Abstract
Over the past decade, there has been rapid growth in the evidence for programs to prevent or reduce intimate partner violence (IPV)–the most common form of men’s violence against women. IPV interventions targeting heterosexual couples have shown significant impact. However, our understanding of how these interventions achieve their impacts on violence–the mechanisms through which change occurs–remains limited. Using data from two follow-up rounds of a randomized controlled trial of the Bandebereho intervention in Rwanda, we constructed conceptually driven structural equation models to represent the processes by which hypothesized mediating variables linked treatment assignment to IPV. We found significant differences in the expected direction between the intervention and control participants on all mediating variables, including men’s alcohol use, communication frequency, emotional closeness, frequency of quarreling, and men’s attitudes related to gender and violence. Several mechanisms–more positive couple dynamics including emotional closeness and communication frequency; men’s gender-equitable attitudes; men’s alcohol use–accounted for the largest proportions of the effect of assignment to the Bandebereho intervention on IPV. Overall, our findings highlight that no one particular component is driving the reductions in violence; instead, the multiple components and pathways account for the intervention’s effects, suggesting that the holistic nature of the intervention may be integral to its positive impact. The Bandebereho trial from which data was used in this analysis was registered on ClinicalTrials.gov prior to completion (NCT02694627).
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Notes
There should have been 576 participants in the intervention group, but one person was mistakenly randomized twice as he was recruited by two facilitators.
We removed one mediation variable, communication satisfaction, from the final model. While it accounted for 15% of the intervention effect in our preregistered model, it had no direct pathway from treatment assignment to it, and the direct pathway from it to IPV was statistically nonsignificant and very close to zero. Thus, it contributed little to understanding the mechanisms by which Bandebereho achieved its impacts on IPV.
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Funding
This study was supported by funding from an anonymous donor (no.5669; no.13720), the Dutch Ministry of Foreign Affairs (no.24935), and the John D. and Catherine T. MacArthur Foundation (#13–103720-000-INP). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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KD, SK, and EK participated in the development of the curriculum. SK and EK monitored the implementation of the intervention but did not have access to the data. KD, RL, and SK were involved in the supervision of data collection but did not directly collect any data.
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The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study protocol was approved by the Rwanda National Health Research Committee (August 25, 2014, NHRC/2014/PROT/0193), the Rwanda National Ethics Committee (October 24, 2014, 346/RNEC/2014), and the Rwanda National Institute of Statistics (February 9, 2015, 0082/2015/NISR).
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Levtov, R.G., Doyle, K., Bingenheimer, J.B. et al. Improved Relationship Quality, Equitable Gender Attitudes, and Reduced Alcohol Abuse as Key Mechanisms to Reduce Intimate Partner Violence in the Bandebereho Couples’ Randomized Trial in Rwanda. Prev Sci 23, 1495–1506 (2022). https://doi.org/10.1007/s11121-022-01445-6
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DOI: https://doi.org/10.1007/s11121-022-01445-6