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Esnat Chirwa - One of the best experts on this subject based on the ideXlab platform.

  • i got courage from knowing that even a daughter in law can earn her living mixed methods evaluation of a family centred intervention to Prevent Violence against women and girls in nepal
    PLOS ONE, 2020
    Co-Authors: Rachel Jewkes, Esnat Chirwa, Nwabisa Shai, Geeta Devi Pradhan, Ratna Shrestha, Abhina Adhikari, Alice Kerrwilson
    Abstract:

    BACKGROUND We developed, and pilot tested a family focused intervention Sammanit Jeevan "Living with Dignity" to reduce gender-based Violence by husbands, change harmful social and gender norms and improve the economic conditions of women through young married women-led income generating activities (IGAs). METHODS We conducted a modified interrupted time series study and qualitative research to evaluate the intervention in two migrant communities in Baglung district, Nepal. We enrolled young married women, their husbands and in-laws from 100 families. 200 women and 157 men completed questionnaires before the programme, and 6, 12 and 18 months afterwards. 18 in-depth interviews were conducted before the programme and 6 and 12 months later. We analysed the data for trends. RESULTS The intervention positively impacted young married women's economic conditions, exposure to Violence and changed inequitable gender attitudes. Some positive outcomes were observed among older women and men. Young women's past month earnings (35.0% - 81.3%, β = 0.11, p-value<0.001) and savings (29.0% - 80.2%, β = 0.14, p-value<0.001) more than doubled over time. Young women experienced much less past year physical IPV over time (10% - 4.4%, β = -0.08, p-value = 0.077). They also perceived that their mothers-in-law were less cruel (mean 9.0-8.6, β = -0.03, p-value = 0.035). Improvements were observed in young women's individual (mean 44.4-43.3, β = -0.04, p-value = 0.297) and perceived community gender attitudes (mean 54.4-51.4, β = -0.19, p-value<0.001) and they reported that their husbands were less controlling (mean 17.5-16.1, β = -007, p-value<0.001). These changes were supported by qualitative findings. CONCLUSIONS Whilst caution is needed in attributing the effect due to lack of control arm, the results suggest that with adequate time and seed funding, Sammanit Jeevan enabled considerable income generation, a strengthened the position of young women in the households and it reduced their exposure to Violence in this community. It warrants further research to optimise its impact.

  • evaluation of the rural response system intervention to Prevent Violence against women findings from a community randomised controlled trial in the central region of ghana
    Global Health Action, 2020
    Co-Authors: Deda Ogum Alangea, Rachel Jewkes, Adolphina Addolartey, Yandisa Sikweyiya, Esnat Chirwa, Dorcas Cokerappiah, Richard Adanu
    Abstract:

    Background: Intimate partner Violence (IPV) affects one in three women globally and undermines women’s human rights, social and economic development, and health, hence the need for integrated inter...

  • what works to Prevent Violence against children in afghanistan findings of an interrupted time series evaluation of a school based peace education and community social norms change intervention in afghanistan
    PLOS ONE, 2019
    Co-Authors: Julienne Corboz, Esnat Chirwa, Wahid Siddiq, Osman Hemat, Rachel Jewkes
    Abstract:

    Background Against a backdrop of more than four decades of war, conflict and insecurity, Afghanistan is recognised as suffering from endemic Violence and children are exposed to multiple forms of Violence, including at the family and school levels. This paper presents the results of an evaluation of school-based peace education and a community-based intervention to change harmful social norms and practices related to gender and the use of Violence in conflict resolution, implemented in Afghanistan with the aim of reducing Violence against and between children. Methods The evaluation consisted of a cross-sectional, interrupted time series design with three data collection points over 12 months. Data was collected from students in 11 secondary schools (seven girls’ and four boys’ schools) in Jawzjan province of Afghanistan, with a total of 361 boys and 373 girls sampled at endline. All children were interviewed with a questionnaire developed for the study. Key outcomes included children’s experience of peer Violence (both perpetration and victimization) at school, corporal punishment both at home and at school, and observation of family Violence. Other outcomes included children’s gender equitable attitudes, attitudes towards child punishment, depression and school performance. Results Between baseline and endline evaluation points, there were significant reductions in various forms of Violence at the school level, including both boys’ and girls’ past month experience of peer Violence victimization, peer Violence perpetration, and corporal punishment by teachers. There were also significant reductions in boys’ and girls’ experience of corporal punishment at home and observation of family Violence, with a particularly strong effect observed among girls. Both boys and girls had significantly more equitable gender attitudes and significantly less Violence-supportive attitudes in relation to children’s punishment, and significantly fewer symptoms of depression. Girls’ school attendance was also significantly higher at endline. Discussion To our knowledge this is the first time that a peace education program has been evaluated in Afghanistan, with or without a community intervention to change harmful social norms and practices related to gender and the use of Violence for conflict resolution. The evaluation suggests that the intervention may have led to a reduction in various forms of Violence, including children’s peer Violence, corporal punishment of children both at school and at home, and in children’s reports of domestic Violence against women at the household level.

  • rural response system to Prevent Violence against women methodology for a community randomised controlled trial in the central region of ghana
    Global Health Action, 2019
    Co-Authors: Adolphina Addolartey, Rachel Jewkes, Deda Ogum Alangea, Yandisa Sikweyiya, Esnat Chirwa, Dorcas Cokerappiah, Richard Adanu
    Abstract:

    ABSTRACTViolence against women (VAW) is common in Ghana, with nation-wide surveys reporting high prevalence of intimate partner Violence (IPV) (physical, sexual and/or emotional Violence). Our tria...

  • the stepping stones and creating futures intervention to Prevent intimate partner Violence and hiv risk behaviours in durban south africa study protocol for a cluster randomized control trial and baseline characteristics
    BMC Public Health, 2017
    Co-Authors: Samantha Willan, Andrew Gibbs, Yandisa Sikweyiya, Laura Washington, Nolwazi Ntini, Thobani Khumalo, Nompumelelo Mbatha, Nwabisa Shai, Esnat Chirwa
    Abstract:

    Preventing intimate partner Violence (IPV) remains a global public health challenge. Studies suggest urban informal settlements have particularly high levels of IPV and HIV-prevalence and these settlements are rapidly growing. The current evidence base of effective approaches to Preventing IPV recognizes the potential of combining economic strengthening and gender transformative interventions. However, few of these interventions have been done in urban informal settlements, and almost none have included men as direct recipients of these interventions. Stepping Stones and Creating Futures intervention is a participatory gender transformative and livelihoods strengthening intervention. It is being evaluated through a cluster randomized control trial amongst young women and men (18–30) living in urban informal settlements in eThekwini Municipality, South Africa. The evaluation includes a qualitative process evaluation and cost-effectiveness analysis. A comparison of baseline characteristics of participants is also included. This is one of the first large trials to Prevent IPV and HIV-vulnerability amongst young women and men in urban informal settlements. Given the mixed methods evaluation, the results of this trial have the ability to develop a stronger understanding of what works to Prevent Violence against women and the processes of change in interventions. NCT03022370 . Registered 13 January 2017, retrospectively registered.

Karen Devries - One of the best experts on this subject based on the ideXlab platform.

  • ecological pathways to Prevention how does the sasa community mobilisation model work to Prevent physical intimate partner Violence against women
    BMC Public Health, 2016
    Co-Authors: Tanya Abramsky, Lori Michau, Nambusi Kyegombe, Karen Devries, Janet Nakuti, Tina Musuya, Ligia Kiss, Charlotte Watts
    Abstract:

    Intimate partner Violence (IPV) against women is a global public health concern. While community-level gender norms and attitudes to IPV are recognised drivers of IPV risk, there is little evidence on how interventions might tackle these drivers to Prevent IPV at the community-level. This secondary analysis of data from the SASA! study explores the pathways through which SASA!, a community mobilisation intervention to Prevent Violence against women, achieved community-wide reductions in physical IPV. From 2007 to 2012 a cluster randomised controlled trial (CRT) was conducted in eight communities in Kampala, Uganda. Cross-sectional surveys of a random sample of community members, aged 18–49, were undertaken at baseline (n = 1583) and 4 years post intervention implementation (n = 2532). We used cluster-level intention to treat analysis to estimate SASA!’s community-level impact on women’s past year experience of physical IPV and men’s past year perpetration of IPV. The mediating roles of community-, relationship- and individual-level factors in intervention effect on past year physical IPV experience (women)/perpetration (men) were explored using modified Poisson regression models. SASA! was associated with reductions in women’s past year experience of physical IPV (0.48, 95 % CI 0.16–1.39), as well as men’s perpetration of IPV (0.39, 95 % CI 0.20–0.73). Community-level normative attitudes were the most important mediators of intervention impact on physical IPV risk, with norms around the acceptability of IPV explaining 70 % of the intervention effect on women’s experience of IPV and 95 % of the effect on men’s perpetration. The strongest relationship-level mediators were men’s reduced suspicion of partner infidelity (explaining 22 % of effect on men’s perpetration), and improved communication around sex (explaining 16 % of effect on women’s experience). Reduced acceptability of IPV among men was the most important individual-level mediator (explaining 42 % of effect on men’s perpetration). These results highlight the important role of community-level norm-change in achieving community-wide reductions in IPV risk. They lend strong support for the more widespread adoption of community-level approaches to Preventing Violence. ClinicalTrials.gov, NCT00790959 . Registered 13th November 2008. The study protocol is available at: http://www.trialsjournal.com/content/13/1/96

  • What is the potential for interventions designed to Prevent Violence against women to reduce children's exposure to Violence? Findings from the SASA! study, Kampala, Uganda.
    Child abuse & neglect, 2015
    Co-Authors: Nambusi Kyegombe, Lori Michau, Tanya Abramsky, Karen Devries, Janet Nakuti, Elizabeth Starmann, Tina Musuya, Lori Heise, Charlotte Watts
    Abstract:

    Intimate partner Violence (IPV) and child maltreatment often co-occur in households and lead to negative outcomes for children. This article explores the extent to which SASA!, an intervention to Prevent Violence against women, impacted children's exposure to Violence. Between 2007 and 2012 a cluster randomized controlled trial was conducted in Kampala, Uganda. An adjusted cluster-level intention to treat analysis, compares secondary outcomes in intervention and control communities at follow-up. Under the qualitative evaluation, 82 in-depth interviews were audio recorded at follow-up, transcribed verbatim, and analyzed using thematic analysis complemented by constant comparative methods. This mixed-methods article draws mainly on the qualitative data. The findings suggest that SASA! impacted on children's experience of Violence in three main ways. First, quantitative data suggest that children's exposure to IPV was reduced. We estimate that reductions in IPV combined with reduced witnessing by children when IPV did occur, led to a 64% reduction in prevalence of children witnessing IPV in their home (aRR 0.36, 95% CI 0.06-2.20). Second, among couples who experienced reduced IPV, qualitative data suggests parenting and discipline practices sometimes also changed-improving parent-child relationships and for a few parents, resulting in the complete rejection of corporal punishment as a disciplinary method. Third, some participants reported intervening to Prevent Violence against children. The findings suggest that interventions to Prevent IPV may also impact on children's exposure to Violence, and improve parent-child relationships. They also point to potential synergies for Violence Prevention, an area meriting further exploration.

  • sasa is the medicine that treats Violence qualitative findings on how a community mobilisation intervention to Prevent Violence against women created change in kampala uganda
    Global Health Action, 2014
    Co-Authors: Nambusi Kyegombe, Lori Michau, Karen Devries, Janet Nakuti, Elizabeth Starmann, Tina Musuya, Charlotte Watts, Lori Heise
    Abstract:

    Background : Intimate partner Violence (IPV) violates women's human rights and is a serious public health concern. Historically strategies to Prevent IPV have focussed on individuals and their relationships without addressing the context under which IPV occurs. Primary Prevention of IPV is a relatively new focus of international efforts and what SASA!, a phased community mobilisation intervention, seeks to achieve. Methods : Conducted in Kampala, Uganda, between 2007 and 2012, the SASA! Study is a cluster randomised controlled trial to assess the community-level impact of SASA! This nested qualitative study explores pathways of individual- and community-level change as a result of SASA! Forty in-depth interviews with community members (20 women, 20 men) were conducted at follow-up, audio recorded, transcribed verbatim and analysed using thematic analysis complemented by constant comparative methods. Results : SASA! influenced the dynamics of relationships and broader community norms. At the relationship level, SASA! is helping partners to explore the benefits of mutually supportive gender roles; improve communication on a variety of issues; increase levels of joint decision-making and highlight non-violent ways to deal with anger or disagreement. Not all relationships experienced the same breadth and depth of change. At the community level, SASA! has helped foster a climate of non-tolerance of Violence by reducing the acceptability of Violence against women and increasing individuals’ skills, willingness, and sense of responsibility to act to Prevent it. It has also developed and strengthened community-based structures to catalyse and support on-going activism to Prevent IPV. Discussion : This paper provides evidence of the ways in which community-based Violence Prevention interventions may reduce IPV in low-income settings. It offers important implications for community mobilisation approaches and for Prevention of IPV against women. This research has demonstrated the potential of social norm change interventions at the community level to achieve meaningful impact within project timeframes. Keywords : community mobilisation; primary Prevention intervention; social norms theory; SASA!; Violence against women; Uganda (Published: 12 September 2014) Citation : Glob Health Action 2014,  7 : 25082 -  http://dx.doi.org/10.3402/gha.v7.25082 SPECIAL ISSUE : This paper is part of the Special Issue:  Intimate Partner Violence and Mental Health . More papers from this issue can be found at  http://www.globalhealthaction.net

  • Findings from the SASA! Study: a cluster randomized controlled trial to assess the impact of a community mobilization intervention to Prevent Violence against women and reduce HIV risk in Kampala, Uganda
    BMC medicine, 2014
    Co-Authors: Tanya Abramsky, Nambusi Kyegombe, Karen Devries, Janet Nakuti, Elizabeth Starmann, Ligia Kiss, Leilani Francisco, Dan K. Kaye, Bonnie Cundill, Tina Musuya
    Abstract:

    Intimate partner Violence (IPV) and HIV are important and interconnected public health concerns. While it is recognized that they share common social drivers, there is limited evidence surrounding the potential of community interventions to reduce Violence and HIV risk at the community level. The SASA! study assessed the community-level impact of SASA!, a community mobilization intervention to Prevent Violence and reduce HIV-risk behaviors. From 2007 to 2012 a pair-matched cluster randomized controlled trial (CRT) was conducted in eight communities (four intervention and four control) in Kampala, Uganda. Cross-sectional surveys of a random sample of community members, 18- to 49-years old, were undertaken at baseline (n = 1,583) and four years post intervention implementation (n = 2,532). Six Violence and HIV-related primary outcomes were defined a priori. An adjusted cluster-level intention-to-treat analysis compared outcomes in intervention and control communities at follow-up. The intervention was associated with significantly lower social acceptance of IPV among women (adjusted risk ratio 0.54, 95% confidence interval (CI) 0.38 to 0.79) and lower acceptance among men (0.13, 95% CI 0.01 to 1.15); significantly greater acceptance that a woman can refuse sex among women (1.28, 95% CI 1.07 to 1.52) and men (1.31, 95% CI 1.00 to 1.70); 52% lower past year experience of physical IPV among women (0.48, 95% CI 0.16 to 1.39); and lower levels of past year experience of sexual IPV (0.76, 95% CI 0.33 to 1.72). Women experiencing Violence in intervention communities were more likely to receive supportive community responses. Reported past year sexual concurrency by men was significantly lower in intervention compared to control communities (0.57, 95% CI 0.36 to 0.91). This is the first CRT in sub-Saharan Africa to assess the community impact of a mobilization program on the social acceptability of IPV, the past year prevalence of IPV and levels of sexual concurrency. SASA! achieved important community impacts, and is now being delivered in control communities and replicated in 15 countries. ClinicalTrials.gov #NCT00790959.

  • findings from the sasa study a cluster randomized controlled trial to assess the impact of a community mobilization intervention to Prevent Violence against women and reduce hiv risk in kampala uganda
    BMC Medicine, 2014
    Co-Authors: Tanya Abramsky, Nambusi Kyegombe, Karen Devries, Janet Nakuti, Elizabeth Starmann, Ligia Kiss, Leilani Francisco, Dan K. Kaye, Bonnie Cundill, Tina Musuya
    Abstract:

    Background: Intimate partner Violence (IPV) and HIV are important and interconnected public health concerns. While it is recognized that they share common social drivers, there is limited evidence surrounding the potential of community interventions to reduce Violence and HIV risk at the community level. The SASA! study assessed the community-level impact of SASA!, a community mobilization intervention to Prevent Violence and reduce HIV-risk behaviors. Methods: From 2007 to 2012 a pair-matched cluster randomized controlled trial (CRT) was conducted in eight communities (four intervention and four control) in Kampala, Uganda. Cross-sectional surveys of a random sample of community members, 18- to 49-years old, were undertaken at baseline (n = 1,583) and four years post intervention implementation (n = 2,532). Six Violence and HIV-related primary outcomes were defined ap riori .A n adjusted cluster-level intention-to-treat analysis compared outcomes in intervention and control communities at follow-up. Results: The intervention was associated with significantly lower social acceptance of IPV among women (adjusted risk ratio 0.54, 95% confidence interval (CI) 0.38 to 0.79) and lower acceptance among men (0.13, 95% CI 0.01 to 1.15); significantly greater acceptance that a woman can refuse sex among women (1.28, 95% CI 1.07 to 1.52) and men (1.31, 95% CI 1.00 to 1.70); 52% lower past year experience of physical IPV among women (0.48, 95% CI 0.16 to 1.39); and lower levels of past year experience of sexual IPV (0.76, 95% CI 0.33 to 1.72). Women experiencing Violence in intervention communities were more likely to receive supportive community responses. Reported past year sexual concurrency by men was signi ficantly lower in intervention compared to control communities (0.57, 95% CI 0.36 to 0.91). Conclusions: This is the first CRT in sub-Saharan Africa to assess the community impact of a mobilization program on the social acceptability of IPV, the past year prevalence of IPV and levels of sexual concurrency. SASA! achieved important community impacts, and is now being delivered in control communities and replicated in 15 countries. Trial registration: ClinicalTrials.gov #NCT00790959, Study protocol available at http://www.trialsjournal.com/content/13/1/96

Rachel Jewkes - One of the best experts on this subject based on the ideXlab platform.

  • i got courage from knowing that even a daughter in law can earn her living mixed methods evaluation of a family centred intervention to Prevent Violence against women and girls in nepal
    PLOS ONE, 2020
    Co-Authors: Rachel Jewkes, Esnat Chirwa, Nwabisa Shai, Geeta Devi Pradhan, Ratna Shrestha, Abhina Adhikari, Alice Kerrwilson
    Abstract:

    BACKGROUND We developed, and pilot tested a family focused intervention Sammanit Jeevan "Living with Dignity" to reduce gender-based Violence by husbands, change harmful social and gender norms and improve the economic conditions of women through young married women-led income generating activities (IGAs). METHODS We conducted a modified interrupted time series study and qualitative research to evaluate the intervention in two migrant communities in Baglung district, Nepal. We enrolled young married women, their husbands and in-laws from 100 families. 200 women and 157 men completed questionnaires before the programme, and 6, 12 and 18 months afterwards. 18 in-depth interviews were conducted before the programme and 6 and 12 months later. We analysed the data for trends. RESULTS The intervention positively impacted young married women's economic conditions, exposure to Violence and changed inequitable gender attitudes. Some positive outcomes were observed among older women and men. Young women's past month earnings (35.0% - 81.3%, β = 0.11, p-value<0.001) and savings (29.0% - 80.2%, β = 0.14, p-value<0.001) more than doubled over time. Young women experienced much less past year physical IPV over time (10% - 4.4%, β = -0.08, p-value = 0.077). They also perceived that their mothers-in-law were less cruel (mean 9.0-8.6, β = -0.03, p-value = 0.035). Improvements were observed in young women's individual (mean 44.4-43.3, β = -0.04, p-value = 0.297) and perceived community gender attitudes (mean 54.4-51.4, β = -0.19, p-value<0.001) and they reported that their husbands were less controlling (mean 17.5-16.1, β = -007, p-value<0.001). These changes were supported by qualitative findings. CONCLUSIONS Whilst caution is needed in attributing the effect due to lack of control arm, the results suggest that with adequate time and seed funding, Sammanit Jeevan enabled considerable income generation, a strengthened the position of young women in the households and it reduced their exposure to Violence in this community. It warrants further research to optimise its impact.

  • evaluation of the rural response system intervention to Prevent Violence against women findings from a community randomised controlled trial in the central region of ghana
    Global Health Action, 2020
    Co-Authors: Deda Ogum Alangea, Rachel Jewkes, Adolphina Addolartey, Yandisa Sikweyiya, Esnat Chirwa, Dorcas Cokerappiah, Richard Adanu
    Abstract:

    Background: Intimate partner Violence (IPV) affects one in three women globally and undermines women’s human rights, social and economic development, and health, hence the need for integrated inter...

  • what works to Prevent Violence against children in afghanistan findings of an interrupted time series evaluation of a school based peace education and community social norms change intervention in afghanistan
    PLOS ONE, 2019
    Co-Authors: Julienne Corboz, Esnat Chirwa, Wahid Siddiq, Osman Hemat, Rachel Jewkes
    Abstract:

    Background Against a backdrop of more than four decades of war, conflict and insecurity, Afghanistan is recognised as suffering from endemic Violence and children are exposed to multiple forms of Violence, including at the family and school levels. This paper presents the results of an evaluation of school-based peace education and a community-based intervention to change harmful social norms and practices related to gender and the use of Violence in conflict resolution, implemented in Afghanistan with the aim of reducing Violence against and between children. Methods The evaluation consisted of a cross-sectional, interrupted time series design with three data collection points over 12 months. Data was collected from students in 11 secondary schools (seven girls’ and four boys’ schools) in Jawzjan province of Afghanistan, with a total of 361 boys and 373 girls sampled at endline. All children were interviewed with a questionnaire developed for the study. Key outcomes included children’s experience of peer Violence (both perpetration and victimization) at school, corporal punishment both at home and at school, and observation of family Violence. Other outcomes included children’s gender equitable attitudes, attitudes towards child punishment, depression and school performance. Results Between baseline and endline evaluation points, there were significant reductions in various forms of Violence at the school level, including both boys’ and girls’ past month experience of peer Violence victimization, peer Violence perpetration, and corporal punishment by teachers. There were also significant reductions in boys’ and girls’ experience of corporal punishment at home and observation of family Violence, with a particularly strong effect observed among girls. Both boys and girls had significantly more equitable gender attitudes and significantly less Violence-supportive attitudes in relation to children’s punishment, and significantly fewer symptoms of depression. Girls’ school attendance was also significantly higher at endline. Discussion To our knowledge this is the first time that a peace education program has been evaluated in Afghanistan, with or without a community intervention to change harmful social norms and practices related to gender and the use of Violence for conflict resolution. The evaluation suggests that the intervention may have led to a reduction in various forms of Violence, including children’s peer Violence, corporal punishment of children both at school and at home, and in children’s reports of domestic Violence against women at the household level.

  • rural response system to Prevent Violence against women methodology for a community randomised controlled trial in the central region of ghana
    Global Health Action, 2019
    Co-Authors: Adolphina Addolartey, Rachel Jewkes, Deda Ogum Alangea, Yandisa Sikweyiya, Esnat Chirwa, Dorcas Cokerappiah, Richard Adanu
    Abstract:

    ABSTRACTViolence against women (VAW) is common in Ghana, with nation-wide surveys reporting high prevalence of intimate partner Violence (IPV) (physical, sexual and/or emotional Violence). Our tria...

  • Economic evaluation of public health interventions: an application to interventions for the Prevention of Violence against women and girls implemented by the “what works to Prevent Violence against women and girls?” global program
    LSE Research Online Documents on Economics, 2019
    Co-Authors: Giulia Ferrari, Charlotte Watts, Sergio Torres-rueda, Christine Michaels-igbokwe, Rachel Jewkes, Anna Vassall
    Abstract:

    Violence against women and girls (VAWG) has important social, economic, and public health impacts. Governments and international donors are increasing their investment in VAWG Prevention programs, yet clear guidelines to assess the ?value for money? of these interventions are lacking. Improved costing and economic evaluation of VAWG Prevention can support programming through supporting priority setting, justifying investment, and planning the financing of VAWG Prevention services. This article sets out a standardized methodology for the economic evaluation of complex, that is, multicomponent and/or multiplatform, programs designed to Prevent VAWG in low- and middle-income countries (LMICs). It outlines an approach that can be used alongside the most recent guidance for the economic evaluation of public health interventions in LMICs. It defines standardized methods of data collection and analysis, outcomes, and unit costs (i.e., average costs per person reached, output or service delivered), and provides guidance to investigate the uncertainty in cost-effectiveness estimates and report results. The costing approach has been developed and piloted as part of the ?What Works to Prevent Violence Against Women and Girls?? (What Works?) program in five countries. This article and its supplementary material can be used by both economists and non-economists to contribute to the generation of new cost-effectiveness data on VAWG Prevention, and ultimately improve the allocative efficiency and financing across VAWG programs.

Charlotte Watts - One of the best experts on this subject based on the ideXlab platform.

  • Economic evaluation of public health interventions: an application to interventions for the Prevention of Violence against women and girls implemented by the “what works to Prevent Violence against women and girls?” global program
    LSE Research Online Documents on Economics, 2019
    Co-Authors: Giulia Ferrari, Charlotte Watts, Sergio Torres-rueda, Christine Michaels-igbokwe, Rachel Jewkes, Anna Vassall
    Abstract:

    Violence against women and girls (VAWG) has important social, economic, and public health impacts. Governments and international donors are increasing their investment in VAWG Prevention programs, yet clear guidelines to assess the ?value for money? of these interventions are lacking. Improved costing and economic evaluation of VAWG Prevention can support programming through supporting priority setting, justifying investment, and planning the financing of VAWG Prevention services. This article sets out a standardized methodology for the economic evaluation of complex, that is, multicomponent and/or multiplatform, programs designed to Prevent VAWG in low- and middle-income countries (LMICs). It outlines an approach that can be used alongside the most recent guidance for the economic evaluation of public health interventions in LMICs. It defines standardized methods of data collection and analysis, outcomes, and unit costs (i.e., average costs per person reached, output or service delivered), and provides guidance to investigate the uncertainty in cost-effectiveness estimates and report results. The costing approach has been developed and piloted as part of the ?What Works to Prevent Violence Against Women and Girls?? (What Works?) program in five countries. This article and its supplementary material can be used by both economists and non-economists to contribute to the generation of new cost-effectiveness data on VAWG Prevention, and ultimately improve the allocative efficiency and financing across VAWG programs.

  • ecological pathways to Prevention how does the sasa community mobilisation model work to Prevent physical intimate partner Violence against women
    BMC Public Health, 2016
    Co-Authors: Tanya Abramsky, Lori Michau, Nambusi Kyegombe, Karen Devries, Janet Nakuti, Tina Musuya, Ligia Kiss, Charlotte Watts
    Abstract:

    Intimate partner Violence (IPV) against women is a global public health concern. While community-level gender norms and attitudes to IPV are recognised drivers of IPV risk, there is little evidence on how interventions might tackle these drivers to Prevent IPV at the community-level. This secondary analysis of data from the SASA! study explores the pathways through which SASA!, a community mobilisation intervention to Prevent Violence against women, achieved community-wide reductions in physical IPV. From 2007 to 2012 a cluster randomised controlled trial (CRT) was conducted in eight communities in Kampala, Uganda. Cross-sectional surveys of a random sample of community members, aged 18–49, were undertaken at baseline (n = 1583) and 4 years post intervention implementation (n = 2532). We used cluster-level intention to treat analysis to estimate SASA!’s community-level impact on women’s past year experience of physical IPV and men’s past year perpetration of IPV. The mediating roles of community-, relationship- and individual-level factors in intervention effect on past year physical IPV experience (women)/perpetration (men) were explored using modified Poisson regression models. SASA! was associated with reductions in women’s past year experience of physical IPV (0.48, 95 % CI 0.16–1.39), as well as men’s perpetration of IPV (0.39, 95 % CI 0.20–0.73). Community-level normative attitudes were the most important mediators of intervention impact on physical IPV risk, with norms around the acceptability of IPV explaining 70 % of the intervention effect on women’s experience of IPV and 95 % of the effect on men’s perpetration. The strongest relationship-level mediators were men’s reduced suspicion of partner infidelity (explaining 22 % of effect on men’s perpetration), and improved communication around sex (explaining 16 % of effect on women’s experience). Reduced acceptability of IPV among men was the most important individual-level mediator (explaining 42 % of effect on men’s perpetration). These results highlight the important role of community-level norm-change in achieving community-wide reductions in IPV risk. They lend strong support for the more widespread adoption of community-level approaches to Preventing Violence. ClinicalTrials.gov, NCT00790959 . Registered 13th November 2008. The study protocol is available at: http://www.trialsjournal.com/content/13/1/96

  • What is the potential for interventions designed to Prevent Violence against women to reduce children's exposure to Violence? Findings from the SASA! study, Kampala, Uganda.
    Child abuse & neglect, 2015
    Co-Authors: Nambusi Kyegombe, Lori Michau, Tanya Abramsky, Karen Devries, Janet Nakuti, Elizabeth Starmann, Tina Musuya, Lori Heise, Charlotte Watts
    Abstract:

    Intimate partner Violence (IPV) and child maltreatment often co-occur in households and lead to negative outcomes for children. This article explores the extent to which SASA!, an intervention to Prevent Violence against women, impacted children's exposure to Violence. Between 2007 and 2012 a cluster randomized controlled trial was conducted in Kampala, Uganda. An adjusted cluster-level intention to treat analysis, compares secondary outcomes in intervention and control communities at follow-up. Under the qualitative evaluation, 82 in-depth interviews were audio recorded at follow-up, transcribed verbatim, and analyzed using thematic analysis complemented by constant comparative methods. This mixed-methods article draws mainly on the qualitative data. The findings suggest that SASA! impacted on children's experience of Violence in three main ways. First, quantitative data suggest that children's exposure to IPV was reduced. We estimate that reductions in IPV combined with reduced witnessing by children when IPV did occur, led to a 64% reduction in prevalence of children witnessing IPV in their home (aRR 0.36, 95% CI 0.06-2.20). Second, among couples who experienced reduced IPV, qualitative data suggests parenting and discipline practices sometimes also changed-improving parent-child relationships and for a few parents, resulting in the complete rejection of corporal punishment as a disciplinary method. Third, some participants reported intervening to Prevent Violence against children. The findings suggest that interventions to Prevent IPV may also impact on children's exposure to Violence, and improve parent-child relationships. They also point to potential synergies for Violence Prevention, an area meriting further exploration.

  • sasa is the medicine that treats Violence qualitative findings on how a community mobilisation intervention to Prevent Violence against women created change in kampala uganda
    Global Health Action, 2014
    Co-Authors: Nambusi Kyegombe, Lori Michau, Karen Devries, Janet Nakuti, Elizabeth Starmann, Tina Musuya, Charlotte Watts, Lori Heise
    Abstract:

    Background : Intimate partner Violence (IPV) violates women's human rights and is a serious public health concern. Historically strategies to Prevent IPV have focussed on individuals and their relationships without addressing the context under which IPV occurs. Primary Prevention of IPV is a relatively new focus of international efforts and what SASA!, a phased community mobilisation intervention, seeks to achieve. Methods : Conducted in Kampala, Uganda, between 2007 and 2012, the SASA! Study is a cluster randomised controlled trial to assess the community-level impact of SASA! This nested qualitative study explores pathways of individual- and community-level change as a result of SASA! Forty in-depth interviews with community members (20 women, 20 men) were conducted at follow-up, audio recorded, transcribed verbatim and analysed using thematic analysis complemented by constant comparative methods. Results : SASA! influenced the dynamics of relationships and broader community norms. At the relationship level, SASA! is helping partners to explore the benefits of mutually supportive gender roles; improve communication on a variety of issues; increase levels of joint decision-making and highlight non-violent ways to deal with anger or disagreement. Not all relationships experienced the same breadth and depth of change. At the community level, SASA! has helped foster a climate of non-tolerance of Violence by reducing the acceptability of Violence against women and increasing individuals’ skills, willingness, and sense of responsibility to act to Prevent it. It has also developed and strengthened community-based structures to catalyse and support on-going activism to Prevent IPV. Discussion : This paper provides evidence of the ways in which community-based Violence Prevention interventions may reduce IPV in low-income settings. It offers important implications for community mobilisation approaches and for Prevention of IPV against women. This research has demonstrated the potential of social norm change interventions at the community level to achieve meaningful impact within project timeframes. Keywords : community mobilisation; primary Prevention intervention; social norms theory; SASA!; Violence against women; Uganda (Published: 12 September 2014) Citation : Glob Health Action 2014,  7 : 25082 -  http://dx.doi.org/10.3402/gha.v7.25082 SPECIAL ISSUE : This paper is part of the Special Issue:  Intimate Partner Violence and Mental Health . More papers from this issue can be found at  http://www.globalhealthaction.net

  • The Good Schools Toolkit to Prevent Violence against children in Ugandan primary schools: study protocol for a cluster randomised controlled trial.
    Trials, 2013
    Co-Authors: Karen Devries, Charlotte Watts, Elizabeth Allen, Jennifer C. Child, Eddy Walakira, Jenny Parkes, Diana Elbourne, Dipak Naker
    Abstract:

    We aim to evaluate the effectiveness of the Good School Toolkit, developed by Raising Voices, in Preventing Violence against children attending school and in improving child mental health and educational outcomes. We are conducting a two-arm cluster randomised controlled trial with parallel assignment in Luwero District, Uganda. We will also conduct a qualitative study, a process evaluation and an economic evaluation. A total of 42 schools, representative of Luwero District, Uganda, were allocated to receive the Toolkit plus implementation support, or were allocated to a wait-list control condition. Our main analysis will involve a cross-sectional comparison of the prevalence of past-week Violence from school staff as reported by children in intervention and control primary schools at follow-up.At least 60 children per school and all school staff members will be interviewed at follow-up. Data collection involves a combination of mobile phone-based, interviewer-completed questionnaires and paper-and-pen educational tests. Survey instruments include the ISPCAN Child Abuse Screening Tools to assess experiences of Violence; the Strengths and Difficulties Questionnaire to measure symptoms of common childhood mental disorders; and word recognition, reading comprehension, spelling, arithmetic and sustained attention tests adapted from an intervention trial in Kenya. To our knowledge, this is the first study to rigorously investigate the effects of any intervention to Prevent Violence from school staff to children in primary school in a low-income setting. We hope the results will be informative across the African region and in other settings. clinicaltrials.gov NCT01678846.

Lori Michau - One of the best experts on this subject based on the ideXlab platform.

  • SASA! Together: An evolution of the SASA! approach to Prevent Violence against women.
    Evaluation and program planning, 2021
    Co-Authors: Lori Michau, Sophie Namy
    Abstract:

    Abstract One in three women globally will experience intimate partner Violence (IPV) with devastating consequences for individual survivors, their families and communities. While prevalence remains high, Violence against women is not inevitable and community mobilization approaches have emerged as particularly promising for transforming the gender inequitable norms and practices that underlie Violence. The SASA! Activist Kit to Prevent Violence Against Women (SASA!), developed by Raising Voices in 2008, provides a theory-based approach for mobilizing communities to transform power imbalances between women and men through critical discussion and positive action. In this article, we provide the rational for revising SASA! after ten years of program learning and formal research. We aim to contribute to the knowledge base around what works to Prevent IPV by describing the core enhancements in the revised version--called SASA! Together—and linking these changes to Raising Voices’ program learning and broader advancements in the field. In addition, we reflect on how current debates—such as how best to “scale up” Violence Prevention programs—were considered and resolved in SASA! Together. The paper concludes by sharing lessons learned that may provide guidance for future revisions development and revisions of evidenced-based programs.

  • Balancing fidelity, contextualisation, and innovation: learning from an adaption of SASA! to Prevent Violence against women in the Dadaab refugee camp
    Gender & Development, 2019
    Co-Authors: Sophie Namy, Natsnet Ghebrebrhan, Mercy Lwambi, Rahma Hassan, Sophia Wanjiku, Jennifer Wagman, Lori Michau
    Abstract:

    ABSTRACTThis article focuses on SASA!, a community mobilisation approach that was developed in Uganda by Raising Voices, with the aim of Preventing Violence against women. SASA! proved effective in reducing intimate partner Violence against women, and has since been used in over 25 countries worldwide. In this article, we draw on recent research into the International Refugee Committee’s implementation of SASA! in Dadaab, Kenya. In particular, we focus on how the refugee camp setting shapes the adaptation and delivery of the SASA! programme and explore the balance to be struck between fidelity to the SASA! methodology, and adaptations to make it suitable for use in this specific humanitarian context.

  • ecological pathways to Prevention how does the sasa community mobilisation model work to Prevent physical intimate partner Violence against women
    BMC Public Health, 2016
    Co-Authors: Tanya Abramsky, Lori Michau, Nambusi Kyegombe, Karen Devries, Janet Nakuti, Tina Musuya, Ligia Kiss, Charlotte Watts
    Abstract:

    Intimate partner Violence (IPV) against women is a global public health concern. While community-level gender norms and attitudes to IPV are recognised drivers of IPV risk, there is little evidence on how interventions might tackle these drivers to Prevent IPV at the community-level. This secondary analysis of data from the SASA! study explores the pathways through which SASA!, a community mobilisation intervention to Prevent Violence against women, achieved community-wide reductions in physical IPV. From 2007 to 2012 a cluster randomised controlled trial (CRT) was conducted in eight communities in Kampala, Uganda. Cross-sectional surveys of a random sample of community members, aged 18–49, were undertaken at baseline (n = 1583) and 4 years post intervention implementation (n = 2532). We used cluster-level intention to treat analysis to estimate SASA!’s community-level impact on women’s past year experience of physical IPV and men’s past year perpetration of IPV. The mediating roles of community-, relationship- and individual-level factors in intervention effect on past year physical IPV experience (women)/perpetration (men) were explored using modified Poisson regression models. SASA! was associated with reductions in women’s past year experience of physical IPV (0.48, 95 % CI 0.16–1.39), as well as men’s perpetration of IPV (0.39, 95 % CI 0.20–0.73). Community-level normative attitudes were the most important mediators of intervention impact on physical IPV risk, with norms around the acceptability of IPV explaining 70 % of the intervention effect on women’s experience of IPV and 95 % of the effect on men’s perpetration. The strongest relationship-level mediators were men’s reduced suspicion of partner infidelity (explaining 22 % of effect on men’s perpetration), and improved communication around sex (explaining 16 % of effect on women’s experience). Reduced acceptability of IPV among men was the most important individual-level mediator (explaining 42 % of effect on men’s perpetration). These results highlight the important role of community-level norm-change in achieving community-wide reductions in IPV risk. They lend strong support for the more widespread adoption of community-level approaches to Preventing Violence. ClinicalTrials.gov, NCT00790959 . Registered 13th November 2008. The study protocol is available at: http://www.trialsjournal.com/content/13/1/96

  • What is the potential for interventions designed to Prevent Violence against women to reduce children's exposure to Violence? Findings from the SASA! study, Kampala, Uganda.
    Child abuse & neglect, 2015
    Co-Authors: Nambusi Kyegombe, Lori Michau, Tanya Abramsky, Karen Devries, Janet Nakuti, Elizabeth Starmann, Tina Musuya, Lori Heise, Charlotte Watts
    Abstract:

    Intimate partner Violence (IPV) and child maltreatment often co-occur in households and lead to negative outcomes for children. This article explores the extent to which SASA!, an intervention to Prevent Violence against women, impacted children's exposure to Violence. Between 2007 and 2012 a cluster randomized controlled trial was conducted in Kampala, Uganda. An adjusted cluster-level intention to treat analysis, compares secondary outcomes in intervention and control communities at follow-up. Under the qualitative evaluation, 82 in-depth interviews were audio recorded at follow-up, transcribed verbatim, and analyzed using thematic analysis complemented by constant comparative methods. This mixed-methods article draws mainly on the qualitative data. The findings suggest that SASA! impacted on children's experience of Violence in three main ways. First, quantitative data suggest that children's exposure to IPV was reduced. We estimate that reductions in IPV combined with reduced witnessing by children when IPV did occur, led to a 64% reduction in prevalence of children witnessing IPV in their home (aRR 0.36, 95% CI 0.06-2.20). Second, among couples who experienced reduced IPV, qualitative data suggests parenting and discipline practices sometimes also changed-improving parent-child relationships and for a few parents, resulting in the complete rejection of corporal punishment as a disciplinary method. Third, some participants reported intervening to Prevent Violence against children. The findings suggest that interventions to Prevent IPV may also impact on children's exposure to Violence, and improve parent-child relationships. They also point to potential synergies for Violence Prevention, an area meriting further exploration.

  • sasa is the medicine that treats Violence qualitative findings on how a community mobilisation intervention to Prevent Violence against women created change in kampala uganda
    Global Health Action, 2014
    Co-Authors: Nambusi Kyegombe, Lori Michau, Karen Devries, Janet Nakuti, Elizabeth Starmann, Tina Musuya, Charlotte Watts, Lori Heise
    Abstract:

    Background : Intimate partner Violence (IPV) violates women's human rights and is a serious public health concern. Historically strategies to Prevent IPV have focussed on individuals and their relationships without addressing the context under which IPV occurs. Primary Prevention of IPV is a relatively new focus of international efforts and what SASA!, a phased community mobilisation intervention, seeks to achieve. Methods : Conducted in Kampala, Uganda, between 2007 and 2012, the SASA! Study is a cluster randomised controlled trial to assess the community-level impact of SASA! This nested qualitative study explores pathways of individual- and community-level change as a result of SASA! Forty in-depth interviews with community members (20 women, 20 men) were conducted at follow-up, audio recorded, transcribed verbatim and analysed using thematic analysis complemented by constant comparative methods. Results : SASA! influenced the dynamics of relationships and broader community norms. At the relationship level, SASA! is helping partners to explore the benefits of mutually supportive gender roles; improve communication on a variety of issues; increase levels of joint decision-making and highlight non-violent ways to deal with anger or disagreement. Not all relationships experienced the same breadth and depth of change. At the community level, SASA! has helped foster a climate of non-tolerance of Violence by reducing the acceptability of Violence against women and increasing individuals’ skills, willingness, and sense of responsibility to act to Prevent it. It has also developed and strengthened community-based structures to catalyse and support on-going activism to Prevent IPV. Discussion : This paper provides evidence of the ways in which community-based Violence Prevention interventions may reduce IPV in low-income settings. It offers important implications for community mobilisation approaches and for Prevention of IPV against women. This research has demonstrated the potential of social norm change interventions at the community level to achieve meaningful impact within project timeframes. Keywords : community mobilisation; primary Prevention intervention; social norms theory; SASA!; Violence against women; Uganda (Published: 12 September 2014) Citation : Glob Health Action 2014,  7 : 25082 -  http://dx.doi.org/10.3402/gha.v7.25082 SPECIAL ISSUE : This paper is part of the Special Issue:  Intimate Partner Violence and Mental Health . More papers from this issue can be found at  http://www.globalhealthaction.net