A combined motivational interviewing and behavioral couples therapy intervention to reduce intimate partner violence and alcohol use in South India

项目摘要/摘要 行为夫妻疗法与动机访谈干预相结合减少亲密关系 南印度的伴侣暴力和饮酒问题 在全球范围内，估计有30%的女性报告说，他们的亲密伴侣在 一辈子。报告亲密伴侣暴力(IPV)的女性短期和长期健康状况更差， 包括性传播感染和艾滋病毒风险增加，产妇健康状况不佳，以及 自杀未遂的风险增加。犯罪者酒精使用障碍(AUD)会增加冒险行为， 并损害解决问题和认知过程，这可能会导致IPV。当前的科学 对这些紧迫问题的理解有以下局限性：a)大多数干预措施要么改善IPV，要么改善澳元 但不是两种结果；b)成功改善两者的干预措施是由训练有素的心理医生提供的 卫生专业人员，限制可获得性和可扩充性；以及c)大多数干预措施只侧重于丈夫 或者妻子，但不能两者兼而有之。这些限制导致了很大的科学和实施差距 在低资源环境下可行、有效和可扩展的干预措施，以同时针对IPV和AUD。 我们的印美合作团队试点测试了一种提供行为夫妇疗法(BCT)的干预措施，基于 论社会认知理论(SCT)对夫妻沟通的促进作用 减少酒精使用的应急管理。这一干预是可以接受的、可行的，并表明 丈夫患有AUD时，IPV和酒精使用对夫妇的初步疗效。我们现在提议建立 关于并扩展这一干预措施，以将BCT与初级保健提供的动机访谈(MI)相结合 减少印度夫妇的酒精使用量和IPV，并在随机对照试验中进行测试。 我们的研究团队在南亚有着悠久的合作研究历史。埃克斯特兰德博士有25年的 印度的研究历史，由NIH资助的11项研究支持，其中6项是PI或MPI 都在拟建的地点。Acharya博士和Ekstrand博士目前负责NIH资助的两项R34和R21研究 在南亚成功使用MI。斯里尼瓦桑博士领导了几项研究，考察了两者之间的关系 AUD和包括IPV在内的高危行为之间的关系，是我们试点干预的高级PI 这项建议是有根据的。斯里尼瓦桑博士还与埃克斯特兰德博士共同参与了NIH资助的三项R01研究的MPI。 我们建议在这一证据基础上，在我们的初级卫生诊所建立强大的研究基础设施 南印度网站。我们将进行一项随机对照试验(n=400对夫妇)，并研究BCT的影响 MI降低IPV和AUD。干预将由初级卫生中心的护士提供，他们 将由一名临床心理学家监督。我们将进行意向处理分析以比较治疗 以及对照组在12个月的随访中的两个主要结果：1)印度家庭的平均得分 暴力和控制量表和2)在一周内酒精测试阴性的天数。我们 将评估次级结果和其他措施，以进行混合方法分析，以评估 影响干预效果的理论化变化机制。如果成功，我们的研究将提供 可以在初级保健环境中提供的低成本夫妇干预IPV和AUD的证据。

PROJECT SUMMARY/ABSTRACT A combined behavioral couples therapy and motivational interviewing intervention to reduce intimate partner violence and alcohol use in South India Globally, an estimated 30% of women have reported physical or sexual violence by an intimate partner in their lifetime. Women who report intimate partner violence (IPV) have worse short- and long-term health outcomes, including increased risk for sexually transmitted infections and HIV, poor maternal health outcomes, and increased risk for suicide attempts. Perpetrator Alcohol Use Disorder (AUD) increases risk taking behaviors, and impairs problem-solving and cognitive processes, which may drive IPV. The current scientific understanding of these urgent issues has following limitations: a) most interventions improve either IPV or AUD but not both outcomes; b) interventions that successfully improve both are delivered by highly trained mental health professionals, limiting access and scalability; and c) most interventions focus on either just the husband or the wife but not both. These limitations have led to a strong scientific and implementation gap of interventions that are feasible, effective, and scalable in low-resource settings to target both IPV and AUD. Our Indo-US collaborative team pilot tested an intervention to deliver behavioral couple’s therapy (BCT), based on principles derived from Social Cognitive Theory (SCT) to enhance couple’s communication, combined with contingency management to reduce alcohol use. This intervention was acceptable, feasible and showed preliminary efficacy of IPV and alcohol use in couples when the husband had AUD. We now propose to build on and extend this intervention to combine BCT with motivational interviewing (MI), delivered by primary care nurses, to reduce alcohol use and IPV among couples in India and to test this in a randomized controlled trial. Our research team has a long history of collaborative research in South Asia. Dr. Ekstrand has a 25 year history of research in India, supported by 11 NIH-funded studies where she was the PI or MPI, six of which were at the proposed site. Drs. Acharya and Ekstrand currently oversee two NIH-funded R34 and R21 studies in South Asia successfully using MI. Dr. Srinivasan has led several studies that examined the relationship between AUD and high-risk behavior, including IPV, and was the senior PI of our pilot intervention on which this proposal is based. Dr Srinivasan has also been MPI on three NIH-funded R01 studies with Dr. Ekstrand. We propose to build on this evidence base and robust research infrastructure at primary health clinics at our South India site. We will conduct a randomized controlled trial (n= 400 couples) and study the impact of BCT and MI in reducing IPV and AUD. The intervention will be delivered by nurses in primary health centers who will be supervised by a clinical psychologist. We will perform intention to treat analyses to compare treatment and control groups on the two primary outcomes at 12-months follow-up: 1) mean scores on the Indian Family Violence and Control Scale and 2) number of days with a negative breathalyzer test over a 1-week period. We will assess secondary outcomes and other measures to conduct mixed-methods analyses to assess the theorized mechanisms of change influencing intervention effectiveness. If successful, our study will provide evidence for a low-cost couples’ intervention for IPV and AUD that can be delivered in primary care settings.