Impact evaluation of the Care Tipping Point Initiative in Nepal: study protocol for a mixed-methods cluster randomised controlled trial

• Type of Material: Article
• Authors: Kathryn Yount, Emory University; Cari Clark, Emory University; Irina Bergenfeld, Emory University; Zara Khan, Emory University; Yuk Cheong, Emory University; Sadhvi Kalra, CARE USA; Sudhindra Sharma, Interdisciplinary Analysts (IDA); Shuvechha Ghimire, Interdisciplinary Analysts (IDA); Ruchira T Naved, International Centre for Diarrhoeal Disease Research Bangladesh; Kausar Parvin, International Centre for Diarrhoeal Disease Research Bangladesh; Mahfuz Al Mamun, International Centre for Diarrhoeal Disease Research Bangladesh; Aloka Talukder, International Centre for Diarrhoeal Disease Research Bangladesh; Anne Laterra, CARE USA; Anne Sprinkel, CARE USA
• Language: English
• Date: 2021-01-01
• Publisher: BMJ PUBLISHING GROUP
• Publication Version: Final Published Version
• Copyright Statement: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/bmjopen-2020-042032
• Title of Journal or Parent Work: BMJ OPEN
• Volume: 11
• Issue: 7
• Start Page: e042032
• End Page: e042032
• Grant/Funding Information: The Nepal Tipping Point Ttrial is supported through a research grant from the Kendeda Fund to CARE USA and subawarded to Emory University.
• Keywords: General & Internal Medicine; Life Sciences & Biomedicine; Medicine, General & Internal; public health; RIGHTS; qualitative research; ASSOCIATION; statistics & research methods; HEALTH; Science & Technology; PROPENSITY SCORE; child protection; GIRL CHILD MARRIAGE
• Research Categories: Sociology, General; Health Sciences, Public Health

Abstract

Introduction Girl child, early and forced marriage (CEFM) persists in South Asia, with long-term consequences for girls. CARE's Tipping Point Initiative (TPI) addresses the causes of CEFM by challenging repressive gender norms and inequalities. The TPI engages different participant groups on programmatic topics and supports community dialogue to build girls' agency, shift inequitable power relations, and change community norms sustaining CEFM. Methods/analysis The Nepal TPI impact evaluation has an integrated, mixed-methods design. The quantitative evaluation is a three-arm, cluster randomised controlled trial (control; Tipping Point Programme (TPP); TPP+ with emphasised social norms change). Fifty-four clusters of ∼200 households were selected from two districts (27:27) with probability proportional to size and randomised. A household census ascertained eligible study participants, including unmarried girls and boys 12-16 years (1242:1242) and women and men 25+ years (270:270). Baseline participation was 1134 girls, 1154 boys, 270 women and 270 men. Questionnaires covered agency; social networks/norms; and discrimination/violence. Thirty in-depth interviews, 8 key-informant interviews and 32 focus group discussions were held across eight TPP/TPP+ clusters. Guides covered gender roles/aspirations; marriage decisions; girls' safety/mobility; collective action; perceived shifts in child marriage; and norms about girls. Monitoring involves qualitative interviews, focus groups and session/event observations over two visits. Qualitative analyses follow a modified grounded theory approach. Quantitative analyses apply intention to treat, regression-based difference-in-difference strategies to assess impacts on primary (married, marriage hazard) and secondary outcomes, targeted endline tracing and regression-based methods to address potential selection bias. Ethics/dissemination The Nepal Social Welfare Council approved CARE Nepal to operate in the study districts. Emory (IRB00109419) and the Nepal Health Research Council (161-2019) approved the study. We follow UNICEF and CARE guidelines for ethical research involving children and gender-based violence. Study materials are here or available on request. We will share findings through clinicaltrials.gov, CARE reports/briefs and publications. Trial registration number NCT04015856.