Background: Intimate partner violence (IPV) is a significant public health issue that affects 1 in 3 women globally and a similarly large number of women in Nepal. Over the past decade, important policy and programmatic steps have been taken to address violence against women in Nepal. There remains a dearth of evidence on the effectiveness of primary violence prevention strategies. The Change Starts at Home study begins to fill this gap by utilizing a multi-component social behaviour change communication (SBCC) strategy involving a radio drama and community mobilization to shift attitudes, norms and behaviours that underpin IPV perpetration in Nepal. Methods/Design: The study uses a concurrent mixed-methods design. The quantitative aspect of the evaluation is a pair-matched, repeated cross-sectional 2-armed, single-blinded cluster trial (RCT: N = 36 clusters, 1440 individuals), comparing a social behaviour change communication (SBCC) strategy to radio programming alone for its impact on physical and / or sexual IPV at the end of programming (12 months’ post-baseline) and 6-months post the cessation of project activities (18-months post baseline). The qualitative aspects of the design include several longitudinal approaches to understand the impact of the intervention and to examine mechanisms of change including in-depth interviews with participants (N = 18 couples), and focus group discussions with community leaders (N = 3 groups), and family members of participants (N = 12 groups). Treatment effects will be estimated with generalized logistic mixed models specified to compare differences in primary outcome from baseline to 12-month follow-up, and baseline to 18-months follow-up in accordance with intention-to-treat principles. Discussion: The study rigorously evaluates the effectiveness of a promising strategy to prevent IPV. The results of the trial will be immediately useful for governmental, nongovernmental, and donor funded programs targeting partner violence or social norms that underpin it. Findings of the study will also contribute to global knowledge on the effectiveness of media and community engagement as a primary prevention strategy for IPV. Trial registration: Trial was registered in clinicaltrials.gov, NCT02942433 , 10/13/2016, retrospectively registered.
Bibliographical noteFunding Information:
This manuscript has been funded by UK aid from the UK government, via the What Works to Prevent Violence Against Women and Girls? Global Programme. The funds were managed by the South African Medical Research Council (Rachel Jewkes, What World to Prevent Violence Global Program Consortium Director). The views expressed do not necessarily reflect the UK government’s official policies. The funder had no role in the design of the study aside from determining the scale used to measure the primary outcome in an effort to standardize it across programme studies.
The study adheres to international guidelines for the protection of participants and staff involved in research on violence against women  and has a data and safety monitoring plan which details procedures and reporting obligations regarding expected risks and planned protections, confidentiality and data security, and adverse events with oversight provided by an Independent Monitor who is unaffiliated with the study. This study will be stopped prior to its completion if it is associated with adverse effects that call into question the safety of the participants enrolled. Institutional Review Board (IRB) approval has been received from the University of Minnesota, where the PI was based when the study was funded, Emory University, where the PI is currently based, George Mason University where the coinvestigator is based and the Nepal National Health Research Council (NHRC). Permission was also received from the District Development Committees representing Nawalparasi, Kapilvastu and Chitwan.
© 2017 The Author(s).