title: Ecological pathways to prevention: How does the SASA! community mobilisation model work to prevent physical intimate partner violence against women?
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  ClinicalTrials.gov, NCT00790959 . Registered 13th November 2008. The study protocol is available at: http://www.trialsjournal.com/content/13/1/96.
authors.affiliation: Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. tanya.abramsky@lshtm.ac.uk.
authors.forename: Tanya
authors.initials: T
authors.lastname: Abramsky
authors.affiliation: Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Devries
authors.affiliation: Raising Voices, 16 Tufnell Drive, Kamwokya, P.O Box 6770, Kampala, Uganda.
authors.forename: Lori
authors.initials: L
authors.lastname: Michau
authors.affiliation: Raising Voices, 16 Tufnell Drive, Kamwokya, P.O Box 6770, Kampala, Uganda.
authors.forename: Janet
authors.initials: J
authors.lastname: Nakuti
authors.affiliation: Centre for Domestic Violence Prevention, 16 Tufnell Drive, Kamwokya, P.O Box 6770, Kampala, Uganda.
authors.forename: Tina
authors.initials: T
authors.lastname: Musuya
authors.affiliation: Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
authors.forename: Ligia
authors.initials: L
authors.lastname: Kiss
authors.affiliation: Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
authors.forename: Nambusi
authors.initials: N
authors.lastname: Kyegombe
authors.affiliation: Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Watts
mesh_terms: D000293:Adolescent; D000328:Adult; D003153:Community Health Services; D003430:Cross-Sectional Studies; D055669:Ecological and Environmental Phenomena; D005260:Female; D006801:Humans; D000066511:Intimate Partner Violence / Q000517:prevention & control* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D015397:Program Evaluation; D012044:Regression Analysis; D014454:Uganda; D055815:Young Adult
keywords: Community mobilisation; East Africa; Gender based violence; Impact evaluation; Intimate partner violence; Pathways analysis; Uganda; Violence prevention