Article Text

Original research
Improving family functioning and reducing violence in the home in North Kivu, Democratic Republic of Congo: a pilot cluster-randomised controlled trial of Safe at Home
  1. Kathryn L Falb1,
  2. Khudejha Asghar2,
  3. Alexandra Blackwell1,
  4. Simon Baseme3,
  5. Martin Nyanguba4,
  6. Danielle Roth5,
  7. Jean de Dieu Hategekimana3
  1. 1International Rescue Committee, Airbel Impact Lab, Washington, DC, USA
  2. 2International Rescue Committee, Violence Prevention and Reponse, Washington, DC, USA
  3. 3International Rescue Committee, Women's Protection and Empowerment, Goma, Congo (the Democratic Republic of the)
  4. 4International Rescue Committee, Child Protection, Goma, Congo (the Democratic Republic of the)
  5. 5International Rescue Committee, Violence Prevention and Response, New York, New York, USA
  1. Correspondence to Kathryn L Falb; Kathryn.falb{at}rescue.org

Abstract

Objective To test the effectiveness of the Safe at Home programme which was developed to improve family well-being and prevent multiple forms of violence in the home.

Design Waitlisted pilot cluster randomised controlled trial.

Setting North Kivu, Democratic Republic of Congo.

Participants 202 heterosexual couples.

Intervention The Safe at Home programme.

Primary and secondary outcome measures The primary outcome was family functioning, with secondary outcomes of past-3 month co-occurring violence, intimate partner violence (IPV) and harsh discipline. Pathway mechanisms assessed included attitudes related to acceptance of harsh discipline, gender equitable attitudes, positive parenting skills and power sharing within the couple.

Results No significant improvements in family functioning were documented for women (β=1.49; 95% CI: −2.75 to 5.74; p=0.49) and men (β=1.09; 95% CI: −3.13 to 4.74; p=0.69). However, women in Safe at Home reported a OR=0.15 (p=0.000), OR=0.23 (p=0.001) and OR=0.29 (p=0.013) change in co-occurring IPV and harsh discipline; physical/sexual/emotional IPV by their partner and use of physical and/or emotional harsh discipline against their child, respectively, as compared with women in the waitlisted group. Men participating in Safe at Home reported a OR=0.23 (p=0.005) change in perpetration of co-occurring violence, OR=0.26 (p=0.003) change in any form of IPV perpetration and OR=0.56 (p=0.19) change in use of harsh discipline against their child as compared with the waitlist arm. Positive changes were also noted in pathway variables around attitudes, skills and behaviours within couples.

Conclusion This pilot trial demonstrated the Safe at Home programme to be highly effective in preventing multiple forms of violence in the home and improving equitable attitudes and skills in couples. Future research should assess longitudinal impact and implementation at scale.

Trial registration number NCT04163549.

  • Child protection
  • PUBLIC HEALTH
  • Maternal medicine

Data availability statement

Data are available upon reasonable request. Deidentified data may be made available upon request to the corresponding author after approval of a proposal by the International Rescue Committee Safe at Home team.

http://creativecommons.org/licenses/by-nc/4.0/

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Data availability statement

Data are available upon reasonable request. Deidentified data may be made available upon request to the corresponding author after approval of a proposal by the International Rescue Committee Safe at Home team.

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Footnotes

  • Contributors Conceptualisation of the study design and intervention approach: KLF, DR and JDDH. Acquisition and interpretation of data: KLF, KA, AB, SB, MN, DR and JDDH. Analysis of data: KA and AB. Drafting the manuscript: KLF, KA and AB. Revising and approving the manuscript: KLF, KA, AB, SB, MN, DR and JDDH. KLF is responsible for the overall content as guarantor.

  • Funding The study was funded through the Bureau of Humanitarian Assistance, United States Agency for International Development (Grant Number 720FDA19GR00186).

  • Competing interests The research team and practitioner team are employed by the same institution.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.