Ignite Creation Date:
2024-05-06 @ 5:31 PM
Last Modification Date:
2024-10-26 @ 2:30 PM
Study NCT ID:
NCT05331248
Status:
RECRUITING
Last Update Posted:
2024-07-10
First Post:
2022-02-16
Brief Title:
Training Local Leaders to Prevent and Reduce Domestic Violence Evidence From Peru
Sponsor:
Duke University
Organization:
Duke University
Study Overview
Official Title:
Training Leaders to Prevent and Reduce Domestic Violence in Their Communities Experimental Evidence From Peru
Status:
RECRUITING
Status Verified Date:
2024-07
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
LIA
Brief Summary:
Leaders in Action LIA is a norms-centered intervention that aims to reduce the acceptance and prevent the incidence of Intimate Partner Violence IPV in Peru by shifting social norms This project takes advantage of the randomization of LIA across 250 villages
LIA has two delivery models a household-based module HT consisting of household training sessions by Community Health Volunteers and a group-based module GT with education sessions in small gender-segregated groups organized by trained facilitators The investigators will cross-randomize each approach to assess efficiency in reducing domestic violence and changing social norms about tolerance toward violence and gender roles The study disentangles the impact of the two modules separately as well as the interaction of the modules while explicitly addressing methodological concerns of previous studies reporting bias from self-reported domestic violence limited statistical power and lack of long-term effects measures
Potential and actual victims of IPV may profit from the intimate atmosphere of household visits and that on the side of women the transmission of information about IPV and services for victims may be facilitated in more private settings At the same time group-level workshops about harmful gender stereotypes and gender norms for women should through social interactions and norm change reinforce the effects of household-level treatments for women The experiment will shed light on the potential mechanisms at play and the theoretical framework underlying IPV through extensive data collection and the calculation of heterogeneous effects The goal of this project is to deliver new rigorous evidence to the scientific and policy community by experimentally evaluating the impact of a state-run IPV intervention and its main components It provides insights into the effectiveness of distinct program components assesses cost-effectiveness as well as potential to scale and evaluates the mechanisms leading to the reduction of IPV
LIA has two delivery models a household-based module HT consisting of household training sessions by Community Health Volunteers and a group-based module GT with education sessions in small gender-segregated groups organized by trained facilitators The investigators will cross-randomize each approach to assess efficiency in reducing domestic violence and changing social norms about tolerance toward violence and gender roles The study disentangles the impact of the two modules separately as well as the interaction of the modules while explicitly addressing methodological concerns of previous studies reporting bias from self-reported domestic violence limited statistical power and lack of long-term effects measures
Potential and actual victims of IPV may profit from the intimate atmosphere of household visits and that on the side of women the transmission of information about IPV and services for victims may be facilitated in more private settings At the same time group-level workshops about harmful gender stereotypes and gender norms for women should through social interactions and norm change reinforce the effects of household-level treatments for women The experiment will shed light on the potential mechanisms at play and the theoretical framework underlying IPV through extensive data collection and the calculation of heterogeneous effects The goal of this project is to deliver new rigorous evidence to the scientific and policy community by experimentally evaluating the impact of a state-run IPV intervention and its main components It provides insights into the effectiveness of distinct program components assesses cost-effectiveness as well as potential to scale and evaluates the mechanisms leading to the reduction of IPV
Detailed Description:
Leaders in Action LIA is a norms-centered intervention run by the Peruvian Ministry for Women and Vulnerable Populations MIMP that aims to reduce the acceptance and incidence of Intimate Partner Violence IPV in Peru by shifting social norms LIA has two main implementation phases first the recruitment of Community Health Volunteers CHVs and second the delivery of content against IPV The delivery of the intervention is assisted by MIMP professionals working in local Women Emergency Centers Centro de Emergencia Mujer or CEM a nationwide network of hubs run by the MIMP that offer wide-ranging support services to IPV victims The CEMs also implement other IPV prevention interventions at the local level
CEMs Promotors MIMPs professionals working at local CEM recruit leaders of local social organizations and train them to be Facilitators of LIA Facilitators are the principal CHVs located in each district center who conduct LIA activities Another type of CHVs are leaders at the village-level who are trained by Facilitators to become Community Agents CAs Both CAs and Facilitators work together to conduct the second phase of LIA the delivery of the intervention through its two delivery models the Household Treatment HT and the Group Treatment GT
Originally the study was designed to only evaluate the HT Thus a first randomization was conducted on our study sample with an even split of 125 control villages and 125 treatment villages The research team and Innovations for Poverty Action IPA Peru deployed a census to identify the population of women in sample villages who met the eligibility criteria for the study and conducted an in-depth baseline survey on women who reported IPV in the census The implementation of the HT began in 2020 and was interrupted by the Covid-19 pandemic The MIMP paused the program in March 2020 until national lockdowns were rescinded in February 2022 Given the intense migration and other demographic changes that took place during the 23-month interruption as well as the potential for new IPV exposure over that period new census and baseline surveys were conducted in 2022 which were used to define the final targeted sample for the intervention
Our study tests two different delivery modes of the program the HT and the GT as well as their combination in a cross-randomized design The 250 villages in our study sample were randomized into 4 treatment arms following a factorial randomization model This resulted in 62 villages receiving only the HT HT only 62 villages receiving only the GT GT only 63 villages receiving both the HT and GT HTGT and 63 villages in the control group The randomization procedure was stratified by CEM the level of IPV risk and the 2018 treatment status villages that had begun implementation of the HT were restricted to remain in the HT only or HTGT treatment arms
The MIMPs original HT design followed a door-to-door delivery approach CHVs in coordination with the local CEM offered 8 treatment sessions to households at risk of IPV These HT sessions took place over a period of 1 to 2 months and were conducted in participants residences While all adult household members were invited to participate the recipients of the HT were in practice primarily women As a result this delivery mode may have been ineffective at influencing norms and beliefs of male participants The household-centered approach is also expensive and difficult to scale up Thus together with the MIMP the research team developed modifications to the HT which resulted in the innovations described below
First in collaboration with the MIMP the research team and IPA Peru developed a telenovela-style series as a key component of the LIA program edutainment component The series consists of four videos that reinforce themes of relationship conflict masculinity and social norms around gender The edutainment component was randomized for the HT only treatment arm so that in 31 villages all households targeted for HT watched the edutainment component as part of the program and in other 31 villages only 50 of the households targeted for HT watched the edutainment component In this second group the households selected to watch the edutainment videos were randomly selected which will allow the research team to experimentally identify the effect of the edutainment videos In the other treatment arms GT only and HTGT the edutainment component is implemented for all participants
Second in order to strengthen the effect of LIA and to reach potential perpetrators which are predominantly men as well as victims of IPV we developed a different delivery format with the MIMP the GT The GT follows a gender-segregated yet community-wide delivery approach in a group discussion format Existing evidence suggests that interventions which target both perpetrators and victims can have a substantial impact on attitudes towards and the incidence of IPV and that simultaneously addressing IPV from different angles can be particularly effective Chakraborty P Osrin D and Daruwalla N 2020 Abramsky T et al 2014 These approaches commonly stress the importance of collaborative learning in support-group-style sessions to confront ideas of masculinity and gender norms Moreover norms change is more likely to happen when individuals are aware of relevant peers who are also changing their beliefs Bursztyn L González A L Yanagizawa-Drott D 2018 As a result the investigators proposed separating groups by gender to provide tailored settings during intervention
This group-based approach entailed 4 GT workshops that integrated various activities and group discussions focused on the same content as the HT The group workshops directed at men had a slightly different curriculum than those directed at women and always had at least one male CHV in the room facilitating the workshop In order to meet this criteria during implementation the MIMP required a larger number of male CHVs than those who were initially recruited through social organizations men are usually recruited in disproportionately low numbers for this style of volunteer work and the initial number of male CHVs was not sufficient for implementation of the GT As a result male CHVs were recruited as program Facilitators from local universities communal associations and other frequently-transited areas GT sessions took place over the course of one month in village community centers schools churches or other communal spaces where village residents would often gather and lasted for approximately two hours Larger villages held multiple GT sessions per workshop to cover all potential participants and some villages were re-visited some months after the expected implementation time to ensure a high uptake
Participant targeting during the GT was the same as in other treatment arms MIMP CHVs approached the houses of women in the targeted sample and extended an invitation for them and their male partners to participate in the intervention However given that the GT is designed to involve the village community at large invitations for the GT were extended to all adults in the village Households in the targeted sample were approached door-to-door multiple times in the week before the GT session while the rest of the village households were only approached once per workshop Aside from door-to-door recruiting the whole village received a notice an hour before each GT session through a loudspeaker usually used for other village-wide activities
The topics covered during both the HT and GT were equivalent to ensure comparability These topics were i gender roles beliefs and stereotypes ii violence cultural patterns and human rights iii healthy relationships within the family iv respect between family members and self-care v assertive communication vi resolution and conflict management vii resources for domestic violence cases and viii leadership and womens agency
Third 50 of the villages assigned for either the HT only GT only or HTGT treatment arms 94 villages total were randomly selected to target one village leader eg village president to receive treatment given the villages treatment assignment This will evaluate if community leaders are impactful in shifting norms at the village level
Fourth we randomized 50 percent of the treated villages to target a random selection of 30 of women who were interviewed in the census but did not report ever experiencing any form of IPV by their current partner This will allow the research team to measure community-level impacts of the intervention through treatment density
After the conclusion of both the HT and the GT a set of qualitative interviews were conducted with the goal of informing the research team on the channels through which the treatments could be reducing IPV as well as capturing information relevant to the design of the endline survey
The research team plans to conduct an endline survey 6-months after the MIMPs implementation of the HT and GT to evaluate the impact of the LIA program and its different innovations on outcome measures such as IPV physical health mental health tolerance towards IPV female agency and social norms
CEMs Promotors MIMPs professionals working at local CEM recruit leaders of local social organizations and train them to be Facilitators of LIA Facilitators are the principal CHVs located in each district center who conduct LIA activities Another type of CHVs are leaders at the village-level who are trained by Facilitators to become Community Agents CAs Both CAs and Facilitators work together to conduct the second phase of LIA the delivery of the intervention through its two delivery models the Household Treatment HT and the Group Treatment GT
Originally the study was designed to only evaluate the HT Thus a first randomization was conducted on our study sample with an even split of 125 control villages and 125 treatment villages The research team and Innovations for Poverty Action IPA Peru deployed a census to identify the population of women in sample villages who met the eligibility criteria for the study and conducted an in-depth baseline survey on women who reported IPV in the census The implementation of the HT began in 2020 and was interrupted by the Covid-19 pandemic The MIMP paused the program in March 2020 until national lockdowns were rescinded in February 2022 Given the intense migration and other demographic changes that took place during the 23-month interruption as well as the potential for new IPV exposure over that period new census and baseline surveys were conducted in 2022 which were used to define the final targeted sample for the intervention
Our study tests two different delivery modes of the program the HT and the GT as well as their combination in a cross-randomized design The 250 villages in our study sample were randomized into 4 treatment arms following a factorial randomization model This resulted in 62 villages receiving only the HT HT only 62 villages receiving only the GT GT only 63 villages receiving both the HT and GT HTGT and 63 villages in the control group The randomization procedure was stratified by CEM the level of IPV risk and the 2018 treatment status villages that had begun implementation of the HT were restricted to remain in the HT only or HTGT treatment arms
The MIMPs original HT design followed a door-to-door delivery approach CHVs in coordination with the local CEM offered 8 treatment sessions to households at risk of IPV These HT sessions took place over a period of 1 to 2 months and were conducted in participants residences While all adult household members were invited to participate the recipients of the HT were in practice primarily women As a result this delivery mode may have been ineffective at influencing norms and beliefs of male participants The household-centered approach is also expensive and difficult to scale up Thus together with the MIMP the research team developed modifications to the HT which resulted in the innovations described below
First in collaboration with the MIMP the research team and IPA Peru developed a telenovela-style series as a key component of the LIA program edutainment component The series consists of four videos that reinforce themes of relationship conflict masculinity and social norms around gender The edutainment component was randomized for the HT only treatment arm so that in 31 villages all households targeted for HT watched the edutainment component as part of the program and in other 31 villages only 50 of the households targeted for HT watched the edutainment component In this second group the households selected to watch the edutainment videos were randomly selected which will allow the research team to experimentally identify the effect of the edutainment videos In the other treatment arms GT only and HTGT the edutainment component is implemented for all participants
Second in order to strengthen the effect of LIA and to reach potential perpetrators which are predominantly men as well as victims of IPV we developed a different delivery format with the MIMP the GT The GT follows a gender-segregated yet community-wide delivery approach in a group discussion format Existing evidence suggests that interventions which target both perpetrators and victims can have a substantial impact on attitudes towards and the incidence of IPV and that simultaneously addressing IPV from different angles can be particularly effective Chakraborty P Osrin D and Daruwalla N 2020 Abramsky T et al 2014 These approaches commonly stress the importance of collaborative learning in support-group-style sessions to confront ideas of masculinity and gender norms Moreover norms change is more likely to happen when individuals are aware of relevant peers who are also changing their beliefs Bursztyn L González A L Yanagizawa-Drott D 2018 As a result the investigators proposed separating groups by gender to provide tailored settings during intervention
This group-based approach entailed 4 GT workshops that integrated various activities and group discussions focused on the same content as the HT The group workshops directed at men had a slightly different curriculum than those directed at women and always had at least one male CHV in the room facilitating the workshop In order to meet this criteria during implementation the MIMP required a larger number of male CHVs than those who were initially recruited through social organizations men are usually recruited in disproportionately low numbers for this style of volunteer work and the initial number of male CHVs was not sufficient for implementation of the GT As a result male CHVs were recruited as program Facilitators from local universities communal associations and other frequently-transited areas GT sessions took place over the course of one month in village community centers schools churches or other communal spaces where village residents would often gather and lasted for approximately two hours Larger villages held multiple GT sessions per workshop to cover all potential participants and some villages were re-visited some months after the expected implementation time to ensure a high uptake
Participant targeting during the GT was the same as in other treatment arms MIMP CHVs approached the houses of women in the targeted sample and extended an invitation for them and their male partners to participate in the intervention However given that the GT is designed to involve the village community at large invitations for the GT were extended to all adults in the village Households in the targeted sample were approached door-to-door multiple times in the week before the GT session while the rest of the village households were only approached once per workshop Aside from door-to-door recruiting the whole village received a notice an hour before each GT session through a loudspeaker usually used for other village-wide activities
The topics covered during both the HT and GT were equivalent to ensure comparability These topics were i gender roles beliefs and stereotypes ii violence cultural patterns and human rights iii healthy relationships within the family iv respect between family members and self-care v assertive communication vi resolution and conflict management vii resources for domestic violence cases and viii leadership and womens agency
Third 50 of the villages assigned for either the HT only GT only or HTGT treatment arms 94 villages total were randomly selected to target one village leader eg village president to receive treatment given the villages treatment assignment This will evaluate if community leaders are impactful in shifting norms at the village level
Fourth we randomized 50 percent of the treated villages to target a random selection of 30 of women who were interviewed in the census but did not report ever experiencing any form of IPV by their current partner This will allow the research team to measure community-level impacts of the intervention through treatment density
After the conclusion of both the HT and the GT a set of qualitative interviews were conducted with the goal of informing the research team on the channels through which the treatments could be reducing IPV as well as capturing information relevant to the design of the endline survey
The research team plans to conduct an endline survey 6-months after the MIMPs implementation of the HT and GT to evaluate the impact of the LIA program and its different innovations on outcome measures such as IPV physical health mental health tolerance towards IPV female agency and social norms
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None
Secondary IDs
| Secondary ID | Type | Domain | Link |
|---|---|---|---|
| 1R01HD101581-01A1 | NIH | None | None |
| 14498 | OTHER | Innovations for Poverty Action | httpsreporternihgovquickSearch1R01HD101581-01A1 |