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Qualitative interviews are increasingly being utilized within the context of intervention trials. While there is emerging assistance for conducting and reporting qualitative analysis, there are limited practical resources available for researchers engaging in a group coding process and interested in ensuring adequate Intercoder Reliability (ICR); the amount of agreement between two or more coders for the codes applied to qualitative text. Assessing the reliability of the coding helps establish the credibility of qualitative findings. We discuss our experience calculating ICR in the context of a behavioural HIV prevention trial for young women in South Africa which involves multiple rounds of longitudinal qualitative data collection. We document the steps that we took to improve ICR in this study, the challenges to improving ICR, and the value of the process to qualitative data analysis. As a result, we provide guidelines for other researchers to consider as they embark on large qualitative projects.

IntroductionCash payments to vulnerable households and/or individuals have increasingly garnered attention as a means to reduce poverty, improve health and achieve other development‐related outcomes. Recent evidence from Malawi and Tanzania suggests that cash transfers can impact HIV‐related behaviours and outcomes and, therefore, could serve as an important addition to HIV prevention efforts.DiscussionThis article reviews the current evidence on cash transfers for HIV prevention and suggests unresolved questions for further research. Gaps include (1) understanding more about the mechanisms and pathways through which cash transfers affect HIV‐related outcomes; (2) addressing key operational questions, including the potential feasibility and the costs and benefits of different models of transfers and conditionality; and (3) evaluating and enhancing the wider impacts of cash transfers on health and development.ConclusionsOngoing and future studies should build on current findings to unpack unresolved questions and to collect additional evidence on the multiple impacts of transfers in different settings. Furthermore, in order to address questions on sustainability, cash transfer programmes need to be integrated with other sectors and programmes that address structural factors such as education and programming to promote gender equality and address HIV.

There is increasing evidence that cash transfer (CT) programs decrease intimate partner violence (IPV). However, little is known about how CTs achieve this impact. We conducted a mixed-method review of studies in low- and middle-income countries (LMICs). Fourteen quantitative and eight qualitative studies met our inclusion criteria, of which eleven and five, respectively, demonstrated evidence that CTs decrease IPV. We found little support for increases in IPV, with only two studies showing overall mixed or adverse impacts. Drawing on these studies, as well as related bodies of evidence, we developed a program theory proposing three pathways through which CT could impact IPV: (a) economic security and emotional well-being, (b) intra-household conflict, and (c) women's empowerment. The economic security and well-being pathway hypothesizes decreases in IPV, while the other two pathways have ambiguous effects depending on program design features and behavioral responses to program components. Future studies should improve IPV measurement, empirical analysis of program mechanisms, and fill regional gaps. Program framing and complementary activities, including those with the ability to shift intra-household power relations are likely to be important design features for understanding how to maximize and leverage the impact of CTs for reducing IPV, and mitigating potential adverse impacts. Intimate partner violence. Domestic violence. Cash transfers. Women's empowerment.

There is increasing evidence that cash transfer (CT) programs decrease intimate partner violence (IPV). However, little is known about how CTs achieve this impact. We conducted a mixed-method review of studies in low- and middle-income countries (LMICs). Fourteen quantitative and eight qualitative studies met our inclusion criteria, of which eleven and five, respectively, demonstrated evidence that CTs decrease IPV. We found little support for increases in IPV, with only two studies showing overall mixed or adverse impacts. Drawing on these studies, as well as related bodies of evidence, we developed a program theory proposing three pathways through which CT could impact IPV: (a) economic security and emotional well-being, (b) intra-household conflict, and (c) women's empowerment. The economic security and well-being pathway hypothesizes decreases in IPV, while the other two pathways have ambiguous effects depending on program design features and behavioral responses to program components. Future studies should improve IPV measurement, empirical analysis of program mechanisms, and fill regional gaps. Program framing and complementary activities, including those with the ability to shift intra-household power relations are likely to be important design features for understanding how to maximize and leverage the impact of CTs for reducing IPV, and mitigating potential adverse impacts. Intimate partner violence. Domestic violence. Cash transfers. Women's empowerment. ; PR ; IFPRI3; ISI; CRP2; G Cross-cutting gender theme; Cash Transfer and Intimate Partner Violence Research Collaborative ; PHND; PIM ; 41 pages ; CGIAR Research Program on Policies, Institutions, and Markets (PIM)

AbstractIntroductionTransactional sex or material exchange for sex is associated with HIV infection among adolescent girls and young women in sub‐Saharan Africa. The motivations for engaging in transactional sex vary from the fulfilment of basic needs, to enhancing social status or for romantic reasons with the expectation that men should provide. Transactional sex is also associated with HIV risk behaviours, such as multiple sexual partners and other determinants of HIV risk, including partner violence and abuse, alcohol consumption and inconsistent condom use.MethodsWe use data from a mixed‐method, cluster randomised controlled trial of the Ujana Salama cash "plus" intervention in rural Tanzania. The data are from the first and third rounds of data collection (2017–2019). The impact evaluation consisted of a parallel mixed‐methods design where the quantitative and qualitative data collection occurred simultaneously, and integration of the findings was done during the discussion. We first examine contextual factors associated with transactional sex using multivariable logistic regression models and then estimate whether the "plus" intervention reduced transactional sex among adolescent girls and young women using analysis of covariance. We used thematic content analysis for analysing qualitative transcripts.ResultsThe prevalence of transactional sex among unmarried adolescent girls and young women at round 3 was 26%. Findings show that increasing age is a risk factor for transactional sex (OR = 1.80; 95% CI: [1.50, 2.17]), staying in school was negatively associated with engagement in transactional sex (OR = 0.24; 95% CI: [0.14, 0.40]). The cash plus intervention showed no impacts on reducing transactional sex (β = 0.003, p = 0.905).ConclusionsThe mechanisms of impact for a cash plus intervention on transactional sex are complex; economic insecurity is an important driver of transactional sex and HIV infection, but psychosocial factors and gendered social norms need consideration in intervention development. Our findings suggest that combination prevention interventions to address the structural drivers of HIV infection should focus on efforts to increase school enrolment and completion.

There is evidence that cash transfers reduce intimate partner violence (IPV), but less is known about the impacts of public works and complementary programmes on IPV. Using mixed-methods we examined whether and how the Ethiopian government's public works programme (that includes cash and/or food for work) alongside complementary activities that engage women and men affected IPV. We analysed midline data collected in July–October 2019 from a randomised controlled trial (RCT) designed to measure the added impacts of the complementary programming in the Amhara and Oromia regions. Eligible households for this analysis had at least one child aged 0–35 months and a primary female caregiver who was married, and under 50 years-old (n = 2604). A nested qualitative study was conducted with a sub-sample of RCT participants from February–March 2020; data included seven focus group discussions and 58 in-depth interviews. Male partners of women who reported experiencing IPV were purposively sampled. Ordinary Least Squares regression analyses were used to estimate the average treatment effect of the complementary programming, and sub-analyses were conducted on the poorest ten households from each village who received additional livelihood transfers. Qualitative data were analysed using thematic content analysis. We found no impacts of the complementary programming on IPV in the full sample, but some impacts among the poorest sample. Evidence on pathways found that both the public works and complementary programming decreased poverty-related stress and arguments within relationships and increased emotional wellbeing. There were some impacts on women's empowerment from the complementary programming. However, men's reactions to women's empowerment were mixed. There was strong evidence that engaging men in nutrition behaviour change communication contributed to improving gender relations. Our findings indicate that social protection and complementary programmes have the potential to be gender transformative and prevent the drivers ...

There is evidence that cash transfers reduce intimate partner violence (IPV), but less is known about the impacts of public works and complementary programmes on IPV. Using mixed-methods we examined whether and how the Ethiopian government's public works programme (that includes food or cash transfers for seasonal labour) alongside complementary activities that engage women and men affected IPV. We analysed midline data collected in July-October 2019 from a randomised controlled trial (RCT) designed to measure the added impacts of the complementary programming in the Amhara and Oromia regions. Eligible households for this analysis had at least one child aged 0-35 months and a primary female caregiver who was married, and under 50 years-old (n = 2604). A nested qualitative study was conducted with a sub-sample of RCT participants from February-March 2020; data included seven focus group discussions and 58 in-depth interviews. Male partners of women who reported experiencing IPV were purposively sampled. Ordinary Least Squares regression analyses were used to estimate the average treatment effect of the complementary programming, and sub-analyses were conducted on the poorest ten households from each village who received additional livelihood transfers. Qualitative data were analysed using thematic content analysis. We found no impacts of the complementary programming on IPV in the full sample, but some impacts among the poorest sample. Evidence on pathways found that both the public works and complementary programming decreased poverty-related stress and arguments within relationships and increased emotional wellbeing. There were some impacts on women's empowerment from the complementary programming. However, men's reactions to women's empowerment were mixed. There was strong evidence that engaging men in nutrition behaviour change communication contributed to improving gender relations. Our findings indicate that social protection and complementary programmes have the potential to be gender transformative and prevent the drivers of IPV.

Maternal mortality rates during childbirth in Sierra Leone are amongst the highest globally, with 1360 maternal deaths per 100,000 live births. Furthermore, the country's neonatal mortality rate is estimated at 39 deaths per 1000 live births. There is growing recognition of the health consequences of gender inequality, but challenges in addressing it. Gendered power dynamics within households affect health outcomes, with men often controlling decisions about their family's health, including their family's use of health services. The Government's Free Health Care Initiative, which abolished user fees for pregnant women, lactating mothers and children under five is promising, however this reform alone is insufficient to meet health goals. Using in-depth interviews and focus group discussions with men and women, this study explores women's economic empowerment and health decision-making in rural Sierra Leone. Findings show the concept of power related to women's income generation, financial independence and being listened to in social relationships. Whilst women's economic empowerment was reported to ease marital tensions, men remained household authority figures, including regarding health decision-making. Economic interventions play an important role in supporting women's economic empowerment and in influencing gender norms, but men's roles and women's social empowerment, alongside economic empowerment, needs consideration.

Despite widening efforts to publicly report health care quality data, patients appear to make little use of these data. Several studies indicate patients' interest in physician-level information, but actual use of physician-level data remains unestablished. Using a randomized experimental design, this study evaluates the extent to which use of a Web site offering physician-level data is affected by three parameters: invitation mode (mail vs. e-mail), employment status (employed vs. retired), and invitation message tone (risk- vs. gain-focused). The results find significantly higher use among those invited by e-mail ( p < .001) and among retired adults ( p < .001). Message tone is not significantly associated with use rates, but a borderline significant result suggests that high-risk message recipients behave differently from those receiving gain-focused messages ( p = .052). The findings emphasize the importance of convenience and process-simplicity in fostering public use of quality data and call for further study of message-tone effects.

IntroductionYoung adolescent women in sub‐Saharan Africa are three to four times more likely to be HIV‐positive than boys or men. One of the relationship dynamics that is likely to be associated with young women's increased vulnerability to HIV is transactional sex. There are a range of HIV‐related risk behaviours that may drive this vulnerability. However, to date, limited epidemiological data exist on the role of transactional sex in increasing HIV acquisition, especially among young women in sub‐Saharan Africa. Our paper presents data on the prevalence of self‐reported engagement in transactional sex and explores whether transactional sex is associated with increased risk of HIV infection among a cohort of young, rural, sexually active South African women. We also explore whether this relationship is mediated through certain HIV‐related risk behaviours.MethodsWe analyzed baseline data from a phase III trial of conditional cash transfers for HIV prevention of 693 sexually active, school‐going young women aged 13–20 years in rural South Africa. We examined the association between young women's engagement in transactional sex and HIV infection. Transactional sex is defined as a non‐commercial, non‐marital sexual relationship whereby sex is exchanged for money and/or gifts. We explored whether this relationship is mediated by certain HIV‐related risk behaviours. We used logistic and multinomial regression and report unadjusted and adjusted odds ratios with 95% CI.ResultsOverall, 14% (n=97) of sexually active young women reported engaging in transactional sex. Engagement in transactional sex was associated with an increased risk of being HIV‐positive (aOR: 2.5, CI: 95% 1.19–5.25, p=0.01). The effect size of this association remained nearly unchanged when adjusted for certain other dimensions of HIV risk that might help explain the underlying pathways for this relationship.ConclusionsThis study provides quantitative support demonstrating that transactional sex is associated with HIV infection in young women. Even though the specific variables tested do not mediate the relationship, a potential explanation for this association may be that the men with whom young women are having sex belong to networks of sexually connected individuals who are at a "high risk" for HIV infection. The results highlight the importance of structural intervention approaches that can alter the context of young women's HIV risk.