Pathways to reduced physical intimate partner violence among women in north-western Tanzania: Evidence from two cluster randomised trials of the MAISHA intervention.
Pathways to reduced physical intimate partner violence among women in north-western Tanzania: Evidence from two cluster randomised trials of the MAISHA intervention.
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DOI：
10.1371/journal.pgph.0002497
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Harvey, Sheila
中科院分区：
文献类型：
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作者：
Abramsky, Tanya;Guadarrama, Diana Sanchez;Kapiga, Saidi;Mtolela, Grace;Madaha, Flora;Lees, Shelley;Harvey, Sheila
亲密伴侣暴力(IPV)影响着全球四分之一以上的女性。经济和社会赋权相结合的干预措施是一种很有前途的IPV预防模式。然而，关于这种干预措施防止IPV的机制，以及在缺乏经济组成部分的情况下，独立的社会赋权干预措施是否能够发挥作用，仍然存在疑问。对Maisha研究数据的二次分析(坦桑尼亚西北部)探索了单独或与小额信贷一起向妇女提供基于群体的性别培训干预措施可能影响实物IPV风险的途径。两个分组随机试验(CRT)评估了Maisha干预措施对妇女IPV风险的影响；CRT01在66个先前存在的小额贷款组(n=919)中的妇女中，CRT02在66个新成立的未接受小额贷款的小组中(n=1125)。在基线和29个月的随访中对女性进行了调查。分组分析探讨了干预对过去一年身体IPV体验的影响是否因参与者的特征而异。采用混合效应Logistic回归(按试验分解)探讨物理IPV干预效应的中介因素。在CRT01中，Maisha与过去一年身体IPV的降低有关(调整后的OR为0.63，95%CI为0.41-0.98)，在那些更年轻、经济上更独立、以前没有身体IPV的人中影响更大。CRT02对总体或亚组间的物理IPV没有影响。在CRT01中，个体层面对IPV的接受性降低和群体层面对IPV干预的信心成为干预效果的潜在中介变量，而关系层面的沟通指标没有受到影响。在CRT02中，对个人层面态度的积极影响并未转化为降低IPV风险。在CRT02中，在干预组中，与伴侣就感知到的性别角色违规而发生的争论有所增加。两次试验都没有导致更多的分居。调查结果说明了解决贫穷和妇女在经济上对男子的依赖的重要性，这是可能阻碍以社会为导向的预防暴力方案的成功的结构性因素。与男子一起制定方案也是减少妇女态度/行为改变所面临的反弹风险的关键。试验注册：ClinicalTrials.gov#NCT02592252。
Intimate partner violence (IPV) affects over one-in-four women globally. Combined economic and social empowerment interventions are a promising IPV prevention model. However, questions remain on the mechanisms through which such interventions prevent IPV, and whether standalone social empowerment interventions can work in the absence of an economic component. This secondary analysis of MAISHA Study data (north-western Tanzania) explores pathways through which a group-based gender-training intervention, delivered to women standalone or alongside microfinance, may impact on physical IPV risk. Two cluster-randomised trials (CRT) assessed the impact of the MAISHA intervention on women’s IPV risk; CRT01 among women in 66 pre-existing microfinance groups (n = 919), and CRT02 among 66 newly-formed groups not receiving microfinance (n = 1125). Women were surveyed at baseline and 29 months follow-up. Sub-group analyses explored whether intervention effects on past-year experience of physical IPV varied by participant characteristics. Mediators of intervention effect on physical IPV were explored using mixed-effects logistic regression (disaggregated by trial). In CRT01, MAISHA was associated with reduced past-year physical IPV (adjusted-OR 0.63, 95%CI 0.41–0.98), with stronger effects among those younger, more financially independent, and without prior physical IPV. CRT02 showed no impact on physical IPV, overall or among sub-groups. In CRT01, individual-level reduced acceptability of IPV and group-level confidence to intervene against IPV emerged as potential mediators of intervention effect, while relationship-level indicators of communication were not impacted. In CRT02, positive impacts on individual-level attitudes did not translate into reduced IPV risk. In CRT02, arguments with partners over perceived transgressions of gender roles increased in the intervention-arm. Neither trial resulted in increased separations. Findings illustrate the importance of addressing poverty and women’s economic dependence on men, structural factors that may impede the success of socially oriented violence prevention programming. Programming with men is also crucial to ameliorate risks of backlash against attitudinal/behavioural change among women. Trial registration: ClinicalTrials.gov #NCT02592252.