Indashyikirwa IPV Prevention Trial in Rwanda
Condition: Intimate Partner Violence
Study type: Interventional

Summary: 
      The purpose of this study is to test whether the Indashyikirwa ("Agents of Change") program
      is effective at preventing intimate partner violence (IPV) in communities in Rwanda.

      Because IPV has many causes, including factors that operate at the individual, couple, and
      community levels, the Indashyikirwa program is designed with multiple elements targeting
      multiple levels. A training program for couples covers gender, power, and relationship
      skills. Individual graduates this program who are interested and eligible go on to an
      activist training program to help support sustained change in their communities. Parallel
      activities operate at the Sector level to create and support change at the community level.
      Sector level activities include (1) training in gender and IPV prevention for local opinion
      leaders. (2) Establishment of "Women's Spaces," which are drop in centers that provide
      support and referrals for women experiencing IPV as well as a wide range of community
      outreach services to educate communities about, gender, power, women's rights, and violence
      prevention.

      Because the intervention is comprised of multiple components and includes elements designed
      to be delivered at the Sector level, Sectors were chosen as the unit of randomization. 28
      sectors spread across 7 districts are participating; randomization as intervention or control
      was stratified across Districts to ensure adequate geographical spread of program delivery
      (Rwandan geographic administrative units are: Province > District > Sector > Cell > Village).
      Within each randomized sector are two separate assessments of program impact: (1) A "Couple
      Cohort" comprised of heterosexual couples who enrol together in the couples training program
      (some of whom continue into the activist training) compared to similarly situated couples in
      control communities who participate only in a standard, ongoing VSLA (village savings and
      loan association) program. Couples cohort members (both intervention and control) are
      surveyed at enrolment, 12 months post-baseline, and 24 months post-baseline. (2) A "Community
      Survey" designed to measure community diffusion of the intervention through the activities of
      the Women's Spaces, Opinion Leader Trainings, and activities of graduates of the activist
      training. The community survey comprises a repeat cross-sectional population-based household
      survey of married/cohabiting adults in intervention communities who are NOT direct
      participants in any of the formal trainings delivered by intervention implementation
      partners, conducted at baseline and 24 months only. This survey is designed to look at
      community level shifts in the occurrence of IPV, as well as changes in support for survivors
      and changes in attitudes among the general population.
    


Intervention name(s): Indashyikirwa Couples Training; Indashyikirwa Activist Training; Indashyikirwa Opinion Leader Training; Indashyikirwa Women's Spaces; Village Savings and Loan Association (VSLA)
Intervention type(s): Behavioral; Behavioral; Behavioral; Other; Behavioral
Intervention description(s): A training curriculum for heterosexual couples in Rwanda comprising 20 3-hour modules (60 hours total) delivered to groups of 15 couples (30 people). Each module facilitated by male and 1 female facilitator. Curriculum topics include: types and uses of personal and interpersonal power (power within, power over, power with, power to), gender, gender based violence, triggers for intimate partner violence, conflict management, economic development, sexuality, alcohol, social norms and community change. Delivered by RWAMREC.; This training is offered to a subset of individuals who complete the couples curriculum (randomly selected from among those who are are willing and eligible). These individuals are trained to serve as community activists, teach peers about the types of power (power within, power over, power with, power to), and advocate for community change to prevent intimate partner violence. Delivered by RWAMREC.; Training delivered to "opinion leaders" (political office holders, religious leaders, service providers), in intervention communities. Training comprised 8 x 3 hour sessions (24 hours) delivered for groups of up to 40 participants. Introduces Opinion Leaders to the concepts of power (power within, power over, power with, power to) and to essential concepts around women's legal rights. Delivered by Rwanda Women's Network.; Establishment of 1 "Women's Space" per intervention sector -- a physical space with trained facilitators on duty from which support and referrals for women experiencing IPV could be offered and ad hoc programming responsive to community needs and interest can be run. Typical activities include once-off open trainings for community members on the concepts of power (power within, power over, power with, power to), essential concepts around women's legal rights, conflict management in families, etc. Delivered by Rwanda Women's Network.; A standard Village Savings and Loan Association program as run nationwide by CARE Rwanda.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This is a community randomised controlled trial, randomized at the level of sector (Rwandan geographic administrative units are: Province > District > Sector > Cell > Village). 28 sectors spread across 7 districts are participating; randomisation as intervention or control was stratified across districts to ensure adequate geographical spread of program delivery. Within each randomised sector are two separate assessments of impact: (1) A "Couple Cohort" comprised of heterosexual couples who enrol together in a couples training program or similarly situated couples in control communities, surveyed at enrolment, 12 months post-baseline, and 24 months post-baseline. (2) A "Community Survey" designed to measure community diffusion which comprises a repeat cross-sectional population-based household survey of married/cohabiting adults in intervention/control communities who are NOT direct participants in the couples cohort, surveyed at baseline and 24 months.
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Intimate Partner Violence; Gender-Based violence; Spouse Abuse; Rwanda; Heterosexual Couples; Activists; Opinion Leaders; Social Change; Social-Ecological Model; Diffusion of Innovation; Cluster Randomized Controlled Trial; Community Randomized Controlled Trial