Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2017

Open Access 01-12-2017 | Study protocol

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

Authors: Andrew Gibbs, Laura Washington, Samantha Willan, Nolwazi Ntini, Thobani Khumalo, Nompumelelo Mbatha, Yandisa Sikweyiya, Nwabisa Shai, Esnat Chirwa, Michael Strauss, Giulia Ferrari, Rachel Jewkes

Published in: BMC Public Health | Issue 1/2017

Login to get access

Abstract

Background

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.

Methods

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.

Discussion

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.

Trial registration

NCT03022370. Registered 13 January 2017, retrospectively registered.
Appendix
Available only for authorised users
Footnotes
2
Dollar rate calculated on 14 September 2016, approximately R7 to US$1
 
Literature
1.
WHO. Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva: WHO; 2013.
2.
Seedat M, Van Niekerk A, Jewkes R, Suffla S, Ratele K. Violence and injuries in South Africa: prioritising an agenda for prevention. Lancet. 2009;374:1011–22.CrossRefPubMed
3.
Machisa M, Jewkes R, Morna C, Rama K. The war at home: gender based violence indicators project. In: Gauteng research report. Johannesburg, South Africa: Gender Links & South African Medical Research Council; 2011.
4.
Jewkes R, Sikweyiya Y, Morrell R, Dunkle K. Gender inequitable masculinity and sexual entitlement in rape perpetration South Africa: findings of a cross-sectional study. PLoS One. 2011;6(12):e29590.CrossRefPubMedPubMedCentral
5.
Devries K, Mak J, Bacchus L, Child J, Falder G, Petzold M, Astbury J, Watts C. Intimate partner violence and incident depressive symptoms and suicide attempts: a systematic review of longitudinal studies. PLoS Med. 2013;10(5):e1001439.CrossRefPubMedPubMedCentral
6.
Foran HM, O’Leary KD. Alcohol and intimate partner violence: a meta-analytic review. Clinical Psychology Rev. 2008;28(7):1222–34.CrossRef
7.
Jewkes R, Dunkle K, Nduna M, Shai N. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet. 2010;376(9734):41–8.CrossRefPubMed
8.
WHO, UN-Habitat. Hidden Cities: unmasking and overcoming health inequities in urban settings. Geneva: WHO and UN-Habitat; 2010.
9.
Thomas L, Vearey J, Mahlangu P. Making a difference to health in slums: an HIV and African perspective. Lancet. 2011;377(9777):1571–2.CrossRefPubMed
10.
Greif MJ, Nii-Amoo Dodoo F, Jayaraman A. Urbanisation, poverty and sexual behaviour: the tale of five African Cities. Urban Stud. 2011;48(5):947–57.CrossRefPubMed
11.
WHO. Our Cities, our health, our future: acting on social determinants for health equity in urban settings. Geneva: WHO; 2008.
12.
Rehle T, Shisana O, Pillay V, Zuma K, Puren A, Parker W. National HIV incidence measures - new insights into the South African epidemic. Samj S Afr Med J. 2007;97(3):194–9.PubMed
13.
Shisana O, Rehle T, Simbayi LC, Zuma K, Jooste S, Zungu N, Labadarios D, Onoya D. South African national HIV prevalence, incidence and behaviour survey, 2012. Cape Town: HSRC Press; 2014.
14.
Jewkes R, Gibbs A, Jama-Shai N, Willan S, Misselhorn A, Mbatha N, Washington L, Mushinga M, Sikweyiya Y. Stepping stones and creating futures intervention: shortened interrupted time series evaluation of a behavioural and structural health promotion and violence prevention intervention for young people in informal settlements in Durban, South Africa. BMC Public Health. 2014;14:1325.CrossRefPubMedPubMedCentral
15.
Hunter M. Love in the time of AIDS: inequality, gender, and rights in South Africa. Durban: University of KwaZulu-Natal Press; 2010.
16.
Kamndaya M, Thomas L, Vearey J, Sartorius B, Kazembe L. Material deprivation affects high sexual risk behavior among young people in urban slums, South Africa. J Urban Health. 2014;91(3):581–91.CrossRefPubMedPubMedCentral
17.
Crush J, Drimie S, Frayne B, Caeser M. The HIVand urban food security nexus in Africa. Food Security. 2011;3:347–62.CrossRef
18.
Jewkes R, Morrell R. Gender and sexuality: emerging perspectives from the heterosexual epidemic in South Africa and implications for HIV risk and prevention. J Int AIDS Soc. 2010;13:6.PubMedPubMedCentral
19.
Silberschmidt M. Disempowerment of men in rural and urban East Africa: implications for male identity and sexual behavior. World Dev. 2001;29(4):657–71.CrossRef
20.
Gibbs A, Jewkes R, Sikweyiya Y, Willan S. Reconstructing masculinity? A qualitative evaluation of the Stepping stones and creating futures intervention in urban informal settlements in South Africa. Culture Health Sexuality. 2015;17(2):208–22.CrossRef
21.
Ellsberg M, Arango DJ, Morton M, Gennari F, Kiplesund S, Contreras M, Watts C. Prevention of violence against women and girls: what does the evidence say? Lancet. 2015;385(9977):1555–66.CrossRefPubMed
22.
Jewkes R, Flood M, Lang J. From work with men and boys to changes of social norms and reduction of inequities in gender relations: a conceptual shift in prevention of violence against women and girls. Lancet. 2015;385(9977):1580–9.CrossRefPubMed
23.
Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Puren A, Duvvury N. Impact of Stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. Brit Med J. 2008;337(7666):a506.CrossRefPubMedPubMedCentral
24.
Hossain M, Zimmerman C, Kiss L, Abramsky T, Kone D, Bakayoko-Topolska M, Annan J, Lehmann H, Watts C. Working with men to prevent intimate partner violence in a conflict-affected setting: a pilot cluster randomized controlled trial in rural Côte d’Ivoire. BMC Public Health. 2014;14(1):1.CrossRef
25.
Gibbs A, Willan S, Misselhorn A, Mangoma J. Combined structural interventions for gender equality and livelihood security: a critical review of the evidence from southern and eastern Africa and the implications for young people. J Int AIDS Soc. 2012;15(Supp 1):17362.PubMedCentral
26.
Pronyk PM, Hargreaves JR, Kim JC, Morison LA, Phetla G, Watts C, Busza J, Porter JD. Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial. Lancet. 2006;368(9551):1973–83.CrossRefPubMed
27.
Pronyk PM, Kim J, Abramsky T, Phetla G, Hargraves J, Morison LA, Watts C, Busza J, Porter JD. A combined microfinance and training intervention can reduce HIV risk behaviour in young female participants. AIDS. 2008;22:1659–65.CrossRefPubMed
28.
Gupta J, Falb KL, Lehmann H, Kpebo D, Xuan Z, Hossain M, Zimmerman C, Watts C, Annan J. Gender norms and economic empowerment intervention to reduce intimate partner violence against women in rural cote d'Ivoire: a randomized controlled pilot study. BMC Int Health Hum Rights. 2013;13(1):46.CrossRefPubMedPubMedCentral
29.
Bandiera O, Buehren N, Burgess R, Goldstein M, Gulesci S, Rasul I, Sulaiman M. Empowering Adolescent Girls: Evidence from a Randomized Control Trial in Uganda In: Washington: World Bank; 2012.
30.
31.
Raj A, Dasgupta A, Goldson I, Lafontant D, Freeman E, Silverman JG. Pilot evaluation of the making employment needs [MEN] count intervention: addressing behavioral and structural HIV risks in heterosexual black men. AIDS Care. 2014;26(2):152–9.CrossRefPubMed
32.
Gibbs A, Sikweyiya Y, Jewkes R. “men value their dignity”: securing respect and identity construction in urban informal settlements in South Africa. Glob Health Action. 2014;7(1):1–10.
33.
Jewkes R, Dunkle K, Koss MP, Levin JB, Nduna M, Jama N, Sikweyiya Y. Rape perpetration by young, rural South African men: prevalence, patterns and risk factors. Soc Sci Med. 2006;63(11):2949–61.CrossRefPubMed
34.
Housing Development Agency South Africa. Informal settlements – KwaZulu-Natal. Durban: HDA; 2011.
35.
Hayes R, Moulton L. Cluster randomised trials. 2009.
36.
Abramsky T, Devries K, Kiss L, Francisco L, Nekuti J, Musuya T, Kyegombe N, Starmann E, Kaye D, Michau L, et al. A community mobilisation intervention to prevent violence against women and reduce HIV/AIDS risk in Kampala, Uganda (the SASA! Study): study protocol for a cluster randomised controlled trial. Trials. 2012;13(96):1–22.
37.
Jewkes R, Nduna M, Jama-Shai N. Stepping stones South Africa: a training manual for sexual and reproductive health communication and relationship skills. Pretoria: MRC; 2010.
38.
Misselhorn A, Jama-Shai N, Mushinga M, Washington L, Mbatha N. Creating futures: supporting young people in building their livelihoods. HEARD: Durban; 2012.
39.
Welbourn A. Stepping stones: a training package in HIV/AIDS, communication and relationship skills. London: Strategies for Hope; 1995.
40.
Misselhorn A, Mushinga M, Jama-Shai N, Washington L. Creating futures: lessons from the development of a livelihood strengthening curriculum for young people in eThekwini’s informal settlements. Sex Education. 2014;14(5):543–55.CrossRef
41.
Gibbs A, Jewkes R, Mbatha N, Washington L, Willan S. Jobs, food, taxis and journals: complexities of implementing Stepping stones and creating futures in urban informal settlements in South Africa. Afr J AIDS Res. 2014;13(2):161–7.CrossRefPubMed
42.
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655.CrossRefPubMedPubMedCentral
43.
Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet. 2004;363(9419):1415–21.CrossRefPubMed
44.
Pulerwitz J, Barker G. Measuring attitudes toward gender norms among young men in Brazil development and psychometric evaluation of the GEM scale. Men Masculinities. 2008;10(3):322–38.CrossRef
45.
Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.CrossRef
46.
Diener E, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Assessment. 1985;49(1):71–5.CrossRef
47.
Saunders JB, Aasland OG, Babor TF, De la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791–804.CrossRefPubMed
48.
Jewkes R, Morrell R, Sikweyiya Y, Dunkle K, Penn-Kekana L. Transactional relationships and sex with a woman in prostitution: prevalence and patterns in a representative sample of South African men. BMC Public Health. 2012;12(1):325.CrossRefPubMedPubMedCentral
49.
Fleming PJ, McCleary-Sills J, Morton M, Levtov R, Heilman B, Barker G. Risk factors for Men’s lifetime perpetration of physical violence against intimate partners: results from the International men and gender equality survey (IMAGES) in eight countries. PLoS One. 2015;10(3):e0118639.CrossRefPubMedPubMedCentral
50.
Laurie H, Lynn P. The use of respondent incentives on longitudinal surveys. Methodol Longitudinal Surv. 2009:205–33.
51.
52.
Hidrobo M, Peterman A, Heise L. The effect of cash, vouchers and food transfers on intimate partner violence: evidence from a randomized experiment in northern Ecuador. International Food Policy Research Institute: Washington, D.C; 2013.
53.
Haushofer J, Shaprio J: Welfare Effects of Unconditional Cash Transfers: evidence from a randomised controlled trial in Kenya. In; 2013.
54.
Rabe-Hesketh S, Skrondal A. Multilevel and longitudinal modeling using Stata. College Station: STATA press; 2008.
55.
Engel B, Keen A. A simple approach for the analysis of generalizea linear mixed models. Statistica Neerlandica. 1994;48(1):1–22.CrossRef
56.
Wight D, Obasi AI. Unpacking the ‘black box’: the importance of process data to explain outcomes. In: Stephenson J, Imrie J, Bonell CP, editors. Effective sexual health interventions: issues in experimental evaluation. Oxford: Oxford Scholarship Online; 2003. p. 1–12.
57.
Wang C, Burris MA. Photovoice: concept, methodology, and use for participatory needs assessment. Health Educ Res. 1997;24(3):369–87.
58.
Gibbs A, Willan S, Jama-Shai N, Washington L, Jewkes R. ‘eh! I felt I was sabotaged!’: facilitators’ understandings of success in a participatory HIV and IPV prevention intervention in urban South Africa. Health Educ Res. 2015;30(6):985–95.CrossRefPubMedPubMedCentral
59.
Michaels-Igbokwe C, Abramsky T, Devries K, Michau L, Musuya T, Watts C. Cost and cost-effectiveness analysis of a community mobilisation intervention to reduce intimate partner violence in Kampala, Uganda. BMC Public Health. 2016;16(1):1.CrossRef
60.
Jan S, Ferrari G, Watts C, Hargraves J, Kim J, Phetla G, Morison LA, Porter JD, Barnett A, Pronyk PM. Economic evaluation of combined microfinance and gender training intervention for the prevention of intimate partner violence in rural South Africa. Health Policy Plan. 2012;26(5):366–72.
61.
Ellsberg M, Heise L. Researching violence against women: a practical guide for researchers and activists, (2005). Washington DC, United States: World Health Organization, PATH Google Scholar; 2005.
62.
Ellsberg M, Heise L. Putting women’s safety first: ethical and safety recommendations for research on domestic violence against women. Geneva, Switzerland: World Health Organization; 1999.
63.
Jewkes R, Sikweyiya Y, Nduna M, Shai NJ, Dunkle K. Motivations for, and perceptions and experiences of participating in, a cluster randomised controlled trial of a HIV-behavioural intervention in rural South Africa. Cult Health Sex. 2012;14(10):1167–82.CrossRefPubMed
64.
Sikweyiya YM, Jewkes R. Disclosure of child murder: a case study of ethical dilemmas in research. S Afr Med J. 2011;101(3):164–9.CrossRefPubMed
65.
Deitchler M, Ballard T, Swindale A, Coates J. Validation of a measure of household hunger for cross-cultural use. Washington, DC: Food and Nurtrition Technical Assistance II Project (FANTA-2), Acedemy for Educational Development; 2010.
Metadata
Title
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
Authors
Andrew Gibbs
Laura Washington
Samantha Willan
Nolwazi Ntini
Thobani Khumalo
Nompumelelo Mbatha
Yandisa Sikweyiya
Nwabisa Shai
Esnat Chirwa
Michael Strauss
Giulia Ferrari
Rachel Jewkes
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-017-4223-x

Other articles of this Issue 1/2017

BMC Public Health 1/2017 Go to the issue

Research article

Tobacco use among Kyrgyzstan medical students: an 11-year follow-up cross-sectional study

Research article

Predictors of early adulthood hypertension during adolescence: a population-based cohort study

Erratum

Erratum to: Social relationships, mental health and wellbeing in physical disability: a systematic review

Research article

Association between midlife health behaviours and transitions out of employment from midlife to early old age: Whitehall II cohort study

Research article

Big hearts, small hands: a focus group study exploring parental food portion behaviours

Research article

Why do parents enrol in a childhood obesity management program?: a qualitative study with parents of overweight and obese children