‘Change really does need to start from home’: A Qualitative Exploration of Individual and Relationship Change in Married Couples in Nepal 公开

McGhee, Susi (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/7m01bk73c?locale=zh
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Abstract

Intimate Partner Violence (IPV) is a pervasive public health problem, affecting 30% of women

worldwide. In Nepal, approximately 33% of women report lifetime experience of IPV, and this is

even more prevalent in rural Nepal, where as many as 54% of women report lifetime physical or

sexual violence. Contributing factors include individual, interpersonal, community and societallevel

factors, and the interplay between them. Engaging men and couples together to reduce and

risk for IPV has been successful in numerous settings. Most effective have been gender

transformative interventions which incorporate reinforcing components, such as mass

communication, group education and community engagement activities. The Change Starts at

Home project is one such intervention which engaged married couples together to reduce and

prevent IPV through a social and behavior change communication strategy, Listening Discussion

Groups and community engagement and mobilization activities. Within the Change project, indepth

interviews were conducted with 18 married couples (n=36 individuals) to identify change

over time. Through theoretically driven analyses, this study analyzed in-depth interviews

conducted at five-months post-baseline. Case- and code-based analysis and thematic summaries

were used to assess individual- and relationship-level change, couple concordance and reporting

patterns within and among couples. Individual- and relationship-level changes emerged within all

couples. Individual changes included alcohol use and roaming tendencies in husbands.

Relationship-level changes comprised gendered labor roles, marital communication, marital and

sexual decision-making, quarreling and conflict resolution and experience of IPV. Engaging

couples in tandem curriculums successfully shifted individual behavior in men and marital

dynamics which underpin risk for IPV. More must be done to determine diffusion and

sustainability of such change over time.

Table of Contents

TABLE OF CONTENTS

CHAPTER I. INTRODUCTION ................................................................................................. 1

The Problem ........................................................................................................................... 1

Problem Justification .............................................................................................................. 1

Theoretical Framework ........................................................................................................... 2

Statement of Purpose .............................................................................................................. 2

CHAPTER II. BACKGROUND AND SIGNIFICANCE ............................................................. 3

Intimate Partner Violence ........................................................................................................ 3

Global and Regional IPV Prevalence ....................................................................................... 3

Associated Health Outcomes and Costs ................................................................................... 4

Contributing Factors to IPV Prevalence ................................................................................... 5

Previous Interventions............................................................................................................. 6

Theoretical Framework ........................................................................................................... 7

Study Aim .............................................................................................................................. 8

CHAPTER III. METHODS ......................................................................................................... 8

Study Context ......................................................................................................................... 8

Participants ............................................................................................................................. 9

Data Collection ....................................................................................................................... 9

Data Analysis........................................................................................................................ 10

CHAPTER IV. RESULTS ........................................................................................................ 11

Characteristics of Sample ...................................................................................................... 11

Individual-level Change ........................................................................................................ 13

Alcohol Use ...................................................................................................................... 13

Roaming Tendencies ......................................................................................................... 14

Relationship-level Change .................................................................................................... 16

Gendered Labor Roles ...................................................................................................... 16

Marital Communication .................................................................................................... 18

Marital and Sexual Decision-making ................................................................................ 21

Quarreling and Conflict Resolution .................................................................................. 24

Experience of IPV ............................................................................................................. 27

CHAPTER V. DISCUSSION .................................................................................................... 31

Findings ................................................................................................................................ 31

Conceptual Framework of Reported Individual- and Relationship-level Change .................... 32

Implications and Recommendations ...................................................................................... 34

Conclusion ............................................................................................................................ 34

REFERENCES ......................................................................................................................... 36

APPENDICES .......................................................................................................................... 41

Appendix A: In-depth Interview Instrument .......................................................................... 41

Appendix B: Couple Case Summary Matrix .......................................................................... 43

Appendix C: Couple Concordance Matrix ............................................................................. 44

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