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Sebők-Welker T, Posta E, Ágrez K, Rádosi A, Zubovics EA, Réthelyi MJ, Ulbert I, Pászthy B, Bunford N. The Association Between Prenatal Maternal Stress and Adolescent Affective Outcomes is Mediated by Childhood Maltreatment and Adolescent Behavioral Inhibition System Sensitivity. Child Psychiatry Hum Dev 2024; 55:1-21. [PMID: 36738426 PMCID: PMC11362206 DOI: 10.1007/s10578-023-01499-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/05/2023]
Abstract
Prenatal maternal stress is linked to offspring outcomes; however, there is little research on adolescents, behavioral, transdiagnostic outcomes, or the mechanisms through which relations operate. We examined, in N = 268 adolescents (Mage = 15.31 years; SD = 1.063; 57.8% boys) whether prenatal maternal stress is associated with adolescent affective outcomes; whether this association is mediated, serially, by childhood home atmosphere and adolescent behavioral inhibition system (BIS) sensitivity; and whether mediational effects are moderated by adolescent attention-deficit/hyperactivity disorder or maternal internalizing symptomology. Prenatal maternal daily stress and major life events were associated with adolescent outcomes through childhood negative atmosphere/neglect and BIS sensitivity, with no evidence of moderation. Results have implications regarding the effect of prenatal maternal stress on offspring outcomes and regarding corresponding sensitive periods.
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Affiliation(s)
- T Sebők-Welker
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
- Doctoral School of Mental Health Sciences, Semmelweis University, Balassa U. 6, Budapest, 1083, Hungary
| | - E Posta
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
| | - K Ágrez
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
| | - A Rádosi
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
- Doctoral School of Mental Health Sciences, Semmelweis University, Balassa U. 6, Budapest, 1083, Hungary
| | - E A Zubovics
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
| | - M J Réthelyi
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa U. 6, Budapest, 1083, Hungary
| | - I Ulbert
- Integrative Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Práter Utca 50/A, Budapest, 1083, Hungary
| | - B Pászthy
- 1st Department of Paediatrics, Semmelweis University, Bókay János U. 53-54, Budapest, 1083, Hungary
| | - N Bunford
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary.
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Wynter K, Francis LM, Borgkvist A, Dixson B, D'Souza L, Duursma E, May C, Sher L, George JS. Effectiveness of Father-Focused Interventions to Prevent or Reduce Intimate Partner Violence During Pregnancy and Early Parenthood: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024:15248380241277270. [PMID: 39302822 DOI: 10.1177/15248380241277270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
During pregnancy and the early parenting period, women are especially vulnerable to intimate partner violence (IPV), with devastating impacts on women, children, and families. The aim of this systematic review was to determine the effectiveness of father-focused interventions to prevent or reduce IPV during pregnancy and early parenthood. Six databases were searched, using a combination of the concepts "fathers," "pregnancy/early parenthood," "IPV" and "intervention." Articles were double screened by title and abstract, and then full-text. Methodological and reporting quality was assessed using the Quality Assessment with Diverse Studies tool. Fifteen papers were eligible for inclusion; these articles were mostly of poor-to-moderate quality. Only three of the articles reported on interventions in lower- and middle-income countries. The most common forms of IPV addressed in these interventions were physical (10), psychological (8), sexual (4), and economic/financial (3). Of 12 articles reporting on data from both intervention and control groups, only six indicated statistically significant results; among these, only three reported robust analyses showing significantly greater reduction in IPV in intervention than in control groups. All three took place in lower- or middle-income countries. Two were underpinned by theoretical frameworks, which considered transforming traditional perceived gender norms. Therefore, interventions based on principles that address transformation of gender norms show promise but the success of such underlying principles needs to be confirmed, and better-quality evidence and reporting are needed for interventions targeting fathers to prevent or reduce IPV.
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Affiliation(s)
- Karen Wynter
- Department of Psychiatry, School of Clinical Sciences, Monash University, Australia
- School of Nursing & Midwifery, Deakin University, Australia
| | - Lauren M Francis
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Australia
| | - Ashlee Borgkvist
- Safe Relationships and Communities Research Group, University of South Australia, Australia
| | - Barnaby Dixson
- School of Health, University of the Sunshine Coast, Australia
- School of Psychology, The University of Queensland, Australia
| | - Levita D'Souza
- School of Educational Psychology and Counselling, Monash University, Australia
| | - Elisabeth Duursma
- Transforming early Education And Child Health (TeEACH) Research Centre, School of Education, University of Western Sydney, Australia
- School of Education, University of Wollongong, Australia
| | - Chris May
- School of Health Sciences, University of Newcastle, Australia
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Alsager A, McCann JK, Bhojani A, Joachim D, Joseph J, Gibbs A, Kabati M, Jeong J. "Good fathers": Community perceptions of idealized fatherhood and reported fathering behaviors in Mwanza, Tanzania. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002587. [PMID: 38990961 PMCID: PMC11238964 DOI: 10.1371/journal.pgph.0002587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/14/2024] [Indexed: 07/13/2024]
Abstract
Globally, perceptions of idealized fatherhood have been expanding beyond men's breadwinning roles to also value men's engagement in nurturing care. While fathers' caregiving behaviors are increasing, most childcare activities are still largely performed by mothers. In this study, we unpacked community members' beliefs about the meaning of "good fathers" and explored the degree to which these values aligned with the main caregiving behaviors reported about fathers with young children under age 2 years in Mwanza, Tanzania. Qualitative data were collected as part of a broader formative research study for which we conducted in-depth interviews with 29 fathers, 23 mothers, 4 village leaders and 4 community health workers as well as 3 focus group discussions with fathers, 2 with mothers, and 6 with both fathers and mothers combined. For this secondary data analysis, we used a grounded theory approach combined with thematic content analysis to investigate the nature of fatherhood. We discovered four key ideals associated with "good fathers": fathers as providers, nurturers, supportive partners, and authoritarians. The primary ideal of fathers as breadwinners was strongly aligned with the main reported practice of fathers trying hard to financially providing for their families. However, paternal behaviors reflecting ideals of fathers as nurturers and supportive partners were less practiced. Although ideals towards good fathers as authoritarian were least explicitly valued, many fathers were reported as engaging in controlling behaviors and using violence. The links between fatherhood ideals and behaviors was influenced by various factors, including poverty, men's limited time availability at home, and restrictive gender norms. Overall, our results reveal some alignment but also inconsistencies between the ideal version of fatherhood and commonly reported paternal practices. These discrepancies highlight the need for further investigation into the underlying factors that both enable and constrain the links between fatherhood ideals and behaviors. Our study results have important implications for the design of interventions that seek to enhance fatherhood to improve the development and wellbeing of children and families.
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Affiliation(s)
- Alya Alsager
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Social and Behavioral Sciences, College of Public Health, Kuwait University, Kuwait City, Kuwait
| | - Juliet K McCann
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Alina Bhojani
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Damas Joachim
- Tanzania Home Economics Organization, Mwanza, Tanzania
| | | | - Andrew Gibbs
- Faculty of Health and Life Sciences, Department of Psychology, University of Exeter, Exeter, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
- Gender and Health Research Institute, South African Medical Research Council, Pretoria, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Mary Kabati
- Tanzania Home Economics Organization, Mwanza, Tanzania
| | - Joshua Jeong
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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Satinsky EN, Kakuhikire B, Baguma C, Cooper-Vince CE, Rasmussen JD, Ashaba S, Perkins JM, Ahereza P, Ayebare P, Kim AW, Puffer ES, Tsai AC. Caregiver preferences for physically harsh discipline of children in rural Uganda. JOURNAL OF FAMILY VIOLENCE 2024; 39:861-874. [PMID: 38962696 PMCID: PMC11218336 DOI: 10.1007/s10896-023-00536-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 07/05/2024]
Abstract
Purpose Physically harsh discipline is associated with poor developmental outcomes among children. These practices are more prevalent in areas experiencing poverty and resource scarcity, including in low- and middle-income countries. Designed to limit social desirability bias, this cross-sectional study in rural Uganda estimated caregiver preferences for physically harsh discipline; differences by caregiver sex, child sex, and setting; and associations with indicators of household economic stress and insecurity. Method Three-hundred-fifty adult caregivers were shown six hypothetical pictographic scenarios depicting children whining, spilling a drink, and kicking a caregiver. Girls and boys were depicted engaging in each of the three behaviors. Approximately half of the participants were shown scenes from a market setting and half were shown scenes from a household setting. For each scenario, caregivers reported the discipline strategy they would use (time out, beating, discussing, yelling, ignoring, slapping). Results Two thirds of the participants selected a physically harsh discipline strategy (beating, slapping) at least once. Women selected more physically harsh discipline strategies than men (b = 0.40; 95% confidence interval [CI], 0.26 to 0.54). Participants shown scenes from the market selected fewer physically harsh discipline strategies than participants shown scenes from the household (b = -0.51; 95% CI, -0.69 to -0.33). Finally, caregivers selected more physically harsh discipline strategies in response to boys than girls. Indicators of economic insecurity were inconsistently associated with preferences for physically harsh discipline. Conclusions The high prevalence of physically harsh discipline preferences warrant interventions aimed at reframing caregivers' approaches to discipline.
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Affiliation(s)
- Emily N. Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | | | | | - Phionah Ahereza
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Andrew W. Kim
- Department of Anthropology, University of California, Berkeley, CA, USA
| | - Eve S. Puffer
- Department of Psychology, Duke University, Durham, NC, USA
| | - Alexander C. Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- Harvard Medical School, Boston, MA, USA
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Siu G, Nsubuga RN, Lachman JM, Namutebi C, Sekiwunga R, Zalwango F, Riddell J, Wight D. The impact of the parenting for respectability programme on violent parenting and intimate partner relationships in Uganda: A pre-post study. PLoS One 2024; 19:e0299927. [PMID: 38787892 PMCID: PMC11125497 DOI: 10.1371/journal.pone.0299927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/23/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND There is a growing need for interventions that reduce both violence against children and intimate partner violence in low- and middle-income countries. However, few parenting interventions deliberately address this link. We tested the feasibility of a 16-session group-based parenting programme, Parenting for Respectability, in semi-rural Ugandan communities. METHODS This was a pre-post study with parents and their children (N = 484 parents; 212 children). RESULTS Pre-post comparisons found large effects for parent-reported reduced harsh parenting (Cohen's f2 = 0.41 overall; f2 = 0.47 (among session attendees); with an overall reduction of 26% for harsh parenting. Session attendees reported higher reductions than non-attendees (p = 0.014), and male caregivers reported higher reductions than female caregivers (p<0.001). Children also reported reduced harsh parenting by attending fathers (f2 = 0.64 overall; f2 = 0.60) and attending mothers (f2 = 0.56 overall; f2 = 0.51); with reduction in harsh parenting ranging between 27% to 29% in the various categories. Overall, spousal violence reduced by 27% (f2 = 0.19 overall; f2 = 0.26 (among session attendees). Both parents and children reported reduced dysfunctional parent relationships; parents: f2 = 0.19 overall; f2 = 0.26 (among session attendees); and children: f2 = 0.35 overall; f2 = 0.32 (for attending parents); with reductions ranging between 22% to 28%. Parents who attended more than 50% of the program reported greater effects on reduced dysfunctional relationships than those who attended less than half of the program (B = -0.74, p = 0.013). All secondary outcomes were improved with f2 ranging between 0.08 and 0.39; and improvements ranging between 6% and 28%. CONCLUSION Results suggest the importance of more rigorous testing to determine program effectiveness.
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Affiliation(s)
- Godfrey Siu
- Child Health and Development Centre, School of Medicine Makerere University College of Health Sciences, Kampala, Uganda
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Global Health, LSHTM, London, United Kingdom
| | | | - Jamie M. Lachman
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- University of Cape Town, Cape Town, South Africa
| | - Carol Namutebi
- Child Health and Development Centre, School of Medicine Makerere University College of Health Sciences, Kampala, Uganda
| | - Richard Sekiwunga
- Child Health and Development Centre, School of Medicine Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Julie Riddell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Daniel Wight
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
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Bacchus LJ, Colombini M, Pearson I, Gevers A, Stöckl H, Guedes AC. Interventions that prevent or respond to intimate partner violence against women and violence against children: a systematic review. Lancet Public Health 2024; 9:e326-e338. [PMID: 38702097 DOI: 10.1016/s2468-2667(24)00048-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 05/06/2024]
Abstract
Efforts to prevent or respond to intimate partner violence (IPV) and violence against children (VAC) are still disparate worldwide, despite increasing evidence of intersections across these forms of violence. We conducted a systematic review to explore interventions that prevent or respond to IPV and VAC by parents or caregivers, aiming to identify common intervention components and mechanisms that lead to a reduction in IPV and VAC. 30 unique interventions from 16 countries were identified, with 20 targeting both IPV and VAC. Key mechanisms for reducing IPV and VAC in primary prevention interventions included improved communication, conflict resolution, reflection on harmful gender norms, and awareness of the adverse consequences of IPV and VAC on children. Therapeutic programmes for women and children who were exposed to IPV facilitated engagement with IPV-related trauma, increased awareness of the effects of IPV, and promoted avoidance of unhealthy relationships. Evidence gaps in low-income and middle-income countries involved adolescent interventions, post-abuse interventions for women and children, and interventions addressing both prevention and response to IPV and VAC. Our findings strengthen evidence in support of efforts to address IPV and VAC through coordinated prevention and response programmes. However, response interventions for both IPV and VAC are rare and predominantly implemented in high-income countries. Although therapeutic programmes for parents, caregivers, and children in high-income countries are promising, their feasibility in low-income and middle-income countries remains uncertain. Despite this uncertainty, there is potential to improve the use of health services to address IPV and VAC together.
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Affiliation(s)
- Loraine J Bacchus
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Manuela Colombini
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Isabelle Pearson
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Anik Gevers
- Sexual Violence Research Initiative, Cape Town, South Africa
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians University of Munich, Munich, Germany
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Thomas D, Nakabugo L, Nambi F, Kibuuka J, Muwonge TR, Feutz E, Thomas KK, Simoni JM, Montgomery ET, Ware N, Wyatt MA, Katz IT, Kadama H, Mujugira A, Heffron R. Intimate Partner Violence and Adherence to PrEP and ART Among Ugandan HIV Serodifferent Couples. J Acquir Immune Defic Syndr 2024; 95:347-354. [PMID: 38133584 PMCID: PMC10896193 DOI: 10.1097/qai.0000000000003368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Intimate partner violence (IPV) is associated with increased risk of HIV acquisition and reduced engagement in HIV care. There is limited understanding of the ways in which IPV exposure and other maladaptive relationship dynamics may influence adherence to antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) for individuals in committed, HIV serodifferent partnerships. METHODS We used binomial generalized linear mixed-effect regression models to evaluate the association between IPV exposure and ART/PrEP adherence among members of serodifferent couples in Uganda. Secondarily, we assessed the association between relationship powerlessness and ART/PrEP adherence. RESULTS We enrolled and followed both partners in 149 heterosexual serodifferent couples. The partner living with HIV was female in 64% of couples. IPV exposure was associated with low ART adherence (15% vs. 5% in quarters with no IPV, odds ratio: 4.78, 95% confidence interval: 1.48 to 15.42), but not low PrEP adherence (33% vs. 36%, P = 0.69). Among HIV-negative individuals, those reporting moderate relationship powerlessness were less likely to have poor PrEP adherence compared with those with low relationship powerlessness (20% vs. 30%, odds ratio: 0.57, 95% confidence interval: 0.36 to 0.90). We observed no association between relationship powerlessness and ART adherence. CONCLUSIONS We found that IPV exposure was associated with low adherence to ART and that relationship powerlessness was associated with good adherence to PrEP. These findings contribute to the evidence base outlining the influence of IPV and relationship power on ART/PrEP adherence for individuals in HIV serodifferent unions.
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Affiliation(s)
- Dorothy Thomas
- Department of Global Health, University of Washington, Seattle, WA
| | | | - Florence Nambi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Joseph Kibuuka
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Erika Feutz
- Department of Global Health, University of Washington, Seattle, WA
| | | | - Jane M. Simoni
- Department of Global Health, University of Washington, Seattle, WA
- Department of Psychology, University of Washington, Seattle, WA
| | - Elizabeth T. Montgomery
- Women's Global Health Imperative, RTI International, Berkeley, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Norma Ware
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | - Monique A. Wyatt
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
- Harvard Global, Cambridge, MA
| | | | | | - Andrew Mujugira
- Department of Global Health, University of Washington, Seattle, WA
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, WA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; and
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Edwards KM, Kumar M, Waterman EA, Mullet N, Madeghe B, Musindo O. Programs to Prevent Violence Against Children in Sub-Saharan Africa: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:593-612. [PMID: 36964686 DOI: 10.1177/15248380231160742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Violence against children-which includes maltreatment (including physical, sexual, psychological and emotional violence, and neglect), bullying (including cyberbullying), youth violence (including physical assault with or without weapons), intimate partner violence (including exposure to domestic violence and direct involvement in teen dating violence), and sexual violence-continues to present itself as a significant public health crisis in Sub-Saharan Africa (SSA) leading to numerous short- and long-term deleterious outcomes. As such, the prevention of violence against children in SSA is a critical public health priority. In this systematic literature review, we identified 45 articles that reported on results from 22 programs that seek to reduce violence against children in SSA. Results suggested that programs that focus on (1) economic strengthening, (2) teachers schools, (3) entire families, (4) caregivers only, and (5) children only are generally effective in reducing violence against children by promoting focused action on the mechanisms of change (e.g., parenting skills, enhanced parent-child relationships, resistance skills for children). To date, no research in SSA has examined the impact of policy interventions on childhood victimization or community-level interventions to change norms and values that support violence against children. Future research is needed to examine the impacts of comprehensive efforts to prevent violence against children in SSA as well as factors that predict uptake and sustainability of such prevention efforts in SSA.
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DeHond A, Brady F, Kalokhe AS. Prevention of Perpetration of Intimate Partner Violence by Men and Boys in Low- and Middle-Income Countries: A Scoping Review of Primary Prevention Interventions. TRAUMA, VIOLENCE & ABUSE 2023; 24:2412-2428. [PMID: 35511498 DOI: 10.1177/15248380221097441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Intimate partner violence (IPV) affects the health of women across the globe, with the greatest burden encountered by women in low- and middle-income countries (LMICs). This scoping review aims to summarize and critically examine primary prevention interventions addressing IPV perpetration by men and boys in LMICs and identify gaps in the evidence base. PubMed, EMbase, and PsychINFO were searched for articles published between January 2001 and October 2020 that examined the efficacy of primary prevention interventions to prevent IPV perpetration by men/boys in LMICs and reported on a quantitative outcome examining IPV perpetration. Data on study population, setting and design, intervention components, evaluation methods, and outcomes were extracted, and study quality was assessed using the Effective Public Health Practice Project tool. Of 8,392 articles, 16 intervention studies met inclusion criteria. All 16 were of moderate or weak quality. The majority were conducted in Africa, delivered by peers, theoretically grounded, and included content to challenge IPV acceptance and gender norms. Half demonstrated intervention efficacy in prevention of IPV perpetration; these studies tended to intervene at multiple levels of the Socio-Ecological Model, be delivered over a minimum of eight sessions, and utilize a validated IPV measure to assess intervention impact. In conclusion, the field of IPV perpetration prevention research in LMICs is rapidly evolving, with many interventions demonstrating promise. Future intervention studies should consider expanding to LMICs outside Africa, targeting school-age youth, exploring whether shorter intervention durations are effective, and addressing the methodological shortcomings noted in the quality assessment.
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Affiliation(s)
- Allayna DeHond
- Department of Global Health, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Forrest Brady
- Department of Global Health, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Ameeta S Kalokhe
- Department of Global Health, Emory Rollins School of Public Health, Atlanta, GA, USA
- Division of Infectious Diseases, Emory School of Medicine, Atlanta, GA, USA
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10
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Livings MS, Hsiao V, Withers M. Breaking the Cycle of Family Violence: A Critique of Family Violence Interventions. TRAUMA, VIOLENCE & ABUSE 2023; 24:2544-2559. [PMID: 35538418 DOI: 10.1177/15248380221098049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
As the intergenerational transmission of family violence is associated with numerous negative outcomes, interventions are needed to interrupt this cycle. Our aim is to review the family violence intervention literature and to assess whether and how interventions interrupt the intergenerational transmission of family violence. Papers about interventions were identified through database searches (PubMed, JSTOR, CINAHL, PsycINFO), supplemented by review of references and relevant review papers. Eligibility criteria included: empirical studies detailing interventions to interrupt or prevent child abuse/maltreatment and/or intimate partner violence, published between January 2000 and August 2020, and written in English. Of the 14 papers included in this narrative review, only 3 explicitly stated that they aimed to break the cycle of family violence; 12 papers came from high-income countries, and 10 focused on individuals, with half focusing on mothers. We identify effective intervention approaches, including long-term one-on-one coaching and home visits to improve parenting. Results demonstrate a dose-response relationship, suggesting the lasting value of increased intervention frequency and duration. We highlight gaps in the literature, including the need for interventions in low-income countries, and those geared toward fathers and neighborhoods/communities. We also examine the many methodological challenges of this work, such as possible biases related to the use of retrospective data, lack of objective outcome measures, and absence of long-term follow-up. Our recommendations for future research include incorporating trauma-informed frameworks, developing standardized definitions and measures to facilitate the comparison of intervention results, and designing more interventions specifically for fathers/husbands and for the prevention of intimate partner violence.
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Affiliation(s)
- Michelle S Livings
- Spatial Sciences Institute, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA
| | - Victor Hsiao
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA, USA
| | - Mellissa Withers
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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11
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Schafer M, Lachman JM, Gardner F, Zinser P, Calderon F, Han Q, Facciola C, Clements L. Integrating intimate partner violence prevention content into a digital parenting chatbot intervention during COVID-19: Intervention development and remote data collection. BMC Public Health 2023; 23:1708. [PMID: 37667352 PMCID: PMC10476288 DOI: 10.1186/s12889-023-16649-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is a serious public health issue which experienced a sharp incline during the onset of COVID-19. Increases in other forms of violence, such as violence against children (VAC), have also been linked to the pandemic, and there have been calls for greater prevention efforts that tackle both forms of violence concurrently. The COVID-19 crisis has highlighted the urgent need for evidence-based and scalable violence prevention interventions that target multiple forms of family violence. Parenting programmes have shown promising results in preventing various forms of family violence, including IPV and VAC, and have recently experienced an expansion in delivery, with digital intervention formats growing. This paper describes the development and evaluation of the IPV prevention content designed and integrated into ParentText, a chatbot parenting intervention adapted from Parenting for Lifelong Health programmes. METHODS The ParentText IPV prevention content was developed using the Six Steps in Quality Intervention Development (6SQuID) framework. This involved targeted literature searches for key studies to identify causal factors associated with IPV and determining those with greatest scope for change. Findings were used to develop the intervention content and theory of change. Consultations were held with academic researchers (n = 5), practitioners (n = 5), and local community organisations (n = 7), who reviewed the content. A formative evaluation was conducted with parents in relationships (n = 96) in Jamaica to better understand patterns in user engagement with the intervention and identify strategies to further improve engagement. RESULTS Using the 6SQuID model, five topics on IPV prevention were integrated into the ParentText chatbot. Text-messages covering each topic, including additional materials such as cartoons and videos, were also developed. The formative evaluation revealed an average user-engagement length of 14 days, 0.50 chatbot interactions per day, and over half of participants selected to view additional relationship content. CONCLUSIONS This article provides a unique contribution as the first to integrate IPV prevention content into a remotely delivered, digital parenting intervention for low-resource settings. The findings from this research and formative evaluation shed light on the promising potential of chatbots as scalable and accessible forms of violence prevention, targeting multiple types of family violence.
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Affiliation(s)
- Moa Schafer
- Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom.
| | - Jamie M Lachman
- Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Frances Gardner
- Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Paula Zinser
- Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Francisco Calderon
- Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Qing Han
- Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
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12
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Jeong J, McCann JK, Alsager A, Bhojani A, Andrew N, Joseph J, Ahun MN, Kabati M, Joachim D. Formative research to inform the future design of a multicomponent fatherhood intervention to improve early child development in Mwanza, Tanzania. Soc Sci Med 2023; 331:116072. [PMID: 37459822 PMCID: PMC10753856 DOI: 10.1016/j.socscimed.2023.116072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 07/29/2023]
Abstract
Fathers can influence child development through various pathways, such as via their caregiving behaviors, marital relationships, and their psychosocial wellbeing. However, few parenting interventions have been designed to target these multiple dimensions among fathers with young children in low- and middle-income countries. In June 2022, we conducted qualitative formative research to explore the perceptions surrounding fatherhood and the underlying barriers and enablers to engaged fathering in Mwanza, Tanzania. We completed individual in-depth interviews with 29 fathers and 23 mothers of children under aged 2 years along with 5 community leaders and 3 community health workers. We also completed 10 focus group discussions: 4 with fathers, 2 with mothers, and 4 mixed groups that combined both fathers and mothers. In total, the sample included 120 respondents stratified from across 4 study communities. Data were analyzed using thematic content analysis. Respondents highlighted that poor couples' relationships (e.g., limited male partner support, male dominance in decision-making) and fathers' mental health problems (e.g., parenting stress) were major priorities affecting fathers. Father involvement in parenting, childcare, and household activities were generally low. These dimensions of fatherhood were interlinked (e.g., poor paternal mental health constrained marital relationships and parenting). A constellation of determinants impacted engaged fathering. Common barriers included poverty, restrictive gender attitudes and norms, men's limited time at home, and inadequate knowledge about caregiving. Key enablers included mutual respect in marital relationships and men's desires to show their love for their families. Our results highlight the cultural relevance and the need for multicomponent strategies that jointly target fathers' caregiving, marital relationships, and psychosocial wellbeing for enhancing nurturing care and promoting early child development in Tanzania. Study findings can be used to inform the design of a future father-inclusive, gender-transformative parenting intervention for engaging and supporting fathers with young children in the local cultural context.
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Affiliation(s)
- Joshua Jeong
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Juliet K McCann
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alya Alsager
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alina Bhojani
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ngusa Andrew
- Tanzania Home Economics Organization, Mwanza, Tanzania
| | | | - Marilyn N Ahun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mary Kabati
- Tanzania Home Economics Organization, Mwanza, Tanzania
| | - Damas Joachim
- Tanzania Home Economics Organization, Mwanza, Tanzania
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Jeong J, Sullivan EF, McCann JK. Effectiveness of father-inclusive interventions on maternal, paternal, couples, and early child outcomes in low- and middle-income countries: A systematic review. Soc Sci Med 2023; 328:115971. [PMID: 37224703 PMCID: PMC10330563 DOI: 10.1016/j.socscimed.2023.115971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/17/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023]
Abstract
Most caregiving interventions for young children are directed to female caregivers. Relatively few have included male caregivers as program participants especially in low- and middle-income countries (LMICs). The range of potential benefits that can be achieved through the engagement of fathers and male caregivers has not been adequately explored from a family systems perspective. We reviewed interventions that engaged male caregivers to support young children in LMICs and summarized impacts on maternal, paternal, couples, and child outcomes. We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Global Health Library for quantitative evaluation studies of social and behavioral interventions that included fathers or other male caregivers to improve nurturing care for young children under 5 years of age in LMICs. Three authors independently extracted data using a structured form. Forty-four articles, representing 33 intervention evaluations, were included. The most common type of intervention targeted fathers along with their female partners and primarily to address child nutrition and health. Across interventions, maternal outcomes were the most evaluated outcomes (82%), followed by paternal (58%), couple's relationship (48%) and child-level outcomes (45%). Overall, father-inclusive interventions had positive impacts on maternal, paternal and couples' relationship outcomes. Although there was greater variation in the degree of supportive evidence for child outcomes compared to maternal, paternal, and couples outcomes, findings suggested mostly positive effects across all outcomes. Limitations included relatively weak study designs and heterogeneity across interventions, outcome types, and measurement tools. Interventions that include fathers and other male caregivers have potential to improve maternal and paternal caregiving, couple's relationships dynamics, and early child outcomes in LMICs. More evaluation studies, using rigorous methods and robust measurement frameworks, is needed to bolster this evidence-base about the effect of fathers' engagement for young children, caregivers, and families in LMICs.
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Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | | | - Juliet K McCann
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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14
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Pérez-Martínez V, Marcos-Marcos J, Cerdán-Torregrosa A, Briones-Vozmediano E, Sanz-Barbero B, Davó-Blanes MC, Daoud N, Edwards C, Salazar M, La Parra-Casado D, Vives-Cases C. Positive Masculinities and Gender-Based Violence Educational Interventions Among Young People: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:468-486. [PMID: 34282677 DOI: 10.1177/15248380211030242] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Hegemonic masculinity has been recognized as contributing to the perpetration of different forms of gender-based violence (GBV). Abandoning hegemonic masculinities and promoting positive masculinities are both strategies used by interventions that foreground a "gender-transformative approach." Preventing GBV among young people could be strengthened by engaging young men. In this article, we aim to systematically review the primary characteristics, methodological quality, and results of published evaluation studies of educational interventions that aim to prevent different forms of GBV through addressing hegemonic masculinities among young people. MAIN BODY We conducted a systematic review of available literature (2008-2019) using Medline (PubMed), Scopus, Web of Science, PsycInfo, the CINAHL Complete Database, and ERIC as well as Google scholar. The Template for Intervention Description and Replication was used for data extraction, and the quality of the selected studies was analyzed using the Mixed Method Appraisal Tool. More than half of the studies were conducted in Africa (n = 10/15) and many were randomized controlled trials (n = 8/15). Most of the studies with quantitative and qualitative methodologies (n = 12/15) reported a decrease in physical GBV and/or sexual violence perpetration/victimization (n = 6/15). Longitudinal studies reported consistent results over time. CONCLUSIONS Our results highlight the importance of using a gender-transformative approach in educational interventions to engage young people in critical thinking about hegemonic masculinity and to prevent GBV.
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Affiliation(s)
- Vanesa Pérez-Martínez
- Community Nursing, Preventive Medicine and Public Health and History of Science Department, 16718University of Alicante, Spain
| | - Jorge Marcos-Marcos
- Community Nursing, Preventive Medicine and Public Health and History of Science Department, 16718University of Alicante, Spain
| | - Ariadna Cerdán-Torregrosa
- Community Nursing, Preventive Medicine and Public Health and History of Science Department, 16718University of Alicante, Spain
| | | | - Belen Sanz-Barbero
- Epidemiology and Statistics Department, National School of Health Carlos III, Madrid, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
| | - MCarmen Davó-Blanes
- Community Nursing, Preventive Medicine and Public Health and History of Science Department, 16718University of Alicante, Spain
| | - Nihaya Daoud
- Department of Public Health, Faculty of Health Sciences, 26732Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Clarie Edwards
- School of Applied Social Studies, 8795University College Cork, Ireland
| | - Mariano Salazar
- Department of Global Public Health, GloSH research group, Karolinska Institutet, Stockholm, Sweden
| | | | - Carmen Vives-Cases
- Community Nursing, Preventive Medicine and Public Health and History of Science Department, 16718University of Alicante, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
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Falb KL, Asghar K, Blackwell A, Baseme S, Nyanguba M, Roth D, Hategekimana JDD. 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. BMJ Open 2023; 13:e065759. [PMID: 36878658 PMCID: PMC10016303 DOI: 10.1136/bmjopen-2022-065759] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 02/01/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE To 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. DESIGN Waitlisted pilot cluster randomised controlled trial. SETTING North Kivu, Democratic Republic of Congo. PARTICIPANTS 202 heterosexual couples. INTERVENTION The Safe at Home programme. PRIMARY AND SECONDARY OUTCOME MEASURES The 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. RESULTS No 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. CONCLUSION This 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 NUMBER NCT04163549.
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Affiliation(s)
- Kathryn L Falb
- International Rescue Committee, Airbel Impact Lab, Washington, DC, USA
| | - Khudejha Asghar
- International Rescue Committee, Violence Prevention and Reponse, Washington, DC, USA
| | | | - Simon Baseme
- International Rescue Committee, Women's Protection and Empowerment, Goma, Congo (the Democratic Republic of the)
| | - Martin Nyanguba
- International Rescue Committee, Child Protection, Goma, Congo (the Democratic Republic of the)
| | - Danielle Roth
- International Rescue Committee, Violence Prevention and Response, New York, New York, USA
| | - Jean de Dieu Hategekimana
- International Rescue Committee, Women's Protection and Empowerment, Goma, Congo (the Democratic Republic of the)
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Asiimwe R, Dwanyen L, Subramaniam S, Kasujja R, Blow AJ. Training of interventionists and cultural adaptation procedures: A systematic review of culturally adapted evidence-based parenting programs in Africa. FAMILY PROCESS 2023; 62:160-181. [PMID: 35570371 DOI: 10.1111/famp.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 06/15/2023]
Abstract
There has been an increase in the implementation of evidence-based parenting programs from high-income countries to several African countries. In this review, we systematically evaluated intervention studies of culturally adapted parenting programs in nine African countries with the objective of examining the quality of training for interventionists and cultural adaptation procedures. A total of 18 studies, obtained from an electronic search of 6 databases, met the inclusion criteria and were evaluated following PRISMA guidelines. The Ecological Validity Model was adopted to organize data on cultural adaptation procedures. Sixteen of the 18 studies reported information regarding the clinical training of interventionists and the cultural adaptations undertaken. Live and interactive workshops were the most common format used to train interventionists in the focal intervention. Overall, cultural adaptations in most studies included translation of intervention protocols into the local language. However, studies varied in the way cultural adaptation procedures were reported with some studies failing to report on cultural adaptation procedures. Concurring with previous literature, attending to issues of culture, power, privilege, access, sustainability, and other relevant concepts to increase the cultural relevance is highly encouraged in parent intervention studies in Africa. This review provides a baseline upon which future training and adaptation procedures can be built.
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Affiliation(s)
- Ronald Asiimwe
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Lekie Dwanyen
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Saila Subramaniam
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Rosco Kasujja
- Department of Mental Health, School of Psychology, Makerere University, Kampala, Uganda
| | - Adrian J Blow
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
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Galvin L, Verissimo CK, Ambikapathi R, Gunaratna NS, Rudnicka P, Sunseri A, Jeong J, O'Malley SF, Yousafzai AK, Sando MM, Mosha D, Kumalija E, Connolly H, PrayGod G, Endyke-Doran C, Kieffer MP. Effects of engaging fathers and bundling nutrition and parenting interventions on household gender equality and women's empowerment in rural Tanzania: Results from EFFECTS, a five-arm cluster-randomized controlled trial. Soc Sci Med 2023; 324:115869. [PMID: 37023660 DOI: 10.1016/j.socscimed.2023.115869] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Advancing gender equality and women's empowerment (GE/WE) may contribute to better child nutrition and development in low-resource settings. However, few empirical studies have generated evidence on GE/WE and examined the potential of engaging men to transform gender norms and power relations in the context of nutrition and parenting programs. We tested the independent and combined effects of engaging couples and bundling nutrition and parenting interventions on GE/WE in Mara, Tanzania. EFFECTS (ClinicalTrials.gov, NCT03759821) was a cluster-randomized 2 × 2 factorial trial plus control. Eighty village clusters were randomly assigned to one of five intervention conditions: standard of care, mothers nutrition, couples nutrition, mothers bundled nutrition and parenting, or couples bundled nutrition and parenting. Between October 2018-May 2019, 960 households were enrolled with children under 18 months of age residing with their mother and father. Community health workers (CHWs) delivered a bi-weekly 24-session hybrid peer group/home visit gender-transformative behavior change program to either mothers or couples. GE/WE outcomes were analyzed as intention-to-treat and included time use, gender attitudes, social support, couples' communication frequency and quality, decision-making power, intimate partner violence (IPV), and women's dietary diversity (WDD). Data were collected from 957 to 815 mothers and 913 and 733 fathers at baseline and endline, respectively. Engaging couples compared to mothers only significantly increased paternal and maternal gender-equitable attitudes, paternal time spent on domestic chores, and maternal decision-making power. Bundling increased maternal leisure time, decreased maternal exposure to any IPV, and increased WDD over 7 days. A combination of engaging couples and bundling was most effective for paternal gender attitudes, couples communication frequency, and WDD over 24 h and 7 days. Our findings generate novel evidence that CHWs can deliver bundled nutrition and parenting interventions to couples in low-resource community settings that advance GE/WE more than nutrition interventions targeting only women.
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Blackwell AH, de Dieu Hategekimana J, Bauma D, Roth D, Thivillier P, O'Connor M, Falb K. Violent Discipline in North Kivu, Democratic Republic of Congo: The Role of Child Gender and Disability Status in Cross-sectional Analysis. Matern Child Health J 2023; 27:861-872. [PMID: 36853372 PMCID: PMC10115712 DOI: 10.1007/s10995-023-03598-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Violence is used to punish or educate children across the world, with detrimental effects on their physical, emotional, and social health that persist into their adulthood. This study aimed to understand the use of violent discipline by caregivers in conflict-affected communities and how it varied by the child's gender and disability level. METHODS Using cross-sectional data collected from 394 respondents (196 men and 198 women) in North Kivu, Democratic Republic of Congo, logistic generalized estimating equations stratified by gender assessed the association between past-three-month perpetration of violent discipline, caregiver demographics, conflict experiences, and disability attitudes, as well as child demographics of age, gender, disability level, and the interaction of gender and disability. RESULTS Compared to women with boy children with no disability, odds of perpetration of violent discipline were higher among those with girl children with no disability (aOR: 2.24; 95%CI: 1.11-4.51) and boy children with moderate or severe disability (aOR: 2.91; 95%CI: 1.14-7.33), and the interaction of girl children with a moderate or severe disability showed a 7.80 increase in odds of perpetration; however, association with women's discriminatory disability attitudes was not significant. In contrast, the interaction of child gender and disability level were not significantly associated with perpetration of violent discipline for men, but disability attitudes were significantly associated (aOR: 1.07; 95%CI: 1.00-1.15). DISCUSSION Results suggest that levels of violence in conflict-affected households in North Kivu, DRC are high, with women reporting higher levels of violent discipline overall, and amplified use of violence against girl children with disabilities. More research and programs with an intersectional lens are needed in conflict settings to better understand and address the use of violent discipline and underlying discriminatory norms around gender and disability.
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Affiliation(s)
- Alexandra H Blackwell
- International Rescue Committee, 122 E 42nd St, New York, NY, 10168, USA. .,Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford, OX1 2ER, United Kingdom.
| | - Jean de Dieu Hategekimana
- International Rescue Committee Democratic Republic of Congo, 8 Avenue des Citronniers, Q. Croiz-Rouge, Kinshasa/Gombe, RD Congo, BP, 8119, South Africa
| | - Daddy Bauma
- International Rescue Committee Democratic Republic of Congo, 8 Avenue des Citronniers, Q. Croiz-Rouge, Kinshasa/Gombe, RD Congo, BP, 8119, South Africa
| | - Danielle Roth
- International Rescue Committee, 122 E 42nd St, New York, NY, 10168, USA
| | | | - Meghan O'Connor
- International Rescue Committee, 122 E 42nd St, New York, NY, 10168, USA
| | - Kathryn Falb
- International Rescue Committee, 122 E 42nd St, New York, NY, 10168, USA
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Jeong J, Sullivan EF, McCann JK, McCoy DC, Yousafzai AK. Implementation characteristics of father-inclusive interventions in low- and middle-income countries: A systematic review. Ann N Y Acad Sci 2023; 1520:34-52. [PMID: 36482863 PMCID: PMC9974925 DOI: 10.1111/nyas.14941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although prior reviews have documented the effectiveness of engaging male caregivers in early childhood interventions, little is known about how these interventions have been designed and implemented to reach, engage, and support male caregivers in low-resource global settings. We searched five bibliographic databases for intervention studies that engaged male caregivers to improve nurturing care for children under 5 years of age in low- and middle-income countries. Forty-four articles met the inclusion criteria, which represented 33 interventions. Fathers specifically were the most common type of male caregivers targeted in these interventions. The majority of interventions invited fathers to participate alongside their female partners. Community-based peer-groups were the most common delivery model. Most interventions used the same program structure for fathers as applied to mothers, with few considering whether implementation adaptations were needed for men. Intervention curricula were multicomponent and largely targeted child nutrition, health, and couples' relationships. A minority of programs addressed parenting, psychosocial wellbeing, violence prevention, gender attitudes, or economic support. Behavior change techniques were limited to interactive counseling and peer learning. Male caregivers remain missing from caregiving interventions for young children. A greater focus on implementation research can inform better inclusion, engagement, and support for male caregivers in nurturing care interventions.
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Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Juliet K McCann
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Dana C McCoy
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Falb K, Blackwell A, Hategekimana JDD, Roth D, O'Connor M. Preventing Co-occurring Intimate Partner Violence and Child Abuse in Eastern Democratic Republic of Congo: The Role of Family Functioning and Programmatic Reflections. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:NP183-NP211. [PMID: 35383473 DOI: 10.1177/08862605221080152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Co-occurring intimate partner violence (IPV) and child abuse occur at staggering levels in eastern Democratic Republic of Congo (DRC), yet little is known about the relationship between these forms of violence and a feminst-grounded conceptualization of family functioning nor how best to programmatically address these multiple forms of violence in the home. Analysis of cross-sectional baseline data from 203 adult couple dyads participating in a randomized controlled trial was undertaken to (1) understand the correlation of family functioning and violence in the home in North Kivu, DRC; (2) unpack potential shared correlates of violence in the home and family functioning, such as attitudes and behaviors; and (3) describe programmatic implications for delivering violence prevention programming that seeks to address multiple forms of violence in the home. Findings suggest over half of all families reported experiencing IPV against women or use of child abuse by any caregiver. Moderate levels of family functioning were also reported, although women reported lower levels. In adjusted models, a one-point change in family functioning score was associated with a 0.12 reduction in odds of co-occurring experience of IPV and use of child abuse for women, and a 0.03 reduction in odds of co-occurring perpetration for men. A focus on improving family functioning as a primary outcome, alongside explicit targeting of harmful gender norms and skills-based approaches, may be a promising avenue to integrate approaches from different violence prevention fields while maintaining a strong dedication to intersectional feminist-grounded approaches that allows for separate, but at times combined, approaches to reducing IPV and child abuse in the home.
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Affiliation(s)
- Kathryn Falb
- 66048International Rescue Committee, Washington, DC, USA
| | | | | | - Danielle Roth
- 66048International Rescue Committee, New York City, NY, USA
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Branco MSS, Altafim ERP, Linhares MBM. Universal Intervention to Strengthen Parenting and Prevent Child Maltreatment: Updated Systematic Review. TRAUMA, VIOLENCE & ABUSE 2022; 23:1658-1676. [PMID: 33973499 DOI: 10.1177/15248380211013131] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Child maltreatment is a severe worldwide public health problem because of its negative consequences and should therefore be prevented through parenting programs to improve parental behavior and practices. The present review aimed to update a published review of 5 years of empirical studies on universal parenting programs to strengthen positive parenting and prevent child maltreatment. A systematic search of the PubMed, Web of Science, PsycINFO, Lilacs, and SciELO databases was performed to identify the studies of group-based structured parenting programs published from 2015 to 2019. Eighteen studies were found that fulfilled the inclusion and exclusion criteria. The results showed that 14 different parenting programs were conducted in high-, medium-, and low-income countries, showing an increase in the number of studies in low-income countries compared with the previous review. In 89% of the studies, the parenting outcomes improved in the post-intervention. Additionally, studies have demonstrated that these programs also improved other parental outcomes such as mental health, couple relationships, coparenting, and coping ability of parents. From 18 studies, nine child variables were evaluated, and eight of them showed a decrease in behavior problems. Regarding the methodological quality of the studies, 55%, 28%, and 17% were classified as moderate, weak, and strong, respectively. In conclusion, the positive changes in parenting and child behavior outcomes encourage the implementation of parenting programs as a universal prevention strategy. Further research should increase the methodological quality of the design study.
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Affiliation(s)
- Marília Souza Silva Branco
- Department of Neurosciences and Behavior, Ribeirao Preto Medical School, University of São Paulo, Brazil
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Lowe H, Dobbin J, Kiss L, Mak J, Mannell J, Watson D, Devakumar D. Mechanisms for the prevention of adolescent intimate partner violence: A realist review of interventions in low- and middle-income countries. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001230. [PMID: 36962608 PMCID: PMC10022317 DOI: 10.1371/journal.pgph.0001230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/09/2022] [Indexed: 03/26/2023]
Abstract
Adolescent girls are among those at the greatest risk of experiencing intimate partner violence (IPV). Despite adolescence being widely regarded as a window of opportunity to influence attitudes and behaviours related to gender equality, evidence on what works to prevent IPV at this critical stage is limited outside of high-income, school-based settings. Even less is understood about the mechanisms of change in these interventions. We conducted a realist review of primary prevention interventions for adolescent IPV in low- and middle-income countries (LMICs) to synthesise evidence on how they work, for whom, and under which circumstances. The review took place in four iterative stages: 1) exploratory scoping, 2) developing initial programme theory, 3) systematic database search, screening and extraction, and 4) purposive searching and refinement of programme theory. We identified eleven adolescent IPV prevention interventions in LMICs, most of which demonstrated a positive impact on IPV experience and/or perpetration (n = 10). Most interventions (n = 9) implemented school- or community-based interactive peer-group education to transform attitudes and norms around gender and relationships for behaviour change. The central mechanism of change related to gender transformative content prompting adolescents to critically reflect on their attitudes and relationships, leading to a reconceptualisation of their values and beliefs. This central mechanism was supported by two secondary implementation mechanisms: 1) the design and delivery of interventions: interactive, age-appropriate education delivered in peer-groups provided adolescents a safe space to engage with content and build communication skills, and 2) the target group: social norms interventions targeting the wider community created enabling environments supportive of individual change. This review highlights the immense potential of gender transformative interventions during the critical period of adolescence for IPV prevention. Future interventions should consider the broader drivers of adolescent IPV and ensure intersectionality informed approaches to maximise their potential to capitalise on this window of opportunity.
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Affiliation(s)
- Hattie Lowe
- Institute for Global Health, University College London, London, United Kingdom
| | - Joanna Dobbin
- Primary Care and Population Health, University College London, London, United Kingdom
| | - Ligia Kiss
- Institute for Global Health, University College London, London, United Kingdom
| | - Joelle Mak
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jenevieve Mannell
- Institute for Global Health, University College London, London, United Kingdom
| | - Daniella Watson
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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Waila J, Lule H, Lowery Wilson M, Bärnighausen T, Abio A. Ugandan Men Exposed to Intimate Partner Violence: A Cross-Sectional Survey of Nationally Representative Data. JOURNAL OF PREVENTION 2022; 43:567-588. [PMID: 35650366 PMCID: PMC9252969 DOI: 10.1007/s10935-022-00683-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 04/30/2022] [Indexed: 11/29/2022]
Abstract
Although women typically constitute the largest proportion of the population who experience the deleterious effects of intimate partner violence (IPV), understanding the bidirectional nature of IPV is important for developing nuanced prevention initiatives. This study examines data from the 2016 Ugandan Demographic and Health Survey. Participants were selected from households in all the 15 regions in Uganda using a two stage sampling design. A total of 2858 men who were in a heterosexual union or separated/divorced were included in the analysis. Univariate and multivariable logistic regression analyses were performed with the aim of identifying associations between selected demographic variables and male exposure to all forms of IPV combined, psychological violence, physical violence and sexual violence. The prevalence of lifetime IPV and during the 12 months preceeding the survey respectively was 43.6 and 30.5% in all forms, with 35.9 and 24.8% reporting psychological, 20.2 and 11.9% for physical and 8.2 and 5.7% sexual violence. The key factors associated with all forms of IPV were being afraid of their wife/partner most of the time (OR = 5.10, 95% CI 2.91, 8.96) controlling behaviour of the intimate partner (OR = 3.80, 95% CI 2.84, 5.07), bi-directional violence against the partner (OR = 3.20, 95% CI 2.49, 4.12), alcohol consumption by the intimate partner (OR = 1.85, 95% CI 1.40, 2.45). The factors associated with males who experience IPV appear to be modifiable and may warrant consideration for inclusion in programs supporting both males and females who experience IPV.
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Affiliation(s)
- Jacinta Waila
- Injury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Herman Lule
- Injury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Turku University Hospital and University of Turku, Turku, Finland
- Department of Surgery, Directorate of Research and Innovations, Kampala International University, Kampala, Uganda
| | - Michael Lowery Wilson
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Germany.
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Germany
| | - Anne Abio
- Injury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Turku University Hospital and University of Turku, Turku, Finland
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Germany
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Wight D, Sekiwunga R, Namutebi C, Zalwango F, Siu GE. A Ugandan Parenting Programme to Prevent Gender-Based Violence: Description and Formative Evaluation. RESEARCH ON SOCIAL WORK PRACTICE 2022; 32:448-464. [PMID: 35431527 PMCID: PMC7612614 DOI: 10.1177/10497315211056246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Purpose: To develop a culturally-sensitive intervention for the early prevention of gender-based violence (GBV) in Uganda. Methods: Programme design followed the 6SQuID model of intervention development and multi-sectorial advice. A formative evaluation was conducted in two communities with six groups and 138 participants. Findings: Four familial predictors of GBV were identified as potentially malleable: poor parent-child attachment, harsh parenting, inequitable gendered socialization and parental conflict. A community-based parenting programme was developed to address them. Its programme theory incorporates Attachment Theory, the concept that positive behavioural control develops emotional control, and Social Learning Theory. Its rationale, structure and content are presented using the TIDieR checklist. A formative evaluation showed the programme to be widely acceptable, culturally appropriate, and perceived to be effective, but also identified challenges. Conclusion: The careful development of this community-based parenting programme shows promise for the early prevention of GBV.
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Affiliation(s)
- Daniel Wight
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Richard Sekiwunga
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Carol Namutebi
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | | | - Godfrey E. Siu
- Child Health and Development Centre, Makerere University, Kampala, Uganda
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Ringwald B, Kababu M, Ochieng CB, Taegtmeyer M, Zulaika G, Phillips-Howard PA, Digolo L. Experiences and Perpetration of Recent Intimate Partner Violence Among Women and Men Living in an Informal Settlement in Nairobi, Kenya: A Secondary Data Analysis. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP423-NP448. [PMID: 32370597 DOI: 10.1177/0886260520916268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Evidence suggests an overlap between intimate partner violence (IPV) experience and perpetration. However, few studies in sub-Saharan Africa have investigated experience and perpetration of IPV among women and men within the same community. This study reports prevalence of past-year IPV experience and perpetration among women and men living in an informal settlement in Nairobi, Kenya, and factors associated with IPV. Data analyzed for this study involved a geographically distributed random sample of 273 women and 429 men who participated in a community survey. We approximated prevalence of IPV experience and perpetration and used logistic regression for estimating associations between individual-level factors and IPV. Women and men experienced similar levels of IPV, but a significantly higher proportion of men reported physical and sexual IPV perpetration. Witnessing violence between parents in childhood was associated with women's physical and sexual, and men's sexual IPV experience; and with women perpetrating emotional, and men perpetrating sexual IPV. Less equitable gender attitudes were associated with men's perpetration of physical IPV. More equitable gender knowledge was associated with women's experience of sexual IPV, and with men perpetrating IPV. Perceived skills to challenge gender inequitable practices were negatively associated with men perpetrating sexual IPV. In conclusion, we found IPV experience and perpetration were highly correlated, and that, contrary to commonly reported gender gaps, men and women experienced similar rates of IPV. We make suggestions for future research, including on IPV prevention interventions in areas with such IPV prevalence that would be beneficial for women and men and future generations.
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O'Connor A, Morris H, Panayiotidis A, Cooke V, Skouteris H. Rapid Review of Men's Behavior Change Programs. TRAUMA, VIOLENCE & ABUSE 2021; 22:1068-1085. [PMID: 32054406 DOI: 10.1177/1524838020906527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Family violence is recognized as the violence toward a family member that is threatening, coercive, controlling, dominating, and causes people to fear for their safety and well-being; this complex problem primarily affects women and children. In order to enhance women and children's safety, Men's Behavior Change Programs (MBCPs) aim to achieve change in perpetrators' violent behaviors, by making men accountable and responsible for their actions. The objective of this rapid review was to examine MBCP content, implementation, and the impact on participant and family outcomes. Thirteen articles and 10 MBCPs were identified, using PRISMA guidelines, electronic database searches, and an inclusion criteria of English peer-reviewed articles examining MBCPs or domestic violence perpetrator programs with male perpetrators of family/domestic/intimate partner violence as program participants. The findings of this review indicated a limited evidence base of detailed MBCP evaluations. Information relating to program content was included for nine MBCPs and covered a wide range of topics. None of the articles examined the links between men's accountability and responsibility to the safety and well-being of women and children. Also, none of the articles included assessments of integrity of program delivery, system processes, or evaluations based on program logics. Positive changes were reported for MBCP participants, including communication, parenting, interpersonal relationships, aggression, abuse, responsibility for behavior, self-awareness power and control tactics, empathy, skills development, cognitive beliefs, behavior control, and abusiveness patterns. A whole family approach was utilized by some of the programs and one article reported on family outcomes.
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Affiliation(s)
- Amanda O'Connor
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Heather Morris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Victoria Cooke
- Relationships Australia Victoria, Camberwell, Victoria, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Warwick Business School, Warwick University, UK
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27
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Bukuluki P, Kisaakye P, Wandiembe SP, Musuya T, Letiyo E, Bazira D. An examination of physical violence against women and its justification in development settings in Uganda. PLoS One 2021; 16:e0255281. [PMID: 34587182 PMCID: PMC8480831 DOI: 10.1371/journal.pone.0255281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/14/2021] [Indexed: 11/18/2022] Open
Abstract
This paper uses data from a community cross-sectional survey to examine the factors that are associated with justification of physical violence against women. Results indicate that respondents who were married at the time of the survey were less likely (OR = 0.29; CI = 0.17–0.52) to agree that it is justified for a man to physically assault his partner that their counterparts who were single. The likelihood to justify physical violence was less likely to happen among respondents with primary education (OR = 0.49; CI = 0.39–0.62), secondary education (OR = 0.40; CI = 0.31–0.53) and vocation or tertiary education (OR = 0.28; CI = 0.19–0.41) than among respondents with no education. Protestants were less likely (OR = 0.77; CI = 0.64–0.94) to justify physical violence than the Catholics. Respondents who were not formally employed were more likely (OR = 1.66; CI = 1.32–2.08) to justify physical violence than their counterparts who were in formal employment in the last three months preceding the survey. Respondents who agreed that it is okay for a man to control his partner’s movements (OR = 1.27; CI = 1.04–1.55), it is okay for a man to have sex with his wife anytime (OR = 2.28; CI = 1.87–2.78), alcohol is the main reason for violence against women (OR = 1.67; CI = 1.33–2.10), men need sex more than women (OR = 1.57; CI = 1.23–1.99) and women know where to obtain support in case of violence (OR = 1.42; CI = 1.00–2.02) were more likely to justify physical violence than respondents who disagreed. The likelihood to justify physical violence was less among respondents who agreed that: violence is not the only way to deal with disagreements (OR = 0.54; CI = 0.33–0.86), it is possible for men to stop violence (OR = 0.62; CI = 0.47–0.82) and it is acceptable for a woman to ask her partner to use a condom (OR = 0.61; CI = 0.51–0.73) than their counterparts who disagreed. There is need to increase investment in social norms change programmes in order to strengthen contestation of tolerance of physical violence among men and women in Uganda.
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Affiliation(s)
- Paul Bukuluki
- School of Social Sciences, Makerere University, Kampala, Uganda
- * E-mail:
| | - Peter Kisaakye
- School of Statistics and Planning, Makerere University, Kampala, Uganda
| | | | - Tina Musuya
- Centre for Domestic Violence Prevention, Mulago, Uganda
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Filiatreau LM, Giovenco D, Twine R, Gómez-Olivé FX, Kahn K, Haberland N, Pettifor A. Examining the relationship between physical and sexual violence and psychosocial health in young people living with HIV in rural South Africa. J Int AIDS Soc 2021; 23:e25654. [PMID: 33340267 PMCID: PMC7749553 DOI: 10.1002/jia2.25654] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/16/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Experiences of violence during youth contravene young people’s rights and increase the risk of depression and poor human immunodeficiency virus (HIV) care outcomes among youth living with HIV (YLWH). Intervention targets for mitigating the negative psychosocial effects of violence are needed, particularly in areas like rural South Africa where violence remains pervasive and mental healthcare is limited. This study aims to quantify the associations between physical and sexual violence and depressive symptoms in YLWH in rural South Africa and explore the modification of these associations by key measures of psychosocial well‐being. Methods We conducted a cross‐sectional survey among 362 YLWH ages 12 to 24 in rural South Africa to ascertain participants’ history of physical and sexual violence, current depressive symptoms (Center for Epidemiological Studies‐Depression Scale) and levels of social support (Medical Outcomes Social Support Scale), resilience (Conner‐Davidson Resilience Scale) and self‐esteem (Rosenberg Self‐Esteem Scale). Log‐binomial regression was used to estimate the association between history of physical or sexual violence and clinically meaningful depressive symptoms (scores ≥16). Effect measure modification by high versus low resilience, social support and self‐esteem was assessed using likelihood ratio tests (α = 0.20). Results A total of 334 individuals with a median age of 21 (interquartile range: 16 to 23) were included in this analysis. Most participants were female (71.3%), single (81.4%) and attending school (53.0%). Ninety‐four participants (28.1%) reported a history of physical or sexual violence and 92 individuals (27.5%) had clinically meaningful depressive symptoms. Meaningful depressive symptoms were significantly higher among participants with a history of physical or sexual violence as compared to those with no history of violence (adjusted prevalence ratio: 2.01; 95% CI: 1.43, 2.83). However, this association was significantly modified by social support (p = 0.04) and self‐esteem (p = 0.02). Conclusions In this setting, the prevalence of meaningful depressive symptoms was significantly higher among YLWH with a history of physical or sexual violence as compared to those without a history of violence. However, higher levels of self‐esteem or social support appeared to mitigate this association. Programmes to improve self‐esteem and social support for youth have the potential to minimize depressive symptoms in YLWH who have experienced physical or sexual violence.
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Affiliation(s)
- Lindsey M Filiatreau
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Danielle Giovenco
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
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29
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Jeong J, Bhatia A, Skeen S, Adhia A. From fathers to peers: Association between paternal violence victimization and peer violence perpetration among youth in Malawi, Nigeria, and Zambia. Soc Sci Med 2021; 278:113943. [PMID: 33894568 DOI: 10.1016/j.socscimed.2021.113943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Interpersonal violence against children and youth, including parental violence and peer violence, are major global health concerns. However, the majority of the parental violence and peer violence literature examines each separately from one another. In this study, we specifically investigate the role of fathers and whether paternal violence victimization is associated with peer violence perpetration, above and beyond maternal violence victimization. We used nationally-representative data from three sub-Saharan African country surveys of the Violence Against Children Surveys, which comprised a pooled sample of 8184 youth aged 13-24 years in Malawi (conducted in 2013), Nigeria (2014), and Zambia (2014). We used multivariable logistic regression models to estimate the association between paternal violence victimization and peer violence perpetration, controlling for maternal violence victimization, witnessing violence, and other covariates. We also tested a structural equation model to determine whether the direct association between paternal violence victimization and peer violence perpetration was mediated through youth mental distress or alcohol use, controlling for other violence exposures and covariates. In the pooled sample, 22.8% of youth reported paternal violence victimization, and 18.8% of youth reported peer violence perpetration in their lifetime. Youth who experienced paternal violence had a greater odds of perpetrating peer violence (OR = 1.74, 95% CI: 1.50-2.02), compared with youth who did not experience paternal violence and after controlling for maternal violence victimization and other covariates. Structural equation model results revealed that approximately a quarter of the total association between paternal violence victimization and peer violence perpetration was mediated by youth mental distress and alcohol use. Our study underscores the role of fathers in the context of parental violence against youth and highlights the need for multicomponent and two-generation violence prevention interventions that address paternal violence and support youth psychosocial wellbeing to prevent cycles of violence perpetration against youth in sub-Saharan Africa.
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Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Amiya Bhatia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
| | - Avanti Adhia
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA.
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30
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Pundir P, Saran A, White H, Subrahmanian R, Adona J. Interventions for reducing violence against children in low- and middle-income countries: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2020; 16:e1120. [PMID: 37016609 PMCID: PMC8356324 DOI: 10.1002/cl2.1120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Background More than half of the children in the world experience some form of interpersonal violence every year. As compared with high-income countries, policy responses in low- and middle-income countries (LMICs) are limited due to resource constraints and paucity of evidence for effective interventions to reduce violence against children in their own contexts, amongst other factors. Objectives The aim of this evidence and gap map (EGM) is to provide an overview of the existing evidence available and to identify gaps in the evidence base on the effectiveness of interventions to reduce violence against children in LMICs. This report covers evidence published in English; a follow-up study is under preparation focusing on evidence in five additional languages-Arabic, Chinese, French, Portuguese and Spanish. Methods The intervention-outcome framework for this EGM is based on INSPIRE-Seven Strategies for Ending Violence against Children, published by WHO and other partners in 2016. The seven strategies include implementation and enforcement of laws; norms and values, safe environment; parent-child and caregiver support; income and economic strengthening; response and support services; education and life skills. The search included both academic and grey literature available online. We included impact evaluations and systematic reviews that assessed the effectiveness of interventions to reduce interpersonal violence against children (0-18 years) in LMICs (World Bank, 2018b). Interventions targeting subpopulation of parents, teachers and caregivers of 0-18 years' age group were also included. A critical appraisal of all included studies was carried out using standardised tools. Results The map includes 152 studies published in English of which 55 are systematic reviews and 97 are impact evaluations. Most studies in the map are from Sub-Saharan Africa. Education and life skills are the most widely populated intervention area of the map followed by income and economic strengthening interventions. Very few studies measure impact on economic and social outcomes, and few conduct cost-analysis. Conclusion More studies focusing on low-income and fragile and conflict-affected settings (FCS) and studying and reporting on cost-analysis are required to address gaps in the evidence. Most interventions covered in the literature focused on addressing a wide range of forms of violence and harm, which limited understanding of how and for whom the interventions work in a given context, for specific forms of violence. More impact evaluation studies are required that assess specific forms of violence, gendered effects of interventions and on diverse social groups in a given context, utilising mixed methods.
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Plourde KF, Thomas R, Nanda G. Boys Mentoring, Gender Norms, and Reproductive Health-Potential for Transformation. J Adolesc Health 2020; 67:479-494. [PMID: 32753346 DOI: 10.1016/j.jadohealth.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/18/2020] [Accepted: 06/09/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Understanding and addressing the unique health and development needs of adolescent boys and young men (ABYM) is critical to achieving positive development outcomes for all genders. While major investments have been historically allocated toward adolescent girls and young women, a handful of approaches designed explicitly to reach ABYM have been successful. This review aims to understand the potential impact of mentoring interventions for ABYM on reproductive health (RH) knowledge and practices; social assets and soft skills; levels of gender-based and interpersonal violence; attitudes around gender equality; and substance use and financial vulnerability. METHODS An electronic search of peer-reviewed and gray literature produced a review of 1,178 articles which yielded a total of 29 articles evaluating the 27 interventions included in the final review. RESULTS Mentoring approaches demonstrate promise for improving soft skills and social assets among ABYM-two factors that are thought to contribute to positive youth development outcomes-and for reducing violence perpetration. While these findings demonstrate the importance of this approach for ABYM in their own right, evidence regarding impact on gender norm transformation, RH, and substance use is mixed. CONCLUSIONS Mentoring programs appear to be a promising practice for ABYM; they have demonstrated the potential to improve soft skills and social assets, as well as to impact rates of violence perpetration. More research is needed to better understand why the evidence for impact on gender norm transformation, RH, and substance use is mixed, and how to build upon those programs that demonstrated positive results.
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Affiliation(s)
- Kate F Plourde
- Research Utilization, GHPR-Global Health and Population Research, FHI 360, Durham, North Carolina.
| | - Reana Thomas
- Research Utilization, GHPR-Global Health and Population Research, FHI 360, Durham, North Carolina
| | - Geeta Nanda
- RMNCH-Reproductive, Maternal, Newborn, and Child Health, GHPR-Global Health and Population Research, FHI 360, Washington, District of Columbia
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32
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Prakash R, Beattie TS, Cislaghi B, Bhattacharjee P, Javalkar P, Ramanaik S, Thalinja R, Davey C, Gafos M, Watts C, Collumbien M, Moses S, Isac S, Heise L. Changes in Family-Level Attitudes and Norms and Association with Secondary School Completion and Child Marriage Among Adolescent Girls: Results from an Exploratory Study Nested Within a Cluster-Randomised Controlled Trial in India. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 21:1065-1080. [PMID: 32720188 DOI: 10.1007/s11121-020-01143-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We evaluated the impact of Samata, a 3-year multilayered intervention among scheduled caste/scheduled tribe (SC/ST) adolescent girls in rural northern Karnataka, on family-level (parents or guardian) attitudes and direct and indirect norms related to child marriage and girl's education. Endline data from 1840 family members were used to assess the effect of Samata on attitudes and norms related to schooling and child marriage, while data from 4097 family members (including 2257 family members at baseline) were used to understand the shifts in attitudes and norms over the period 2014-2017. Overall, we found that the programme had little impact on family-level attitudes and norms. However, there were shifts in some attitudes, norms and perceived sanctions between baseline (when girls were aged 13-14 years) and endline (when girls were aged 15-16 years), with some becoming more progressive (e.g. direct norms related to child marriage) and others more restrictive (e.g. norms around girls completing secondary education and norms related to child marriage and educational drop-out, blaming girls for eve teasing and limiting girls' mobility so as to protect family honour). Moreover, non-progressive norms related to marriage and education were strongly associated with child marriage and secondary school non-completion among adolescent girls in this rural setting. Norms hypothesised to be important for marriage and schooling outcomes were indeed associated with these outcomes, but the intervention was not able to significantly shift these norms. In part, this may have been due to the intervention focusing much of its initial efforts on working with girls alone rather than family members, the relevant reference group. Future interventions that seek to affect norms should conduct formative research to clarify the specific norms affecting the outcome(s) of interest; likewise, programme planners should ensure that all activities engage those most influential in enforcing the norm(s) from the beginning. ClinicalTrials.gov registration number: NCT01996241.
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Affiliation(s)
- Ravi Prakash
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada.
- India Health Action Trust (IHAT), Bangalore, India.
| | - Tara S Beattie
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Beniamino Cislaghi
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Parinita Bhattacharjee
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | | | | | | | - Calum Davey
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Mitzy Gafos
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Charlotte Watts
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Martine Collumbien
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Stephen Moses
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Shajy Isac
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
- India Health Action Trust (IHAT), Bangalore, India
| | - Lori Heise
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg Institute for Global Public Health and JHU School of Nursing, 615 N. Wolfe Street, Baltimore, MD, USA
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Murphy LE, Jack HE, Concepcion TL, Collins PY. Integrating Urban Adolescent Mental Health Into Urban Sustainability Collective Action: An Application of Shiffman & Smith's Framework for Global Health Prioritization. Front Psychiatry 2020; 11:44. [PMID: 32153435 PMCID: PMC7044235 DOI: 10.3389/fpsyt.2020.00044] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 01/17/2020] [Indexed: 12/19/2022] Open
Abstract
The majority (55%) of the world's population lives in urban environments. Of relevance to global mental health, the rapid growth in urban populations around the world and the attendant risks coincide with the presence of the largest population of adolescents the global community has seen to date. Recent reviews on the effects of the urban environment on mental health report a greater risk of depression, anxiety, and some psychotic disorders among urban dwellers. Increased risk for mental disorders is associated with concentrated poverty, low social capital, social segregation, and other social and environmental adversities that occur more frequently in cities. To address these problems, urban adolescent mental health requires attention from decision makers as well as advocates who seek to establish sustainable cities. We examine opportunities to increase the prominence of urban adolescent mental health on the global health and development agenda using Shiffman and Smith's framework for policy priorities, and we explore approaches to increasing its relevance for urban health and development policy communities. We conclude with suggestions for expanding the community of actors who guide the field and bridging the fields of mental health and urban development to meet urban adolescent mental health needs.
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Affiliation(s)
- Lauren E. Murphy
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Helen E. Jack
- Department of Internal Medicine, University of Washington, Seattle, WA, United States
| | - Tessa L. Concepcion
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Pamela Y. Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
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Henry JB, Julion WA, Bounds DT, Sumo J. Fatherhood Matters: An Integrative Review of Fatherhood Intervention Research. J Sch Nurs 2019; 36:19-32. [PMID: 31495253 DOI: 10.1177/1059840519873380] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Positive father involvement is critical to the healthy social, emotional, and academic outcomes of children at all stages of development. The purpose of this integrative review was to identify, categorize, and evaluate the potential impact of fatherhood interventions on father and child outcomes. A systematic search of four major research databases yielded 44 studies published between 1988 and 2018 that met study inclusion criteria. The most effective interventions were delivered in the community, with fathers convened in groups. Content focused on promoting positive parenting, co-parenting, and father/child relationships. Consequently, father involvement and child cognitive and socioemotional development were improved. Academic settings were underutilized in the fatherhood interventions in this review. We conclude that in order to optimize healthy child development, school officials must adopt a more inclusive stance toward the involvement of fathers in their children's education. Future randomized trials of fatherhood interventions delivered within school-based settings are warranted.
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Affiliation(s)
- Joi B Henry
- Rush University Medical Center, Rush University College of Nursing, Chicago, IL, USA
| | - Wrenetha A Julion
- Rush University Medical Center, Rush University College of Nursing, Chicago, IL, USA
| | - Dawn T Bounds
- Rush University Medical Center, Rush University College of Nursing, Chicago, IL, USA
| | - Jen'nea Sumo
- Rush University Medical Center, Rush University College of Nursing, Chicago, IL, USA
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Latzman NE, Casanueva C, Brinton J, Forman‐Hoffman VL. The promotion of well-being among children exposed to intimate partner violence: A systematic review of interventions. CAMPBELL SYSTEMATIC REVIEWS 2019; 15:e1049. [PMID: 37131508 PMCID: PMC8356495 DOI: 10.1002/cl2.1049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
| | | | - Julia Brinton
- RTI InternationalResearch Triangle ParkNorth Carolina
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Stark L, Seff I, Hoover A, Gordon R, Ligiero D, Massetti G. Sex and age effects in past-year experiences of violence amongst adolescents in five countries. PLoS One 2019; 14:e0219073. [PMID: 31283760 PMCID: PMC6613770 DOI: 10.1371/journal.pone.0219073] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/14/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To date, there has been insufficient focus on age and sex differences in studies of violence amongst adolescents and young adults in low- and middle-income countries. As adolescence is a formative period during which experiencing violence can have both short- and long-term consequences, we aim to investigate experiences of violence by age and sex across five countries. Methods Incidences of past-year violence victimization were estimated by sex across two-year age bands (13–24 years) using Violence Against Children Survey datasets from Cambodia, Haiti, Kenya, Malawi, and Tanzania. Analyses were conducted separately for each country. The presence of an association with age and each type of violence was identified using logistic regressions separately by sex. Sex was then added to the models as an interaction term and adjusted Wald tests were used to assess differences between males and females in age effects. Results Risk of physical violence by both an adult caregiver and a community member decreased with age for both sexes in all countries. In contrast, risk of IPV increased with age for both sexes in all countries. Although some countries displayed a steeper increase in risk of IPV and sexual violence with age for males, females face higher overall levels of risk for these forms of violence. Conclusion Findings highlight how adolescents’ and young adults’ risk of violence changes with age and type of violence. The analysis underscores the importance of collecting violence data disaggregated by age and sex to best inform policies and programming. Implications and contributions We analyzed five Violence Against Children Surveys (VACS) and found age effects for physical, sexual, and intimate partner violence for adolescents 13–24 years old. Age effects for sexual violence are stronger among females than males. Future policies targeting adolescents should consider how age and gender influence risk of violence.
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Affiliation(s)
- Lindsay Stark
- George Warren Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
- * E-mail:
| | - Ilana Seff
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Anna Hoover
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Rebecca Gordon
- Together for Girls, Washington D.C., United States of America
| | - Daniela Ligiero
- Together for Girls, Washington D.C., United States of America
| | - Greta Massetti
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Catalano RF, Skinner ML, Alvarado G, Kapungu C, Reavley N, Patton GC, Jessee C, Plaut D, Moss C, Bennett K, Sawyer SM, Sebany M, Sexton M, Olenik C, Petroni S. Positive Youth Development Programs in Low- and Middle-Income Countries: A Conceptual Framework and Systematic Review of Efficacy. J Adolesc Health 2019; 65:15-31. [PMID: 31010725 DOI: 10.1016/j.jadohealth.2019.01.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Positive youth development (PYD) has served as a framework for youth programs in high-income countries since the 1990s and has demonstrated broad behavioral health and developmental benefits. PYD programs build skills, assets, and competencies; foster youth agency; build healthy relationships; strengthen the environment; and transform systems to prepare youth for successful adulthood. The goal of this article was to systematically review the impact of PYD programs in low- and middle-income countries (LMICs). METHODS Targeted searches of knowledge repository Web sites and keyword searches of Scopus and PubMed identified over 21,500 articles and over 3,700 evaluation reports published between 1990 and mid-2016. Ninety-four PYD programs with evaluations in LMICs were identified, of which 35 had at least one experimental or rigorous quasi-experimental evaluation. RESULTS Sixty percent of the 35 programs with rigorous evaluations demonstrated positive effects on behaviors, including substance use and risky sexual activity, and/or more distal developmental outcomes, such as employment and health indicators. CONCLUSIONS There is promising evidence that PYD programs can be effective in LMICs; however, more rigorous examination with long-term follow-up is required to establish if these programs offer benefits similar to those seen in higher income countries.
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Affiliation(s)
- Richard F Catalano
- The Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington
| | - Martie L Skinner
- The Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington.
| | | | | | - Nicola Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - George C Patton
- Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Cassandra Jessee
- International Center for Research on Women, Washington, DC; Making Cents International, Washington, DC
| | | | | | - Kristina Bennett
- Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Meroji Sebany
- International Center for Research on Women, Washington, DC
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Mootz JJ, Stark L, Meyer E, Asghar K, Roa AH, Potts A, Poulton C, Marsh M, Ritterbusch A, Bennouna C. Examining intersections between violence against women and violence against children: perspectives of adolescents and adults in displaced Colombian communities. Confl Health 2019; 13:25. [PMID: 31198437 PMCID: PMC6558814 DOI: 10.1186/s13031-019-0200-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 04/30/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Research examining the interrelated drivers of household violence against women and violence against children is nascent, particularly in humanitarian settings. Gaps remain in understanding how relocation, displacement and ongoing insecurity affect families and may exacerbate household violence. METHODS Employing purposive sampling, we used photo elicitation methods to facilitate semi-structured, in-depth interviews with female and male adolescents and adults aged 13-75 (n = 73) in two districts in Colombia from May to August of 2017. Participants were displaced and/or residing in neighborhoods characterized by high levels of insecurity from armed groups. RESULTS Using inductive thematic analysis and situating the analysis within a feminist socioecological framework, we found several shared drivers of household violence. Intersections among drivers at all socioecological levels occurred among societal gender norms, substance use, attempts to regulate women's and children's behavior with violence, and daily stressors associated with numerous community problems. A central theme of relocation was of family compositions that were in continual flux and of family members confronted by economic insecurity and increased access to substances. CONCLUSIONS Findings suggest interventions that systemically consider families' struggles with relocation and violence with multifaceted attention to socioecological intersections.
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Affiliation(s)
- Jennifer J. Mootz
- Department of Psychiatry, Columbia University, New York, NY USA
- New York State Psychiatric Institute, New York, USA
| | - Lindsay Stark
- Program on Forced Migration and Health, Mailman School of Public Health, Columbia University, New York, NY USA
- George Warren Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO 63130 USA
| | - Elizabeth Meyer
- Program on Forced Migration and Health, Mailman School of Public Health, Columbia University, New York, NY USA
| | - Khudejha Asghar
- Department of Population,Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Alina Potts
- UNICEF Office of Research-Innocenti, Florence, Italy
| | | | - Mendy Marsh
- The Equality Institute, Melbourne, Australia
| | - Amy Ritterbusch
- School of Government, Universidad de los Andes, Bogotá, Colombia
| | - Cyril Bennouna
- Program on Forced Migration and Health, Mailman School of Public Health, Columbia University, New York, NY USA
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Settergren SK, Mujaya S, Rida W, Kajula LJ, Kamugisha H, Kilonzo Mbwambo J, Kisanga F, Mizinduko MM, Dunbar MS, Mwandalima I, Wazee H, Prieto D, Mullick S, Erie J, Castor D. Cluster randomized trial of comprehensive gender-based violence programming delivered through the HIV/AIDS program platform in Mbeya Region, Tanzania: Tathmini GBV study. PLoS One 2018; 13:e0206074. [PMID: 30521530 PMCID: PMC6283609 DOI: 10.1371/journal.pone.0206074] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 10/02/2018] [Indexed: 12/26/2022] Open
Abstract
The Tathmini GBV study was a cluster randomized trial to assess the impact of a comprehensive health facility- and community-based program delivered through the HIV/AIDS program platform on reduction in gender-based violence and improved care for survivors. Twelve health facilities and surrounding communities in the Mbeya Region of Tanzania were randomly assigned to intervention or control arms. Population-level effects were measured through two cross-sectional household surveys of women ages 15–49, at baseline (n = 1,299) and at 28 months following program scale-out (n = 1,250). Delivery of gender-based violence services was assessed through routine recording in health facility registers. Generalized linear mixed effects models and analysis of variance were used to test intervention effects on population and facility outcomes, respectively. At baseline, 52 percent of women reported experience of recent intimate partner violence. The odds of reporting experience of this violence decreased by 29 percent from baseline to follow-up in the absence of the intervention (time effect OR = 0.71, 95% CI: 0.57–0.89). While the intervention contributed an additional 15 percent reduction, the effect was not statistically significant. The program, however, was found to contribute to positive, community-wide changes including less tolerance for certain forms of violence, more gender equitable norms, better knowledge about gender-based violence, and increased community actions to address violence. The program also led to increased utilization of gender-based violence services at health facilities. Nearly three times as many client visits for gender-based violence were recorded at intervention (N = 1,427) compared to control (N = 489) facilities over a 16-month period. These visits were more likely to include provision of an HIV test (55.3% vs. 19.6%, p = .002). The study demonstrated the feasibility and impact of integrating gender-based violence and HIV programming to combat both of these major public health problems. Further opportunities to scale out GBV prevention and response strategies within HIV/AIDS service delivery platforms should be pursued. Trial Registration: Pan African Clinical Trials Registry No. PACTR201802003124149.
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Affiliation(s)
| | | | - Wasima Rida
- Consultant to Palladium, Washington, DC, United States of America
| | - Lusajo J Kajula
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Hussein Kamugisha
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Felix Kisanga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mucho M Mizinduko
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Megan S Dunbar
- Pangaea Global AIDS, Oakland, California, United States of America
| | | | - Hijja Wazee
- Walter Reed Program/Henry Jackson Foundation, Mbeya, Tanzania
| | - Diana Prieto
- United States Agency for International Development, Washington, DC, United States of America
| | | | - Jennifer Erie
- United States Agency for International Development, Dar es Salaam, Tanzania
| | - Delivette Castor
- United States Agency for International Development, Washington, DC, United States of America
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Jeong J, Siyal S, Fink G, McCoy DC, Yousafzai AK. "His mind will work better with both of us": a qualitative study on fathers' roles and coparenting of young children in rural Pakistan. BMC Public Health 2018; 18:1274. [PMID: 30453979 PMCID: PMC6245824 DOI: 10.1186/s12889-018-6143-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/23/2018] [Indexed: 11/23/2022] Open
Abstract
Background Parents are the primary providers of nurturing care for young children’s healthy early development. However, the literature on parenting in early childhood, especially in low- and middle-income countries, has primarily focused on mothers. In this study, we investigate how parents make meaning of fathers’ parenting roles with regards to their young children’s early health and development in rural Pakistan. Methods Data were collected between January and March 2017 through in-depth interviews with fathers (N = 33) and their partners (N = 32); as well as separate focus group discussions with fathers (N = 7) and mothers (N = 7). Data were analyzed using thematic content analysis. Results Parents described a distinct division of roles between fathers and mothers; and also several shared caregiving roles of fathers and mothers. Specifically, parents highlighted aspects of fathers’ coparenting and several common ways by which fathers supported their partners. We found that these gendered divisions in parenting roles were strongly embedded within a complex network of interacting factors across the individual, family, and sociocultural contexts of the study community. Conclusions Our findings suggest a more family-centered conceptualization of fatherhood during early childhood that encompasses both fathers’ direct engagement with their young children and their indirect contributions through coparenting, while recognizing a variety of contextual systems that shape paternal parenting. Future parenting interventions that reflect the lived experiences of both fathers and mothers as parents and partners may further enhance the nurturing care environments that are critical for promoting healthy early child development.
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Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, 11th floor, Boston, MA, USA.
| | | | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, 11th floor, Boston, MA, USA
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Stark L, Seff I, Asghar K, Roth D, Bakamore T, MacRae M, Fanton D’Andon C, Falb KL. Building caregivers' emotional, parental and social support skills to prevent violence against adolescent girls: findings from a cluster randomised controlled trial in Democratic Republic of Congo. BMJ Glob Health 2018; 3:e000824. [PMID: 30398222 PMCID: PMC6203064 DOI: 10.1136/bmjgh-2018-000824] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/12/2018] [Accepted: 06/16/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Parenting programmes are increasingly popular for reducing children's exposure to interpersonal violence in low/middle-income countries, but there is limited evidence on their effectiveness. We investigated the incremental impact of adding a caregiver component to a life skills programme for adolescent girls, assessing girls' exposure to violence (sexual and others) and caregivers' gender attitudes and parenting behaviours. METHODS In this two-arm, single-blinded, cluster randomised controlled trial, we recruited 869 adolescent girls aged 10-14 and 764 caregivers in South Kivu, Democratic Republic of Congo. Following a baseline survey, participants were divided into 35 clusters based on age, language and location. Eighteen clusters were randomised to the treatment arm and 17 clusters to the wait-list control arm. Adolescent girls in both arms received 32 life skills sessions; caregivers in the treatment arm received 13 complementary caregiver sessions. The primary outcome was girls' self-reported exposure to sexual violence in the last 12 months; secondary outcomes included self-reports of specific forms of sexual violence, physical and emotional violence, transactional sex, child marriage for girls and parenting behaviours for caregivers. Intent-to-treat and per-protocol analyses were conducted. RESULTS At 12 months of follow-up, the intervention showed no impact on sexual violence (adjusted OR=0.95; 95% CI 0.65 to 1.37) or any secondary outcomes for girls. The intervention was associated with improved supportive parenting behaviours. Protocol adherence was also associated with improvements in these outcomes. CONCLUSION While the caregiver curriculum improved some parenting outcomes, additional programmatic adaptations may be needed to reduce adolescent girls' violence exposure in humanitarian settings. TRIAL REGISTRATION NUMBER NCT02384642.
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Affiliation(s)
- Lindsay Stark
- George Warren Brown School of Social Work, Washington University in Saint Louis, St. Louis, Missouri, USA
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Ilana Seff
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Khudejha Asghar
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Danielle Roth
- International Rescue Committee, New York City, New York, USA
| | | | - Mairi MacRae
- International Rescue Committee, New York City, New York, USA
| | | | - Kathryn L Falb
- International Rescue Committee, New York City, New York, USA
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Stark L, Asghar K, Seff I, Yu G, Tesfay Gessesse T, Ward L, Assazenew Baysa A, Neiman A, Falb KL. Preventing violence against refugee adolescent girls: findings from a cluster randomised controlled trial in Ethiopia. BMJ Glob Health 2018; 3:e000825. [PMID: 30398223 PMCID: PMC6203052 DOI: 10.1136/bmjgh-2018-000825] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 11/05/2022] Open
Abstract
Introduction Interpersonal violence is a critical public health concern in humanitarian contexts, but evidence of effective violence prevention programmes targeting adolescent girls is lacking. We investigated the efficacy of a life skills and safe spaces programme to reduce adolescent girls’ experiences of interpersonal violence in a refugee setting. Methods In this two-arm, single-blinded, cluster randomised controlled trial, we recruited 919 Sudanese and South Sudanese girls ages 13–19 years residing in refugee camps in Ethiopia. Girls were divided into 31 clusters, with 457 and 462 participants assigned to the intervention and control arms, respectively. Intervention clusters received 30 life skills sessions delivered in safe spaces and 8 complementary sessions for caregivers. The primary outcome was exposure to sexual violence in the previous 12 months. Secondary outcomes included disaggregated forms of sexual violence, physical violence, emotional violence, transactional sex, child marriage, feelings of safety, attitudes around rites of passage and perceptions of social support. Intent-to-treat analysis was used. Results At 12-month follow-up, the intervention was not significantly associated with reduction in exposure to sexual violence (adjusted OR =0.96, 95% CI 0.59 to 1.57), other forms of violence, transactional sex or feelings of safety. The intervention was associated with improvements in attitudes around rites of passage and identified social supports. Additionally, the intervention showed a decrease in reported child marriage among girls who were married at baseline. Conclusion While the intervention impacted key markers along the causal pathway to violence reduction, further research and programmatic adaptations are needed to prevent violence towards adolescents in humanitarian contexts. Trial registration NCT02506543.
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Affiliation(s)
- Lindsay Stark
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA.,Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Khudejha Asghar
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Ilana Seff
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Gary Yu
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA.,New York University Rory Meyers College of Nursing, New York City, New York, USA
| | | | - Leora Ward
- International Rescue Committee, New York City, New York, USA
| | | | - Amy Neiman
- International Rescue Committee, New York City, New York, USA
| | - Kathryn L Falb
- International Rescue Committee, New York City, New York, USA
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Doyle K, Levtov RG, Barker G, Bastian GG, Bingenheimer JB, Kazimbaya S, Nzabonimpa A, Pulerwitz J, Sayinzoga F, Sharma V, Shattuck D. Gender-transformative Bandebereho couples' intervention to promote male engagement in reproductive and maternal health and violence prevention in Rwanda: Findings from a randomized controlled trial. PLoS One 2018; 13:e0192756. [PMID: 29617375 PMCID: PMC5884496 DOI: 10.1371/journal.pone.0192756] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 01/18/2018] [Indexed: 12/02/2022] Open
Abstract
Background Rigorous evidence of the effectiveness of male engagement interventions, particularly on how these interventions impact relationship power dynamics and women’s decision-making, remains limited. This study assessed the impact of the Bandebereho gender-transformative couples’ intervention on impact on multiple behavioral and health-related outcomes influenced by gender norms and power relations. Methods We conducted a multi-site randomised controlled trial in four Rwandan districts with expectant/current fathers and their partners, who were randomised to the intervention (n = 575 couples) or control group (n = 624 couples). Primary outcomes include women’s experience of physical and sexual IPV, women’s attendance and men’s accompaniment at ANC, modern contraceptive use, and partner support during pregnancy. At 21-months post-baseline, 1123 men and 1162 partners were included in intention to treat analysis. Generalized estimating equations with robust standard errors were used to fit the models. Findings The Bandebereho intervention led to substantial improvements in multiple reported outcomes. Compared to the control group, women in the intervention group reported: less past-year physical (OR 0.37, p<0.001) and sexual IPV (OR 0.34, p<0.001); and greater attendance (IRR 1.09, p<0.001) and male accompaniment at antenatal care (IRR 1.50, p<0.001); and women and men in the intervention group reported: less child physical punishment (women: OR 0.56, p = 0.001; men: OR 0.66, p = 0.005); greater modern contraceptive use (women: OR 1.53, p = 0.004; men: OR 1.65, p = 0.001); higher levels of men’s participation in childcare and household tasks (women: beta 0.39, p<0.001; men: beta 0.33, p<0.001); and less dominance of men in decision-making. Conclusions Our study strengthens the existing evidence on male engagement approaches; together with earlier studies our findings suggest that culturally adapted gender-transformative interventions with men and couples can be effective at changing deeply entrenched gender inequalities and a range of health-related behavioral outcomes. Trial registration ClinicalTrials.gov NCT02694627
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Affiliation(s)
- Kate Doyle
- Promundo-US, Washington, DC, United States of America
| | - Ruti G. Levtov
- Promundo-US, Washington, DC, United States of America
- * E-mail:
| | - Gary Barker
- Promundo-US, Washington, DC, United States of America
| | - Gautam G. Bastian
- Gender Innovation Lab, World Bank, Washington, DC, United States of America
| | - Jeffrey B. Bingenheimer
- Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
| | | | - Anicet Nzabonimpa
- Maternal, Child and Community Health Division, Rwanda Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda
| | - Julie Pulerwitz
- HIV and AIDS Program, Population Council, Washington, Washington, DC, United States of America
| | - Felix Sayinzoga
- Maternal, Child and Community Health Division, Rwanda Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda
| | - Vandana Sharma
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
| | - Dominick Shattuck
- Institute for Reproductive Health, Georgetown University, Washington, DC, United States of America
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Bacchus LJ, Colombini M, Contreras Urbina M, Howarth E, Gardner F, Annan J, Ashburn K, Madrid B, Levtov R, Watts C. Exploring opportunities for coordinated responses to intimate partner violence and child maltreatment in low and middle income countries: a scoping review. PSYCHOL HEALTH MED 2017; 22:135-165. [DOI: 10.1080/13548506.2016.1274410] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Loraine J. Bacchus
- Faculty of Public Health and Policy, Department of Global Health & Development, Gender Violence and Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Manuela Colombini
- Faculty of Public Health and Policy, Department of Global Health & Development, Gender Violence and Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Emma Howarth
- NIHR CLAHRC East of England, University of Cambridge, Cambridge, UK
| | - Frances Gardner
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Oxford, UK
| | - Jeannie Annan
- Research, Evaluation and Learning Unit, International Rescue Organisation, New York, NY, USA
| | - Kim Ashburn
- Institute for Reproductive Health, Georgetown University, Washington, DC, USA
| | - Bernadette Madrid
- Child Protection Unit, University of Philippines, Quezon City, Philippines
| | | | - Charlotte Watts
- Faculty of Public Health and Policy, Department of Global Health & Development, Gender Violence and Health Centre, London School of Hygiene & Tropical Medicine, London, UK
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