Effectiveness of community-based health education intervention on knowledge, attitudes, and controlling behaviors related to intimate partner violence in Hadiya Zone, Central Ethiopia: a cluster randomized controlled trial

BACKGROUND: In Ethiopia, a substantial proportion of women experience physical, psychological, or sexual violence perpetrated by their husbands or intimate partners. There is limited evidence on interventions aiming to improve awareness, alter attitudes, and control behavior related to IPV in Ethiopia. Therefore, this study aimed to evaluate the effectiveness of community-based health education (CBHE) targeting couples on knowledge, attitudes, and controlling behavior among women in Hadiya zone, central Ethiopia. METHODS: A community-based, parallel-group, two-arm cluster randomized controlled trial design was employed to evaluate the effect of a CBHE intervention on knowledge, attitude, and controlling behavior related to IPV in Hadiya zone, central Ethiopia. A total of 432 women (216 in the intervention groups and 216 in the control groups) were involved in the study. The intervention was provided for couples over a period of six consecutive months. Generalized Estimating Equation (GEE) and difference-in-difference analysis were conducted to evaluate the effectiveness of the intervention on the outcomes. RESULTS: About 94.4% of the mothers in the intervention groups and 95% of the women in the control groups were available for intention-to-treat analysis at the end of the intervention. Women in the intervention groups were about 5 times more likely to have good knowledge of IPV than those in the control groups (AOR = 4.8; 95% CI 2.9-7.9). Mothers in the intervention were 70% less likely to have a supportive attitude towards wife-beating compared to mothers in the control group (AOR = 0.3; 95% CI 0.2, 0.5). Likewise, mothers in the intervention groups were 60% less likely to justify controlling behavior from their husbands compared to those in the control groups (AOR = 0.4; 95% CI 0.3, 0.7). CONCLUSIONS: This study highlights that CBHE intervention led to a significant improvement in participants' knowledge of IPV against women. It also resulted in a marked reduction in the acceptance of wife-beating and justification of controlling behaviors. These findings provide strong evidence to support the broader scale-up of this intervention. TRIAL REGISTRATION: This trial was recorded in the ClinicalTrials.gov registry with the identifier NCT05856214 on May 4, 2023.