The goal of this uncontrolled intervention study is to assess whether Zithandani Stepping Stones and Creating Futures is feasible to deliver, acceptable for participants, safe for participants and to estimate effect sizes, in young (ages 18-40 years) heterosexual couples, living in urban informal settlements in eThekwini Municipality, South Africa. The main questions it aims to answer are: 1. Is Zithandani SSCF feasible to deliver to young couples, and what are the barriers and opportunities in intervention delivery? 2. Is Zithandani SSCF acceptable to participants? What do they like and what do they not like about the intervention? 3. Is Zithandani SSCF safe for female participants and do they engage adequately? 4. Does Zithandani SSCF show indication of positive change on key indicators and what are the effect sizes? Participants will be recruited as heterosexual couples and participate in 14 sessions, each approximately 3 hours long, with between 4 and 6 other couples, focused on gender norms, livelihoods and communication.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
PREVENTION
Masking
NONE
Enrollment
100
Delivered to heterosexual couples. 14 group based sessions, with each session lasting approximately 3 hours. Sessions are delivered by two trained facilitators. Intervention focused on transforming gender norms, strengthening communication, reducing symptoms of poor mental health and improving relationship dynamics. Mixture of couples focused, same-gender discussions, and whole group discussions.
South African Medical Research Council
Durban, South Africa
Physical IPV
Self-reports focused on men's perpetration and women's experience of physical intimate partner violence in the past 3 months, based on the WHO Violence Against Women Module - with 5 items. Recoded as a binary (yes/no)
Time frame: 6 months post baseline
Sexual IPV
Self-reports focused on men's perpetration and women's experience of sexual intimate partner violence in the past 3 months, based on the WHO Violence Against Women Module - with 3 items. Recoded as a binary (yes/no)
Time frame: 6 months post baseline
Emotional IPV
Self-reports focused on men's perpetration and women's experience of sexual intimate partner violence in the past 3 months, based on the WHO Violence Against Women Module - with 8 items. Recoded as a binary (yes/no)
Time frame: 6 months post baseline
Economic IPV
Self-reports focused on men's perpetration and women's experience of sexual intimate partner violence in the past 3 months, based on the WHO Violence Against Women Module - with 7 items. Recoded as a binary (yes/no)
Time frame: 6 months post baseline
Gender Attitudes
Attitudes in relation to gender and acceptability of violence (9 items) based on prior research in South Africa. Responses (Strongly Disagree to Strongly Agree) range 9-45, higher scores indicative of greater inequitable gender attitudes.
Time frame: 6 months post baseline
Violence towards children
Among those reporting a child living in their home, perpetration of physical and/or emotional abuse in the past 4 weeks against the child, using 4 items. Recoded into yes/no.
Time frame: 6 months post baseline
Trust in relationship/partner measured using the Dyadic Trust scale
8 Items forming the Dyadic Trust (Larzelere \& Huston, 1980), summed with range 8-45. Higher scores indicate more trust in relationship/partner.
Time frame: 6 months post baseline
Relationship Satisfaction
5 items (Woolf-King et al., 2019) focused on satisfaction in relationship, with scores from 0-50, and higher scores indicate greater satisfaction in relationship.
Time frame: 6 months post baseline
Fear of Emotional Intimacy
35 items, from (Descutner \& Thelen, 1991) responses Strongly Disagree to Strongly Agree (5 point Likert), range 35-175. Higher scores indicate greater fear of emotional intimacy.
Time frame: 6 months post baseline
Empathy for Partner assessed with the Interpersonal Reactivity Index for Couples (IRIC) scale.
13 items, Empathetic concern using the Interpersonal Reactivity Index for Couples (IRIC) scale. (Péloquin \& Lafontaine, 2010) summed together to create score. Score range: 0-52, with higher scores indicating greater empathy for partner.
Time frame: 6 months post baseline
Sexual Intimacy
13 items, drawn from Conroy et al. (2021), developed in Malawi, and previously used in South Africa. Responses: Strongly disagree to strongly agree (4 point Likert response). Individual items summed together to create a continuous score (13-52). Higher scores indicative of greater sexual intimacy
Time frame: 6 months post baseline
Communication with partner assessed using the Communications Pattern Questionnaire
11 items, from the Communications Pattern Questionnaire and previously used in South Africa (Woolf-King et al., 2019). Range 11-55, higher scores indicate 'better' communication with partner.
Time frame: 6 months post baseline
Depressive Symptoms assessed using the Patient Health Questionnaire - 9 (PHQ9)
Patient Health Questionnaire - 9 (PHQ9) asking about past 2 week symptoms of depression. Range 0-27. Higher scores indicative of more symptoms of depression.
Time frame: 6 months post baseline
Anxiety Symptoms assessed using the Generalised Anxiety Disorder 7 (GAD7) questionnaire
Generalised Anxiety Disorder 7 (GAD7) (Spitzer et al., 2006) asking about past 2 weeks symptoms of anxiety. Range 0-21. Highers scores indicative of more symptoms of anxiety.
Time frame: 6 months post baseline
Emotional Dysregulation assessed using the Difficulties in Emotional Regulation Scale 16
Difficulties in Emotional Regulation Scale 16 (DERS-16) - 16 items (Bjureberg et al., 2016) adapted for use in South Africa. Range 16-80, with higher scores indicating greater emotional dysregulation.
Time frame: 6 months post baseline
Alcohol Consumption in past 3 months, assessed with modified Alcohol use disorders identification test consumption (AUDIT C)
Alcohol use disorders identification test consumption (AUDIT C) (3 items). Rather than asking about past 12 months as is normal, items reworded to ask about past 3 months (e.g. In the last 3 months, how often do you have a drink containing alcohol?). Response options as in original scale. Scores range from 0-13, with higher scores indicating more alcohol consumption.
Time frame: 6 months post baseline
Earnings in past month
A single item question asks "Considering all the money you earned from jobs or selling things (excluding grants), how much did you earn last month?" Responses are in Rands (ZAR) and a continuous scale, with no upper limit.
Time frame: 6 months post baseline
Money participant saved in past month
A single item question asks "In the last month how much did you put aside for savings?" Responses are in Rands (ZAR) and are on a continuous scale, with no upper limit.
Time frame: 6 months post baseline
Hunger in the past month
Household food-security questionnaire (3 items) asking about hunger in the household in the past 4 weeks. Range 3-12 with higher scores indicative of greater food insecurity.
Time frame: 6 months post baseline
Frequency of work efforts
7 items asking about work effort in the past 3 months, adapted for use in South Africa. Scored 0-3, with range 0-21, with higher scores indicative of greater livelihoods effort.
Time frame: 6 months post baseline
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