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Ecological pathways to prevention: How does the SASA! community mobilisation model work to prevent physical intimate partner violence against women?
BMC Public Health. 2016 Apr 16; 16:339.BP

Abstract

BACKGROUND

Intimate partner violence (IPV) against women is a global public health concern. While community-level gender norms and attitudes to IPV are recognised drivers of IPV risk, there is little evidence on how interventions might tackle these drivers to prevent IPV at the community-level. This secondary analysis of data from the SASA! study explores the pathways through which SASA!, a community mobilisation intervention to prevent violence against women, achieved community-wide reductions in physical IPV.

METHODS

From 2007 to 2012 a cluster randomised controlled trial (CRT) was conducted in eight communities in Kampala, Uganda. Cross-sectional surveys of a random sample of community members, aged 18-49, were undertaken at baseline (n = 1583) and 4 years post intervention implementation (n = 2532). We used cluster-level intention to treat analysis to estimate SASA!'s community-level impact on women's past year experience of physical IPV and men's past year perpetration of IPV. The mediating roles of community-, relationship- and individual-level factors in intervention effect on past year physical IPV experience (women)/perpetration (men) were explored using modified Poisson regression models.

RESULTS

SASA! was associated with reductions in women's past year experience of physical IPV (0.48, 95 % CI 0.16-1.39), as well as men's perpetration of IPV (0.39, 95 % CI 0.20-0.73). Community-level normative attitudes were the most important mediators of intervention impact on physical IPV risk, with norms around the acceptability of IPV explaining 70 % of the intervention effect on women's experience of IPV and 95 % of the effect on men's perpetration. The strongest relationship-level mediators were men's reduced suspicion of partner infidelity (explaining 22 % of effect on men's perpetration), and improved communication around sex (explaining 16 % of effect on women's experience). Reduced acceptability of IPV among men was the most important individual-level mediator (explaining 42 % of effect on men's perpetration).

CONCLUSIONS

These results highlight the important role of community-level norm-change in achieving community-wide reductions in IPV risk. They lend strong support for the more widespread adoption of community-level approaches to preventing violence.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT00790959 . Registered 13th November 2008. The study protocol is available at: http://www.trialsjournal.com/content/13/1/96.

Authors+Show Affiliations

Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. tanya.abramsky@lshtm.ac.uk.Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.Raising Voices, 16 Tufnell Drive, Kamwokya, P.O Box 6770, Kampala, Uganda.Raising Voices, 16 Tufnell Drive, Kamwokya, P.O Box 6770, Kampala, Uganda.Centre for Domestic Violence Prevention, 16 Tufnell Drive, Kamwokya, P.O Box 6770, Kampala, Uganda.Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27084116

Citation

Abramsky, Tanya, et al. "Ecological Pathways to Prevention: How Does the SASA! Community Mobilisation Model Work to Prevent Physical Intimate Partner Violence Against Women?" BMC Public Health, vol. 16, 2016, p. 339.
Abramsky T, Devries KM, Michau L, et al. Ecological pathways to prevention: How does the SASA! community mobilisation model work to prevent physical intimate partner violence against women? BMC Public Health. 2016;16:339.
Abramsky, T., Devries, K. M., Michau, L., Nakuti, J., Musuya, T., Kiss, L., Kyegombe, N., & Watts, C. (2016). Ecological pathways to prevention: How does the SASA! community mobilisation model work to prevent physical intimate partner violence against women? BMC Public Health, 16, 339. https://doi.org/10.1186/s12889-016-3018-9
Abramsky T, et al. Ecological Pathways to Prevention: How Does the SASA! Community Mobilisation Model Work to Prevent Physical Intimate Partner Violence Against Women. BMC Public Health. 2016 Apr 16;16:339. PubMed PMID: 27084116.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ecological pathways to prevention: How does the SASA! community mobilisation model work to prevent physical intimate partner violence against women? AU - Abramsky,Tanya, AU - Devries,Karen M, AU - Michau,Lori, AU - Nakuti,Janet, AU - Musuya,Tina, AU - Kiss,Ligia, AU - Kyegombe,Nambusi, AU - Watts,Charlotte, Y1 - 2016/04/16/ PY - 2015/09/15/received PY - 2016/04/08/accepted PY - 2016/4/17/entrez PY - 2016/4/17/pubmed PY - 2016/12/15/medline KW - Community mobilisation KW - East Africa KW - Gender based violence KW - Impact evaluation KW - Intimate partner violence KW - Pathways analysis KW - Uganda KW - Violence prevention SP - 339 EP - 339 JF - BMC public health JO - BMC Public Health VL - 16 N2 - BACKGROUND: Intimate partner violence (IPV) against women is a global public health concern. While community-level gender norms and attitudes to IPV are recognised drivers of IPV risk, there is little evidence on how interventions might tackle these drivers to prevent IPV at the community-level. This secondary analysis of data from the SASA! study explores the pathways through which SASA!, a community mobilisation intervention to prevent violence against women, achieved community-wide reductions in physical IPV. METHODS: From 2007 to 2012 a cluster randomised controlled trial (CRT) was conducted in eight communities in Kampala, Uganda. Cross-sectional surveys of a random sample of community members, aged 18-49, were undertaken at baseline (n = 1583) and 4 years post intervention implementation (n = 2532). We used cluster-level intention to treat analysis to estimate SASA!'s community-level impact on women's past year experience of physical IPV and men's past year perpetration of IPV. The mediating roles of community-, relationship- and individual-level factors in intervention effect on past year physical IPV experience (women)/perpetration (men) were explored using modified Poisson regression models. RESULTS: SASA! was associated with reductions in women's past year experience of physical IPV (0.48, 95 % CI 0.16-1.39), as well as men's perpetration of IPV (0.39, 95 % CI 0.20-0.73). Community-level normative attitudes were the most important mediators of intervention impact on physical IPV risk, with norms around the acceptability of IPV explaining 70 % of the intervention effect on women's experience of IPV and 95 % of the effect on men's perpetration. The strongest relationship-level mediators were men's reduced suspicion of partner infidelity (explaining 22 % of effect on men's perpetration), and improved communication around sex (explaining 16 % of effect on women's experience). Reduced acceptability of IPV among men was the most important individual-level mediator (explaining 42 % of effect on men's perpetration). CONCLUSIONS: These results highlight the important role of community-level norm-change in achieving community-wide reductions in IPV risk. They lend strong support for the more widespread adoption of community-level approaches to preventing violence. TRIAL REGISTRATION: ClinicalTrials.gov, NCT00790959 . Registered 13th November 2008. The study protocol is available at: http://www.trialsjournal.com/content/13/1/96. SN - 1471-2458 UR - https://www.unboundmedicine.com/medline/citation/27084116/Ecological_pathways_to_prevention:_How_does_the_SASA_community_mobilisation_model_work_to_prevent_physical_intimate_partner_violence_against_women L2 - https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3018-9 DB - PRIME DP - Unbound Medicine ER -