Primary Prevention of Intimate Partner Violence in India: a pilot study of the couples-based intervention Ghya Bharari Ekatra.

Abstract

BACKGROUND\nThe high global prevalence of intimate partner violence (IPV) and its association with poor physical and mental health underscore the need for effective primary prevention. We previously developed Ghya Bharai Ekatra (GBE), a couples-based primary prevention intervention for IPV among newly-married couples residing in slum communities in Pune, India.\n\n\nOBJECTIVE\nThrough the present pilot study we aimed to explore the acceptance, safety, feasibility, and preliminary efficacy of GBE.\n\n\nMETHODS\nBetween January and May 2018, we enrolled and assigned 20 couples to receive GBE plus information on IPV support services and 20 control couples to receive information on IPV support services alone. The GBE intervention was delivered over 6 weekly sessions to groups of 3-5 couples by lay peer educators in the communities in which the participants reside. Intervention components addressed relationship quality, resilience, communication and conflict negotiation, self-esteem, sexual communication and sexual health knowledge, and norms around IPV. Outcome evaluation included exit interviews with participants and peers to examine acceptance and feasibility challenges and baseline and 3-month follow-up interviews to examine change in IPV reporting and mental health (by women) and alcohol misuse (by men). Process evaluation examined dose delivered, dose received, fidelity, recruitment, participation rate, and context.\n\n\nRESULTS\nHalf (40/83) of the eligible couples approached agreed to participate in the GBE intervention. Retention rates were high (85% across all 6 sessions), feedback from exit interviews suggested the content and delivery methods were very well-received, and the community was highly supportive of the intervention. The principal feasibility challenge involved recruiting men of lowest income who were dependent on daily wages. No safety concerns were reported by female participants over the course of the intervention nor at the three-month follow-up. There were no reported physical or sexual IPV events in either group, but fewer incidents of psychological abuse in GBE participants (18% or 3/17) vs. control (25% or 4/16) at 3-month follow-up, and significant improvement in overall mental health of female intervention participants and declines in the controls (change in mean General Health Questionnaire (GHQ-12) Score: -0.13 intervention; +0.13 controls, p=0.10).\n\n\nCONCLUSIONS\nGBE has high acceptance, feasibility, and preliminary efficacy in preventing IPV and improving mental health among women. Next steps include refining intervention content based on pilot findings and examining intervention efficacy through a large-scale randomized trial with longer follow-up.\n\n\nCLINICALTRIAL\nThe trial was registered at ClinicalTrials.gov (registration number: NCT03332134) and the Clinical Trials Registry of India (registration number: CTRI/2018/01/011596).\n\n\nINTERNATIONAL REGISTERED REPORT\nRR2-10.2196/11533.