Gender and Health Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
Gender Violence and Health Centre, London School of Hygiene & Tropical Medicine, Locon, UK.
BMJ Glob Health. 2020 Dec;5(12). doi: 10.1136/bmjgh-2020-002439.
Between 2015 and 2018, three civil society organisations in Rwanda implemented , 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.
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 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).
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.
The 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.
2015 年至 2018 年期间，卢旺达的三个民间社会组织实施了一项四部分干预措施，旨在减少夫妻之间和社区内的亲密伴侣暴力（IPV）。我们评估了该方案的性别转换课程对夫妻的影响。
根据村庄储蓄和贷款协会（VLSA）小组的密度，有目的地选择部门（n=28），并按区分层随机（n=14）分配到完整的社区一级方案（n=14）或仅 VLSA 对照（n=14）。在每个部门中，从 VLSA 招募的 60 对夫妻接受了 21 次课程或常规的 VLSA。未尝试进行盲法。主要结局是在基线后 24 个月时，过去一年中男性对女性的身体/性 IPV 的实施（对男性而言）或女性对男性的经历（对女性而言），假设干预组比对照组减少（ClinicalTrials.gov：NCT03477877）。
我们在干预部门招募了 828 名女性和 821 名男性，在对照组招募了 832 名女性和 830 名男性；在终点，815 名女性（98.4％）和 763 名男性（92.9％）在干预组和 802 名女性（96.4％）和 773 名男性（93.1％）可用于意向治疗分析。与对照组相比，干预组的女性在 24 个月时更不可能报告身体和/或性 IPV（调整后的相对风险（aRR）=0.44，95％CI 0.34 至 0.59）。与对照组相比，干预组的男性在 24 个月时也不太可能报告身体和/或性 IPV 的实施（aRR=0.54，95％CI 0.38 至 0.75）。干预的其他益处包括减少对打妻子的接受度、与伴侣的冲突、抑郁、对儿童的体罚以及改善冲突管理、沟通、信任、自我效能感、自我评定健康、家庭收入、粮食安全和预防 IPV 的行动。没有与研究相关的伤害。
夫妻培训课程在减少卢旺达农村地区男女夫妻之间的 IPV 方面非常有效。应考虑扩大规模并适应类似环境。
