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

• Published in: BMC public health Vol. 16; no. 340; p. 339
• Main Authors: Abramsky, Tanya, Devries, Karen M, Michau, Lori, Nakuti, Janet, Musuya, Tina, Kiss, Ligia, Kyegombe, Nambusi, Watts, Charlotte
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16-04-2016; BioMed Central; BMC
• Subjects: Acceptability; Acquired immune deficiency syndrome; Activism; Adolescent; Adult; Aggression; AIDS; Attitudes; Behavior; Clusters; Community; Community change; Community Health Services; Community mobilisation; Community relations; Cross-Sectional Studies; Domestic violence; Ecological and Environmental Phenomena; Evaluation; Family violence; Female; Gender; Gender roles; Gender-based violence; Health aspects; Health behavior; Health promotion; HIV; Human immunodeficiency virus; Humans; Impact evaluation; Infidelity; Intervention; Intimate partner violence; Intimate Partner Violence - prevention & control; Intimate Partner Violence - statistics & numerical data; Leadership; Logistic Models; Male; Medical protocols; Men; Methods; Middle Aged; Mobilization; Norms; Pathways analysis; Poisson Distribution; Prevention; Program Evaluation; Protocol (computers); Public health; Regression Analysis; Regression models; Risk; Secondary analysis; Uganda; Violence; Violence against women; Violence prevention; Women; Young Adult; Uganda; Kampala Uganda; Gender based violence; Violence prevention; Impact evaluation; Intimate partner violence; Community mobilisation; Uganda; East Africa; Pathways analysis
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-016-3018-9

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