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

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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.