Description

IPV is a major global public health concern affecting millions of women worldwide, with caregivers of young children particularly vulnerable. IPV undermines women's health and wellbeing and disrupts caregiving environments, parenting practices, and early child development. While parenting interventions have demonstrated benefits for child outcome, few explicitly integrate violence prevention and gender-transformative components. This study is a cluster-randomized controlled trial designed to generate rigorous evidence on the effectiveness, implementation, and scalability of Familia Imara, a couples-focused, group-based parenting intervention that integrates nurturing care content with gender-transformative and violence prevention approaches and is delivered by CHWs.

The study will be conducted in the Mara and Geita regions of Tanzania using a multi-stage sampling strategy, including ward, village, and household selection. Villages will be randomly assigned to either the intervention or control arm. In each village, approximately 14 couples with a child under two years of age will be enrolled per cohort.

The trial will be implemented in two sequential cohorts to assess both effectiveness and pathways to scale. In Cohort 1, intervention villages will receive the Familia Imara program delivered by trained CHWs. Training, mentorship, and supervision of CHWs will be led primarily by implementing partners, in collaboration with government supervisors. Control villages will serve as a waitlist comparison group and will not receive the intervention during this phase. In Cohort 2, the same villages will retain their original study arm assignment. In intervention villages, the same CHWs will deliver the program to newly formed groups of eligible caregivers. During this phase, re-training, mentorship, and supervision will be led primarily by government supervisors, with reduced involvement from implementing partners, to assess the feasibility of scale-up and integration into existing government systems. In control villages, the waitlist control condition will end, and CHWs from these villages will be newly trained to deliver the intervention. Program delivery in these villages will follow a model similar to Cohort 1, with joint involvement of implementing partners and government supervisors.

The Familia Imara program consists of group sessions delivered twice monthly over approximately 10 months, including a mixture of joint couples' sessions and separate peer group sessions for mothers and fathers. Core content includes responsive caregiving, play and communication, nutrition and infant and young child feeding, positive discipline, gender norms, non-violent conflict resolution, and prevention of IPV.

Cohort 1 will enroll approximately 2,072 couples (4,144 individuals), consisting of 2,072 mothers and 2,072 fathers who are partnered with each other. In Cohort 2, an additional 1,036 new couples (2,072 individuals) will be enrolled in the intervention villages that previously received the program. Quantitative surveys will be administered at baseline and follow-up time points to assess changes in outcomes within and between study arms over time, as well as differences across delivery models.