Intimate partner violence (IPV) and violence against children (VAC) are interlinked and are
major social, development and public health concerns. Globally it is estimated that
approximately 30% ever-partnered women worldwide have experienced physical and/or sexual
violence by an intimate partner at some point in their lives. IPV prevalence among women in
Uganda is very high. The Uganda Demographic and Health Survey 2018 found that 36% of women
had ever experienced partner physical violence, while 22% had ever experienced partner sexual
violence. Violence against children is extremely widespread globally, with approximately half
of all children - one billion aged 2-17 years - reporting having experienced violence in the
past year. Furthermore, one in five women and up to one in ten men have been victims of
sexual violence in childhood. The Uganda national VAC survey 2015 found that 59% girls and
68% boys had experienced physical violence in their childhood, and 35% girls and 17% boys had
experienced sexual violence in their childhood. Such violence in Uganda and most Sub-Saharan
African countries is usually perpetrated by people known to children in their homes and
community. IPV and VAC are major causes of morbidity and mortality, they undermine the social
functioning of the victims and their families, and have lifetime consequences for physical,
sexual, reproductive and mental health. The prevention of both forms of violence would
contribute to many Sustainable Development Goals since they strain health systems, lower
educational achievement and economic productivity, and undermine economic and social
development, and elimination of IPV is essential to Goal Five.
Many studies confirm the link between VAC and IPV, suggesting the need for an integrated
approach to their prevention. A recent narrative review identified six ways in which they are
interrelated: they have many shared risk factors, starting in the family; social norms
legitimise both and discourage children and women from seeking help; both often occur within
the same household both can be transmitted across generations; they can have similar
consequences across the lifespan, and finally, both intersect in adolescence, a time of
heightened vulnerability to violence.
Factors perpetuating IPV and VAC exist at multiple socio-ecological levels. For IPV, familial
level factors include having been abused as a child, having an absent or rejecting father,
inter-partner conflict, and male control of wealth and decision-making. Community level
factors include women's isolation and male peer groups that legitimize men's violence. At the
macro level IPV is associated with cultural norms that condone violence within the family,
schools and community, establish rigid gender roles and link masculinity to toughness, male
honour, dominance and ownership of women, and it thrives where policy, legislation and
implementation of laws is weak. VAC is more likely in families that have difficulties
developing stable, warm and positive relationships, where parents are unresponsive to their
children, have harsh or inconsistent parenting styles, believe that corporal punishment is an
acceptable form of discipline or have a poor understanding of child development, and
therefore unrealistic expectations about the child's behaviour.
Recognizing that IPV is perpetuated at multiple levels, preventative interventions often
focus on other psychosocial problems, e.g. poverty or alcohol abuse, as well as on
inter-partner violence, although they are more effective if their main aim is to reduce IPV.
The shared familial risk factors for IPV and VAC, and the increasing policy interest in
optimizing parenting influence, provides a great opportunity for early intervention. An
increasing number of parenting programs are being implemented and tested in LMICs to reduce
VAC, and evidence is emerging that, if delivered by trained lay workers, they can be
effective in improving child outcomes. However, interventions directly addressing early
prevention of both IPV and VAC in LMICS remain limited.
Furthermore, very few parenting programs in LMICs harness cultural drivers and pre-existing
motivations to change behaviour. In sub-Saharan Africa little attention has been paid to one
of the most important dimensions of parenthood for both mothers and fathers: the need to
maintain the family's respectability, in large part achieved through the appropriate
behaviour of the children and their parents. This core motivation might be harnessed in the
design of interventions to reduce spousal violence, modify negative parenting and encourage
sensitive parenting, in order to reduce children's future risk of sexual, physical and/or
emotional violence. In Uganda, the investigators are not aware of any parenting programs that
deliberately recruit parental couples to complete both single and mixed sex sessions. The
Investigators therefore designed a community-based parenting program, - Parenting for
Respectability (PfR), - to address this gap in Uganda, and contribute evidence on how a
parenting program can address both IPV and VAC. Following careful formative evaluation, the
investigators conducted a pre-post study to establish whether there was sufficient evidence
of effectiveness to warrant progression to a randomized controlled trial.
The programme has undergone formative evaluation (2014-16), 'Proof of Concept' pre-post
outcome evaluation (2016-2019), and with support from Evaluation Fund, is currently being
evaluated to assess implementation and scale-up modalities (April 2020-October 2021) in
central Uganda. The investment in developing PfR so far has provided important lessons about
the acceptability of PfR and how to refine it. Preliminary outcome evidence suggests that a
rigorous evaluation of PfR is warranted. The pre-post study has found significant change
across primary outcomes for both parent- and child-reports, including large effects for
reduced harsh parenting (Cohen's f2 = 0.42, p < .001) and dysfunctional spousal relationships
(Cohen's f2 = 0.28, p < .001), as well as increased positive parenting (Cohen's f2 = 0.48, p
< .001). The programme has been disseminated widely in Uganda (www.parenting.ug.org), and
both government and NGOs have expressed interest to scale it. However, two key uncertainties
remain: (i) the optimal way to scale up the intervention in a 'real-world setting', and (ii)
whether the evidence of effectiveness would be confirmed through a more rigorous,
experimental, evaluation. As a result, this study will combine a rigorous cluster randomised
control trial (cRCT) evaluation of PfR with an implementation study using a hybrid type 2
design to examine its effectiveness and cost-effectiveness as well as answer critical
contextually relevant implementation science questions. This is essential to ensure that
precious resources are not wasted and that there are no harmful unintended consequences from
the programme.