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Abstract
Background Between 2015 and 2018, three civil society organisations in Rwanda implemented Indashyikirwa, a four-part intervention designed to reduce intimate partner violence (IPV) among couples and within communities. We assessed the impact of the programme’s gender transformative curriculum for couples.
Methods Sectors (n=28) were purposively selected based on density of village savings and loan association (VLSA) groups and randomised (with stratification by district) to either the full community-level Indashyikirwa programme (n=14) or VSLA-only control (n=14). Within each sector, 60 couples recruited from VSLAs received either a 21-session curriculum or VSLA as usual. No blinding was attempted. Primary outcomes were perpetration (for men) or experience (for women) of past-year physical/sexual IPV at 24 months post-baseline, hypothesised to be reduced in intervention versus control (ClinicalTrials.gov: NCT03477877).
Results We enrolled 828 women and 821 men in the intervention sectors and 832 women and 830 men in the control sectors; at endline, 815 women (98.4%) and 763 men (92.9%) in the intervention and 802 women (96.4%) and 773 men (93.1%) were available for intention-to-treat analysis. Women in the intervention compared with control were less likely to report physical and/or sexual IPV at 24 months (adjusted relative risk (aRR)=0.44, 95% CI 0.34 to 0.59). Men in the intervention compared with control were also significantly less likely to report perpetration of physical and/or sexual IPV at 24 months (aRR=0.54, 95% CI 0.38 to 0.75). Additional intervention benefits included reductions in acceptability of wife beating, conflict with partner, depression, and corporal punishment against children and improved conflict management, communication, trust, self-efficacy, self-rated health, household earnings, food security and actions to prevent IPV. There were no study-related harms.
Conclusions The Indashyikirwa couples’ training curriculum was highly effective in reducing IPV among male/female couples in rural Rwanda. Scale-up and adaptation to similar settings should be considered.
- health education and promotion
- prevention strategies
- public health
- Cluster randomised trial
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Footnotes
Handling editor Seye Abimbola
Contributors KD codesigned the study with LH, led the quantitative fieldwork, led the statistical analysis and led the first draft of the manuscript. ES contributed to study design, led the qualitative fieldwork, led the literature review, contributed to interpretation of the findings and cowrote the manuscript. SC participated in data management and statistical analysis and contributed to interpretation of the findings and cowrote the manuscript. LH codesigned the study with KD, supported quantitative and qualitative fieldwork, participated in statistical analysis and interpretation of the findings and cowrote the manuscript. All authors contributed to drafting and revising the manuscript. All authors read and approved the final manuscript.
Funding This work was conducted as part of What Works To Prevent Violence? A Global Programme on Violence Against Women and Girls (VAWG) funded by the UK Government’s Department for International Development (DFID). However, the views expressed do not necessarily reflect the department’s official policies and the funders had no role in study design; collection, management, analysis and interpretation of data; writing of the report; or the decision to submit the paper for publication. Funding was managed by the South African Medical Research Council.
Competing interests None declared.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting or dissemination plans of this research. Refer to the Methods section for further details.
Patient consent for publication Not required.
Ethics approval Ethical approval was obtained from the Rwandan National Ethics Committee (340/RNEC/2015) and the South Africa Medical Research Council Ethics Committee (EC033-10/2015). A required research permit was obtained from the National Institute of Statistics Rwanda (0738/2015/10/NISR).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement De-identified individual participant data are available from the corresponding author, but may require permission from the Rwandan Ministry of Gender and Family Promotion (MIGEPROF) before transfer. Data cannot be shared publicly because of the need to ensure that all use complies with the research permit issued by the National Institute of Statistics Rwanda and is approved by the Rwandan Ministry of Gender and Family Promotion (MIGEPROF).