A model of sexually and physically victimized women's process of attaining effective formal help over time: the role of social location, context, and intervention

Development and Usability of a Mobile Support Application for Sexual Violence Victims Connecting With Formal Support Organizations

The lack of awareness and accessibility about the support organizations for preventing sexual violence and assisting victims hampers the effectiveness of the social safety net. A mobile application based on a connection to support agencies was developed and evaluated for usability. A group of 15 experts and a group of 30 users evaluated usability. The developed mobile application focused on "Emergency Report," "Support Agencies and Services," and "Counseling for Support." The strength of the application was acknowledged in providing easy-to-find, reliable, useful, and necessary information, highlighting the positive usability and applicability of the mobile support application for sexual violence victims.

The Role of Gender and Sexuality in the Experience, Internalization, and Mental Health Correlates of Sexual Victimization Stigma

The stigma associated with sexual victimization (SV) can add to the psychological burden on survivors. We compared experiences of SV and SV stigma by survivor gender and sexuality and evaluated the relevance of public and internalized sources of this stigma to their psychological functioning. An online survey containing measures of SV type (sexual harassment and assault), public SV stigma, internalized SV stigma (self-blame, self-shame, anticipated-shame), and psychological functioning (depression, anxiety, stress, and post-traumatic stress disorder [PTSD] symptomatology) was completed by 877 women and 211 men aged 18 to 66 years (M = 30.2, SD = 8.06), of whom 73.9% were heterosexual and 26.1% identified as a sexual minority (same-sex-attracted, bisexual, pansexual, or asexual). Sexual harassment and assault were more prevalent in women and sexual minority men. Analysis of Covariance (ANCOVA) with age and SV frequency as covariates also revealed poorer psychological functioning in sexual minority men, and higher levels of SV stigma in sexual minority women and men. Multigroup path analyses further showed that exposure to public stigma was associated with poorer psychological functioning, that internalized stigma partly mediated these associations, and that the magnitude of the associations (particularly those involving self-shame and anticipated shame) was often greater in men and sexual minorities. The results add to our understanding of the role of gender and sexuality in the experience, internalization, and psychological impact of SV-related stigma on survivors. The results also highlight the need for societal shifts toward acknowledging and validating experiences of SV in men and sexual minorities, alongside women, and the development of intersectionality-informed interventions for SV stigma in survivors.

Can This Provider Be Trusted? A Review of the Role of Trustworthiness in the Provision of Community-Based Services for Intimate Partner Violence Survivors

While there is a growing literature on intimate partner violence (IPV) survivors and service providers, it is limited by its largely atheoretical and descriptive nature, and its emphasis on individual-level survivors' help-seeking. We seek to broaden our understanding by shifting the focus onto organizations and service systems and introducing the concept of these providers' trustworthiness toward survivors. Provider trustworthiness in delivering services includes benevolence (locally available and caring), fairness (accessible to all and non-discriminatory), and competence (acceptable and effective in meeting survivors' needs). Guided by this conceptualization, we conducted an integrative review drawing on four databases: PsycINFO, PubMed, Web of Science, and Westlaw. We identified studies for inclusion that were published between January 2005 and March 2022, and we examined the trustworthiness of community-based providers serving adult IPV survivors in the United States, including domestic violence services, health and mental health care, the legal system, and economic support services (N = 114). Major findings include (1) many survivors live in communities with no shelter beds, mental health care, or affordable housing; (2) many services are inaccessible because they lack, for example, bilingual staff, sliding fees, or telehealth options; (3) too many providers are harmful or discriminatory toward survivors, especially those who are, for example, sexual or gender minorities, immigrants or non-English-speaking, poor, or Native, Black, or Latinx; (4) many providers appear to be incompetent, lack evidence-based training, and are ineffective in meeting survivors' needs. We call on researchers, advocates, and providers to examine provider trustworthiness, and we offer an introduction to measuring it.

Labeling Victimization Experiences and Self as Predictors of Service Need Perceptions and Talking to Police

Theoretical frameworks suggest that how victims of violence against women (VAW) label their experiences and selves shapes their help-seeking intentions and behaviors. Quantitative studies assessing this relationship have focused on sexual assault and have neglected self-labels, thus this study adds to the research by including multiple forms of VAW and both experience-labels (e.g., "abuse") and self-labels (e.g., "victim"). Data came from a community-based sample of 1,284 adult, female victims of physical intimate partner violence, sexual assault, and/or stalking. These women participated in a state-wide phone survey in 2020 to determine victimization prevalence and were selected for the present analyses based on their victimization experiences. Bivariate analyses and multivariate logistic regression models were used to determine whether experience- and self-labels predicted the likelihood of perceiving the need for legal services, victim services, shelter or safe housing, and/or medical care, as well as talking to police. Both applying a label to one's experiences with VAW and applying a label to oneself in relation to those experiences approximately doubled the odds of perceiving a need for formal services. The significance of self-labels seemed to be driven by the "survivor" label, as using a "victim" label was not related to need perceptions, but a "survivor" label doubled or tripled the odds of perceiving a need for formal services. Applying a label to one's experiences with VAW almost doubled the odds of talking to the police, and, again, use of the "survivor" self-label significantly increased the odds of talking to the police. These findings confirm the importance of labeling one's victimization experiences and self, and indicate that greater attention be paid to the labels that victims use and how the use of labels might be improved so that they are more likely to seek and attain meaningful help and services.

"I established a life; I can re-establish it again": Lived experiences of intimate partner violence in Mongolia

Violence against women persists globally, transcending intersecting backgrounds, such as race, gender, socio-economic status, education, and ableness. The reality remains that women across diverse intersections continue to endure various forms of violence. According to a nationwide study, 30 % of women experience intimate partner violence during their lifetime in Mongolia. The present research adopts an intersectional lens to comprehensively address the survival experiences of Mongolian women who had lived through intimate partner violence. In-depth semi-structured interviews were conducted with 21 participants recruited through purposive sampling, most of whom had ended a relationship involving intimate partner violence. Thematic analysis was used to identify patterns and themes among survival experiences. Although women's experiences varied, intimate partner violence confronted them with the dilemma of maintaining or going against traditional values, including family unity when seeking protection (and safety) for themselves and their children. The women's survival experiences included a combination of building a sense of community and rebuilding a sense of self, while self-contentment was achieved when the women ceased to blame themselves. This study highlights a critical shift in mindset and behavior by investigating the survival experiences of women who defy social norms, prioritizing family unity over personal well-being. Recognition of survivors' efforts to cease self-blame and seek support signifies a crucial advancement in the survival process. The findings suggest a positive trend toward self-empowerment and a willingness to access the necessary resources and support systems. From a practical standpoint, these findings advocate for strengthening current interventions that empower survivors to challenge norms, cease self-blame, and actively seek assistance.

Connecting to Community: Violence Prevention Barriers, Geography, and Preventionist Perceptions of Community Leadership and Opportunities

Violence is a public health concern, negatively impacting individual and community health and safety. Although violence can be prevented, prevention efforts are complex in part because they require addressing community factors. Despite an increase in funding and support for community violence prevention, relatively little is known about what prevention practice barriers may be related to community factors. This study addressed this gap by surveying a statewide sample of violence preventionists. We explored if coordination and logistical barriers and rural geography are associated with perceptions of two community factors: community opportunities and leadership quality. As part of a statewide assessment of violence and prevention efforts, 130 violence preventionists completed surveys. Results showed that both perceived coordination barriers and rural geography were negatively associated with perceptions of existing community opportunities, representative/influential leadership, and leadership commitment. Perceived logistical barriers were positively associated with perceived leadership commitment. Findings suggest that support reducing community coordination barriers in particular-and to support rural violence prevention work more broadly-is needed.

Preventing sexual violence in sexual orientation and gender diverse communities: A call to action

Background: Members of the lesbian, gay, bisexual, transgender, queer, and other sexual orientation and gender diverse (SOGD) communities are at disproportionately higher risk for sexual violence compared to cisgender heterosexual people. Despite this elevated risk, relatively few sexual violence prevention efforts effectively reduce these victimization disparities based on sexual orientation or gender identity.Objective: This narrative review provides an overview of the prevalence of sexual violence in the SOGD communities, delineates risk factors for sexual victimization among SOGD community members, and reviews and evaluates existing prevention efforts for the SOGD communities. We outline specific recommendations for ensuring that prevention efforts meet the needs of the SOGD communities.Method: Drawing on ecological systems theory and public health approaches to sexual violence prevention, we outline current approaches and opportunities for preventionists and scholars to push the field forward.Results: There have been promising prevention programmes designed to be implemented within SOGD communities specifically; however, it is important that general primary prevention programmes endeavour to specifically address sexual violence perpetrated against SOGD people. While many packaged programmes that endeavour to prevent sexual violence across all gender identities and sexual orientations are inclusive of SOGD participants, more programming is needed that integrates anti-oppression training to target social norms that perpetuate SOGD-specific rape myths and normalize sexual violence against SOGD community members.Conclusion: Ecological prevention strategies in line with a public health approach for primary prevention may be particularly valuable for reducing victimization disparities based on SOGD status and identity. Comprehensive sexual education and anti-discrimination policies should be considered front-line prevention programming. To assess if these strategies are effective, the implementation of large-scale surveillance surveys that use comprehensive assessments of sexual orientation, gender identity, and sexual violence are needed. Using theoretically grounded implementation strategies for prevention programmes can ensure effective programme delivery.

Sexual Violence Disclosure in #Notokay: Disclosure Goals, Disclosure-Facilitating Resources, and Overall Disclosure Trajectory

This study investigated the disclosure goals, disclosure-facilitating resources, and overall disclosure trajectory of 16 women who participated in the 2016 #notokay antisexual violence campaign. Findings indicate that most participants' disclosure goals were approach focused. Factors that facilitated disclosure were social media affordances and psychological, professional, and financial resources. Participants' overall disclosure trajectory was upward, but not linear, and disclosure outcomes included self-growth and awareness of the intersectional nature of violence. The findings suggest that the disclosure processes model can be strengthened by considering goal-relevant resources as a structural or environmental factor that influences the choice of approach versus avoidance goals, and consequently, beneficial or harmful disclosure outcomes. Further, by investigating how participants' #notokay disclosure was situated in their other online and offline disclosure episodes, this study provides a contextualized perspective of online hashtagged disclosures of sexual violence.

"You Can't Meet Everyone's Needs After-Hours": After-Hours Domestic and Family Violence Services in Rural and Remote Areas

Domestic and family violence is a significant issue in the Murrumbidgee region of New South Wales, Australia, mirroring national and international concerns about gender-based violence. Generally, there are known barriers associated with providing domestic and family violence (DFV) services in rural and remote communities; however, little research has considered the specific service needs and service barriers in the after-hours period. This is crucial. The already limited rural and remote services available during business hours are further constricted in the after-hours period. This article reports on research about after-hours service need and service challenges in six target communities in the Murrumbidgee region.

Impact of Sexual Assault Survivor Identity on Patient Care in the Emergency Department

Interactions between emergency department (ED) staff and sexual assault (SA) survivors can be a source of retraumatization for survivors, increasing their risk of posttraumatic stress and decreasing utilization of longitudinal medical care. Little is known about nationwide trends in ED staff attitudes and behaviors toward survivors, including the impact of survivor identity. We conducted a survey to determine if survivor identity influenced ED staff behaviors. A nationwide survey of SA patient advocates was conducted between June and August 2021. Advocates are volunteers or staff dispatched from rape crisis centers to support survivors during ED care. Advocates participated in an online survey to determine the frequency of observing six potentially retraumatizing provider attitudes and behaviors. Adaptive questioning was used to explore the impact of survivor identity on each attitude or behavior and which identity groups were more likely to be affected. Three hundred fifteen advocates responded to the survey. Less than 10% indicated that ED staff often or always convey disbelief or blame to survivors. Almost 75% of advocates indicated that they often or always observe ED staff showing empathy to survivors. Disparities were found in provider attitudes. Over 75% of advocates observed that survivors' mental health status or substance use impacted conveyed belief from providers. Patients who were intoxicated when assaulted, had psychiatric disorders, were Black, Hispanic/LatinX, or indigenous, or were not cis-females were more likely to experience disbelief. Patients who were white and/or cis-gender females were more likely to be pressured by ED staff to complete the forensic exam and/or report to the police. Our study documents disparities in ED staff behavior towards SA survivors according to survivor identity. Given that post-assault ED interactions are critical turning points in survivors' future medical processes, disparities in ED care may be linked to larger disparities in healing from trauma.

Women's Formal Help-Seeking Before and After Their Abusive Partner Initiates Relationship Violence Treatment

Intimate partner violence survivors (N = 122) reported on formal help-seeking before and after their male partners enrolled in a Relationship Violence Intervention Program (RVIP). At baseline, only 20% of survivors had ever received domestic abuse (DA) counseling. DA counseling was more common among survivors with more extensive partner abuse exposures, and for black women residing in suburban versus urban communities. New help-seeking was associated with survivor perceptions of the abusive partner's stage of change. RVIP impact may be enhanced through culturally sensitive survivor outreach that is responsive to a broad range of needs and includes repeated contact over time.

Reflecting and rejuvenating our work, together: One team's consideration of AJCP publications on gender-based violence

Community psychology has long valued reflexive praxis as a critical part advancing our research and action. In this Virtual Special Issue (VSI), we, a group of community psychologists and gender-based violence (GBV) researchers at many different points in our careers, reflected on GBV publications that have appeared in AJCP. We examine the ways in which community psychology broadly and articles in AJCP more specifically have conceptualized GBV as a sociocultural issue, how GBV intersects with other oppressions and forms of violence, the tension when systems that aspire to support survivors are inequitable and focused on ameliorative change, and the importance of interventions being locally informed and locally driven. By highlighting selected GBV-focused articles published in AJCP, this VSI discusses (a) understanding and transforming culture via robust research and local partnerships, (b) targeting effective interventions for survivors, (c) invoking systems and targeting change in institutional environments, and (d) making connections between local efforts and broader social movements. To continue to move forward, we conclude we must reflect, embrace methodological plurality, partner, and push for structural change. Reflective questions regarding research and action are offered, to address gender-based violence.

Bias Crime and Victimization Among Latinx Adults: Formal and Informal Help Seeking

Latinx adults have become increasingly vulnerable to bias motivated victimization. The impact of such incidents on Latinx communities is severely understudied, particularly concerning whether or not victims will seek help as a result of such events. Evidence within other victimization contexts demonstrate Latinx populations may be less likely to seek formal help from police, medical providers, and other formal authorities, relying instead on informal support networks such as family and friends. The current study sought to understand formal and informal help-seeking behavior among Latinx adults who experienced bias motivated victimization. The Understanding and Measuring Bias Victimization against Latinos study obtained rates of bias victimization and subsequent help-seeking behavior among Latinx adults who reported experiencing bias victimization (n = 315, 34.6% of full sample of 910). Those who experience bias victimization seek formal help at much lower rates than informal forms of support. Logistic regression analyses controlling the type of victimization demonstrated that participants who experienced a victimization constituting a hate crime were more likely to seek formal help compared to experiencing non-criminal bias events. Implications include addressing barriers to Latinx bias victims seeking forms of help, in addition to understanding the potential polyvictimization histories that predict why Latinx adults may decide to seek help.

Survivor, family and professional experiences of psychosocial interventions for sexual abuse and violence: a qualitative evidence synthesis

BACKGROUND

It is well-established that experiencing sexual abuse and violence can have a range of detrimental impacts; a wide variety of interventions exist to support survivors in the aftermath. Understanding the experiences and perspectives of survivors receiving such interventions, along with those of their family members, and the professionals who deliver them is important for informing decision making as to what to offer survivors, for developing new interventions, and enhancing their acceptability.

OBJECTIVES

This review sought to: 1. identify, appraise and synthesise qualitative studies exploring the experiences of child and adult survivors of sexual abuse and violence, and their caregivers, regarding psychosocial interventions aimed at supporting survivors and preventing negative health outcomes in terms of benefits, risks/harms and barriers; 2. identify, appraise and synthesise qualitative studies exploring the experiences of professionals who deliver psychosocial interventions for sexual abuse and violence in terms of perceived benefits, risks/harms and barriers for survivors and their families/caregivers; 3. develop a conceptual understanding of how different factors influence uptake, dropout or completion, and outcomes from psychosocial interventions for sexual abuse and violence; 4. develop a conceptual understanding of how features and types of interventions responded to the needs of different user/survivor groups (e.g. age groups; types of abuse exposure; migrant populations) and contexts (healthcare/therapeutic settings; low- and middle-income countries (LMICs)); 5. explore how the findings of this review can enhance our understanding of the findings from the linked and related reviews assessing the effectiveness of interventions aimed at supporting survivors and preventing negative health outcomes.

SEARCH METHODS

In August 2021 we searched MEDLINE, Embase, PsycINFO and nine other databases. We also searched for unpublished reports and qualitative reports of quantitative studies in a linked systematic review, together with reference checking, citation searches and contacting authors and other researchers to identify relevant studies.

SELECTION CRITERIA

We included qualitative and mixed-methods studies (with an identifiable qualitative component) that were linked to a psychosocial intervention aimed at supporting survivors of sexual abuse and violence. Eligible studies focused on at least one of three participant groups: survivors of any age, gender, sexuality, ethnicity or [dis]ability who had received a psychosocial intervention; their carers, family members or partners; and professionals delivering such interventions. We placed no restrictions in respect of settings, locations, intervention delivery formats or durations.

DATA COLLECTION AND ANALYSIS

Six review authors independently assessed the titles, abstracts and full texts identified. We extracted data using a form designed for this synthesis, then used this information and an appraisal of data richness and quality in order to stratify the studies using a maximum variation approach. We assessed the methodological limitations using the Critical Skills Appraisal Programme (CASP) tool. We coded directly onto the sampled papers using NVivo and synthesised data using a thematic synthesis methodology and used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We used a narrative synthesis and matrix model to integrate our qualitative evidence synthesis (QES) findings with those of intervention review findings.

MAIN RESULTS

We identified 97 eligible studies and sampled 37 of them for our analysis. Most sampled studies were from high-income countries, with four from middle-income and two from low-income countries. In 27 sampled studies, the participants were survivors, in three they were intervention facilitators. Two included all three of our stakeholder groups, and five included two of our groups. The studies explored a wide range of psychosocial interventions, with only one type of intervention explored in more than one study. The review indicates that features associated with the context in which interventions were delivered had an impact on how individuals accessed and experienced interventions. This included organisational features, such as staff turnover, that could influence survivors' engagement with interventions; the setting or location in which interventions were delivered; and the characteristics associated with who delivered the interventions. Studies that assess the effectiveness of interventions typically assess their impact on mental health; however, as well as finding benefits to mental health, our QES found that study participants felt interventions also had positive impacts on their physical health, mood, understanding of trauma, interpersonal relationships and enabled them to re-engage with a wide range of areas in their lives. Participants explained that features of interventions and their contexts that best enabled them to benefit from interventions were also often things that could be a barrier to benefiting from interventions. For example, the relationship with the therapist, when open and warm was a benefit, but if such a relationship could not be achieved, it was a barrier. Survivors' levels of readiness and preparedness to both start and end interventions could have positive (if they were ready) or negative (if they were not) impacts. Study participants identified the potential risks and harms associated with completing interventions but felt that it was important to face and process trauma. Some elements of interventions were specific to the intervention type (e.g. faith-based interventions), or related to an experience of an intervention that held particular relevance to subgroups of survivors (e.g. minority groups); these issues could impact how individuals experienced delivering or receiving interventions.

AUTHORS' CONCLUSIONS

We had high or moderate confidence in all but one of our review findings. Further research in low- and middle-income settings, with male survivors of sexual abuse and violence and those from minority groups could strengthen the evidence for low and moderate confidence findings. We found that few interventions had published quantitative and qualitative evaluations. Since this QES has highlighted important aspects that could enable interventions to be more suitable for survivors, using a range of methodologies would provide valuable information that could enhance intervention uptake, completion and effectiveness. This study has shown that although survivors often found interventions difficult, they also appreciated that they needed to work through trauma, which they said resulted in a wide range of benefits. Therefore, listening to survivors and providing appropriate interventions, at the right time for them, can make a significant difference to their health and well-being.

PROTOCOL: Informal social support interventions for improving outcomes for victim-survivors of domestic violence and abuse: An evidence and gap map

This is the protocol for a Campbell Evidence Gap Map. The main objectives of the EGM are: establish the nature and extent of the primary empirical evidence on informal social support interventions, identify interventions and clusters of evidence suitable for systematic review/evidence synthesis and identify gaps in the evidence on informal social support interventions.

Help-Seeking Among Women of Haitian Descent in the Dominican Bateyes

People of Haitian descent in the Dominican Republic are at high risk of violence, including interpersonal violence, and experience multiple levels of structural oppression. However, limited research exists specifically about women of Haitian descent in this context, who are at unique risk for violence and marginalization given intersectional oppression related to antiblackness, xenophobia, and misogyny. It is unclear what resources and supports exist for women of Haitian descent living in the Dominican Republic, and whether women can effectively meet their needs through available supports. This study analyzed 25 life history interviews to understand help-seeking patterns to address self-defined needs among women of Haitian descent. Analysis focused on narratives of interpersonal violence, as most research on this issue focuses on experiences of women in the global north. Thematic analysis demonstrated that women navigate a variety of informal supports, primarily with other women in their kinship networks, to address different needs, including material, emotional, and interpersonal-but primarily to address needs related to pregnancy and childcare, interpersonal violence, and housing. Women also sought help from male family members and formal institutions, though less frequently compared to help-seeking from other women. Outcomes of help-seeking, including who provided effective help, conditions of support, and negative reactions varied. Implications of women's patterns of help-seeking in this context, and how they compare to patterns within the larger help-seeking literature are discussed.

Sexual assault survivors' engagement with advocacy services during the COVID-19 pandemic

Sexual assault advocates provide support to survivors as they navigate medical, legal, housing, and other complex systems. However, social distancing measures enacted in response to coronavirus disease 2019 (COVID-19) forced changes to traditional advocacy services. The current study aimed to understand how the COVID-19 pandemic transformed survivors' engagement with sexual assault advocacy services. Semi-structured interviews were conducted with 12 sexual assault advocates from a community-based advocacy organization in Detroit. Thematic analysis was employed to uncover emergent themes reflecting COVID-19's impact on survivors' engagement with advocacy services. Three themes were identified: (1) Disruption to advocacy services; (2) difficulty obtaining tangible resources; and (3) desire for COVID-related support, information, and resources. This study highlights the needs of sexual assault survivors during the COVID-19 pandemic and explores how public health emergencies have the potential to exacerbate the needs of this vulnerable population. Implications and future directions for service provision and research are considered.

Examining contextual influences on the service needs of homeless and unstably housed domestic violence survivors

Domestic violence (DV) is a leading cause of homelessness for women, yet many DV agencies are just beginning to focus on helping clients stabilize their housing situations. The purpose of this study was to better understand the contexts and service needs of unstably housed and homeless DV survivors, to promote more efficient and successful service matching from DV agencies. We examined whether DV survivors could be grouped by particular features, histories, and contextual factors, and how these group differences impacted what they needed from DV agencies. The sample included 406 homeless and unstably housed DV survivors who had recently sought DV services. Latent class analysis supported the identification of four distinct classes: (1) highest disadvantages service seeker, (2) moderate disadvantages-criminal legal system service seeker, (3) moderate disadvantages service seeker, and (4) lower disadvantages service seeker. Additionally, we were able to profile each class, and test the types of services survivors in each class needed from agencies.

Latent Profiles of Social Reactions to Sexual Assault Disclosure Among Undergraduate Women

The types of social reactions that victims receive when they disclose experiences of sexual assault are important for post-trauma recovery. Using a person-centered analytic approach, we identified latent profiles based upon the nature of two types of negative (turning against and unsupportive acknowledgment) and two types of positive (emotional support and informational/tangible aid) reactions received by 300 undergraduate women who disclosed sexual assault. Analyses identified four latent profiles characterized by (a) moderate emotional support/low negative reactions, (b) moderate emotional support/moderate negative reactions, (c) high positive/some unsupportive acknowledgment reactions, and (d) moderate positive/high negative reactions. Differences between the profiles in sexual assault acknowledgment, self- and perpetrator-blame, and some assault-related characteristics (victim injury but not victim or perpetrator intoxication) were identified. Group comparisons revealed that the two profiles characterized by greater negative reactions reported greater posttraumatic stress, whereas the profile characterized by moderate support/moderate negative reactions reported greater depression. No differences were identified for hazardous alcohol use. Findings highlight the importance of addressing negative reactions to sexual assault disclosure as potential barriers to recovery. Colleges may benefit from programming targeted at disclosure recipients as part of violence prevention efforts. A broader societal shift is also imperative to eliminate stigmatization of victims. Additional online materials for this article are available on PWQ’s website at: http://journals.sagepub.com/doi/suppl/10.1177/03616843211038924 .

The Effects of Social Location and Situational Factors on Young Women's Disclosure of Intimate Partner Violence Across Relationships

The goal of the study was to examine disclosure of physical and sexual intimate partner violence (IPV) victimization across abusive relationships within a sociodemographically diverse sample of young women. We recruited 283 participants, ages 18 to 24, from a university, a 2-year college, and community sites serving low-income young women, and assessed physical and sexual IPV victimization, and related disclosure, across each of their abusive relationships (415 total). We used multilevel modeling to examine the effects of social location and situational factors on the odds of any disclosure of abuse during first relationships and across relationships. The rate of physical IPV disclosure was 50%, vs. 29% for sexual IPV. Multilevel model results indicated setting, IPV type, high frequency sexual IPV, and fear were significantly related to any disclosure.

"Being Married Doesn't Mean You Have to Reach the End of the World": Safety Planning With Intimate Partner Violence Survivors and Service Providers in Three Urban Informal Settlements in Nairobi, Kenya

Intimate partner violence (IPV) harms women physically, sexually, and psychologically. Safety strategies, or harm reduction techniques implemented by women undergoing recurrent violence, may help mitigate the negative health, economic, and social consequences of IPV. This study aimed to understand recommended and utilized safety strategies among three urban informal settlements in Nairobi, Kenya. Semi-structured key informant discussions (KIDs; n = 18) with community-based service providers and focus group discussions (FGDs; n = 49) with IPV survivors were conducted. All interviews were audio-recorded, transcribed, and translated verbatim from Swahili to English. Inductive thematic analysis was used to structure codes. Convergence matrices were used to analyze emergent strategies by data source (service providers vs. IPV survivors). Women preferred safety strategies that they could implement unassisted as first line of harm reduction. Strategies included removing stressors, proactive communication, avoidance behaviors, sexual and reproductive health (SRH), economic, leaving partner for safety, child safety, and securing personal property. Strategies recommended by service providers and utilized by IPV survivors differed, with clear divergence indicated for leaving the abusive relationship, SRH, and personal property strategies. Innovative strategies emerged from IPV survivors for safeguarding property. Similar to upper-income and other low and middle-income contexts, women experiencing IPV in urban informal settlements of Nairobi actively engage in behaviors to maximize safety and reduce harm to themselves and their families. Integration of strategies known to be helpful to women in these communities into community-based prevention and response is strongly encouraged. Increased synergy between recommended and implemented safety strategies can enhance programming and response efforts.

Experiences of Disclosure and Reactions of Close Ones from the Perspective of Child Sexual Abuse Survivors: A Qualitative Analysis of Gender Specificities

The disclosure of child sexual abuse (CSA) is a complex process that remains partially understood, despite its crucial role in survivors' recovery. Gender specific experiences of disclosure have been little investigated while this information is crucial to better tailor interventions for survivors. This qualitative study aims to 1) explore survivors' experiences in disclosing to close ones, and 2) contrast experiences of male and female survivors. Fifty-one CSA survivors (25 women and 26 men) aged 18 years or older were recruited via community services for survivors. Two main categories emerged from thematic content analysis: 1) experiences of disclosure hindering CSA recovery or 2) ones fostering CSA recovery. Men felt ignored when their close ones were focused on their own emotions of indifference, helplessness and guilt toward CSA. Men felt guilty when confronted with reactions of blame for their own inaction or disempowered when pressured to remain silent or to forgive. Women felt ignored when their close ones showed anger toward their perpetrator. Women felt guilty when they were held accountable for CSA events or disempowered when pressured to take legal actions. Women, but not men, reported feeling considered through caring and heart-to-heart discussions. Recommendations for awareness messages and practitioners are discussed.

Internalization and Opposition to Stigmatized Social Discourse among Incest Survivors

Despite the high prevalence of incest, survivors are reluctant to disclose its existence for reasons such as shame, guilt and the presence of an accusatory and stigmatizing social discourse. The current mixed methods study examined the internal discourses of 13 incest survivors in Israel, reflected in self-reported internal dialogs which emerged during interviews. The qualitative analysis revealed a dialectical tension between two themes - one reflecting an internalization of the social discourse (manifested as quotes taken from social discourse and uttered by the survivors) and the other an agentic discourse (manifested in utterances either resisting the social discourse or showing an empowering advertence to one's own fulcrum). The quantitative analysis showed that for seven participants the internalized social discourse expressions were most frequent, for five the agentic expressions were most frequent, and that for one the discourses were at equilibrium. The ubiquitous sub-themes manifested in the internalized social discourse were: victimhood (feelings of vulnerability and helplessness), survivorship (meaningless existence, despair and hopelessness), negative self-esteem and self-pathology (perception of the self as having pathological psychological problems), and denial/repression of the abuse. The ubiquitous sub-themes manifested in the agentic discourse were: positive self-image and sense of potency, hope, optimism and positive perception of life, and uprising against the parents and institutions that did not give support. The discussion is based on Butler's concept of vulnerability, which suggests how to address the harms inflicted by incest without erasing aspects of the survivors' agency and growth.

"Back Home You Just Go Talk to the Family": The Role of Family Among Women Who Seek Help for Intimate Partner Violence Pre- and Postresettlement to the United States

Gaps in knowledge remain regarding how and from whom women resettling to the United States as refugees seek help for intimate partner violence (IPV), and what happens when they do. This study examined ways in which women seek help for IPV across varied contexts and at different times both pre- and postresettlement. Researchers used a purposive sampling approach to recruit women who resettled to the United States as refugees (n = 35). An inductive approach to thematic analysis led to an examination of the role of family in seeking help for IPV and seeking help in the absence of family. The findings speak to the importance of applying a social support lens to theory, practice, and research concerned with women's help-seeking for IPV in the resettlement context.

Evaluation in the Real World: Decision Points and Rationales in Creating A Rigorous Study Designed to Convey Ecologically Valid Findings

Rigorously evaluating community-based interventions for multiply marginalized populations is fraught with challenges under the best of circumstances. This manuscript describes the methodology chosen to evaluate an innovative model designed to help survivors of intimate partner violence obtain safe and stable housing. We justify the choice of evaluation design from a community psychology perspective and detail why we believe the multi-method, multi-source design, that also focuses on social context, will maximize ecological validity and, therefore, propel the scale-up of the intervention if it is found to be effective. Longitudinal data are being collected from program recipients over time, the advocates who worked with them, agency service records, and monthly documentation of agency resources on hand that can impact services provided. Special attention is focused on capturing contextual information that can impact program success. While randomized control trials are still too often heralded as "the gold standard" for measuring intervention effectiveness, we maintain that the current design, which was developed in partnership with key community stakeholders, holds more promise when evaluating many community-based programs.

Exploring Help Seeking Patterns for Emerging Adult Victims Using the National Intimate Partner and Sexual Violence Survey

Emerging adulthood is a critical developmental period and a particularly important one for studying responses to interpersonal victimization as they can shape future coping patterns. This study focuses on non-college-attending emerging adults to explore their use of help seeking and satisfaction with resources. Comparisons are made with their college-attending counterparts. The findings highlight (a) the importance of friends across gender and education levels as a common resource and one perceived as helpful and (b) the large proportion of victims of interpersonal violence who do not seek any help. These results are discussed in connection with future research and policy implications.

Migrant Women's Help-Seeking Decisions and Use of Support Resources for Intimate Partner Violence in China

In China, women who domestically relocate from rural or less developed regions to major cities are at a higher risk for intimate partner violence (IPV) than their non-migrant counterparts. Few studies have focused on Chinese domestic migrant women's help-seeking for IPV and their use of different sources of support. The present study aimed to identify factors that influence migrant women's help-seeking decisions. In addition, we also examined factors that contribute to migrant women's use of diverse sources of support for IPV. A sample of 280 migrant women victimized by IPV in the past year at the time of the survey was drawn from a larger cross-sectional study conducted in four major urban cities in China, including Beijing, Shanghai, Guangzhou, and Shenzhen. Using a multinomial logistic regression model and a zero-inflated Poisson model, we found that factors influencing migrant women's help-seeking decisions and their use of diverse sources of support included socioeconomic factors, IPV type, relationship-related factors, knowledge of China's first anti-Domestic Violence Law, and perception of the effectiveness of current policies. We discuss implications for future research and interventions.

Underserved survivors of sexual assault: a systematic scoping review

Background: Despite knowledge about the extensive and often long-lasting consequences of sexual assault, many survivors remain underserved by formal support systems (e.g. medical, mental health and criminal justice systems). Reasons for underutilizing services are as diverse as the survivors themselves, and little is known about which survivors are most underserved and why they are underserved. Objective: To help organize existing findings on this topic, a systematic scoping review was conducted to identify adult survivors of sexual assault, who may be particularly underserved when attempting to obtain services in Western countries. Method: Five databases (PsycINFO, Embase, MEDLINE, Scopus and CINAHL) were systematically searched for studies published in English from 2000 onwards using terms such as 'sexual assault', 'help seeking', 'formal support', 'barriers' and variations thereof. Results: A total of 41 studies were included in the present scoping review, resulting in seven main categories of underserved survivors: Ethnic and cultural minorities, Disabilities, Financial vulnerability, Sexual and gender minorities, Mental health conditions, Problematic substance use, and Older age. Barriers encountered by survivors with these characteristics included limited access to formal supports and insufficient training and awareness among service providers about how to best support survivors. Conclusions: Recommendations include the need for more survivor-centred, culturally appropriate and trauma-informed services and more attention to survivors belonging to underserved groups in policy, practice and research.

Advocacy With Survivors of Intimate Partner Violence: What It Is, What It Isn't, and Why It's Critically Important

Survivors of intimate partner violence arrive at the doors of domestic violence (DV) programs with a wide variety of needs, including long-term safety and healing, housing, economic stability, health and well-being, and community connection. Although some DV programs offer holistic approaches to survivors, many focus the vast majority of their attention and resources on providing emotional support and safety planning rather than advocating with survivors for their access to needed resources and opportunities. Although services focused on emotional support and safety planning are important, they alone are not likely to result in the life changes that many survivors are seeking. Programs that provide genuine advocacy for survivors-defined as partnering with them to represent their rights and interests while linking them to concrete resources, protections, and opportunities-have been found to be effective and well received. Although an early pillar of DV programs, this type of advocacy has fallen by the wayside in many agencies. In this article, the authors make a case for re-invigorating advocacy efforts designed to improve the life circumstances of survivors. We argue that such efforts will make DV programs more relevant and sought after by a wider range of survivors and that agencies will see real change occur at both the individual and community levels.

Help-seeking, trust and intimate partner violence: social connections amongst displaced and non-displaced Yezidi women and men in the Kurdistan region of northern Iraq

Background

Conflict and displacement impact the social fabric of communities through the disruption of social connections and the erosion of trust. Effective humanitarian assistance requires understanding the social capital that shapes patterns of help-seeking in these circumstances - especially with stigmatised issues such as violence against women (VAW) and intimate partner violence (IPV).

Methods

A novel social mapping methodology was adopted amongst a Yezidi population displaced by ISIS (ISIS: Islamic State of Iraq and Syria, locally known as Da’esh) occupation and a neighbouring settled Yezidi population in the Kurdistan region of northern Iraq in late 2016. Six participatory workshops were conducted to identify available resources with respect to: meeting basic needs, dispute resolution and VAW. Subsequently, 51 individual interviews were conducted (segmented by gender and settlement status) to identify connectedness to, and trust in, the resources identified, with a focus on IPV against women.

Results

90% of participants reported God as a key source of help in the previous 6 months, representing the most widely cited resource. Following God, the most accessed and trusted resources were family and community, with NGO (non-governmental organisation) provision being the least. Women drew more strongly upon familial resources than men (Χ² = 5.73, df = 1, p = 0.017). There was reduced trust in resources in relation to seeking help with IPV. A distinction between trust to provide emotional support and trust to resolve issues was identified. Settled women were 1.6 times more likely to trust community members and government services and 3.7 times more likely to trust NGOs than displaced women.

Conclusions

Mapping social connections and trust provides valuable insight into the social capital available to support help-seeking in populations of humanitarian concern. For these Yezidi populations, family, religious and community resources were the most widely utilised and trusted. Trust was mostly reserved for family and their main religious leader regarding IPV against women. Lack of trust appeared to be a major barrier to stronger engagement with available NGO provision, particularly amongst displaced women. The role of faith and religious resources for this population is clearly significant, and warrants an explicitly faith-sensitive approach to humanitarian assistance.

Help-Seeking Behaviors and Barriers Among Black Women Exposed to Severe Intimate Partner Violence: Findings From a Nationally Representative Sample

This article examined general help-seeking utilization and barriers among U.S. Black women reporting severe physical intimate partner violence (IPV). Data from the National Survey of American Life (NSAL), the largest and most detailed survey on Blacks residing in the United States, were analyzed. Among U.S. Black women reporting severe physical IPV, many sought the help of a psychiatrist (13.8%) or other mental health professionals (14.0%). Multivariate findings revealed associations between help-seeking utilization and sociodemographic factors. Queries from open responses suggested potential cultural and ethnic differences between African American and Caribbean Black women reporting intimate partner violence in relation to barriers to help-seeking.

Improving Safety Among Pregnant Women Reporting Domestic Violence in Nepal-A Pilot Study

Introduction: Domestic violence (DV) during pregnancy is associated with poor health outcomes for both the mother and newborn, and sometimes death. In a low-income country like Nepal, women have few options to leave abusive situations. Therefore, there is a need for interventions to improve their safety. The aim of our study was to explore the use of safety measures before and after an educational intervention among women who have reported DV during pregnancy. Materials and methods: Of 1010 pregnant women screened consecutively for DV using the Abuse Assessment Screen (AAS) during routine antenatal care, 181 women reported domestic violence. All 1010 participating pregnant women were taught 15 safety measures using a locally developed flipchart. We obtained contact with 80 of the 181 eligible women postpartum, of whom 62 completed the follow-up assessment. We explored and described the use of safety measures at baseline and follow-up, using a standardized instrument called the Safety Behavior Checklist. Results: At follow-up, less than half of the women (n = 30, or 48.3%) reported any form of DV. Of the women who reported DV at follow-up, significantly more reported the experience of both violence and fear at baseline (21.9%, p = 0.01) compared with the women who did not report DV at follow-up (3.3%, p = 0.01). Women reporting DV at baseline and follow-up used more safety measures at baseline (56) and follow-up (80) compared with women reporting DV at baseline only (36 and 46). Women reporting DV at baseline and follow-up used more safety measures for the first time at follow-up, 57 new measures compared with the 28 new measures used by women reporting DV at baseline only. Conclusions: The use of a flipchart teaching session on safety measures within antenatal care may increase the number of safety measures women use to protect themselves during pregnancy and decrease the risks of adverse health effects of DV.

Self-Reported Mental and Physical Health Symptoms and Potentially Traumatic Events Among Lesbian, Gay, Bisexual, Transgender, and Queer Individuals: The Role of Shame

OBJECTIVE

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals disproportionately face exposure to potentially traumatic events-adverse experiences that may have a traumatizing effect-and experience shame as a common consequence. Previous research demonstrates associations between shame and psychological and physical health issues among those with exposure to potentially traumatic events in general, with limited attention among LGBTQ individuals specifically. This study determined whether shame partially mediated the relationship between potentially traumatic events exposure and self-reported mental and physical health symptoms among LGBTQ individuals.

METHOD

Participants were 218 self-identified LGBTQ individuals who reported experiencing at least one potentially traumatic event (e.g., childhood sexual abuse). Online surveys assessed the type and frequency of potentially traumatic events exposure, shame, self-reported mental health (depression symptoms, posttraumatic stress disorder symptoms, and substance use), and physical health symptoms (sexual risk behavior, somatic symptoms, and chronic health conditions).

RESULTS

Greater potentially traumatic events exposure was associated with greater shame, and greater shame was associated with worse self-reported mental and physical health. Potentially traumatic events exposure had a direct effect on self-reported mental and physical health, and shame partially mediated this relationship.

CONCLUSION

Shame represents an important and modifiable factor that relates to poor health and may be amenable to change through psychosocial interventions. Given the prevalence of negative self-attribution stemming from potentially traumatic events exposure, in addition to the internalization of stigma among this population, practitioners need to uncover interventions specifically targeting shame when working with LGBTQ individuals.

An Exploration of Sexual Assault Survivors' Discourse Online on Help-Seeking

Although sexual assault is associated with significant negative psychological health outcomes, few survivors seek support from formal providers. This study explored the barriers to accessing and benefitting from services for sexual assault, as disclosed in narrative posts on social media, using qualitative methodology. Of the 1,179 narratives posted to the subreddit'r/rapecounseling' that were reviewed, 81 data extracts from 52 women were included in this study based on predefined inclusion/exclusion criteria. Six themes were identified that prevented survivors from accessing or benefitting from help. Internal barriers included feeling overwhelmed and avoidance-based coping. External barriers included availability of services, suitability of services, and therapist-caused harms. Stigma was the only barrier that was experienced both internally and externally. These findings suggest a need for more supportive mental health services.

After Disclosure: A Research Protocol to Respond to Disclosures of Abuse and Sexual Violence in Research With Adults With Intellectual Disabilities

People with intellectual disabilities (ID) have high lifetime risk of abuse and assault, including sexual violence. As adults with ID participate in research, researchers must be prepared for disclosures of past or current abuse. In collaboration with our state's protective agency, we developed a protocol for responding effectively to disclosures of sexual violence from adult research participants with ID. We completed a literature review clarifying best practices for responding to disclosures of abuse by adults with ID. The literature focused on various professionals but we were unable to find evidence clarifying researchers' roles in responding to sexual violence. Working with our state protective services agency, we adapted these practices to develop protocols and an algorithm for responding to disclosure, as well as materials for participants. Our protocol for abuse reporting considers all members of the research team to be mandated reporters, emphasizes informed consent, and details specific steps for responding to disclosures of abuse in the context of research. It represents a collaboration between academic researchers and community partners. Research participation by people with ID may represent an opportunity for disclosure of past or current abuse, and therefore, it is imperative that researchers are equipped to respond effectively. Policy-level responses to prevent abuse and enable justice are also needed; however, ensuring that researchers respond systematically and effectively to disclosures is crucial to the ethical conduct of research with a vulnerable population. We anticipate that the frequency with which researchers will need to use this protocol will depend on the nature of their research. In practice, we recommend including this protocol as part of the overall study protocol and submitting it for Institutional Review Board (IRB) approval. Future research to test our protocol in the field is recommended.

Predicting the Effects of Sexual Assault Research Participation: Reactions, Perceived Insight, and Help-Seeking

This study examined effects of participating in survey research for women sexual assault survivors with other trauma histories to understand the role of study participation on perceived insight and long-term help-seeking behaviors. A diverse sample of 1,863 women from a large Midwestern city participated in a 3-year study on women's experiences with sexual assault. Regression analyses were conducted to (a) examine predictors of immediate positive and negative reactions to survey participation and (b) assess the impact of the survey on perceived insight and women's long-term help-seeking behavior. Overall, most women in the study had a higher positive than negative reaction to the survey (92%), with a significant proportion indicating they sought additional services as a result of participation (55%). Women with child sexual abuse (CSA), more emotion dysregulation, and more characterological self-blame had more negative reactions to the survey, whereas those with more education and individual adaptive coping had more positive reactions. Women who said they gained insight from answering survey questions were most likely to seek additional help. This study extends the literature by examining cumulative trauma and postassault symptoms in relation to the effects of survey participation. This is also the first study of women sexual assault survivors to find a relationship between gaining perceived insight from research and subsequent help-seeking. Participating in sexual assault research may help survivors gain greater insight into their recovery, which can lead them to seek out more resources for their ongoing trauma-related problems.

Rural Location and Relative Location: Adding Community Context to the Study of Sexual Assault Survivor Time Until Presentation for Medical Care

Despite a strong empirical base linking community context and proximity to resources to individual health care access, studies examining predictors of sexual assault survivor time until presentation for medical care have not yet examined these relationships. This study addresses this gap. The data included retrospective records on a sample of 1,630 female survivors who reported their sexual assault to law enforcement and were subsequently seen by a sexual assault nurse examiner (SANE) in one of eight Alaskan communities between the years 1996 and 2006. Logistic regression models were used to determine whether delays in presentation (presentation 12 hr or more after assault) differed for women presenting in unique communities (rural location), and between those whose assault and exam occurred in different communities versus occurring in the same community (relative location). Although rural location did not seem to have a unique impact on time until presentation, differing locations (i.e., relative location) of assaults and exams increased the likelihood of delays in presentation. Non-American Indian/Alaska Native race/ethnicity and knowing one's assailant(s) also increased the likelihood of delays. These results indicate that in addition to a need for further research, there is a need for more appropriate and reliable sexual assault medical services across communities, and that survivors assaulted by known assailants should be targeted in efforts to reduce time until presentation.

Disseminating the Community Advocacy Project in Mexico: A Feasibility Study

The Community Advocacy Project is an evidence-based practice that has been shown to lead to numerous positive changes in the lives of intimate partner violence (IPV) survivors. Prior research conducted in the Midwest United States, and with primarily African American and Anglo American survivors, has shown that this short-term, community-based advocacy intervention results in increased safety and quality of life even 2 years after the intervention ends. The current study describes the process of culturally adapting and disseminating this program in Monterrey, Mexico, with a sample of low-income Mexican IPV survivors exposed to a variety of considerable contextual stressors. Interviews were conducted with advocates, advocate supervisors, and survivors to examine the acceptability and utility of the intervention. Twenty-seven IPV survivors, seven advocates, and four advocate supervisors participated in the intervention research. Advocates and their supervisors were highly laudatory, believing the intervention to be culturally relevant and effective. Encouraging changes were found for survivors as well, with positive changes over time being found on safety, quality of life, social support, and depression.

Counselling-based psychosocial intervention to improve the mental health of abused pregnant women: a protocol for randomised controlled feasibility trial in a tertiary hospital in eastern Nepal

INTRODUCTION

The strong correlation between domestic and family violence (DFV) and mental health has been well documented in studies. Pregnancy is a period when both DFV and mental distress tend to occur and/or accentuate. Although limited, available evidence from developed countries has shown continual support and education as psychological first aid that can reduce DFV and improve mental health. However, there is significantly less number of studies from resource-constrained countries; thus, there continues to be a substantial gap in knowledge and awareness regarding effective interventions for DFV.

METHODS AND ANALYSIS

A two-arm randomised trial with a nested qualitative study has been planned to assess feasibility and treatment effect estimates of a counselling-based psychosocial intervention among pregnant women with a history of abuse. A total of 140 pregnant women who meet the inclusion criteria will be recruited into the study. Block randomisation will be used to allocate women equally into two groups. The intervention group will receive a counselling session, an information booklet and continuous support by a researcher, while women in the control group will receive contact information of local support services. Feasibility measures, such as rates of recruitment, consent and retention, will be calculated. Qualitative interviews with participants and healthcare providers will explore the acceptability and usability of the intervention. Outcome measures, such as psychological distress, quality of life, social support and self-efficacy, will be measured at baseline, 4 weeks postintervention and 6 weeks postpartum.

ETHICS AND DISSEMINATION

This study has obtained ethical approval from the Griffith University Human Research Ethics Committee, the Nepal Health Research Council and the Institutional Review Board of a tertiary hospital in Dharan, Nepal. The findings will be disseminated via peer-reviewed publications and conference presentations and will be used to inform a future multicentre trial.

TRIAL REGISTRATION NUMBER

12618000307202; Pre-results.

The health equity measurement framework: a comprehensive model to measure social inequities in health

BACKGROUND

Despite the wealth of frameworks on social determinants of health (SDOH), two current limitations include the relative superficial description of factors affecting health and a lack of focus on measuring health equity. The Health Equity Measurement Framework (HEMF) addresses these gaps by providing a more encompassing view of the multitude of SDOH and drivers of health service utilisation and by guiding quantitative analysis for public health surveillance and policy development. The objective of this paper is to present the HEMF, which was specifically designed to measure the direct and indirect effects of SDOH to support improved statistical modelling and measurement of health equity.

METHODS

Based on a framework synthesis, the HEMF development involved initially integrating theoretical components from existing SDOH and health system utilisation frameworks. To further develop the framework, relevant publications on SDOH and health equity were identified through a literature review in major electronic databases. White and grey literatures were critically reviewed to identify strengths and gaps in the existing frameworks in order to inform the development of a unique health equity measurement framework. Finally, over a two-year period of consultation, scholars, health practitioners, and local policy influencers from municipal and provincial governments provided critical feedback on the framework regarding its components and causal relationships.

RESULTS

This unified framework includes the socioeconomic, cultural, and political context, health policy context, social stratification, social location, material and social circumstances, environment, biological factors, health-related behaviours and beliefs, stress, quality of care, and healthcare utilisation. Alongside the HEMF's self-exploratory diagram showing the causal pathways in-depth, a number of examples are provided to illustrate the framework's usefulness in measuring and monitoring health equity as well as informing policy-making.

CONCLUSIONS

The HEMF highlights intervention areas to be influenced by strategic public policy for any organisation whose purview has an effect on health, including helping non-health sectors (such as education and labour) to better understand how their policies influence population health and perceive their role in health equity promotion. The HEMF recognises the complexity surrounding the SDOH and provides a clear, overarching direction for empirical work on health equity.

"I Still Feel Like I Am Not Normal": A Review of the Role of Stigma and Stigmatization Among Female Survivors of Child Sexual Abuse, Sexual Assault, and Intimate Partner Violence

Child sexual abuse (CSA), sexual assault (SA), and intimate partner violence (IPV) occur within social contexts that shape how survivors judge themselves and are evaluated by others. Because these are gendered sexual and intimate crimes that violate social norms about what is appropriate and acceptable, survivors may experience stigma that includes victim-blaming messages from the broader society as well as specific stigmatizing reactions from others in response to disclosure; this stigmatization can be internalized among survivors as self-blame, shame, and anticipatory stigma. Stigma and stigmatization play an important role in shaping survivors' thoughts, feelings, and behaviors as they recover; their risk of revictimization; and their help-seeking and attainment process. In this review, we synthesize recent CSA, SA, and IPV research ( N = 123) that examines female survivors' self-blame, shame, internalized stigma, and anticipatory stigma as well as negative social reactions in response to survivors' disclosure. We highlight critical findings as well as implications for research, practice, and policy, and we note gaps in our current knowledge.

Coercive Control in Intimate Partner Violence: Relationship with Women's Experience of Violence, Use of Violence, and Danger

OBJECTIVE

The objective of this study was to better understand the experience of coercive control as a type of IPV by examining associations between coercive control and women's experiences of particular forms of violence, use of violence, and risk of future violence.

METHOD

As part of a larger research study, data were collected from 553 women patients at two hospital emergency departments who had experienced recent IPV and unhealthy drinking. Baseline assessments, including measures of coercive control, danger, and experience and use of psychological, physical, and sexual forms of IPV in the prior three months were analyzed.

RESULTS

Women experiencing coercive control reported higher frequency of each form of IPV, and higher levels of danger, compared to women IPV survivors who were not experiencing coercive control. There was no statistically significant association between experience of coercive control and women's use of psychological or sexual IPV; women who experienced coercive control were more likely to report using physical IPV than women who were not experiencing coercive control.

CONCLUSIONS

Findings contribute to knowledge on the relationship between coercive control and specific forms of violence against intimate partners. A primary contribution is the identification that women who experience coercive control may also use violence, indicating that a woman's use of violence does not necessarily mean that she is not also experiencing severe and dangerous violence as well as coercive control. In fact, experience of coercive control may increase victims' use of physical violence as a survival strategy.

Service seeking experiences of college-aged sexual and intimate partner violence victims with a mental health and/or behavioral disability

OBJECTIVE

To examine mental health service experiences following sexual violence (SV) and intimate partner violence (IPV) victimization among college women with a disability.

PARTICIPANTS

College women (n = 27, ages 19 to 24) with a disability who experienced at least one SV/IPV occurrence; interviewed July/August 2016.

METHODS

Qualitative study using in-depth interviews, with thematic analysis.

RESULTS

Women tended to wait several months (or did not seek care at all) following SV/IPV, because they downplayed their experience (e.g., not wanting to label an experience as "rape"). Those seeking services primarily did so because of escalating mental health concerns. Among service seekers, women were satisfied when professionals validated their experiences/concerns; and were dissatisfied when faced with extended wait time for care and/or professionals unskilled with SV/IPV and mental health. However, women still sought care following negative experiences.

CONCLUSIONS

Improved access to integrated care for SV/IPV and mental health, along with skilled professionals, is essential.

Reporting Sexual Victimization During Incarceration: Using Ecological Theory as a Framework to Inform and Guide Future Research

The U.S. Department of Justice estimates that between 149,200 and 209,400 incidents of sexual victimization occur annually in prisons and jails. However, very few individuals experiencing sexual victimization during incarceration report these incidents to correctional authorities. Federal-level policy recommendations derived from the Prison Rape Elimination Act suggest mechanisms for improving reporting as well as standards for the prevention, investigation, and prosecution of prison-based sexual victimization. Despite these policy recommendations, sexual assault persists in prisons and jails, with only 8% of prisoners who experience sexual assault reporting their victimization. This review focuses on gaps in the existing research about what factors influence whether adult victims in incarcerated systems will report that they have been sexually assaulted. Using ecological theory to guide this review, various levels of social ecology are incorporated, illuminating a variety of factors influencing the reporting of sexual victimization during incarceration. These factors include the role of individual-level behavior, assault characteristics, the unique aspects and processes of the prison system, and the social stigma that surrounds individuals involved in the criminal/legal system. This review concludes with recommendations for future research, policy, and practice, informed by an ecological conceptualization of reporting.

Health and Health Care From the Perspective of Intimate Partner Violence Adult Female Victims in Shelters: Impact of IPV, Unmet Needs, Barriers, Experiences, and Preferences

Intimate partner violence (IPV) predicts poor health for victims and their children, but little is known about the perspective of victims. This study reports the perspectives of adult female IPV victims about the impact of IPV on their health and barriers of health care access for themselves and their children. The majority rated their health as good to excellent (69%). However, 83.5% indicated that IPV negatively affected their health; 53.5% had unmet health care needs. Mental health care was the most common unmet need for women; children's unmet needs were immunizations and preventive care. Transportation difficulties posed the biggest barrier to health care access.

Common ground, complementary approaches: adapting the Housing First model for domestic violence survivors

The Housing First model has been shown to be a highly effective approach to achieving permanent housing for chronically homeless individuals with serious mental illness and chemical dependency. There are numerous components of the model that lend themselves toward achieving similar goals for homeless domestic violence (DV) survivors and their children. A leading cause of homelessness for women, many of whom are mothers, is DV. This article describes the commonalities between the Housing First model and the tenets of DV victim advocacy work and explores how Housing First can be adapted to effectively achieve safe and stable housing for DV survivors and their children. Preliminary evidence for the adapted model - termed Domestic Violence Housing First - is provided, and policy implications are discussed.

Deciding Where to Turn: A Qualitative Investigation of College Students' Helpseeking Decisions After Sexual Assault

Sexual assault is a widespread problem on college campuses that has been the subject of substantial attention in recent years (Ali, 2011; Krebs, Lindquist, Berzofsky, Shook-Sa, & Peterson, 2016). Resources designed to address the problem exist, but there is evidence that they are underutilized by survivors (Campbell, 2008). The current study used grounded theory to explore how sexual assault survivors make decisions about helpseeking. In-depth interviews were conducted with 14 college sexual assault survivors to develop a theoretical model for their decision-making process. The resulting model, Deciding Where to Turn, suggests that survivors engage in three key decision points: determining if there is a problem related to the sexual assault (Do I Need Help), considering options (What Can I Do), and weighing the consequences of these options (What Will I Do). This process results in one of four behavioral choices: cope on one's own, seek support from friends/family, seek support from formal resources, or covert helpseeking, where needs are met without disclosure. Deciding Where to Turn contributes to the literature by providing a framework for understanding helpseeking decisions after sexual assault, highlighting the need to match reactions to survivor perceptions. The concept of covert helpseeking in particular adds to the way researchers and practitioners think about helpseeking. Research and practice implications are discussed.