Bandebereho 6 Year Follow up RCT in Rwanda

Study Overview
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Brief Summary
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This study seeks to conduct a six-year follow-up of the Bandebereho randomized control trial (RCT) to assess the longer-term impact of the gender-transformative Bandebereho couples intervention on participating men, women, and their children. The Bandebereho program was implemented by the Rwanda Men's Resource Centre (RWAMREC) and Promundo-US, in collaboration with the Rwanda Ministry of Health and local authorities between 2013 and 2015. A two-arm RCT collected three rounds of data from 1,199 couples (575 treatment; 624 control) starting in 2015-16: baseline (pre-intervention), 9 month follow-up, and 21-month follow-up. The findings at 21-months demonstrated significant impacts of the intervention on multiple gender and health-related outcomes. This study will conduct surveys with men enrolled in the RCT and their female partners 6 years after the intervention, to assess its long-term impact on reproductive and maternal health, gender attitudes and household dynamics, intimate partner violence, mental health and wellbeing, parenting, and child development. In addition, child assessments will be conducted with a sub-sample of 800 children aged 4 to 7 years to directly assess early childhood development outcomes.

Detailed Description
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This study seeks to conduct a six-year follow-up of the Bandebereho randomized controlled trial (RCT) to assess the longer-term impact of the gender-transformative Bandebereho couples intervention on participating men, women, and their children. The Bandebereho program being assessed was first implemented by the Rwanda Men's Resource Center (RWAMREC) and Promundo-US, in collaboration with the Rwanda Ministry of Health and local authorities in Karongi, Musanze, Nyaruguru and Nyaruguru districts between 2013 and 2015. A two-arm RCT was conducted with 1,199 couples (575 treatment; 624 control) in 2015-16. Three rounds of data were collected: baseline (pre-intervention), 9 month follow-up (4 months post-intervention), and 21-month follow-up (16 months post-intervention). The findings at 21-months demonstrated significant impacts of the intervention on multiple gender and health-related outcomes. The proposed study will conduct surveys with men enrolled in the RCT and their female partners, to assess the longer-term impact of the intervention on reproductive and maternal health, gender attitudes and household dynamics, intimate partner violence, mental health and wellbeing, parenting, and child development. In addition, child assessments will be conducted with a sub-sample of 800 children aged 4 to 7 years to directly assess early childhood development outcomes.

Official Title
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Bandebereho Randomized Control Trial: Six Year Follow-up to Assess the Impact of a Gender-transformative Intervention With Couples to Promote Men's Engagement in Maternal, Newborn and Child Health, Caregiving and Healthier Couple Relations

Conditions
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Gender Relations, Violence, Child Development, Contraception, Prenatal Care, Partner Communication

Intervention / Treatment
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* Behavioral: MenCare+/Bandebereho fathers'/couples' group education


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria at baseline: Men aged 21-35 years Living with a partner Expectant (or soon to be) father or father of young children under-5 Living in an area with a group facilitator Exclusion Criteria at baseline: - Participated in previous cycles of the same intervention

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 35 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: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>See intervention description | Behavioral: MenCare+/Bandebereho fathers'/couples' group education<br>* MenCare+/Bandebereho was a 3 year project to engage men in maternal, newborn and child health (MNCH) and in sexual and reproductive health in Rwanda. A core component of the project is fathers'/couples' group education. The target participants were first-time parents or parents of young children living in 16 rural and semi-urban sectors selected by the implementing partner in collaboration with local authorities. The MenCare+/Bandebereho fathers'/couples' group education engaged men in 15 weekly sessions of group discussion, critical reflection and interactive activities led by a trained facilitator using a curriculum developed by RWAMREC and Promundo and approved by the Rwandan Ministry of Health, adapted from the Program P Manual. Men's partners participate in 6-8 sessions. The sessions focused on men's role in MNCH, family planning, sharing household responsibilities, intimate partner violence, conflict resolution, family budgeting, and gender equality.<br>* Other names: Program P;|
| No Intervention: Control<br>Participants randomized into the control arm are surveyed at the same time points as intervention participants, but did not receive any intervention. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Women's experiences of intimate partner violence (physical & sexual) | A composite capturing self-reported exposure to a standard set of violent acts by a partner in past 12 months, adapted from World Health Organisation's multi-country study on violence against women. | Experience of violence in past 12 months, measured 6 years post intervention | 
| Use of violence/harsh punishment against children | A composite capturing respondents' self reported use of various harsh discipline acts in the past month, adapted from the UNICEF Multiple Indicator Cluster Surveys (MICS) study. | 6 years post intervention | 
| Observation-based child development measure | Observation-based scores on the International Development and Early Learning Assessment (IDELA) for children ages 4-7 | 6 years post intervention | 
| Child behavior assessment | Parent-reported scores on Strengths and Difficulties Questionnaire (SDQ) | 6 years post intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Family planning | Self reported responses on current use of family planning methods, using Demographic and Health Survey (DHS) measure. | 6 years post intervention | 
| Antenatal care (ANC) service utilization | Self reported responses on women's frequency of ANC visits during most recent pregnancy, using DHS measure (women only). | 6 years post intervention | 
| Antenatal care (ANC) accompaniment | Self reported responses on men's frequency of accompaniment to ANC visits during most recent pregnancy, adapted from International Men and Gender Equality Survey. | 6 years post intervention | 
| Parenting behaviors with children | Composite variable capturing behaviors with children in the past week (e.g. reading stories, playing, etc.) adapted from IDELA HOME and select items related to parenting behaviors adapted from the Parenting and Family Adjustment Scales (PAFAS). | 6 years post intervention | 
| Parenting behaviors and adjustment | Select items related to parenting behaviors and feelings adapted from the Parenting and Family Adjustment Scales (PAFAS). | 6 years post intervention | 
| Time spent/gender division of caregiving/domestic tasks and paid work | a) A composite measure of self-reported time spent on specific tasks in the past week; and b) self-reported distribution of tasks between partners. | 6 years post intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Gender, Violence, Early childhood development (ECD), Caregiving, Parenting, MNCH, Reproductive health