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

描述(由申请者提供)：在印度年轻的已婚女性中，基于性别的身体、心理和性暴力(GBV)的流行率高得惊人。然而，实施的GBV预防干预措施很少，而且这些干预措施都没有经过严格评估。我们的目标是通过对创新的基于妇女赋权的GBV预防干预措施进行探索性研究来填补这一空白。这项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进行的研究的基础上，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，提高年轻已婚妇女的权力和减轻GBV的努力将是有限的。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的权力转向减少对媳妇(DILs)的GBV。基于这一证据和在其他地方成功降低GBV的妇女赋权方法，我们开发了干预措施Dil Mil(在印度国家语言印地语中的意思是“心在一起”)。在社会认知理论和Heise关于GBV的社会生态框架的指导下，Dil Mil旨在赋予Dil-MIL双亲以知识、技能和社会支持，这些知识、技能和社会支持对于缓解GBV和DIL中相关的不良健康后果至关重要。我们选择产前护理作为实施这一干预措施的背景，是因为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，而且很可能是安全的。R21的目的是进行第二阶段试验，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第三阶段有效性试验。这项拟议的研究是一项随机对照试验，共有140对夫妇，包括怀孕的DILs(年龄18-30岁，怀孕前或怀孕中期，有GBV病史)及其MILs。招募工作将在班加罗尔为贫困社区服务的四个初级卫生中心进行。将提供标准护理或标准护理加上Dil Mil干预，并将在产后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来评估干预的可行性和安全性(目标1)。将使用意向治疗原则分析干预对中间结果--DILS和MILS赋权(目标2)--以及产后头6个月DILS中GBV发生率的影响、DILS的感知生活质量和心理社会状况以及母婴健康结果(目标3)的数据。根据这一证据，我们将确定是否值得进行第三阶段试验。总之，这项研究将对在高流行率环境下应对GBV的新的、迫切需要的措施产生重要的见解，并极有可能对公共卫生产生重大影响。 公共卫生相关性：越来越多的研究表明，基于性别的暴力(GBV)是一项重大的全球公共卫生挑战。然而，缺乏证据来指导项目规划和政策制定努力，以减少GBV。我们的研究将评估一种创新的女性赋权干预措施的可行性、安全性和潜在有效性，以减少GBV和相关的不良健康后果。预计研究结果将提供证据，以确定是否值得进行第三阶段有效性试验，并促进预防GBV的科学基础。

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.