A community-based intervention to challenge attitudes towards intimate partner violence: results from a randomised community trial in rural South-West Nigeria

Abstract

Introduction: Intimate partner violence (IPV) is a major public health concern worldwide, with significant repercussions for women's health. In some parts of the world, IPV is considered an acceptable practice, especially in rural areas. Attitudes supportive of IPV have been reported as one of the foremost predictors of IPV, and a shift in the attitudes that permit, promote, and perpetuate IPV is required to substantially reduce its occurrence. Community-based interventions are a feasible strategy to engage community members in efforts to prevent IPV. This study tested a community mobilisation intervention to challenge attitudes towards IPV and prevent violence within intimate relationships.

Methods: This randomised community trial was conducted in selected rural communities in Oyo State, Nigeria, between January 2019 and April 2021. The study employed a convergent parallel mixed-methods design and a three-stage sampling technique in selecting two local government areas, eight communities and the study participants. The 6-month community mobilisation intervention, focused on creating awareness and challenging attitudes supportive of IPV, was evaluated using two cross-sectional surveys (pre-and post-intervention), 12 in-depth interviews, and nine focus group discussions. The outcomes for this study, assessed using the WHO Women's Health Questionnaire, included attitudes supportive of IPV, women's experiences of IPV and men's perpetration of IPV. Difference-in-differences (DID) regression models were estimated to compare changes in IPV levels in the intervention and control arms, while qualitative data were analysed using a thematic approach.

Results: At baseline, 628 men and 667 women responded to the survey, and 640 men and 658 women responded to the survey at endline. The median age of the respondents was 35 years at baseline and 40 years at endline. In the intervention group, the proportion of women with attitudes supportive of IPV reduced between baseline and endline from 65.2% to 35.1% versus 45.2% to 32.7% in the control group (DID= -0.116, p=0.039). Women's past year experience of IPV also reduced from 30.3% to 1.2% versus 48.4% to 33.2% in the control group (DID= -0.131, p=0.006). Changes in the proportion of men who had attitudes supportive of IPV or perpetrated IPV did not follow this trend. In the intervention group, the proportion of men with attitudes supportive of IPV increased between baseline and endline from 40.1% to 44.6%, as they did in the control group - from 43.7% to 45.8% (DID=0.015, p=0.805). Men's past-year perpetration of IPV reduced from 29.9% to 19.9% versus 43.2% to 10.2% in the control group (DID= -0.050, p=0.155). Respondents to the qualitative interviews in both the intervention and control groups at baseline were aware of the various forms of IPV in their communities, and had attitudes supportive of physical violence; however, those in the intervention group alluded to a reduction in IPV at endline.

Conclusion: This trial demonstrates the potential of community mobilisation as an intervention that can reduce the proportion of women who have attitudes supportive of IPV and had experienced IPV in the previous year.

Keywords: Nigeria; intimate partner violence; perpetration; attitudes towards intimate partner violence.