JMIR Publications

ABSTRACT

Background:

Intimate partner violence (IPV) disproportionately affects low-and middle-income countries (LMICs), like Nepal. Women experiencing IPV are at higher risk of developing depression, anxiety, and post-traumatic stress disorder. The shortage of trained frontline health care providers coupled with stigma related to IPV and mental health disorders fuels low service uptake among women experiencing IPV. Domestic Violence Intervention (DeVI) is a combination of ‘Problem Management Plus’ (PM+) developed by the World Health Organization with a violence prevention component.

Objective:

To implement and evaluate feasibility, acceptability, and effectiveness of the DeVI targeting secondary prevention of violence and addressing psychological distress among women experiencing IPV.

Methods:

A parallel cluster-randomized trial will be conducted in 24 health care facilities across eight districts in Madhesh Province, Nepal. Women aged 18-49 years, non-pregnant or pregnant in the 1st trimester with a history of IPV exposure in last 12 months, General Health Questionnaire (GHQ) (assessing current mental health) score of 3 or more, and having lived with a husband or in-laws for at least 6 months will be included in the study. A total sample size of 912 was calculated using 80% power and α at 0.05% to detect 15% absolute risk reduction in IPV frequency and 50% reduction in GHQ symptom score in the intervention arm. The health care facilities will be randomly assigned to either of the arm in ratio of 1:1. Women visiting health care facility in intervention and control cluster will be recruited in intervention and control arm respectively. Thirty eight participants in each health facility will be included in the trial to meet the desired sample size. Eligible participants allocated to either arm will be assessed at baseline and follow-ups (6 weeks, 17 weeks and 52 weeks after baseline).

Results:

This study was funded in 2019. Over 50% of eligible women have been recruited in both intervention and control sites. As of 29th December 2022, 269 eligible women in intervention arm and 309 eligible women in control arm have been enrolled in the trial.

Conclusions:

If the intervention is effective, it offers evidence on how non-specialists mental health care providers can address IPV associated harm in resource constrained, high IPV burden settings like Nepal. Study findings could also provide evidence to integrate similar services into routine health program in LMICs like Nepal to prevent IPV and manage mental health problems among women experiencing IPV. Clinical Trial: ClinicalTrials.gov NCT05426863; https://clinicaltrials.gov/ct2/show/NCT05426863