"Change Really Does Need to Start From Home": Impact of an Intimate Partner Violence Prevention Strategy Among Married Couples in Nepal

Preventing violence and enhancing mental health among clients of an invitro fertilization clinic in Jordan: results of a pre/post pilot test of the use of cognitive behavioral therapy

INTRODUCTION

Infertility increases women's risk of intimate partner violence (IPV). Cognitive behavioral therapy (CBT) is commonly used to treat mental health problems among fertility treatment seeking patients. CBT has not been tested for its potential to reduce IPV in this population. We pilot test the use of CBT to prevent IPV and improve patients' mental health in a fertility clinic in Jordan.

METHODS

Of 38 eligible fertility-treatment seeking couples, 16 consented and underwent up to 11 CBT sessions (average = 9) over 3 months. Interviews at baseline and 16 weeks post intervention (endline) assessed IPV, quality of life, social support, coping, and fear of spouse. Wilcoxon signed-rank and McNemar's tests were used to assess change in outcomes.

RESULTS

At baseline, women's rates of IPV, depression, and anxiety were 75%, 87.5%, and 75% respectively, whereas men's rates of depression and anxiety were each 80%. Average baseline post-traumatic stress disorder (PTSD) symptoms for men and women were 3.3 and 2.7 respectively out of 5. IPV decreased 25% after treatment, and women reported less spousal fear. For both men and women, depression, anxiety, and PTSD symptoms decreased and social support and fertility quality of life improved.

CONCLUSION

Psychosocial support should be standard of care for the treatment of infertility given the burden of mental health problems and IPV and the utility of CBT in this patient population. Co-design with couples is needed to identify strategies to bolster participation along with population-based interventions to combat the stigma of infertility and mental health service use and enhance women's status.

Prevention interventions for interpersonal violence occurring under the influence of alcohol: A mixed method systematic review

AIMS

To (a) explore risk indicators related to interpersonal violence occurring under the influence of alcohol and to (b) search for interventions addressed towards violence perpetrators to prevent violence occurring under the influence of alcohol.

DESIGN

Mixed method systematic review. This study has been registered in the International Prospective Register of Systematic Reviews with register number CRD42021217848.

DATA SOURCES

A systematic search was conducted on PubMed, CINAHL, PsycINFO and Scopus in October 2021.

REVIEW METHODS

Two researchers independently examined 1076 papers following the inclusion criteria. After three rounds of selection (title, abstract and full text), the quality and bias assessments were conducted independently by two reviewers. The data were analysed with inductive and deductive content analyses.

RESULTS

Of the 1076 papers retrieved, 16 papers were eligible for inclusion, addressing 13 different interventions. Interventions were divided into three types (individual-, group- and family-level) and were constructed on several background frameworks, with cognitive behavioural therapy being the most common framework. Family-level interventions seemed to yield the most effective results. Violence occurring under the influence of alcohol was mostly researched as men being the perpetrators and women being the victims of violence. Several indicators that increased the risk of violence victimization or perpetration, such as trait jealousy and disparity in education, were identified.

CONCLUSION

Interventions emerging from the systematic review were heterogenous, and the outcomes of the interventions were versatile. The disparity between interventions and outcome measures made it challenging to reliably compare the effectiveness between interventions. Using standardized outcome measure instruments and unifying research on interventions are needed to reliably assess the effectiveness of different interventions.

A summative content analysis of how programmes to improve the right to sexual and reproductive health address power

INTRODUCTION

Power shapes all aspects of global health. The concept of power is not only useful in understanding the current situation, but it is also regularly mobilised in programmatic efforts that seek to change power relations. This paper uses summative content analysis to describe how sexual and reproductive health (SRH) programmes in low-income and middle-income countries explicitly and implicitly aim to alter relations of power.

METHODS

Content analysis is a qualitative approach to analysing textual data; in our analysis, peer-reviewed articles that describe programmes aiming to alter power relations to improve SRH constituted the data. We searched three databases, ultimately including 108 articles. We extracted the articles into a spreadsheet that included basic details about the paper and the programme, including what level of the social ecological model programme activities addressed.

RESULTS

The programmes reviewed reflect a diversity of priorities and approaches to addressing power, though most papers were largely based in a biomedical framework. Most programmes intervened at multiple levels simultaneously; some of these were 'structural' programmes that explicitly aimed to shift power relations, others addressed multiple levels using a more typical programme theory that sought to change individual behaviours and proximate drivers. This prevailing focus on proximate behaviours is somewhat mismatched with the broader literature on the power-related drivers of SRH health inequities, which explores the role of embedded norms and structures.

CONCLUSION

This paper adds value by summarising what the academic public health community has chosen to test and research in terms of power relations and SRH, and by raising questions about how this corresponds to the significant task of effecting change in power relations to improve the right to SRH.

Evaluating Complex Interventions Using Qualitative Longitudinal Research: A Case Study of Understanding Pathways to Violence Prevention

Evaluating social change programs requires methods that account for changes in context, implementation, and participant experience. We present a case study of a school-based partner violence prevention program with young people, where we conducted 33 repeat interviews with nine participants during and after an intervention and analyzed participant trajectories. We show how repeat interviews conducted during and after a social change program were useful in helping us understand how the intervention worked by providing rich contextual information, elucidating gradual shifts among participants, and identifying aspects of the intervention that appear to influence change. Long-term effects of social change interventions are very hard to quantify or measure directly. We argue that a qualitative longitudinal approach provides a way to measure subtle changes that can serve as proxies for longer term impacts.

Intimate partner violence against reproductive-age women and associated factors in Peru: evidence from national surveys, 2015-2017

PURPOSE

We aimed to evaluate the factors associated with intimate partner violence (IPV) against reproductive-age women in Peru.

METHODS

Secondary analysis of the ENDES 2015-2017. ENDES is a multi-stage survey with a probabilistic sampling design for the urban and rural areas of the 25 regions of Peru. A total of 62,870 women of reproductive age (15-49 years) were included. IPV was defined as any report of violence (physical, psychological or sexual) committed by the last partner of the women. Categorical variables were described using absolute frequencies and weighted proportions. We used generalized linear models with Poisson family and log link function to calculate prevalence ratios (PR) for the associated factors with their respective 95% confidence intervals.

RESULTS

The overall IPV was 38.7%. The prevalence of sexual, psychological and physical IPV was 6.9%, 26.8%, and 31.2%, respectively. The frequency of any IPV was lower in younger women, those living with their intimate partners or married, and those living in a coastal region different from Lima. IPV was more frequent among women with a low educational level, or with a partner with low educational level, with children, with a partner with alcohol habit, in women with a history of violence by the father against the mother and living in the highlands or the jungle.

CONCLUSIONS

In Peru, IPV affects nearly four in ten women (physical and psychological types were the most frequent). The factors associated with IPV can be useful markers to identify the most vulnerable groups for implementing interventions intended to decrease the prevalence of IPV.

Diffusion in social norms change about violence against women: A longitudinal analysis of intervention data from a cluster randomised trial

This study examines the diffusion effects of a Social and Behaviour Change Communication intervention in Nepal targeting gender equity and violence against women. The Change trial involves weekly radio programming, listening and discussion groups (LDGs), and community engagement. This longitudinal study analyses a repeated cross-sectional two-armed, pair-matched, single blinded cluster trial of a 9-month intervention. We used probability proportionate to size methodology to identify 72 wards in the Terai region, half of which were randomly assigned to the intervention. For the community-based survey, 20 women per ward were chosen using simple random sampling (N = 1440). Ten women from each intervention ward (N = 360) were also selected to participate in radio LDGs. Injunctive norms were measured with the Partner Violence Norms Scale-PVNS. Each one person increase in diffusion was associated with a 0.04 (SE = 0.01, p-value < 0.01) higher endline norms score, adjusting for confounders. There was evidence of effect modification with a significant baseline norm by diffusion interaction term (Estimate = -0.12, p-value = 0.04). Findings demonstrated that diffusion was related to endline norms only in communities with lower baseline levels of gender equitable norms. Study findings support the importance of diffusion as a pathway to intervention scale-up and norms change.