Adapting an evidenced-based intervention to reduce IPV for use among young heterosexual couples in South Africa

Violence against women is common globally, with an estimate one-third of women experiencing this in their lifetime. In our previous work we have found that young (ages 18-30 years) women living in urban informal settlements experience even higher rates, with around two-thirds experiencing physical and/or sexual IPV in the past year.

While there are a growing number of interventions that seek to reduce violence against women, very few of them are successful for young women in urban informal settlements. In this project we seek to take one effective intervention - Stepping Stones and Creating Futures - and strengthen it to make it more effective, through delivering it to heterosexual couples.

In a prior study we showed that Stepping Stones and Creating Futures could reduce men's perpetration of IPV. Other studies have shown that working with couples, rather than 'individual' people can strengthen intervention outcomes. Our prior qualitative work supports this, with some men describing how in Stepping Stones and Creating Futures they worked with their female partner (not in the intervention) to improve outcomes. Another project we have just completed, which focused on young women in similar contexts, found that they thought a couples focused intervention would be beneficial for them.

In this project we will adapt Stepping Stones and Creating Futures for use with young (18-30) heterosexual couples living in urban informal settlements in Durban, South Africa. We will first undertake qualitative research with young people and local stakeholders to understand relationship dynamics, among young people. We will then adapt the Stepping Stones and Creating Futures theory of change, curriculum and implementation manuals for use with young couples, engaging extensively with young people in this process.

Throughout this work a central focus will be on ensuring women's safety in the project and in the revised intervention curriculum and implementation manuals. And we will undertake additional interviews and workshops to ensure this.

We will finally pilot the adapted intervention with 100 couples recruited through communities. We will focus on the acceptability, feasibility and safety of the intervention, with follow-up at 6 months. A secondary outcome will be to assess potential effects sizes of the intervention. If the intervention is promising we will write a protocol for a follow up trial to compare the couples intervention with the original intervention.

To ensure young people's meaningful engagement we will establish from the beginning of the project a Young People's Advisory Group, comprising of 10 young people (5 women, 5 men) from similar backgrounds to the communities we are targeting. This group will meet regularly and we will discuss the project with them, test sessions and receive feedback, shaping the project as we go through their engagement.

Strengthening effective IPV prevention interventions to make them more so is critical if we are to achieve SDG5.2 and maximise the cost-effectiveness of interventions. One effective intervention is Stepping Stones and Creating Futures (SSCF), which in an RCT reduced men's perpetration of IPV and alcohol use, and strengthen livelihoods. Preliminary qualitative work suggested some men worked with their main female partner to enact change.

In this project we will draw on Wight's Six steps in quality intervention development (6SQuID) framework to adapt SSCF for use with young heterosexual couples living in urban informal settlements in Durban, South Africa. We will initially focus on understanding the challenges and dynamics of young people in relationships in these contexts, the triggers for violence and the strategies they use to negotiate these. We will run a parallel process to understand the questions of safety of working with couples who may have complex relationships (e.g. hidden, and/or multiple) and how to ensure women's safety in such processes.

Drawing on these data we will then revise the theory of change for SSCF to make it useable with couples. We will then work with a group of young people to check the theory of change. Finally we will adapt SSCF curriculum and implementation manuals for use with young heterosexual couples, before conducting 'pre-tests' of interventions.

Once we have an adapted SSCF curriculum and implementation manual we will conduct an uncontrolled pilot with 6 months of follow-up. We anticipate we will first recruit 100 men, who will receive some intervention before recruiting their main female partner for the rest of the intervention. Our primary focus is on acceptability, feasibility and safety of the intervention. Our secondary outcome is an estimate of effect sizes on IPV in the intervention.

We will establish a Young People's Advisory Group (YPAG) who will meet regularly with the team.