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ObjectiveTo test the effectiveness of the Safe at Home programme which was developed to improve family well-being and prevent multiple forms of violence in the home.DesignWaitlisted pilot cluster randomised controlled trial.SettingNorth Kivu, Democratic Republic of Congo.Participants202 heterosexual couples.InterventionThe Safe at Home programme.Primary and secondary outcome measuresThe primary outcome was family functioning, with secondary outcomes of past-3 month co-occurring violence, intimate partner violence (IPV) and harsh discipline. Pathway mechanisms assessed included attitudes related to acceptance of harsh discipline, gender equitable attitudes, positive parenting skills and power sharing within the couple.ResultsNo significant improvements in family functioning were documented for women (β=1.49; 95% CI: −2.75 to 5.74; p=0.49) and men (β=1.09; 95% CI: −3.13 to 4.74; p=0.69). However, women in Safe at Home reported a OR=0.15 (p=0.000), OR=0.23 (p=0.001) and OR=0.29 (p=0.013) change in co-occurring IPV and harsh discipline; physical/sexual/emotional IPV by their partner and use of physical and/or emotional harsh discipline against their child, respectively, as compared with women in the waitlisted group. Men participating in Safe at Home reported a OR=0.23 (p=0.005) change in perpetration of co-occurring violence, OR=0.26 (p=0.003) change in any form of IPV perpetration and OR=0.56 (p=0.19) change in use of harsh discipline against their child as compared with the waitlist arm. Positive changes were also noted in pathway variables around attitudes, skills and behaviours within couples.ConclusionThis pilot trial demonstrated the Safe at Home programme to be highly effective in preventing multiple forms of violence in the home and improving equitable attitudes and skills in couples. Future research should assess longitudinal impact and implementation at scale.Trial registration numberNCT04163549.

IntroductionThe study objective was to understand the effectiveness of Engaging Men through Accountable Practice (EMAP), a group-based discussion series which sought to transform gender relations in communities, on intimate partner violence (IPV), gender inequitable attitudes and related outcomes.MethodsA two-armed, matched-pair, cluster randomised controlled trial was conducted between 2016 and 2018 in eastern Democratic Republic of Congo. Adult men (n=1387) and their female partners (n=1220) participated in the study. The primary outcomes of the study were female report of past year physical and/or sexual IPV and men’s intention to commit violence. Secondary outcomes included men’s gender attitudes, women’s economic and emotional IPV, women’s perception of negative male behaviours and perceived quality of the relationship.ResultsMen in EMAP reported significant reductions in intention to commit violence (β=−0.76; SE=0.23; pConclusionInterventions engaging men have the potential to change gender attitudes and behaviours in conflict-affected areas. However, while EMAP led to changes in gender attitudes and behaviours related to perpetration of IPV, the study showed no overall reduction of women’s experience of IPV. Further research is needed to understand how working with men may lead to long-term and meaningful changes in IPV and related gender equitable attitudes and behaviours in conflict areas.Trial registration numberNCT02765139.

On 21 January 2017, millions of people across the globe stood up to demand that women's and girls' rights be respected and guaranteed. This call for global women's rights is especially critical at a time when the number of displaced persons totals 63.5 million—representing the highest global prevalence of displaced persons that the world has witnessed since World War II.1 Declining government stability and diminishing wealth are overwhelmingly viewed as the primary drivers of protracted and new conflicts that fuel such large-scale displacement. Yet, nearly a decade of research indicates that the status of women is also a critical predictor of a nation's security, and that women's rights must be safeguarded both in response to conflicts as well as an integral strategy towards preventing future humanitarian crises.2 This includes gender equity in educational attainment, political representation, economic empowerment, and safety in public and within the privacy of their homes. While equality and violence against women and girls has received high-level attention within global platforms, such as the 2030 Agenda for Sustainable Development,3 gaps remain regarding research on effective programmes that can reduce and prevent such violence from taking place. One in three women worldwide experience physical or sexual violence from a male partner (ie, intimate partner violence, hereafter IPV) at some point in their lifetime, and the health consequences have been extensively documented.4 In conflict-affected settings, IPV levels are higher, with lifetime prevalence estimates ranging from 20% to 59% within select conflict-affected countries in Sub-Saharan Africa.5 However, research and programmatic attention aiming to combat IPV in conflict settings are sparse. This is in part due to urgency in addressing basic health issues and physical infrastructure,6 donor and media prioritisation of sexual violence as a weapon of war without adequate attention to IPV, and logistical …