Stepping Stones and Creating Futures: A group-based approach to addressing violence against women through working with men

Intimate partner controlling behaviour and intimate partner violence among married women in rural areas in South Africa

BACKGROUND

Violence against women is a critical public health issue, and Intimate Partner Violence (IPV) is prevalent globally as its predominant form. Despite extensive research on its prevalence, the connection between IPV and controlling behaviour has not been sufficiently researched, especially within the context of rural living. This study contributes to this gap by assessing the relationship between intimate partner controlling behaviour and IPV among rural dwellers in South Africa.

METHODS

The study used the domestic violence module data from the 2016 South Africa Demographic and Health Survey (SADHS). The data were analysed using both descriptive statistics- percentages, mean, and standard deviation- and inferential statistics-logistic regression.

RESULT

The study found intimate partner controlling behaviour as a predictor of IPV among married women residing in rural communities in South Africa. Accusations of infidelity, restrictions on seeing family members, general movement control, and jealousy were the forms of intimate partner controlling behaviour that predicted the occurrence of IPV.

CONCLUSION

Intimate partner controlling behaviour is associated with intimate partner violence. Based on this finding, we argue that preventative, and responsive approaches that combine education, awareness raising, pathways to help seeking, women's personal development and empowerment will have greater benefits in helping to tackle the problem of controlling behaviour and intimate partner violence against rural women in South Africa.

Stepping Stones and Creating Futures Plus: A pilot randomised controlled trial of a co-developed intervention with young South Africans

Marginalised young women and men in South Africa experience and perpetrate high rates of intimate partner violence (IPV), shaped by their contexts and life histories. To address this, we co-developed Stepping Stones and Creating Futures Plus (SSCF+) with young women and men living in marginalised communities to reduce IPV, strengthen livelihoods and improve mental health. We assessed the intervention's feasibility, acceptability and potential impact, when delivered to small single-gender friendship groups, through a mixed-methods study. We had 30 groups for men and women, and randomly allocated groups to receive the intervention or not. In-depth interviews were conducted post-intervention with n=23 women and n=22 men. Participants were aged 18-30 living in selected communities. We assessed the acceptability of the intervention (participant attendance, overall views) and evidence of change in IPV perpetration (men) and experience (women), livelihoods and mental health 5-6 months post-baseline, and hypothesised mechanisms of change. N=163 men and N=162 women were recruited and we followed up 96.9% men and 100% women at endline. 81% women and 53% men attended at least 70% of sessions, but 3 clusters (10%) ended early. Participants reported the intervention was relevant and enjoyable for them, although they raised some areas for strengthening. At endline, women reported non-significant reductions in physical IPV (aOR0.64, 0.27, 1.53), sexual IPV (aOR0.59, 0.21, 1.65) and severe IPV (aOR0.73, 0.30, 1.75), and significant improvements in livelihoods and mental health. Men reported significantly less physical IPV perpetration (aOR0.38, 0.17, 0.81) and non-significant reductions in sexual IPV (aOR0.77, 0.39, 1.51) and severe IPV (aOR0.86, 0.47, 1.56), as well as improved livelihoods, but no change in mental health. The co-developed SSCF+ intervention was acceptable and showed promise in reducing IPV and strengthening livelihoods, as well as addressing overlapping risk factors. Further research is required to determine its effectiveness. The study was pre-registered at clinicaltrials.gov (NCT05783336).

Do Gender-Based Violence Interventions Consider the Impacts of Climate Change? A Systematic Review

Climate change and extreme weather events have been shown to increase incidences of gender-based violence (GBV). Numerous organizations have devoted significant time, resources, and effort to the design and implementation of interventions aimed at reducing GBV in Africa. Some interventions effectively reduce violence, but GBV persists and remains pervasive. The United Nations has called for GBV interventions that consider the impact of climate change on violence. This review aims to determine whether public health interventions intended to reduce GBV in Africa take into account the effects of climate change on the region and the population. PubMed, PsychArticles, and CINAHL databases were searched systematically in February 2023 for interventions conducted in Africa published between 2010 and 2023. There were a total of 86 articles in the final review that described 40 distinct interventions. The intervention designs included empowerment and participatory approaches (microfinance, microfinance plus, community education, and community engagement), changing social and cultural norms (community education, community engagement, and media), and school-based programs. None of the 40 interventions mentioned climate, weather, or climate change as a component of the intervention. There are several opportunities to improve existing, successful GBV interventions in order to increase their efficacy. GBV interventions could incorporate economic independence programs that do not rely on agriculture and include climate change education. These findings could facilitate the integration of two previously distinct research disciplines-climate change and GBV prevention-to inform future research and develop more effective and cost-efficient interventions.

Cluster randomized controlled trial of Stepping Stones and Creating Futures to reduce mental health challenges among young men in informal settlements in KwaZulu-Natal Province, South Africa

BACKGROUND

Informal settlements are high density areas in and around cities, characterized by a lack of formal planning and basic amenities, being known in South Africa for high levels of mental disorder driven by violence, and complex social and economic challenges. In particular, young men's poor mental health goes untreated, with relatively few evidenced-based interventions available in this setting.

AIM

This cluster randomized controlled trial investigated the effectiveness of Stepping Stones and Creating Futures (SS/CF), a participatory gender transformative and economic empowerment intervention, on the mental health of young men living in South African informal settlement.

METHODS

A total of 674 young men ages 18 to 30 years were recruited in 34 clusters in Durban's urban informal settlements. Clusters were randomly allocated (1:1) to either the experimental SS/CF or control arm and participants were followed-up over 24-months. Intention-to-treat analysis based on generalized estimating equations (GEE) were fitted to quantify the impact of SS/CF on the men's anxiety and post-traumatic stress (PTS) symptomatology.

RESULTS

At end of the 24 months follow-period, anxiety (adjusted odds ratio [aOR]: 0.62, p = .04, 95% CI [0.39, 0.99]) and PTS (aOR = 0.52, p = .03, 95% CI [0.29, 0.93]) were significantly lower for group assigned to the SS/CF compared to the control group.

CONCLUSION

SS/CF, a gender transformative and livelihoods strengthening intervention designed to address poverty and other socio-economic challenges in informal settlements reduced anxiety and PTS among men with mental health challenges living in informal settlements.

Adaptation and pre-test of a shortened Stepping Stones and Creating Futures intervention focused on HIV for young men in rural South Africa

Men's engagement in HIV prevention and treatment is suboptimal, including in South Africa. We sought to address this through adapting an evidence-based intervention, Stepping Stones and Creating Futures (SSCF), to strengthen its HIV content and provide a more scalable (shorter) intervention in rural South Africa. We then conducted a mixed methods pre-test of the intervention among young men aged 18-35 years. To adapt SSCF, we reviewed the current evidence base and worked with male Peer Navigators to update the SSCF theory of change (ToC) and manual. The revised intervention was ~45 hours (9 sessions) as opposed to ~63 hours and included a greater focus on HIV prevention and treatment technologies. Overall, 64% (n = 60) of men approached agreed to participate in the intervention, uptake (attending one session) among those who agreed was n = 35(58%) and retention (attending 6 or more sessions) was n = 25(71%). Qualitative data emphasized the intervention was acceptable, with young men describing it as something they liked. The qualitative data also broadly supported the intervention ToC, including the normalization of HIV in men's lives, and the importance of health for men in achieving their life goals. However, it also highlighted the need to focus more on HIV-related stigma and fear, and the importance of HIV self-testing kits in encouraging testing. We revised the ToC and manual in light of this data. The adapted SSCF is acceptable and supports the ToC. Next steps is an evaluation to look at effectiveness of the intervention.

The search for tailored treatments: Discussion of five interventions for perpetrators of intimate partner violence

This commentary on five articles comprising this Journal of Clinical Psychology: In Session issue on therapeutic interventions for perpetrators of intimate partner violence (IPV) brings together relevant issues reflected in these papers concerning the need for tailored treatments for a heterogenous population of individuals with differing characteristics, psychopathology, risk factors and needs. Among the key issues addressed in this commentary are typologies of IPV, the influence of personality disorder and attachment in the predisposition to perpetrating IPV and identifying therapeutic factors common to these interventions. The discussion is contextualised within a field beset by controversy and political ideology which limits the impact of empirical research.