The Economics of Domestic Violence: Evidence From Bangladesh

NCT06916377 | Active Not Recruiting DMC

• 1 other identifier: 2000026184
• Study Type: interventional
• Target: 440
• Locations: 1 country
• Sites: 1

Brief Summary

This project aims to test the scalability and cost-effectiveness of edutainment-soap operas designed to challenge harmful social norms and promote resilience-as a strategy to improve mental health and reduce intimate partner violence (IPV) in rural Bangladesh. Investigators will run a clustered randomized control trial in which villages will be randomized to one of three versions of the same soap opera: (i) Norms: Challenges harmful norms that condone IPV, targeting the belief that violence is an acceptable way to assert control or maintain reputation, (ii) Norms + Skills: builds on the norms campaign by adding CBT-based skills for stress management and non-violent conflict resolution, (iii) Placebo: No violence content. Investigators will evaluate the impact on attitudes towards IPV and IPV incidence.

Conditions

Intimate Partner Violence (IPV); Intimate Partner Violence Prevention

Outcome Measures

Primary Outcomes (11)

• Demographic and Health Survey (DHS) to assess Acceptability of IPV

  Standardized attitudinal questions from the Demographic and Health Survey (DHS), which capture whether violence is considered justified in specific situations to measure changes in husbands' personal attitudes towards IPV. Measured by the average score on a justification index across treatments. This index is a normalized index of how justified men think it is for a husband to use IPV.

  1 month post intervention

• Hypothetical vignettes to assess Acceptability of IPV

  Hypothetical vignettes, where respondents evaluate the likely and socially acceptable behavior of a hypothetical husband whose wife transgressed a gender norm. These vignettes mitigate social desirability bias and improve the accuracy of responses on sensitive topics to measure changes in husbands' personal attitudes towards IPV. Measured by the average level of violence respondents across treatments believe hypothetical husband will and should assign if the hypothetical wife transgresses. The scale will be between 0 and 5.

  1 month post intervention

• Hypothetical vignettes to assess Perceptions about others' acceptability of IPV.

  Husbands' perceptions about others' attitudes towards IPV were measured using the hypothetical vignettes. Respondents estimate the attitudes of the other surveyed men in their community using visual aids and stickers, each representing a different respondent. Hypothetical vignettes, where respondents evaluate the likely and socially acceptable behavior of a hypothetical husband whose wife transgressed a gender norm. These vignettes mitigate social desirability bias and improve the accuracy of responses on sensitive topics to measure changes in husbands' personal attitudes towards IPV. This will be measured by the average level of violence respondents across treatments believe other men in their community will assign if the hypothetical wife transgresses. The scale will be between 0 and 5.

  1 month post intervention

• Use of coping strategies to assess Men's resilience and mental health.

  Men's coping and emotional self-regulation strategies are measured using an index constructed from responses provided by their wives. This index includes selected questions on men's approaches to conflict management from the Revised Conflict Tactics Scale, adapted items from the Bengali version of the Brief Resilient Coping Scale that capture spouses' perceptions of men's behavior, and measures of substance use. IPV-related questions are intentionally excluded, as these behaviors represent a distinct conceptual category measured separately. To simplify interpretation, the index is standardized relative to the control group by subtracting the control group's mean and dividing by its standard deviation. Consequently, the resulting index has a mean of zero and a standard deviation of one within the control group. Higher values of the index indicate more positive coping styles and better emotional regulation.

  1 month post intervention

• Patient Health Questionnaire-9 (PHQ-9) to assess Men's resilience and mental health.

  Husbands' self-reported symptoms of depression measured using the PHQ-9 scale. PHQ-9 is a 9-item validated questionnaire used to screen for depression with a range of scores from 0-45. A cumulative score of ≥10 is considered positive with lower scores indicating no or mild anxiety.

  1 month post intervention

• Stressors and experiences to assess Men's resilience and mental health.

  Husbands' open-ended responses on daily stressors and positive experiences to measure husbands' resilience and emotional well-being. A summary index with two subcomponents is developed. First, a sub-index of daily events using an adapted version of the Daily Hassles and Uplifts Scale that includes items relevant to our target population. Second, a sub-index that aggregates men's appraisal of stressors and is based on the 10-item version of the Perceived Stress Scale validated in Bangladesh. Each subcomponent is standardized to have a mean of zero and a standard deviation of one for the control group. The summary index is defined as the equally weighted average of these standardized sub-indexes, with signs oriented so that higher values consistently indicate more favorable outcomes (fewer stressors and/or lower perceived stress).

  1 month post intervention

• Biometric stress indicators to assess Men's resilience and mental health.

  Biometric stress indicators, captured by Empatica E4 wristbands during sensitive survey modules, measuring physiological markers of emotional regulation and stress to measure husbands' resilience and emotional well-being. Specifically, electrodermal activity (EDA) data, expressed in microsiemens (μS), is used to analyze Skin Conductance Responses (SCRs). SCRs are quantified using a trough-to-peak (TTP) analysis, where the amplitude of each response is measured as the difference between the peak and the preceding trough within a defined time window. To identify event-related SCRs, a response window of 1 to 5 seconds following a stimulus is applied, with a minimum amplitude threshold of 0.01 μS to detect significant responses. The primary outcome variable is the sum of SCR amplitudes for significant responses. The average sum of SCR amplitudes across treatment groups is compared to assess differences in physiological stress responses.

  1 month post intervention

• Adapted version of the DHS to assess Prevalence and frequency of IPV.

  An adapted version of the DHS, covering physical, psychological, financial, and sexual violence. To enhance privacy and reduce misreporting, women use visual response tools to answer these questions privately to measure women's experiences of IPV. Measured by the average of a standardized IPV index. This is a normalized index which captures the frequency (never, very few times, sometimes, or very often) of women's reported experiences of IPV in the past six months. Higher values indicate higher frequency of IPV.

  1 month post intervention

• Number of participants with IPV-related injuries to assess Prevalence and frequency of IPV.

  Enumerators' reports of visible IPV-related injuries, such as bruises, documented using a standardized reporting protocol. Enumerators receive specialized training to identify and record signs of physical violence, with a focus on facial bruises and scratches, which remain visible even for veiled women to measure women's experiences of IPV.

  1 month post intervention

• Health assessments to assess Prevalence and frequency of IPV.

  Health assessments by community health workers, who check for IPV-related injuries to measure women's experiences of IPV. Measured by the percentage of female respondents across treatments on whom community health workers identify IPV-related injuries.

  1 month post intervention

• Incidence of IPV to assess Prevalence and frequency of IPV.

  Women's self-reports of IPV through rolling phone surveys six to twelve months post-intervention. Measured by the average of a standardized IPV index. This is a normalized index which captures the frequency (never, very few times, sometimes, or very often) of women's reported experiences of IPV in the past six months.

  Baseline and 6-12 months post intervention

Secondary Outcomes (5)

• Respectable man scale to assess Men's self-esteem.

  1 month post intervention

• Perceived respectabillity to assess Men's reputation

  1 month post intervention

• Cost-effectiveness of the edutainment campaigns assessed by Reduction to IPV exposure

  1 month post intervention

• Cost-effectiveness of the edutainment campaigns assessed by benefit-to-cost ratio

  1 month post intervention

• Cost-effectiveness of the edutainment campaigns assessed by benefit-to-cost ratio

  1 month post intervention

Study Arms (12)

Norms with Private Delivery

EXPERIMENTAL

Soap opera that challenges harmful norms that condone IPV, targeting the belief that violence is an acceptable way to assert control or maintain reputation Private Delivery Mode: Men watch the soap opera privately at home on handheld devices.

Behavioral: Edutainment Content: Norms Campaign

Norms + Skills with Private Delivery

EXPERIMENTAL

Soap opera that builds on the norms campaign by adding CBT-based skills for stress management and non-violent conflict resolution Private Delivery Mode: Men watch the soap opera privately at home on handheld devices.

Behavioral: Edutainment Content: Norms Campaign; Behavioral: Cognitive Behavioral Therapy (CBT)-based skills

Placebo with Private Delivery

EXPERIMENTAL

Soap opera that features unrelated content to serve as a control group, isolating the effects of norms and resiliency messaging. Private Delivery Mode: Men watch the soap opera privately at home on handheld devices.

Behavioral: Edutainment Content: Placebo Campaign

Norms with Public Delivery

EXPERIMENTAL

Soap opera that challenges harmful norms that condone IPV, targeting the belief that violence is an acceptable way to assert control or maintain reputation Public Delivery Mode: Men watch the soap opera publicly through community screenings.

Behavioral: Edutainment Content: Norms Campaign

Norms + Skills with Public Delivery

EXPERIMENTAL

Soap opera that builds on the norms campaign by adding CBT-based skills for stress management and non-violent conflict resolution Public Delivery Mode: Men watch the soap opera publicly through community screenings.

Behavioral: Edutainment Content: Norms Campaign; Behavioral: Cognitive Behavioral Therapy (CBT)-based skills

Placebo with Public Delivery

EXPERIMENTAL

Soap opera that features unrelated content to serve as a control group, isolating the effects of norms and resiliency messaging. Public Delivery Mode: Men watch the soap opera publicly through community screenings.

Behavioral: Edutainment Content: Placebo Campaign

Norms with Private Delivery and Cash-for-Work program

EXPERIMENTAL

Soap opera that challenges harmful norms that condone IPV, targeting the belief that violence is an acceptable way to assert control or maintain reputation Private Delivery Mode: Men watch the soap opera privately at home on handheld devices. Cash-for-Work: Small weekly payments for viewing and providing feedback on the media content.

Behavioral: Edutainment Content: Norms Campaign

Norms + Skills with Private Delivery and Cash-for-Work program

EXPERIMENTAL

Soap opera that builds on the norms campaign by adding CBT-based skills for stress management and non-violent conflict resolution Private Delivery Mode: Men watch the soap opera privately at home on handheld devices. Cash-for-Work: Small weekly payments for viewing and providing feedback on the media content.

Behavioral: Edutainment Content: Norms Campaign; Behavioral: Cognitive Behavioral Therapy (CBT)-based skills

Placebo with Private Delivery and Cash-for-Work program

EXPERIMENTAL

Soap opera that features unrelated content to serve as a control group, isolating the effects of norms and resiliency messaging. Private Delivery Mode: Men watch the soap opera privately at home on handheld devices. Cash-for-Work: Small weekly payments for viewing and providing feedback on the media content.

Behavioral: Edutainment Content: Placebo Campaign

Norms with Public Delivery and Cash-for-Work program

EXPERIMENTAL

Soap opera that challenges harmful norms that condone IPV, targeting the belief that violence is an acceptable way to assert control or maintain reputation Public Delivery Mode: Men watch the soap opera publicly through community screenings. Cash-for-Work: Small weekly payments for viewing and providing feedback on the media content.

Behavioral: Edutainment Content: Norms Campaign

Norms + Skills with Public Delivery and Cash-for-Work program

EXPERIMENTAL

Soap opera that builds on the norms campaign by adding CBT-based skills for stress management and non-violent conflict resolution Public Delivery Mode: Men watch the soap opera publicly through community screenings. Cash-for-Work: Small weekly payments for viewing and providing feedback on the media content.

Behavioral: Edutainment Content: Norms Campaign; Behavioral: Cognitive Behavioral Therapy (CBT)-based skills

Placebo with Public Delivery and Cash-for-Work program

EXPERIMENTAL

Soap opera that features unrelated content to serve as a control group, isolating the effects of norms and resiliency messaging. Public Delivery Mode: Men watch the soap opera publicly through community screenings. Cash-for-Work: Small weekly payments for viewing and providing feedback on the media content.

Behavioral: Edutainment Content: Placebo Campaign

Interventions

Edutainment Content: Norms Campaign BEHAVIORAL

Soap opera that challenges harmful norms that condone IPV, targeting the belief that violence is an acceptable way to assert control or maintain reputation.

Norms + Skills with Private Delivery; Norms + Skills with Private Delivery and Cash-for-Work program; Norms + Skills with Public Delivery; Norms + Skills with Public Delivery and Cash-for-Work program; Norms with Private Delivery; Norms with Private Delivery and Cash-for-Work program; Norms with Public Delivery; Norms with Public Delivery and Cash-for-Work program

Cognitive Behavioral Therapy (CBT)-based skills BEHAVIORAL

CBT-based skills for stress management and non-violent conflict resolution.

Norms + Skills with Private Delivery; Norms + Skills with Private Delivery and Cash-for-Work program; Norms + Skills with Public Delivery; Norms + Skills with Public Delivery and Cash-for-Work program

Edutainment Content: Placebo Campaign BEHAVIORAL

Soap opera that features unrelated non-violent content

Placebo with Private Delivery; Placebo with Private Delivery and Cash-for-Work program; Placebo with Public Delivery; Placebo with Public Delivery and Cash-for-Work program

Eligibility Criteria

• Age: 18 Years - 65 Years
• Gender Eligibility Details: Husband (male) and wife (female) from each household
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• married men and women over the legal age of majority in Bangladesh

Sponsors & Collaborators

• Yale University: lead
• Grand Challenges Canada: collaborator
• Weiss Foundation: collaborator
• World Bank - Sexual Violence Research Initiative (SVRI): collaborator
• Fund for Innovation in Development: collaborator
• USAID Development Innovation Ventures: collaborator
• The Agency Fund, International Growth Centre (IGC): collaborator
• National Science Foundation: collaborator

Study Sites (1)

BRAC University

Dhaka, Bangladesh

Location

MeSH Terms

Interventions

Cognitive Behavioral Therapy

Intervention Hierarchy (Ancestors)

Behavior Therapy; Psychotherapy; Behavioral Disciplines and Activities

Study Officials

• Nina Buchmann, PhD

  Yale University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: PREVENTION
• Intervention Model: FACTORIAL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Treatment assignment was stratified at the union level, the smallest administrative rural unit. From the two districts combined, a total of 88 unions were selected using Probability Proportional to Size (PPS). Each union contained 5 clusters (villages), yielding a total of 440 clusters. In each village, investigators randomly sampled 20 married couples aged 18-65, yielding a total of 8,800 married couples.

Study Record Dates

• First Submitted: March 31, 2025
• First Posted: April 8, 2025
• Study Start: September 19, 2023
• Primary Completion: December 1, 2025
• Study Completion: December 1, 2025
• Last Updated: April 8, 2025

Record last verified: 2025-03

Data Sharing

• IPD Sharing: Will not share

Locations

BA (1)