在类别分析（LCA），根据拟合统计数据和理论合理性确定男性气质类别，然后使用描述性统计数据（数量、百分比、平均值）和 p 值以及多项模型（95%置信区间、p 值）评估与每个类别分配相关的因素。为了按群体评估干预效果，我们使用意向治疗分析，通过干预和对照组比较每个男性气质类别的男性，使用广义估计方程报告未经调整和调整后的优势比（aOR）。共有 674 名男性在基线时被招募，LCA 确定了三类男性：高暴力（29%的男性）、中暴力（50%的男性）和低暴力（21%的男性）。多项模型表明，处于暴力程度较高的群体的男性更支持暴力行为，有更多的不良经历，更多的抑郁症状，工作更多。按男性气质类别来看，SS-CF 的影响在最暴力的男性中有所降低，过去一年的身体亲密伴侣暴力（aOR0.59，p=0.014）、情绪亲密伴侣暴力（aOR0.44，p=0.044）和经济亲密伴侣暴力（aOR0.35，p=0.004）显著减少，其他类别的男性则没有显著减少。这项分析表明，强化的群体为基础的干预措施可能对社区中最暴力的男性产生重大影响。
