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Which men change in intimate partner violence prevention interventions? A trajectory analysis in Rwanda and South Africa

INTRODUCTION: Emerging evidence suggests working with men to prevent intimate partner violence (IPV) perpetration can be effective. However, it is unknown whether all men benefit equally, or whether different groups of men respond differentially to interventions. METHODS: We conducted trajectory mod...

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Autores principales: Gibbs, Andrew, Dunkle, Kristin, Mhlongo, Shibe, Chirwa, Esnat, Hatcher, Abigail, Christofides, Nicola J, Jewkes, Rachel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239517/
https://www.ncbi.nlm.nih.gov/pubmed/32424011
http://dx.doi.org/10.1136/bmjgh-2019-002199
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author Gibbs, Andrew
Dunkle, Kristin
Mhlongo, Shibe
Chirwa, Esnat
Hatcher, Abigail
Christofides, Nicola J
Jewkes, Rachel
author_facet Gibbs, Andrew
Dunkle, Kristin
Mhlongo, Shibe
Chirwa, Esnat
Hatcher, Abigail
Christofides, Nicola J
Jewkes, Rachel
author_sort Gibbs, Andrew
collection PubMed
description INTRODUCTION: Emerging evidence suggests working with men to prevent intimate partner violence (IPV) perpetration can be effective. However, it is unknown whether all men benefit equally, or whether different groups of men respond differentially to interventions. METHODS: We conducted trajectory modelling using longitudinal data from men enrolled in intervention arms of three IPV trials in South Africa and Rwanda to identify trajectories of IPV perpetration. We then use multinomial regression to describe baseline characteristics associated with group allocation. RESULTS: In South Africa, the Stepping Stones and Creating Futures (SS-CF) trial had 289 men and the CHANGE trial had 803 men, and in Rwanda, Indashyikirwa had 821 men. We identified three trajectories of IPV perpetration: a low-flat (60%–67% of men), high with large reduction (19%–24%) and high with slight increase (10%–21%). Baseline factors associated men in high-start IPV trajectories, compared with low-flat trajectory, varied by study, but included higher poverty, poorer mental health, greater substance use, younger age and more childhood traumas. Attitudes supportive of IPV were consistently associated with high-start trajectories. In separate models comparing high-reducing to high-increasing trajectories, baseline factors associated with reduced IPV perpetration were depressive symptoms (relative risk ratio, RRR=3.06, p=0.01 SS-CF); living separately from their partner (RRR=2.14, p=0.01 CHANGE); recent employment (RRR=1.85, p=0.04 CHANGE) and lower acceptability of IPV (RRR=0.60, p=0.08 Indashyikirwa). Older aged men had a trend towards reducing IPV perpetration in CHANGE (p=0.06) and younger men in Indashyikirwa (p=0.07). CONCLUSIONS: Three distinct groups of men differed in their response to IPV prevention interventions. Baseline characteristics of past traumas and current poverty, mental health and gender beliefs predicted trajectory group allocation. The analysis may inform targeting of interventions towards those who have propensity to change or guide how contextual factors may alter intervention effects. TRIAL REGISTRATION NUMBERS: NCT03022370; NCT02823288; NCT03477877.
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spelling pubmed-72395172020-05-28 Which men change in intimate partner violence prevention interventions? A trajectory analysis in Rwanda and South Africa Gibbs, Andrew Dunkle, Kristin Mhlongo, Shibe Chirwa, Esnat Hatcher, Abigail Christofides, Nicola J Jewkes, Rachel BMJ Glob Health Original Research INTRODUCTION: Emerging evidence suggests working with men to prevent intimate partner violence (IPV) perpetration can be effective. However, it is unknown whether all men benefit equally, or whether different groups of men respond differentially to interventions. METHODS: We conducted trajectory modelling using longitudinal data from men enrolled in intervention arms of three IPV trials in South Africa and Rwanda to identify trajectories of IPV perpetration. We then use multinomial regression to describe baseline characteristics associated with group allocation. RESULTS: In South Africa, the Stepping Stones and Creating Futures (SS-CF) trial had 289 men and the CHANGE trial had 803 men, and in Rwanda, Indashyikirwa had 821 men. We identified three trajectories of IPV perpetration: a low-flat (60%–67% of men), high with large reduction (19%–24%) and high with slight increase (10%–21%). Baseline factors associated men in high-start IPV trajectories, compared with low-flat trajectory, varied by study, but included higher poverty, poorer mental health, greater substance use, younger age and more childhood traumas. Attitudes supportive of IPV were consistently associated with high-start trajectories. In separate models comparing high-reducing to high-increasing trajectories, baseline factors associated with reduced IPV perpetration were depressive symptoms (relative risk ratio, RRR=3.06, p=0.01 SS-CF); living separately from their partner (RRR=2.14, p=0.01 CHANGE); recent employment (RRR=1.85, p=0.04 CHANGE) and lower acceptability of IPV (RRR=0.60, p=0.08 Indashyikirwa). Older aged men had a trend towards reducing IPV perpetration in CHANGE (p=0.06) and younger men in Indashyikirwa (p=0.07). CONCLUSIONS: Three distinct groups of men differed in their response to IPV prevention interventions. Baseline characteristics of past traumas and current poverty, mental health and gender beliefs predicted trajectory group allocation. The analysis may inform targeting of interventions towards those who have propensity to change or guide how contextual factors may alter intervention effects. TRIAL REGISTRATION NUMBERS: NCT03022370; NCT02823288; NCT03477877. BMJ Publishing Group 2020-05-17 /pmc/articles/PMC7239517/ /pubmed/32424011 http://dx.doi.org/10.1136/bmjgh-2019-002199 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Original Research
Gibbs, Andrew
Dunkle, Kristin
Mhlongo, Shibe
Chirwa, Esnat
Hatcher, Abigail
Christofides, Nicola J
Jewkes, Rachel
Which men change in intimate partner violence prevention interventions? A trajectory analysis in Rwanda and South Africa
title Which men change in intimate partner violence prevention interventions? A trajectory analysis in Rwanda and South Africa
title_full Which men change in intimate partner violence prevention interventions? A trajectory analysis in Rwanda and South Africa
title_fullStr Which men change in intimate partner violence prevention interventions? A trajectory analysis in Rwanda and South Africa
title_full_unstemmed Which men change in intimate partner violence prevention interventions? A trajectory analysis in Rwanda and South Africa
title_short Which men change in intimate partner violence prevention interventions? A trajectory analysis in Rwanda and South Africa
title_sort which men change in intimate partner violence prevention interventions? a trajectory analysis in rwanda and south africa
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239517/
https://www.ncbi.nlm.nih.gov/pubmed/32424011
http://dx.doi.org/10.1136/bmjgh-2019-002199
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