Ecological pathways to prevention: How does the SASA! community mobilisation model work to prevent physical intimate partner violence against women?
BackgroundIntimate 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.MethodsFrom 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.ResultsSASA! 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).ConclusionsThese 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 registrationClinicalTrials.gov, NCT00790959. Registered 13th November 2008.The study protocol is available at: http:/www.trialsjournal.com/content/13/1/96
BMC Public Health