A combined motivational interviewing and behavioral couples therapy intervention to reduce intimate partner violence and alcohol use in South India

动机访谈和行为夫妻治疗相结合的干预措施，以减少印度南部的亲密伴侣暴力和酗酒

• 批准号: 10365818
• 负责人: Bibhav Acharya
• 金额: $ 66.03万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10365818
• 关键词: Address; Adherence; Aggressive behavior; Alcohol consumption; Alcohols; Asia; Attention; Automobile Driving; Behavior; Behavior Therapy; Behavioral; Breathalyzer Tests; Clinic; Clinical; Collaborations; Communication; Control Groups; Couples; Couples Therapy; Critical Pathways; Cues; Data; Education; Effectiveness of Interventions; Event; Family Violence; Funding; Future; Goals; HIV; Health; Health Professional; Health system; Heavy Drinking; Home; Husband; Impairment; India; Individual; Intention; Intervention; Interview; Intoxication; Marital Relationships; Maternal Health; Measures; Mediation; Mental Health; Meta-Analysis; Methods; Modeling; Nurses; Outcome; Participant; Perception; Pilot Projects; Population; Primary Health Care; Primary Nursing Care; Problem Solving; Process; Protocols documentation; Psychologist; Public Health; Questionnaires; Randomized; Randomized Controlled Trials; Recording of previous events; Reporting; Research; Research Infrastructure; Resource-limited setting; Risk; Risk-Taking; Role; Services; Sex Behavior; Sexually Transmitted Diseases; Site; Suicide attempt; Supervision; Target Populations; Testing; Therapeutic Intervention; Training; Treatment Efficacy; Trust; United States; United States National Institutes of Health; Violence; Vulnerable Populations; Wife; Woman; alcohol use disorder; anger management; base; cognitive process; cohort; conflict resolution; contingency management; coping; cost; disorder risk; evidence base; experience; follow-up; global health; group intervention; high risk behavior; improved; intervention refinement; intimate partner violence; mental training; motivational enhancement therapy; perpetrators; pilot test; primary care setting; primary outcome; reduced alcohol use; scale up; secondary outcome; sexual violence; skills; skills training; social cognitive theory; social stigma; successful intervention; suicidal risk; treatment as usual; treatment comparison; treatment group; violence perpetration

PROJECT SUMMARY/ABSTRACT A combined behavioral couples therapy and motivational interviewing intervention to reduce intimate partner violence and alcohol use in South India Globally, an estimated 30% of women have reported physical or sexual violence by an intimate partner in their lifetime. Women who report intimate partner violence (IPV) have worse short- and long-term health outcomes, including increased risk for sexually transmitted infections and HIV, poor maternal health outcomes, and increased risk for suicide attempts. Perpetrator Alcohol Use Disorder (AUD) increases risk taking behaviors, and impairs problem-solving and cognitive processes, which may drive IPV. The current scientific understanding of these urgent issues has following limitations: a) most interventions improve either IPV or AUD but not both outcomes; b) interventions that successfully improve both are delivered by highly trained mental health professionals, limiting access and scalability; and c) most interventions focus on either just the husband or the wife but not both. These limitations have led to a strong scientific and implementation gap of interventions that are feasible, effective, and scalable in low-resource settings to target both IPV and AUD. Our Indo-US collaborative team pilot tested an intervention to deliver behavioral couple’s therapy (BCT), based on principles derived from Social Cognitive Theory (SCT) to enhance couple’s communication, combined with contingency management to reduce alcohol use. This intervention was acceptable, feasible and showed preliminary efficacy of IPV and alcohol use in couples when the husband had AUD. We now propose to build on and extend this intervention to combine BCT with motivational interviewing (MI), delivered by primary care nurses, to reduce alcohol use and IPV among couples in India and to test this in a randomized controlled trial. Our research team has a long history of collaborative research in South Asia. Dr. Ekstrand has a 25 year history of research in India, supported by 11 NIH-funded studies where she was the PI or MPI, six of which were at the proposed site. Drs. Acharya and Ekstrand currently oversee two NIH-funded R34 and R21 studies in South Asia successfully using MI. Dr. Srinivasan has led several studies that examined the relationship between AUD and high-risk behavior, including IPV, and was the senior PI of our pilot intervention on which this proposal is based. Dr Srinivasan has also been MPI on three NIH-funded R01 studies with Dr. Ekstrand. We propose to build on this evidence base and robust research infrastructure at primary health clinics at our South India site. We will conduct a randomized controlled trial (n= 400 couples) and study the impact of BCT and MI in reducing IPV and AUD. The intervention will be delivered by nurses in primary health centers who will be supervised by a clinical psychologist. We will perform intention to treat analyses to compare treatment and control groups on the two primary outcomes at 12-months follow-up: 1) mean scores on the Indian Family Violence and Control Scale and 2) number of days with a negative breathalyzer test over a 1-week period. We will assess secondary outcomes and other measures to conduct mixed-methods analyses to assess the theorized mechanisms of change influencing intervention effectiveness. If successful, our study will provide evidence for a low-cost couples’ intervention for IPV and AUD that can be delivered in primary care settings.

项目摘要/摘要 联合行为伴侣疗法和动机访谈干预措施，以减少亲密 印度南部的伴侣暴力和饮酒 在全球范围内，估计有30％的妇女报告了亲密伴侣的身体或性暴力 寿命。举报亲密伴侣暴力（IPV）的妇女的短期和长期健康状况更糟， 包括增加性传播感染和艾滋病毒的风险增加，遗嘱健康状况不佳以及 自杀企图的风险增加。肇事者饮酒障碍（AUD）增加了冒险行为， 并损害解决问题的过程和认知过程，这可能会驱动IPV。当前的科学 了解这些紧急问题有以下局限性：a）大多数干预措施改善IPV或AUD 但不是两个结果； b）成功改善两者的干预措施是由训练有素的精神 卫生专业人员，限制访问和可扩展性； c）大多数干预措施只关注丈夫 或妻子，但不是两者。这些局限性导致了巨大的科学和实施差距 可行，有效且可在低资源设置中可进行的干预措施，以针对IPV和AUD。 我们的Indo-US协作团队飞行员测试了一项干预措施，以提供行为夫妇的疗法（BCT），基于 关于从社会认知理论（SCT）得出的原则，以增强夫妻的交流 应急管理以减少饮酒。这种干预是可以接受的，可行的，并显示 丈夫有aud时，夫妻中IPV和酒精使用的初步效率。我们现在建议建造 并扩展此干预措施，以将BCT与基准提供的动机访谈（MI）相结合 护士，减少印度夫妇中的饮酒和IPV，并在一项随机对照试验中对其进行测试。 我们的研究团队在南亚拥有悠久的合作研究历史。 Ekstrand博士有25年 印度的研究历史，得到了11项NIH资助的研究，她是PI或MPI，其中6个 在拟议的地点。博士。 Acharya和Ekstrand目前监督两项NIH资助的R34和R21研究 在南亚成功使用MI。 Srinivasan博士领导了几项研究，研究了关系 在包括IPV在内的AUD和高风险行为之间，并且是我们的飞行员干预的高级PI 该提案是基于的。 Srinivasan博士也曾与Ekstrand博士进行三项NIH资助的R01研究。 我们建议在我们的初级健康诊所的证据基础和强大的研究基础设施基础上建立 南印度遗址。我们将进行一项随机对照试验（n = 400对夫妇），并研究BCT的影响 和MI减少IPV和AUD。干预措施将由护士的初级卫生中心进行 将由临床心理学家监督。我们将执行意图以治疗分析以比较治疗 在12个月的随访中，对两个主要结果的对照组：1）印度家庭的平均分数 暴力和控制量表以及2）在1周期间进行阴性育种者测试的天数。我们 将评估次要结果和其他措施，以进行混合方法分析以评估 变化的理论机制会影响干预效果。如果成功，我们的研究将提供 低成本夫妇干预IPV和AUD的证据可以在初级保健环境中提供。