Stepping Stones and Creating Futures Plus: A pilot randomised controlled trial of a co-developed intervention with young South Africans.

Marginalised young women and men in South Africa experience and perpetrate high rates of intimate partner violence (IPV), shaped by their contexts and life histories. To address this, we co-developed Stepping Stones and Creating Futures Plus (SSCF+) with young women and men living in marginalised communities to reduce IPV, strengthen livelihoods and improve mental health. We assessed the intervention's feasibility, acceptability and potential impact, when delivered to small single-gender friendship groups, through a mixed-methods study. We had 30 groups for men and women, and randomly allocated groups to receive the intervention or not. In-depth interviews were conducted post-intervention with n=23 women and n=22 men. Participants were aged 18-30 living in selected communities. We assessed the acceptability of the intervention (participant attendance, overall views) and evidence of change in IPV perpetration (men) and experience (women), livelihoods and mental health 5-6 months post-baseline, and hypothesised mechanisms of change. N=163 men and N=162 women were recruited and we followed up 96.9% men and 100% women at endline. 81% women and 53% men attended at least 70% of sessions, but 3 clusters (10%) ended early. Participants reported the intervention was relevant and enjoyable for them, although they raised some areas for strengthening. At endline, women reported non-significant reductions in physical IPV (aOR0.64, 0.27, 1.53), sexual IPV (aOR0.59, 0.21, 1.65) and severe IPV (aOR0.73, 0.30, 1.75), and significant improvements in livelihoods and mental health. Men reported significantly less physical IPV perpetration (aOR0.38, 0.17, 0.81) and non-significant reductions in sexual IPV (aOR0.77, 0.39, 1.51) and severe IPV (aOR0.86, 0.47, 1.56), as well as improved livelihoods, but no change in mental health. The co-developed SSCF+ intervention was acceptable and showed promise in reducing IPV and strengthening livelihoods, as well as addressing overlapping risk factors. Further research is required to determine its effectiveness. The study was pre-registered at clinicaltrials.gov (NCT05783336).