Ecological pathways to prevention: How does the SASA! community mobilisation model work to prevent physical intimate partner violence against women?

BMC Public Health. 2016 Apr 16;16:339. doi: 10.1186/s12889-016-3018-9.

Abstract

Background: Intimate partner violence (IPV) against women is a global public health concern. While community-level gender norms and attitudes to IPV are recognised drivers of IPV risk, there is little evidence on how interventions might tackle these drivers to prevent IPV at the community-level. This secondary analysis of data from the SASA! study explores the pathways through which SASA!, a community mobilisation intervention to prevent violence against women, achieved community-wide reductions in physical IPV.

Methods: From 2007 to 2012 a cluster randomised controlled trial (CRT) was conducted in eight communities in Kampala, Uganda. Cross-sectional surveys of a random sample of community members, aged 18-49, were undertaken at baseline (n = 1583) and 4 years post intervention implementation (n = 2532). We used cluster-level intention to treat analysis to estimate SASA!'s community-level impact on women's past year experience of physical IPV and men's past year perpetration of IPV. The mediating roles of community-, relationship- and individual-level factors in intervention effect on past year physical IPV experience (women)/perpetration (men) were explored using modified Poisson regression models.

Results: SASA! was associated with reductions in women's past year experience of physical IPV (0.48, 95 % CI 0.16-1.39), as well as men's perpetration of IPV (0.39, 95 % CI 0.20-0.73). Community-level normative attitudes were the most important mediators of intervention impact on physical IPV risk, with norms around the acceptability of IPV explaining 70 % of the intervention effect on women's experience of IPV and 95 % of the effect on men's perpetration. The strongest relationship-level mediators were men's reduced suspicion of partner infidelity (explaining 22 % of effect on men's perpetration), and improved communication around sex (explaining 16 % of effect on women's experience). Reduced acceptability of IPV among men was the most important individual-level mediator (explaining 42 % of effect on men's perpetration).

Conclusions: These results highlight the important role of community-level norm-change in achieving community-wide reductions in IPV risk. They lend strong support for the more widespread adoption of community-level approaches to preventing violence.

Trial registration: ClinicalTrials.gov, NCT00790959 . Registered 13th November 2008. The study protocol is available at: http://www.trialsjournal.com/content/13/1/96.

Keywords: Community mobilisation; East Africa; Gender based violence; Impact evaluation; Intimate partner violence; Pathways analysis; Uganda; Violence prevention.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Community Health Services*
  • Cross-Sectional Studies
  • Ecological and Environmental Phenomena*
  • Female
  • Humans
  • Intimate Partner Violence / prevention & control*
  • Intimate Partner Violence / statistics & numerical data
  • Logistic Models
  • Male
  • Middle Aged
  • Poisson Distribution
  • Program Evaluation
  • Regression Analysis
  • Uganda
  • Young Adult

Associated data

  • ClinicalTrials.gov/NCT00790959