Psychological and social impact of promoting positive masculinity in reducing gender-based violence

ISRCTN	ISRCTN14765686
DOI	https://doi.org/10.1186/ISRCTN14765686
Secondary identifying numbers	R2HC

Submission date: 18/07/2019
Registration date: 06/01/2020
Last edited: 14/10/2022

Recruitment status: No longer recruiting
Overall study status: Completed
Condition category: Other

Prospectively registered

Protocol

Statistical analysis plan

Results

Individual participant data

Record updated in last year

Plain English summary of protocol

Background and study aims
During the last two decades, the Democratic Republic of Congo (DRC) has been plagued by wars and violent conflicts whereby Sexual Gender-Based Violence (SGBV) constituted a major problem, particularly in the eastern part of the country. In the North and South Kivu, rape and sexual violence were used as a weapon of war. This study aims to provide empirical evidence about the psychological and social impact of the improved public health intervention in the reduction of SGBV, particularly the intervention that promotes positive masculinity. The study is restricted to the psychological and social impact on the Living Peace Intervention (LPint), which is a group therapeutic method implemented by Living Peace Institute aimed to promote positive masculinity by working with men perceived as violent by their communities in the North and South Kivu of the Democratic Republic of Congo (DRC). To this end, the primary aim is to measure the psychological and social impact of LPint by looking at GBV reduction and its consequences for the targeted men, their wives/partners, their children and their communities. The secondary aim assesses whether this change in behavior (i.e. reduced GBV) is mediated or moderated by a reduction in symptoms of Post-Traumatic Stress Disorder (PTSD) or other psychopathological conditions.

Who can participate?
Participants in the study include adult male and female (above 18 years of age) who will have expressed their ability to understand the study purpose and consent to take part in the study. They include male beneficiaries of Living Peace intervention (LPint), as well as male and female who have not benefited from Lpint. Approximately 800 male and 800 female will participate.

What does the study involve?
The Living Peace intervention in Eastern DRC, through a group therapeutic method, works with men who are perceived as violent by their communities. Through a 16-session, 16-week group therapeutic intervention. Selected participants sit together in groups of 15 men, the men work around the concept of Positive Masculinity to reduce Gender-Based Violence (GBV). Through promoting positive masculinity, men are assisted to develop alternative coping strategies to violence that are gender transformative and constructive in dealing with problems. Men are guided to internalize new norms on masculinities and gender relations that highlight men’s capacity and responsibility in promoting security and peace.

What are the possible benefits and risks of participating?
This study will help to understand the relationship between conflict and SGBV from the perpetrator perspective in relation to mental health, as well as how an intervention can reduce this problem. The study will enable to understand whether a change in men’s SGBV due to Living Peace intervention (LPint) is moderated or mediated by a reduction in symptoms of mental health conditions (i.e., PTSD, Depression, Alcohol abuse). Therefore, the study’s results are expected to be exploited (used) in the longer term to improve health results through more cost-effective public health interventions in humanitarian crises. Anticipated risks of participating include private or sensitive information that may damage the social standing or reputation of participants.

Where is the study run from?
The study will be carried out in 30 villages affected by the conflict in the North and South Kivu of the DRC where Living Peace Institute (LPI) is operating. Stakeholders include various research institutions and operational humanitarian organizations, as well as individual research experts, locally and internationally. Four key partner institutions include (1) the Center for Mental Health (CMH) of the University of Rwanda, College of Medicine and Health Sciences; (2) the Center for Gender Studies (CGS), University of Rwanda; (3) the Living Peace Institute (LPI) located in Goma; (4) the Institut Supérieur du Lac (ISL) that gives university-level training in mental health, clinical psychology and counselling based in Goma, DRC; as well as (5) trauma individual specialists.

When is the study starting and how long is it expected to run for?
The study started in 2018 and is expected to run for 2 years

Who is funding the study?
The study is funded by a registered charity in England and Wales that finds solutions to complex humanitarian problems through research and innovation (ELRHA) which means Enhancing Learning & Research for Humanitarian Assistance.

Who is the main contact?
Stefan Jansen (sjansen.ur@gmail.com).

Contact information

Dr Stefan Jansen
Scientific

KK 737 Street
Gikondo
Kigali
PO BOX 4285
Kigali
N/A
Rwanda

ORCID ID	0000-0001-5293-1673
Phone	+250784575900
Email	sjansen.ur@gmail.com

Study information

Study design	Randomized controlled trial
Primary study design	Interventional
Secondary study design	Cluster randomised trial
Study setting(s)	Community
Study type	Prevention
Participant information sheet	ISRCTN14765686_PIS_20Aug19.docx
Scientific title	Evaluating the psychological and social impact by promoting positive masculinity through the ‘Living Peace’ intervention (LPiNT) in DRC
Study acronym	LPiNT
Study objectives	1. Success of LPiNT implies GBV reduction 2. Success of LPiNT in GBV reduction is mediated by reduction of PSTD or other social pathological conditions
Ethics approval(s)	1. Approved 15/04/2019, University of Rwanda (UR), Research Ethical Review Board (PO Box 4285, Kigali, Rwanda; +252574302; jbgahutu@yahoo.com), no ref 2. Approved 18/06/2018, Institut Superieur du Lac Research Ethical Commission (PO Box 20, Goma, Democratic Republic of Congo; no tel; islsantementale@gmail.com), no ref 3. Approval extended 12/08/2020, University of Rwanda Research Ethical Board (PO Box 4285, Kigali, Rwanda; +252574302/+250786872933; sundayfrax@gmail.com), no ref
Health condition(s) or problem(s) studied	Sexual and gender-based violence
Intervention	This study will use a Cluster Randomized Controlled Trial (CRCT) with persons-level and cluster-level outcomes. The counterfactual is villages that are listed as being eligible for LPint, but where no group therapy sessions are happening. The unit of randomization is an LPint locality (LPint-L), mostly a village, where on average two or three LPint groups of 15 men can be formed. This design allows us to make comparisons between LPint-Ls so we can measure the impact of LPint on the level of communities. From a selected list of eligible LPint-Ls, we will randomly allocate half of the LPint-Ls to the treatment group and half to the control group. All eligible men in a LPint-L, for both treatment and control groups, are recruited in the study. Concerning the primary aim of measuring the psychological and social impact of LPint, this study will look at GBV reduction and its consequences for the targeted men, their wives/partners, their children and their communities. With regard to the secondary aim assessing whether change in behavior (i.e. reduced GBV) is mediated or moderated by a reduction in symptoms of post-traumatic stress disorder (PTSD) or other psychopathological conditions, the study will use standardized scales of PTSD and other psychopathological conditions to test whether they mediate or moderate the reduction of GBV. Finally, to contextualize empirical findings, we will use qualitative research, with individual and focus group interviews as methods, to understand cultural idioms of distress and cultural explanation models. A rotary method using papers was used for randomisation of villages. Through a 16-session, 16-week group therapeutic intervention. Selected participants sit together in groups of 15 men, the men work around the concept of Positive Masculinity to reduce Gender-Based Violence (GBV). Through promoting positive masculinity, men are assisted to develop alternative coping strategies to violence that are gender transformative and constructive in dealing with problems. Men are guided to internalize new norms on masculinities and gender relations that highlight men’s capacity and responsibility in promoting security and peace. The group therapy sessions are led by the facilitators of the case/experimental group. This means that they are selected based on merit. They are trained to facilitate group therapy sessions by the LP Master trainers (who are mostly psychologists) based on the LP Intervention. These master trainers do a monthly clinical supervision to make sure the group therapy is going as planned. Data will be collected in three rounds: baseline (before the group therapy session start), endline1 (immediately after the end of the group therapy sessions), and endline2 (1 full year after the end of the group therapy sessions). This will allow for a quantitative measure of the impact of LPint immediately after and 1 year after. In addition, at baseline, some participants will be randomly selected to participate in qualitative focus group discussions or individual in-depth interviews.
Intervention type	Behavioural
Primary outcome measure	Collected at baseline, immediately post-therapy (16 weeks), and 1 year post-therapy: 1. The impact on men is measured using a standardised questionnaire (IMAGES survey), interviews (individual and focus group) and fieldwork notes 2. The impact on families is measured using a standardised questionnaire (IMAGES survey), interviews (individual and focus group) and fieldwork notes 3. The impact on communities is measured using a standardised questionnaire (IMAGES survey), interviews (individual and focus group) and fieldwork notes
Secondary outcome measures	Collected at baseline, immediately post-therapy (16-weeks), and one-year post-therapy: 1. Symptoms of PTSD are measured using a standardised questionnaire (IMAGES survey), interviews (individual and focus group) and fieldwork notes 2. Symptoms of depression are measured using a standardised questionnaire (IMAGES survey), interviews (individual and focus group) and fieldwork notes 3. Symptoms of alcohol abuse are measured using a standardised questionnaire (IMAGES survey), interviews (individual and focus group) and fieldwork notes
Overall study start date	01/06/2018
Completion date	30/11/2021

Eligibility

Participant type(s)	Mixed
Age group	Adult
Sex	Both
Target number of participants	800
Key inclusion criteria	Able to understand and give informed consent
Key exclusion criteria	Minors
Date of first enrolment	01/07/2018
Date of final enrolment	31/07/2018

Locations

Countries of recruitment

Congo, Democratic Republic

Study participating centres

Bandare

South Kivu
N/A
Congo, Democratic Republic

Bwegera

South Kivu
N/A
Congo, Democratic Republic

Katogota

South Kivu
N/A
Congo, Democratic Republic

Lubarika

South Kivu
N/A
Congo, Democratic Republic

Luvungi 1

South Kivu
N/A
Congo, Democratic Republic

Luvungi 2

South Kivu
N/A
Congo, Democratic Republic

Mirungu

South Kivu
N/A
Congo, Democratic Republic

Ndolera

South Kivu
N/A
Congo, Democratic Republic

Nyamutiri

South Kivu
N/A
Congo, Democratic Republic

Quartier Kasha

South Kivu
N/A
Congo, Democratic Republic

Quartier Mukukwe

South Kivu
N/A
Congo, Democratic Republic

Quartier Panzi

South Kivu
N/A
Congo, Democratic Republic

Quartier Karhale

South Kivu
N/A
Congo, Democratic Republic

Quartier Lumumba

South Kivu
N/A
Congo, Democratic Republic

Quartier Nyakavogo

South Kivu
N/A
Congo, Democratic Republic

Bethel