TY - JOUR PY - 2016// TI - Ecological pathways to prevention: How does the SASA! community mobilisation model work to prevent physical intimate partner violence against women? JO - BMC public health A1 - Abramsky, Tanya A1 - Devries, Karen M. A1 - Michau, Lori A1 - Nakuti, Janet A1 - Musuya, Tina A1 - Kiss, Ligia A1 - Kyegombe, Nambusi A1 - Watts, Charlotte SP - e339 EP - e339 VL - 16 IS - 1 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.

Language: en

LA - en SN - 1471-2458 UR - http://dx.doi.org/10.1186/s12889-016-3018-9 ID - ref1 ER -