IPV, Sexual Violence
Conditions
Keywords
informal settlements, poverty
Brief summary
This study evaluates whether the behavioural/structural interventions of Stepping Stones and Creating Futures can reduce the incidence of intimate partner violence in urban informal settlements amongst young people. Half the participants will receive the interventions, while the other half will be in a control wait-list, only receiving the intervention after final data collection.
Interventions
BEHAVIORALStepping Stones and Creating Futures
Stepping Stones consists of 10 sessions. It seeks to strengthen relationships and to transform views on gender and in the process impact on exposure to, or participation in, gender-based violence and HIV risk. These cover gender and peer influences our actions; sex and love; conception and contraception; STIs and HIV; safer sex and condoms; GBV; motivations for behaviour (including influences of alcohol and poverty); and communication skills. Creating Futures is a facilitated group intervention of eleven sessions. It seeks to strengthen livelihoods. The key sessions include: setting medium term livelihood goals, the need for assets and coping with crises; social resources for livelihoods (trust and community participation); getting and keeping jobs; and savings and spending.
Sponsors
London School of Hygiene and Tropical Medicine
Department for International Development, United Kingdom
Project Empower
University of KwaZulu
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 30 Years
Healthy volunteers
Yes
Inclusion criteria
* Normally resident in informal settlement cluster * Not formally employed * Able to communicate in main study languages (English, isiZulu, iXhosa)
Exclusion criteria
* Under 18 * Mental deficit (learning difficulty, mental illness or substance abuse)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Any Past Year Physical Intimate Partner Violence Perpetration (Men) and Experience (Women) | 24 months post baseline | Physical intimate partner violence is assessed using five items based on the WHO VAW scale. A positive response to any item leads to a person being classified as perpetrating (men) and experiencing (women) in the past year. With 0=none, 1=yes. |
| Any Past Year Sexual Intimate Partner Violence Perpetration (Men) and Experience (Women) | 24 months post baseline | Sexual intimate partner violence is assessed using three items based on the WHO VAW scale. A positive response to any item leads to a person being classified as perpetrating (men) and experiencing (women) in the past year. With 0=none, 1=yes. |
| Past Year Severe Sexual and/or Physical Intimate Partner Violence Perpetration (Men) and Experience (Women) | 24 months post baseline | Severe sexual and/or physical intimate partner violence perpetration (men) and experience (women) is assessed using 8 items. Past year severe sexual and/or physical IPV is assessed as positive if a person responds to two (or more) items as once, or one item as few (or more), essentially creating a more than once categorization. |
| Controlling Behaviours | 24 months post baseline | Controlling behaviours are assessed using a modified Sexual Relationship Power (SRP) scale. Men's control of female sexual partner's and women's experience of controlling behaviours from a male partner. A mean score is calculated with higher scores indicating more controlling (bad). Range: 0-24 |
| Earnings in Past Month | 24 months post baseline | A single item question asks Considering all the money you earned from jobs or selling things (excluding grants), how much did you earn last month? Responses are in Rands and a continuous scale, with no upper limit. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of People Quarreling With Partner About Alcohol Use | 24 months post baseline | A single item binary response question asks whether participants have argued about alcohol with their sexual partner in the past year (0=no; 1=yes). Only asked to those who reported alcohol use in the past year. |
| Last Sexual Partner of Participant is the Main Partner | 24 months post baseline | A single item assess who the participant last had sex with, with possible responses being: main partner, casual partner, once-off sex partner or ex-partner. As per the protocol, we recategorised this into either 1=main partner or 0=other. Positive change is towards main partner. And the reported number (proportion) is those reporting Main partner. |
| Transactional Sex Past Year | 24 months post baseline | Five item scale asks about transactional sex with casual or once-off sexual partners in the past year based on the scale developed and tested by Dunkle et al (2004). Each item has a no/yes response. A response of yes to any is classified as having engaged in transactional sex. |
| Gender Attitudes | 24 months post baseline | Modified gender equitable men's scale (GEMS) assess participant's gender attitudes. A mean score is calculated with higher scores indicative of more gender inequitable attitudes (range: 0-60) |
| Stress About Lack of Work | 24 months post baseline | Four items assess participants' feelings of stress about not enough work, based on a scale developed for the IMAGES study. Mean score calculated, with higher scores indicating more stress (range: 4-20) |
| Individual's Ability to Mobilise Money in an Emergency | 24 months post baseline | A single item asks participants how hard it would be to mobilise R200 (\ US$15) in an emergency. Those responding it would be very difficult, or somewhat difficult are classified as finding it hard (=1). Those responding fairly easy or easy are classified as not finding it hard (=0). Reported number (proportion) is of those finding it hard to mobilise money in an emergency. A positive change is towards a lower proportion. |
| Stolen Because of Hunger in Past Month | 24 months post baseline | Single item question asks about stealing because of lack of food or money in the past month with responses never, once, every week or every day. Responses are recoded, as per protocol, into 0=never and 1=once or more. The number/proportion of those stealing in the past month is reported. A lower proportion is a positive change. |
| Shame About Lack of Work | 24 months post baseline | Four items assess participants' feelings of shame about not enough work, based on a scale developed for use in the IMAGES study, with . Mean score calculated, with higher scores indicative of more shame (range: 4-16) |
| Depressive Symptomology | 24 months post baseline | Past week depressive symptomology is assessed by the Centre for Epidemiological Studies Depression (CESD) scale, with the full twenty items (range 0-60). A mean score is calculated, with higher scores indicating more depression. |
| Number of Participants Reporting Suicidal Ideation | 24 months post baseline | Past four week suicidal ideation was assessed using a single item question. Responses are either 0=no, or 1=yes. |
| Life Circumstances | 24 months post baseline | Four items modified from the Satisfaction with Life Scale (SWLS) by Denier et al. (1985), with items on a five point Likert Scale (range 0-20) higher scores indicative of greater life satisfaction. |
| Problem Alcohol Use | 24 months post baseline | Problem drinking in the past year is assessed using the AUDIT (alcohol use disorders identification test) scale. With a range of 0-40, and recoded with scores of 8 or more classifing a participant as having potentially problematic alcohol use. |
Countries
South Africa
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Women - Intervention Women who received the Stepping Stones and Creating Futures intervention | 339 |
| Men - Intervention Men who received the intervention | 338 |
| Women - Control Women in the wait list control | 338 |
| Men - Control Men in the wait list control | 336 |
| Total | 1,351 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 6 | 12 |
| Overall Study | Lost to Follow-up | 174 | 109 |
Baseline characteristics
| Characteristic | Total | Men - Intervention | Women - Control | Men - Control | Women - Intervention |
|---|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 1351 Participants | 338 Participants | 338 Participants | 336 Participants | 339 Participants |
| Race and Ethnicity Not Collected | 0 Participants | — | — | — | — |
| Region of Enrollment South Africa | 1351 participants | 338 participants | 338 participants | 336 participants | 339 participants |
| Sex: Female, Male Female | 677 Participants | 0 Participants | 338 Participants | 0 Participants | 339 Participants |
| Sex: Female, Male Male | 674 Participants | 338 Participants | 0 Participants | 336 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 5 / 339 | 3 / 338 | 3 / 338 | 7 / 336 |
| other Total, other adverse events | 0 / 339 | 0 / 338 | 0 / 338 | 0 / 336 |
| serious Total, serious adverse events | 3 / 339 | 2 / 338 | 0 / 338 | 0 / 336 |
Outcome results
Primary
Any Past Year Physical Intimate Partner Violence Perpetration (Men) and Experience (Women)
Physical intimate partner violence is assessed using five items based on the WHO VAW scale. A positive response to any item leads to a person being classified as perpetrating (men) and experiencing (women) in the past year. With 0=none, 1=yes.
Time frame: 24 months post baseline
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Women - Intervention | Any Past Year Physical Intimate Partner Violence Perpetration (Men) and Experience (Women) | 134 Participants |
| Men - Intervention | Any Past Year Physical Intimate Partner Violence Perpetration (Men) and Experience (Women) | 86 Participants |
| Women - Control | Any Past Year Physical Intimate Partner Violence Perpetration (Men) and Experience (Women) | 155 Participants |
| Men - Control | Any Past Year Physical Intimate Partner Violence Perpetration (Men) and Experience (Women) | 118 Participants |
p-value: =0.68695% CI: [0.62, 1.37]Regression, Logistic
p-value: =0.03295% CI: [0.51, 0.97]Regression, Logistic
Primary
Any Past Year Sexual Intimate Partner Violence Perpetration (Men) and Experience (Women)
Sexual intimate partner violence is assessed using three items based on the WHO VAW scale. A positive response to any item leads to a person being classified as perpetrating (men) and experiencing (women) in the past year. With 0=none, 1=yes.
Time frame: 24 months post baseline
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Women - Intervention | Any Past Year Sexual Intimate Partner Violence Perpetration (Men) and Experience (Women) | 86 Participants |
| Men - Intervention | Any Past Year Sexual Intimate Partner Violence Perpetration (Men) and Experience (Women) | 52 Participants |
| Women - Control | Any Past Year Sexual Intimate Partner Violence Perpetration (Men) and Experience (Women) | 101 Participants |
| Men - Control | Any Past Year Sexual Intimate Partner Violence Perpetration (Men) and Experience (Women) | 73 Participants |
p-value: 0.55595% CI: [0.64, 1.28]Regression, Logistic
p-value: 0.07295% CI: [0.54, 1.03]Regression, Logistic
Primary
Controlling Behaviours
Controlling behaviours are assessed using a modified Sexual Relationship Power (SRP) scale. Men's control of female sexual partner's and women's experience of controlling behaviours from a male partner. A mean score is calculated with higher scores indicating more controlling (bad). Range: 0-24
Time frame: 24 months post baseline
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Women - Intervention | Controlling Behaviours | 9.75 score on a scale |
| Men - Intervention | Controlling Behaviours | 9.96 score on a scale |
| Women - Control | Controlling Behaviours | 9.70 score on a scale |
| Men - Control | Controlling Behaviours | 9.96 score on a scale |
p-value: 0.98495% CI: [-0.88, 0.86]Regression, Linear
p-value: 0.83995% CI: [-0.51, 0.63]Regression, Linear
Primary
Earnings in Past Month
A single item question asks Considering all the money you earned from jobs or selling things (excluding grants), how much did you earn last month? Responses are in Rands and a continuous scale, with no upper limit.
Time frame: 24 months post baseline
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Women - Intervention | Earnings in Past Month | 565 Rands |
| Men - Intervention | Earnings in Past Month | 988 Rands |
| Women - Control | Earnings in Past Month | 385 Rands |
| Men - Control | Earnings in Past Month | 817 Rands |
p-value: <0.000195% CI: [0.43, 1.51]Tobit
p-value: 0.52195% CI: [-0.42, 0.83]Tobit
Primary
Past Year Severe Sexual and/or Physical Intimate Partner Violence Perpetration (Men) and Experience (Women)
Severe sexual and/or physical intimate partner violence perpetration (men) and experience (women) is assessed using 8 items. Past year severe sexual and/or physical IPV is assessed as positive if a person responds to two (or more) items as once, or one item as few (or more), essentially creating a more than once categorization.
Time frame: 24 months post baseline
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Women - Intervention | Past Year Severe Sexual and/or Physical Intimate Partner Violence Perpetration (Men) and Experience (Women) | 151 Participants |
| Men - Intervention | Past Year Severe Sexual and/or Physical Intimate Partner Violence Perpetration (Men) and Experience (Women) | 99 Participants |
| Women - Control | Past Year Severe Sexual and/or Physical Intimate Partner Violence Perpetration (Men) and Experience (Women) | 171 Participants |
| Men - Control | Past Year Severe Sexual and/or Physical Intimate Partner Violence Perpetration (Men) and Experience (Women) | 135 Participants |
p-value: 0.67295% CI: [0.66, 1.31]Regression, Logistic
p-value: 0.01995% CI: [0.52, 0.94]Regression, Logistic
Secondary
Depressive Symptomology
Past week depressive symptomology is assessed by the Centre for Epidemiological Studies Depression (CESD) scale, with the full twenty items (range 0-60). A mean score is calculated, with higher scores indicating more depression.
Time frame: 24 months post baseline
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Women - Intervention | Depressive Symptomology | 21.95 score on a scale |
| Men - Intervention | Depressive Symptomology | 19.26 score on a scale |
| Women - Control | Depressive Symptomology | 23.11 score on a scale |
| Men - Control | Depressive Symptomology | 20.35 score on a scale |
p-value: 0.06795% CI: [-3.14, 0.11]Regression, Linear
p-value: 0.39895% CI: [-2.48, 0.99]Regression, Linear
Secondary
Gender Attitudes
Modified gender equitable men's scale (GEMS) assess participant's gender attitudes. A mean score is calculated with higher scores indicative of more gender inequitable attitudes (range: 0-60)
Time frame: 24 months post baseline
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Women - Intervention | Gender Attitudes | 21.98 score on a scale |
| Men - Intervention | Gender Attitudes | 24.99 score on a scale |
| Women - Control | Gender Attitudes | 21.65 score on a scale |
| Men - Control | Gender Attitudes | 25.15 score on a scale |
p-value: 0.71895% CI: [-1.09, 1.58]Regression, Linear
p-value: 0.71295% CI: [-1.87, 1.28]Regression, Linear
Secondary
Individual's Ability to Mobilise Money in an Emergency
A single item asks participants how hard it would be to mobilise R200 (\ US$15) in an emergency. Those responding it would be very difficult, or somewhat difficult are classified as finding it hard (=1). Those responding fairly easy or easy are classified as not finding it hard (=0). Reported number (proportion) is of those finding it hard to mobilise money in an emergency. A positive change is towards a lower proportion.
Time frame: 24 months post baseline
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Women - Intervention | Individual's Ability to Mobilise Money in an Emergency | 27 Participants |
| Men - Intervention | Individual's Ability to Mobilise Money in an Emergency | 37 Participants |
| Women - Control | Individual's Ability to Mobilise Money in an Emergency | 30 Participants |
| Men - Control | Individual's Ability to Mobilise Money in an Emergency | 31 Participants |
p-value: 0.17495% CI: [0.89, 1.9]Regression, Logistic
p-value: 0.12995% CI: [0.89, 2.5]Regression, Logistic
Secondary
Last Sexual Partner of Participant is the Main Partner
A single item assess who the participant last had sex with, with possible responses being: main partner, casual partner, once-off sex partner or ex-partner. As per the protocol, we recategorised this into either 1=main partner or 0=other. Positive change is towards main partner. And the reported number (proportion) is those reporting Main partner.
Time frame: 24 months post baseline
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Women - Intervention | Last Sexual Partner of Participant is the Main Partner | 185 Participants |
| Men - Intervention | Last Sexual Partner of Participant is the Main Partner | 138 Participants |
| Women - Control | Last Sexual Partner of Participant is the Main Partner | 182 Participants |
| Men - Control | Last Sexual Partner of Participant is the Main Partner | 159 Participants |
p-value: 0.52695% CI: [0.73, 1.84]Regression, Logistic
p-value: 0.93195% CI: [0.67, 1.56]Regression, Logistic
Secondary
Life Circumstances
Four items modified from the Satisfaction with Life Scale (SWLS) by Denier et al. (1985), with items on a five point Likert Scale (range 0-20) higher scores indicative of greater life satisfaction.
Time frame: 24 months post baseline
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Women - Intervention | Life Circumstances | 10.28 score on a scale |
| Men - Intervention | Life Circumstances | 10.59 score on a scale |
| Women - Control | Life Circumstances | 9.88 score on a scale |
| Men - Control | Life Circumstances | 10.03 score on a scale |
p-value: 0.67995% CI: [-0.52, 0.8]Regression, Linear
p-value: 0.0895% CI: [-0.07, 1.16]Regression, Linear
Secondary
Number of Participants Reporting Suicidal Ideation
Past four week suicidal ideation was assessed using a single item question. Responses are either 0=no, or 1=yes.
Time frame: 24 months post baseline
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Women - Intervention | Number of Participants Reporting Suicidal Ideation | 83 Participants |
| Men - Intervention | Number of Participants Reporting Suicidal Ideation | 49 Participants |
| Women - Control | Number of Participants Reporting Suicidal Ideation | 72 Participants |
| Men - Control | Number of Participants Reporting Suicidal Ideation | 65 Participants |
p-value: 0.22895% CI: [0.85, 1.97]Regression, Logistic
p-value: 0.55895% CI: [0.53, 1.41]Regression, Logistic
Secondary
Number of People Quarreling With Partner About Alcohol Use
A single item binary response question asks whether participants have argued about alcohol with their sexual partner in the past year (0=no; 1=yes). Only asked to those who reported alcohol use in the past year.
Time frame: 24 months post baseline
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Women - Intervention | Number of People Quarreling With Partner About Alcohol Use | 39 Participants |
| Men - Intervention | Number of People Quarreling With Partner About Alcohol Use | 54 Participants |
| Women - Control | Number of People Quarreling With Partner About Alcohol Use | 47 Participants |
| Men - Control | Number of People Quarreling With Partner About Alcohol Use | 79 Participants |
p-value: 0.63595% CI: [0.67, 1.92]Regression, Logistic
p-value: 0.25695% CI: [0.41, 1.27]Regression, Logistic
Secondary
Problem Alcohol Use
Problem drinking in the past year is assessed using the AUDIT (alcohol use disorders identification test) scale. With a range of 0-40, and recoded with scores of 8 or more classifing a participant as having potentially problematic alcohol use.
Time frame: 24 months post baseline
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Women - Intervention | Problem Alcohol Use | 4.27 score on a scale |
| Men - Intervention | Problem Alcohol Use | 6.81 score on a scale |
| Women - Control | Problem Alcohol Use | 4.62 score on a scale |
| Men - Control | Problem Alcohol Use | 7.97 score on a scale |
p-value: 0.8195% CI: [-1.21, 0.95]Regression, Linear
p-value: 0.04195% CI: [-2.01, -0.04]Regression, Linear
Secondary
Shame About Lack of Work
Four items assess participants' feelings of shame about not enough work, based on a scale developed for use in the IMAGES study, with . Mean score calculated, with higher scores indicative of more shame (range: 4-16)
Time frame: 24 months post baseline
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Women - Intervention | Shame About Lack of Work | 10.3 score on a scale |
| Men - Intervention | Shame About Lack of Work | 10.7 score on a scale |
| Women - Control | Shame About Lack of Work | 10.7 score on a scale |
| Men - Control | Shame About Lack of Work | 10.9 score on a scale |
p-value: 0.13795% CI: [-0.72, 0.24]Regression, Linear
p-value: 0.72195% CI: [-0.58, 0.4]Regression, Linear
Secondary
Stolen Because of Hunger in Past Month
Single item question asks about stealing because of lack of food or money in the past month with responses never, once, every week or every day. Responses are recoded, as per protocol, into 0=never and 1=once or more. The number/proportion of those stealing in the past month is reported. A lower proportion is a positive change.
Time frame: 24 months post baseline
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Women - Intervention | Stolen Because of Hunger in Past Month | 88 Participants |
| Men - Intervention | Stolen Because of Hunger in Past Month | 91 Participants |
| Women - Control | Stolen Because of Hunger in Past Month | 84 Participants |
| Men - Control | Stolen Because of Hunger in Past Month | 105 Participants |
p-value: 0.17495% CI: [0.89, 1.9]Regression, Logistic
p-value: 0.83695% CI: [0.64, 1.43]Regression, Logistic
Secondary
Stress About Lack of Work
Four items assess participants' feelings of stress about not enough work, based on a scale developed for the IMAGES study. Mean score calculated, with higher scores indicating more stress (range: 4-20)
Time frame: 24 months post baseline
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Women - Intervention | Stress About Lack of Work | 12.0 score on a scale |
| Men - Intervention | Stress About Lack of Work | 11.8 score on a scale |
| Women - Control | Stress About Lack of Work | 12.1 score on a scale |
| Men - Control | Stress About Lack of Work | 12.0 score on a scale |
p-value: 0.33295% CI: [-0.7, 0.24]Regression, Linear
p-value: 0.46895% CI: [-0.71, 0.32]Regression, Linear
Secondary
Transactional Sex Past Year
Five item scale asks about transactional sex with casual or once-off sexual partners in the past year based on the scale developed and tested by Dunkle et al (2004). Each item has a no/yes response. A response of yes to any is classified as having engaged in transactional sex.
Time frame: 24 months post baseline
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Women - Intervention | Transactional Sex Past Year | 111 Participants |
| Men - Intervention | Transactional Sex Past Year | 138 Participants |
| Women - Control | Transactional Sex Past Year | 118 Participants |
| Men - Control | Transactional Sex Past Year | 146 Participants |
p-value: 0.69195% CI: [0.63, 1.36]Regression, Logistic
p-value: 0.69295% CI: [0.6, 1.4]Regression, Logistic