Training Local Leaders to Prevent and Reduce Domestic Violence Evidence From Peru

Study Overview
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Brief Summary
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Leaders in Action (LIA) is a norms-centered intervention that aims to reduce the acceptance and prevent the incidence of Gender-based Violence (GBV) 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 GBV may profit from the intimate atmosphere of household visits, and that on the side of women, the transmission of information about GBV 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 GBV 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 GBV 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 GBV.

Detailed Description
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Leaders in Action (LIA) is a norms-centered intervention that aims to reduce the acceptance and prevent the incidence of gender-based violence (GBV) in Peru by shifting social norms. LIA has two main phases: first, the recruitment of community health volunteers (CHVs) and second, delivering content against GBV to the population at risk in rural villages. There are two types of CHV. First, government's women centers' (CEM) Promotors (professionals from the Peruvian Ministry of Women (MIMP) working at local CEMs) recruit leaders of local social organizations and trained them to be Facilitators of LIA. These Facilitators are to be located in each district center and will conduct LIA activities across all treated villages in the district. The second type are leaders at the village level who will be trained by Facilitators to become Community Agents. Both Community Agents and Facilitators are to be known as CHVs and will work together to conduct the second phase of LIA: training sessions of the two delivery models, a household model (HT) and a group-based and gender-segregated model (GT). Under the HT, LIA follows a door-to-door delivery approach: CHVs, in coordination with the local CEM, offer 8 training sessions to households at risk of domestic violence (Household Treatment - HT). However, the recipients of the HT are in practice primarily women. This is because the treatment is delivered door-to-door by mainly female CHVs, who are recruited disproportionately for this style of volunteer work in any setting. Female CHVs may be ineffective at influencing norms and beliefs of male participants given strong local masculinity norms. The household-centered approach is also expensive and difficult to scale. In order to strengthen the effect of LIA and to reach potential perpetrators as well as victims of GBV, the MIMP will implement a gender-segregated yet community-wide delivery approach in a group discussion format. This group-based approach (GT) will entail 4 workshops using media dramatizations of social problems/education entertainment (edutainment), on the same content as delivered in the HT. Existing evidence suggests that interventions that target perpetrators as well as victims can have a substantial impact on attitudes towards and the incidence of domestic violence, and that simultaneously addressing GBV from different angles can be particularly effective. These approaches commonly stress the importance of collaborative learning in support-group style sessions to confront ideas of masculinity and gender norms. Norms change is dependent on belief change at the individual-level, which is more likely to happen when individuals are aware of relevant peers also changing beliefs. The investigators propose separating groups by gender to provide tailored settings. The series of workshops will engage potential GBV victims and perpetrators in group discussions about their social reality using participatory methods. The topics for the series of workshops will be equivalent to those covered in household visits to ensure comparability: i) gender roles, beliefs and stereotypes; ii) violence, cultural patterns and human rights; iii) healthy relationships within the family; iv) good treatment between family members and self-care; v) Assertive communication; vi) resolution and conflict management; vii) resources for domestic violence cases; and viii) leadership and women agency. Sessions will take place over four months in a village community center, school, or church, and will last for approximately two hours and consist of groups of 15-20 participants per session. Larger villages will hold multiple sessions per month to cover all potential participants. To maximize attendance, the workshops will have the same hierarchy as traditional village meetings - events the population of this setting attends regularly - and will be coordinated with the village leader.

Official Title
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Training Leaders to Prevent and Reduce Domestic Violence in Their Communities: Experimental Evidence From Peru

Conditions
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Domestic Violence

Intervention / Treatment
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* Behavioral: Leaders in Action: Household Training
* Behavioral: Leaders in Action: Group Training
* Behavioral: Leaders in Action: Village Leaders Targeting


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women with a male current partner. Women who reported having ever experienced any form of physiological, physical, or sexual violence from the current partner. Male partners of women who reported having ever experienced any form of physiological, physical, or sexual violence from their current partner. Exclusion Criteria: Women and men with formal complaints of domestic violence are excluded to participate as Facilitators and Community Agents

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: LIA Household Training<br>This treatment arm is an 8-session training with a tailored schedule at the household level that targets couples at risk of domestic violence. The sessions are delivered by Community Health Volunteers: 1 Facilitator and 1 Community Agent. The training aims to raise awareness of GBV and social norms around domestic violence and is delivered at the household level in a private environment. Additionally, the intervention includes sessions on soft skills and conflict resolution. The session topics are: i) gender roles, beliefs and stereotypes; ii) violence, cultural patterns and human rights; iii) healthy relationships within the family; iv) good treatment between family members and self-care; v) Assertive communication; vi) resolution and conflict management; vii) resources for domestic violence cases; and viii) leadership and women's agency. | Behavioral: Leaders in Action: Household Training<br>* Leaders in Action (LIA) is a norms-centered intervention that aims to reduce the acceptance and prevent the incidence of gender-based violence (GBV) in Peru by shifting social norms around GBV. LIA has two main phases: first, the recruitment of CHVs and second, delivering content against GBV to population at risk in rural villages. There are two types of CHV, first CEM's Promotors (MIMP's professionals working at local Women Centers - CEM) recruit leaders of local social organizations and trained them to be Facilitators of LIA. These Facilitators are to be located in each district center and will conduct LIA activities across all treated villages in the district. The second type are leaders at the village level who will be trained by Facilitators to become Community Agents. Both Community Agents and Facilitators are to be known as CHVs and will work together to conduct the second phase of LIA: training sessions at households level to women at risk of IPV.<br>* Other names: HT;|
| Experimental: LIA Group Training<br>This treatment arm is an 4-session training delivered in gender-segregated groups at the village level that targets couples at risk of domestic violence in separate spaces. The sessions are delivered by Community Health Volunteers: 1 Facilitator and 1 Community Agent. The training aims to raise awareness of GBV and social norms around domestic violence and is delivered at the household in a private environment. The sessions topics are: i) gender roles, beliefs and stereotypes; ii) violence, cultural patterns and human rights; iii) healthy relationships within the family; iv) good treatment between family members and self-care; v) Assertive communication; vi) resolution and conflict management; vii) resources for domestic violence cases; and viii) leadership and women agency. | Behavioral: Leaders in Action: Group Training<br>* Leaders in Action (LIA) is a norms-centered intervention that aims to reduce the acceptance and prevent the incidence of gender-based violence (GBV) in Peru by shifting social norms around GBV. LIA has two main phases: first, the recruitment of CHVs and second, delivering content against GBV to population at risk in rural villages. First CEM's Promotors (MIMP's professionals working at local Women Centers - CEM) recruit leaders of local social organizations and trained them to be Facilitators of LIA. These Facilitators are to be located in each district center and will conduct LIA activities across all treated villages in the district. Then, Facilitators train additional volunteers at the village level who will become Community Agents. Both Community Agents and Facilitators are to be known as CHVs and will work together to conduct the second phase of LIA: gender-segregated and village-level group sessions using edutainment and workshop-style sessions to men and women at risk of IPV.<br>* Other names: GT;|
| Experimental: LIA Household and Group Training<br>This treatment arm combines LIA Household and Group training. Villages in this arm will first receive the 8-sessions household-level intervention, then the 4-sessions of village-level gender-segregated group intervention will follow. The sessions topics for both interventions are: i) gender roles, beliefs and stereotypes; ii) violence, cultural patterns and human rights; iii) healthy relationships within the family; iv) good treatment between family members and self-care; v) Assertive communication; vi) resolution and conflict management; vii) resources for domestic violence cases; and viii) leadership and women agency. | Behavioral: Leaders in Action: Household Training<br>* Leaders in Action (LIA) is a norms-centered intervention that aims to reduce the acceptance and prevent the incidence of gender-based violence (GBV) in Peru by shifting social norms around GBV. LIA has two main phases: first, the recruitment of CHVs and second, delivering content against GBV to population at risk in rural villages. There are two types of CHV, first CEM's Promotors (MIMP's professionals working at local Women Centers - CEM) recruit leaders of local social organizations and trained them to be Facilitators of LIA. These Facilitators are to be located in each district center and will conduct LIA activities across all treated villages in the district. The second type are leaders at the village level who will be trained by Facilitators to become Community Agents. Both Community Agents and Facilitators are to be known as CHVs and will work together to conduct the second phase of LIA: training sessions at households level to women at risk of IPV.<br>* Other names: HT;Behavioral: Leaders in Action: Group Training<br>* Leaders in Action (LIA) is a norms-centered intervention that aims to reduce the acceptance and prevent the incidence of gender-based violence (GBV) in Peru by shifting social norms around GBV. LIA has two main phases: first, the recruitment of CHVs and second, delivering content against GBV to population at risk in rural villages. First CEM's Promotors (MIMP's professionals working at local Women Centers - CEM) recruit leaders of local social organizations and trained them to be Facilitators of LIA. These Facilitators are to be located in each district center and will conduct LIA activities across all treated villages in the district. Then, Facilitators train additional volunteers at the village level who will become Community Agents. Both Community Agents and Facilitators are to be known as CHVs and will work together to conduct the second phase of LIA: gender-segregated and village-level group sessions using edutainment and workshop-style sessions to men and women at risk of IPV.<br>* Other names: GT;|
| Experimental: LIA Household Training + Leader Targeting<br>This treatment arm is an 8-session training with a tailored schedule at the household level that targets couples at risk of domestic violence. The sessions are delivered by Community Health Volunteers: 1 Facilitator and 1 Community Agent. The training aims to raise awareness of GBV and social norms around domestic violence and is delivered at the household level in a private environment. Additionally, the intervention includes sessions on soft skills and conflict resolution. The session topics are: i) gender roles, beliefs and stereotypes; ii) violence, cultural patterns and human rights; iii) healthy relationships within the family; iv) good treatment between family members and self-care; v) Assertive communication; vi) resolution and conflict management; vii) resources for domestic violence cases; and viii) leadership and women's agency. An additional village leader (e.g. village president) would be targeted with LIA's household training. | Behavioral: Leaders in Action: Household Training<br>* Leaders in Action (LIA) is a norms-centered intervention that aims to reduce the acceptance and prevent the incidence of gender-based violence (GBV) in Peru by shifting social norms around GBV. LIA has two main phases: first, the recruitment of CHVs and second, delivering content against GBV to population at risk in rural villages. There are two types of CHV, first CEM's Promotors (MIMP's professionals working at local Women Centers - CEM) recruit leaders of local social organizations and trained them to be Facilitators of LIA. These Facilitators are to be located in each district center and will conduct LIA activities across all treated villages in the district. The second type are leaders at the village level who will be trained by Facilitators to become Community Agents. Both Community Agents and Facilitators are to be known as CHVs and will work together to conduct the second phase of LIA: training sessions at households level to women at risk of IPV.<br>* Other names: HT;Behavioral: Leaders in Action: Village Leaders Targeting<br>* Leaders in Action (LIA) would target one village leader (e.g. president, mayor, etc.) to receive either LIA's household or group treatment. The treatment will be based on the original village treatment assignment.<br>|
| Experimental: LIA Group Training + Leader Targeting<br>This treatment arm is an 4-session training delivered in gender-segregated groups at the village level that targets couples at risk of domestic violence in separate spaces. The sessions are delivered by Community Health Volunteers: 1 Facilitator and 1 Community Agent. The training aims to raise awareness of GBV and social norms around domestic violence and is delivered at the household in a private environment. The sessions topics are: i) gender roles, beliefs and stereotypes; ii) violence, cultural patterns and human rights; iii) healthy relationships within the family; iv) good treatment between family members and self-care; v) Assertive communication; vi) resolution and conflict management; vii) resources for domestic violence cases; and viii) leadership and women agency. An additional village leader (e.g. village president) would be targeted with LIA's group training. | Behavioral: Leaders in Action: Group Training<br>* Leaders in Action (LIA) is a norms-centered intervention that aims to reduce the acceptance and prevent the incidence of gender-based violence (GBV) in Peru by shifting social norms around GBV. LIA has two main phases: first, the recruitment of CHVs and second, delivering content against GBV to population at risk in rural villages. First CEM's Promotors (MIMP's professionals working at local Women Centers - CEM) recruit leaders of local social organizations and trained them to be Facilitators of LIA. These Facilitators are to be located in each district center and will conduct LIA activities across all treated villages in the district. Then, Facilitators train additional volunteers at the village level who will become Community Agents. Both Community Agents and Facilitators are to be known as CHVs and will work together to conduct the second phase of LIA: gender-segregated and village-level group sessions using edutainment and workshop-style sessions to men and women at risk of IPV.<br>* Other names: GT;Behavioral: Leaders in Action: Village Leaders Targeting<br>* Leaders in Action (LIA) would target one village leader (e.g. president, mayor, etc.) to receive either LIA's household or group treatment. The treatment will be based on the original village treatment assignment.<br>|
| Experimental: LIA Household and Group Training + Leader Targeting<br>This treatment arm combines LIA Household and Group training. Villages in this arm will first receive the 8-sessions household-level intervention, then the 4-sessions of village-level gender-segregated group intervention will follow. The sessions topics for both interventions are: i) gender roles, beliefs and stereotypes; ii) violence, cultural patterns and human rights; iii) healthy relationships within the family; iv) good treatment between family members and self-care; v) Assertive communication; vi) resolution and conflict management; vii) resources for domestic violence cases; and viii) leadership and women agency. An additional village leader (e.g. village president) would be targeted with both LIA's household and group training. | Behavioral: Leaders in Action: Household Training<br>* Leaders in Action (LIA) is a norms-centered intervention that aims to reduce the acceptance and prevent the incidence of gender-based violence (GBV) in Peru by shifting social norms around GBV. LIA has two main phases: first, the recruitment of CHVs and second, delivering content against GBV to population at risk in rural villages. There are two types of CHV, first CEM's Promotors (MIMP's professionals working at local Women Centers - CEM) recruit leaders of local social organizations and trained them to be Facilitators of LIA. These Facilitators are to be located in each district center and will conduct LIA activities across all treated villages in the district. The second type are leaders at the village level who will be trained by Facilitators to become Community Agents. Both Community Agents and Facilitators are to be known as CHVs and will work together to conduct the second phase of LIA: training sessions at households level to women at risk of IPV.<br>* Other names: HT;Behavioral: Leaders in Action: Group Training<br>* Leaders in Action (LIA) is a norms-centered intervention that aims to reduce the acceptance and prevent the incidence of gender-based violence (GBV) in Peru by shifting social norms around GBV. LIA has two main phases: first, the recruitment of CHVs and second, delivering content against GBV to population at risk in rural villages. First CEM's Promotors (MIMP's professionals working at local Women Centers - CEM) recruit leaders of local social organizations and trained them to be Facilitators of LIA. These Facilitators are to be located in each district center and will conduct LIA activities across all treated villages in the district. Then, Facilitators train additional volunteers at the village level who will become Community Agents. Both Community Agents and Facilitators are to be known as CHVs and will work together to conduct the second phase of LIA: gender-segregated and village-level group sessions using edutainment and workshop-style sessions to men and women at risk of IPV.<br>* Other names: GT;Behavioral: Leaders in Action: Village Leaders Targeting<br>* Leaders in Action (LIA) would target one village leader (e.g. president, mayor, etc.) to receive either LIA's household or group treatment. The treatment will be based on the original village treatment assignment.<br>|
| No Intervention: Control group<br>Villages in the control group will not receive any intervention. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intimate Partner Violence | For women only. The researchers will replicate a standard Demographic Household Survey domestic violence module, administered through self-paced questionnaire. The indicator will take the value of 1 if a woman reports at least 1 event of intimate-partner violence, and 0 if a woman reports not having experienced any events intimate-partner violence. The indicator values are 0 and 1; with 1 meaning a woman suffered from intimate-partner violence and 0 meaning a women did not suffered intimate-partner violence in the period. | 06 months after the intervention | 
| Women's Index of Physical Health | For women only. The researchers will use World Health Organization questionnaires on physical health. The index values are 0 to 1; higher scores mean better outcomes. | 06 months after the intervention | 
| Women's Index of Mental health | For women. The researchers will use World Health Organization SQR20 questionnaires for mental distress. The index values are 0 to 1; higher scores mean better outcomes. | 06 months after the intervention | 
| Men's Index of Mental health | For men. The researchers will use World Health Organization SQR20 questionnaires for mental distress. The index values are 0 to 1; higher scores mean better outcomes. | 06 months after the intervention | 
| Men's Index of Tolerance towards Violence against Women | For men. The researchers will use 8 statements about the justification of violence (asking whether the participants agree or disagree with these statements). The index values are 0 to 1; higher scores mean worse outcomes. | 06 months after the intervention | 
| Women's Index of Tolerance towards Violence against Women | For women. The researchers will use 8 statements about the justification of violence (asking whether the participants agree or disagree with these statements). The index values are 0 to 1; higher scores mean worse outcomes. | 06 months after the intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Index Women Agency | For women only. The researchers will use 8 items of a self-efficacy scale. The scale values are 0 to 1; higher scores mean better outcomes. | 06 months after the intervention | 
| Men's Index of Social Norms | For men. The researchers will use 8 statements about the justification of violence (asking whether the participants agree or disagree with these statements). The index values are 0 to 1; higher scores mean better outcomes. | 06 months after the intervention | 
| Women's Index of Social Norms | For women. The researchers will use 8 statements about the justification of violence (asking whether the participants agree or disagree with these statements). The index values are 0 to 1; higher scores mean better outcomes. | 06 months after the intervention | 
| Violence from non-Partner | For women only. The researchers will replicate a standard Demographic Household Survey questions for non-partner violence, administered through self-paced questionnaire. The indicator will take the value of 1 if a woman reports at least 1 event of non-partner violence, and 0 if a woman reports not having experienced any events of non-partner violence. The indicator values are 0 and 1; with 1 meaning a woman suffered from non-partner violence and 0 meaning a women did not suffered non-partner violence in the period. | 06 months after the intervention |