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

项目概要/摘要 一项结合行为伴侣疗法和动机访谈干预的研究， 印度南部的伴侣暴力和酗酒问题 在全球范围内，估计有30%的妇女报告说，她们在工作中受到亲密伴侣的身体暴力或性暴力。 辈子报告亲密伴侣暴力的妇女的短期和长期健康结果更差， 包括性传播感染和艾滋病毒的风险增加，孕产妇健康状况不佳， 增加自杀企图的风险。肇事者酒精使用障碍（AUD）增加了冒险行为， 并损害解决问题和认知过程，这可能会推动IPV。目前的科学 对这些紧迫问题的理解存在以下局限性：a）大多数干预措施改善IPV或AUD 但不是两种结果; B）成功改善这两种结果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，限制了获得和可扩展性;以及c）大多数干预措施都只关注丈夫 或者是妻子但不是两个都是这些限制导致了巨大的科学和实施差距， 在低资源环境下，针对IPV和AUD的干预措施是可行的，有效的和可扩展的。 我们的印度-美国合作团队试点测试了一种干预措施，以提供行为夫妇疗法（BCT），基于 运用社会认知理论的原则，加强夫妻沟通，并结合 应急管理，以减少酒精的使用。这种干预是可以接受的，可行的，并表明 当丈夫患有AUD时，IPV和酒精使用在夫妇中的初步疗效。我们现在建议建立 并将这种干预措施扩展到联合收割机结合动机访谈（MI），由初级保健提供 护士，以减少印度夫妇的酒精使用和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。埃克斯特兰德医生有25年的 在印度的研究历史，由11个NIH资助的研究，她是PI或MPI的支持，其中六个， 在提议的地点。Acharya和Ekstrand博士目前负责两项NIH资助的R34和R21研究 在南亚成功地使用MI。斯里尼瓦桑博士领导了几项研究， 澳元和高风险行为之间的关系，包括IPV，并且是我们试点干预的高级PI， 这个建议是有根据的。Srinivasan博士还与Ekstrand博士一起参与了三项NIH资助的R 01研究。 我们建议在我们的初级卫生诊所建立这一证据基础和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），研究BCT的影响 MI降低IPV和AUD。干预措施将由初级卫生中心的护士提供， 将由临床心理学家监督我们将进行意向治疗分析， 在12个月随访时，对两个主要结局进行比较：1）印第安家庭的平均评分 暴力和控制量表和2）1周内呼气测醉器测试阴性的天数。我们 将评估次要结果和其他措施，以进行混合方法分析， 影响干预有效性的理论化变化机制。如果成功，我们的研究将提供 证据表明，低成本的夫妇干预IPV和AUD，可以在初级保健机构提供。

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.