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

描述（由申请人提供）：身体，心理和基于性别的性暴力（GBV）的流行率在印度年轻已婚妇女中高得惊人。然而，很少有预防基于性别的暴力的干预措施得到实施，而且这些干预措施都没有得到严格的评价。我们的目标是填补这一空白进行探索性研究的创新妇女赋权为基础的性别暴力预防干预。拟议的研究建立在我们以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，那么加强年轻已婚妇女的权力和减轻性别暴力的努力将受到限制。以前的研究表明，婆婆（MIL）是一个战略性的家庭切入点，并且有可能将他们在家庭中行使的权力重新定向到减少针对儿媳（DIL）的GBV。基于这一证据和在其他地方成功减少性别暴力的妇女赋权方法，我们制定了干预措施Dil Mil（印度国语印地语的意思是"心在一起"）。在社会认知理论和海瑟的性别暴力社会生态框架的指导下，Dil Mil旨在为DIL-MIL二人组提供知识，技能和社会支持，这些对减轻DIL中的性别暴力和相关不良健康后果至关重要。我们选择产前保健作为实施这一干预措施的背景，因为妇女的产前保健在印度城市几乎普遍使用。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II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III期有效性试验。拟议的研究是一项随机对照试验，包括140对妊娠DIL（年龄18至30岁，处于妊娠早期或中期，有GBV病史）及其MIL。招聘将在班加罗尔的四个为贫困社区服务的初级卫生中心进行。将提供标准护理或标准护理加Dil Mil干预，并在产后3个月和6个月进行评价。我们将使用描述性统计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（目标1）。将使用意向治疗原则分析干预措施对中间结局--DIL和MIL赋权（目标2）--的影响数据，以及DIL在产后前6个月内GBV发生率、DIL感知的生活质量和心理社会状态以及母婴健康结局（目标3）的影响数据。根据这些证据，我们将确定是否值得进行3期试验。总之，这项研究将产生重要的见解，一个新的，迫切需要在高流行率的环境中应对性别暴力，很可能有重大的公共卫生影响。 公共卫生相关性：越来越多的研究表明，基于性别的暴力（GBV）是一个重大的全球公共卫生挑战。然而，缺乏证据来指导减少性别暴力的方案规划和政策制定工作。我们的研究将评估一种创新的妇女赋权干预措施的可行性、安全性和潜在有效性，以减少性别暴力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3期有效性试验，并推进基于性别的暴力预防的科学。

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.