Empowering Daughters and Mother-in-laws to Mitigate Gender-based Violence and Pro

描述（由申请人提供）：在印度的年轻已婚妇女中，身体、心理和性暴力（GBV）的发生率高得惊人。然而，实施的性别暴力预防干预措施很少，而且这些干预措施都没有得到严格评估。我们的目标是通过开展一项创新性的基于妇女赋权的性别暴力预防干预的探索性研究来填补这一空白。拟议的研究建立在我们之前在印度班加罗尔城市贫困社区的研究基础上，该研究表明，如果不解决主要由婚姻家庭塑造的更广泛的生活背景，那么提高年轻已婚妇女权力和减轻性别暴力的努力将受到限制。先前的研究表明，婆婆（MILs）是一个战略性的家庭切入点，有可能将她们在家庭中行使的权力转向减少对儿媳的性别暴力。基于这些证据，以及在其他地方成功减少性别暴力的妇女赋权方法，我们开发了Dil Mil（印度国语印地语的意思是“心在一起”）干预措施。在社会认知理论和Heise关于性别暴力的社会生态框架的指导下，Dil Mil旨在为Dil - Mil夫妇提供知识、技能和社会支持，这些知识、技能和社会支持对减轻性别暴力和相关的不良健康结果至关重要。我们选择产前护理作为实施这一干预措施的背景，因为在印度城市妇女几乎普遍使用产前护理。第一阶段的试点研究表明，我们的方法是可以接受的，可能是安全的。本R21的目的是进行2期试验，以检查Dil Mil的可行性、安全性和潜在有效性，以确定是否值得进行3期有效性试验。拟议的研究是一项随机对照试验，有140对夫妇，包括怀孕的DILs（年龄在18至30岁，在怀孕的前三个月或中期，有GBV史）及其mil。招聘将在为班加罗尔贫困社区服务的四个初级保健中心进行。对双胎进行标准护理或标准护理加Dil - Mil干预，并在产后3个月和6个月进行评估。我们将使用描述性统计来描述研究人群的特征，并使用定性和定量数据评估干预的可行性和安全性（目的1）。将使用意向治疗原则分析干预对中间结果的影响的数据——对dill和mil的授权（目标2）和产后前6个月dill中性别暴力的发生率、dill的感知生活质量和社会心理状态以及母婴健康结果（目标3）的影响。基于这些证据，我们将决定是否需要进行三期试验。总之，这项研究将为在高流行环境中对性别暴力采取一种新的、迫切需要的应对措施提供重要见解，并极有可能对公共卫生产生重大影响。

DESCRIPTION (provided by applicant): The prevalence of physical, psychological, and sexual gender-based violence (GBV) is staggeringly high among young, married women in India. However, few GBV prevention interventions have been implemented, and none of these interventions has been rigorously evaluated. We aim to fill this gap by conducting exploratory research on an innovative women's empowerment-based GBV prevention intervention. The proposed study builds on our previous research in urban poor communities in Bangalore, India, which revealed that efforts to enhance young, married women's power and to mitigate GBV will be limited if the broader context of their lives, which is shaped mainly by the marital family, is unaddressed. Previous research suggests that mothers-in-law (MILs) are a strategic familial entry point and that it may be possible to redirect the power they wield in the family toward reducing GBV against daughters-in-law (DILs). Based on this evidence and women's empowerment approaches that have successfully reduced GBV elsewhere, we developed the intervention Dil Mil (meaning "Hearts Together" in India's national language, Hindi). Guided by the Social Cognitive Theory and Heise's social-ecological framework of GBV, Dil Mil aims to empower DIL-MIL dyads with knowledge, skills, and social support critical to the mitigation of GBV and related adverse health outcomes among DILs. We chose antenatal care as the context for implementing this intervention because of women's nearly universal use of antenatal care in urban India. A phase 1 pilot study demonstrated that our approach is acceptable and likely to be safe. The aim of this R21 is to conduct a phase 2 trial to examine the feasibility, safety, and potential effectiveness of Dil Mil in order to determine if a phase 3 effectiveness trial is merited. The proposed study is a randomized controlled trial with 140 dyads comprising pregnant DILs (aged 18 to 30 years, in their first or second trimester of pregnancy, with a history of GBV) and their MILs. Recruitment will take place at four primary health centers serving poor communities in Bangalore. Dyads will be offered standard care or standard care plus the Dil Mil intervention, and evaluations will be conducted at 3 months and 6 months postpartum. We will characterize the study population using descriptive statistics and assess feasibility and safety of the intervention using qualitative and quantitative data (Aim 1). Data on the effect of the intervention on intermediary outcomes-the empowerment of DILs and MILs (Aim 2)-and on the incidence of GBV among DILs during the first 6 months postpartum, DILs' perceived quality of life and psychosocial status, and maternal and infant health outcomes (Aim 3) will be analyzed using the intention-to-treat principle. Based on this evidence, we will determine if a phase 3 trial is merited. In conclusion, this study will generate important insights on a novel, urgently needed response to GBV in a high prevalence setting and is highly likely to have a significant public health impact. PUBLIC HEALTH RELEVANCE: A growing body of research indicates that gender-based violence (GBV) is a major global public health challenge. Yet, there is a dearth of evidence to guide program planning and policy-making efforts to reduce GBV. Our study will evaluate the feasibility, safety, and potential effectiveness of an innovative women's empowerment intervention to reduce GBV and related adverse health outcomes. It is expected that the study findings will provide evidence to determine if a phase 3 effectiveness trial is merited and advance the science underlying GBV prevention.