Leaders in Action (LIA) is a norms-centered intervention run by the Peruvian Ministry for
Women and Vulnerable Populations (MIMP) that aims to reduce the acceptance and incidence
of Intimate Partner Violence (IPV) in Peru by shifting social norms. LIA has two main
implementation phases: first, the recruitment of Community Health Volunteers (CHVs) and
second, the delivery of content against IPV. The delivery of the intervention is assisted
by MIMP professionals working in local "Women Emergency Centers" (Centro de Emergencia
Mujer, or CEM), a nationwide network of hubs run by the MIMP that offer wide-ranging
support services to IPV victims. The CEMs also implement other IPV prevention
interventions at the local level.
CEM's Promotors (MIMP's professionals working at local CEM) recruit leaders of local
social organizations and train them to be Facilitators of LIA. Facilitators are the
principal CHVs located in each district center who conduct LIA activities. Another type
of CHVs are leaders at the village-level who are trained by Facilitators to become
Community Agents (CAs). Both CAs and Facilitators work together to conduct the second
phase of LIA: the delivery of the intervention through its two delivery models, the
Household Treatment (HT) and the Group Treatment (GT).
Originally, the study was designed to only evaluate the HT. Thus, a first randomization
was conducted on our study sample with an even split of 125 control villages and 125
treatment villages. The research team and Innovations for Poverty Action (IPA) Peru
deployed a census to identify the population of women in sample villages who met the
eligibility criteria for the study, and conducted an in-depth baseline survey on women
who reported IPV in the census. The implementation of the HT began in 2020, and was
interrupted by the Covid-19 pandemic. The MIMP paused the program in March 2020 until
national lockdowns were rescinded in February 2022. Given the intense migration and other
demographic changes that took place during the 23-month interruption, as well as the
potential for new IPV exposure over that period, new census and baseline surveys were
conducted in 2022, which were used to define the final targeted sample for the
intervention.
Our study tests two different delivery modes of the program, the HT and the GT, as well
as their combination, in a cross-randomized design. The 250 villages in our study sample
were randomized into 4 treatment arms following a factorial randomization model. This
resulted in 62 villages receiving only the HT (HT only), 62 villages receiving only the
GT (GT only), 63 villages receiving both the HT and GT (HT+GT), and 63 villages in the
control group. The randomization procedure was stratified by CEM, the level of IPV risk,
and the 2018 treatment status (villages that had begun implementation of the HT were
restricted to remain in the HT only or HT+GT treatment arms).
The MIMP's original HT design followed a door-to-door delivery approach: CHVs, in
coordination with the local CEM, offered 8 treatment sessions to households at risk of
IPV. These HT sessions took place over a period of 1 to 2 months and were conducted in
participants' residences. While all adult household members were invited to participate,
the recipients of the HT were, in practice, primarily women. As a result, this delivery
mode may have been ineffective at influencing norms and beliefs of male participants. The
household-centered approach is also expensive and difficult to scale up. Thus, together
with the MIMP, the research team developed modifications to the HT which resulted in the
innovations described below.
First, in collaboration with the MIMP, the research team and IPA Peru developed a
telenovela-style series as a key component of the LIA program (edutainment component).
The series consists of four videos that reinforce themes of relationship conflict,
masculinity, and social norms around gender. The edutainment component was randomized for
the HT only treatment arm, so that in 31 villages, all households targeted for HT watched
the edutainment component as part of the program, and in other 31 villages, only 50% of
the households targeted for HT watched the edutainment component. In this second group,
the households selected to watch the edutainment videos were randomly selected, which
will allow the research team to experimentally identify the effect of the edutainment
videos. In the other treatment arms (GT only and HT+GT), the edutainment component is
implemented for all participants.
Second, in order to strengthen the effect of LIA and to reach potential perpetrators,
which are predominantly men, as well as victims of IPV, we developed a different delivery
format with the MIMP: the GT. The GT follows a gender-segregated yet community-wide
delivery approach in a group discussion format. Existing evidence suggests that
interventions which target both perpetrators and victims can have a substantial impact on
attitudes towards and the incidence of IPV, and that simultaneously addressing IPV from
different angles can be particularly effective (Chakraborty, P., Osrin, D. and Daruwalla,
N., 2020; Abramsky, T. et al., 2014). These approaches commonly stress the importance of
collaborative learning in support-group-style sessions to confront ideas of masculinity
and gender norms. Moreover, norms change is more likely to happen when individuals are
aware of relevant peers who are also changing their beliefs (Bursztyn, L., González, A.
L., Yanagizawa-Drott, D. (2018)). As a result, the investigators proposed separating
groups by gender to provide tailored settings during intervention.
This group-based approach entailed 4 GT workshops that integrated various activities
and group discussions focused on the same content as the HT. The group workshops
directed at men had a slightly different curriculum than those directed at women,
and always had at least one male CHV in the room facilitating the workshop. In order
to meet this criteria during implementation, the MIMP required a larger number of
male CHVs than those who were initially recruited through social organizations; men
are usually recruited in disproportionately low numbers for this style of volunteer
work, and the initial number of male CHVs was not sufficient for implementation of
the GT. As a result, male CHVs were recruited as program Facilitators from local
universities, communal associations, and other frequently-transited areas. GT
sessions took place over the course of one month in village community centers,
schools, churches, or other communal spaces where village residents would often
gather, and lasted for approximately two hours. Larger villages held multiple GT
sessions per workshop to cover all potential participants, and some villages were
re-visited some months after the expected implementation time to ensure a high
uptake.
Participant targeting during the GT was the same as in other treatment arms: MIMP
CHVs approached the houses of women in the targeted sample, and extended an
invitation for them and their male partners to participate in the intervention.
However, given that the GT is designed to involve the village community at large,
invitations for the GT were extended to all adults in the village. Households in the
targeted sample were approached door-to-door multiple times in the week before the
GT session, while the rest of the village households were only approached once per
workshop. Aside from door-to-door recruiting, the whole village received a notice an
hour before each GT session through a loudspeaker usually used for other
village-wide activities.
The topics covered during both the HT and GT were equivalent to ensure
comparability. These topics were: i) gender roles, beliefs and stereotypes; ii)
violence, cultural patterns and human rights; iii) healthy relationships within the
family; iv) respect between family members and self-care; v) assertive
communication; vi) resolution and conflict management; vii) resources for domestic
violence cases; and viii) leadership and women's agency.
Third, 50% of the villages assigned for either the HT only, GT only, or HT+GT treatment
arms (94 villages total) were randomly selected to target one village leader (e.g.
village president) to receive treatment given the village's treatment assignment. This
will evaluate if community leaders are impactful in shifting norms at the village level.
Fourth, we randomized 50 percent of the treated villages to target a random selection of
30% of women who were interviewed in the census but did not report ever experiencing any
form of IPV by their current partner. This will allow the research team to measure
community-level impacts of the intervention through treatment density.
After the conclusion of both the HT and the GT, a set of qualitative interviews were
conducted with the goal of informing the research team on the channels through which the
treatments could be reducing IPV, as well as capturing information relevant to the design
of the endline survey.
The research team plans to conduct an endline survey 6-months after the MIMP's
implementation of the HT and GT to evaluate the impact of the LIA program and its
different innovations on outcome measures such as: IPV, physical health, mental health,
tolerance towards IPV, female agency, and social norms.