An evaluation of interventions to decrease intimate partner violence to pregnant women

Interventions for intimate partner violence during the perinatal period: A scoping review: A systematic review

Background

Intimate partner violence (IPV) is a prevalent global health problem. IPV that occurs before pregnancy often continues during the perinatal period, resulting in ongoing violence and many adverse maternal, obstetrical, and neonatal outcomes.

Objectives

This scoping review is designed to broadly capture all potential interventions for perinatal IPV and describe their core components and measured outcomes.

Search Methods

We conducted a search for empirical studies describing IPV interventions in the perinatal population in June 2022. The search was conducted in MEDLINE, EMBASE, PsycInfo, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science, Applied Social Sciences Index & Abstracts, ClinicalTrials.gov and MedRxiv. Hand searching of references from select articles was also performed.

Selection Criteria

Included studies described an intervention for those experiencing IPV during the perinatal period, including 12 months before pregnancy, while pregnant or in the 12 months post-partum. The search encompassed January 2000 to June 2022 and only peer-reviewed studies written in either English or French were included. Included interventions focused on the survivor exposed to IPV, rather than healthcare professionals administering the intervention. Interventions designed to reduce IPV revictimization or any adverse maternal, obstetrical, or neonatal health outcomes as well as social outcomes related to IPV victimization were included.

Data Collections and Analysis

We used standard methodological procedures expected by The Campbell Collaboration.

Main Results

In total, 10,079 titles and abstracts were screened and 226 proceeded to full text screening. A total of 67 studies included perinatal IPV interventions and were included in the final sample. These studies included a total of 27,327 participants. Included studies originated from 19 countries, and the majority were randomized controlled trials (n = 43). Most studies were of moderate or low quality. Interventions included home visitation, educational modules, counseling, and cash transfer programs and occurred primarily in community obstetrician and gynecologist clinics, hospitals, or in participants' homes. Most interventions focused on reducing revictimization of IPV (n = 38), improving survivor knowledge or acceptance of violence, knowledge of community resources, and actions to reduce violence (n = 28), and improving maternal mental health outcomes (n = 26). Few studies evaluated the effect of perinatal IPV interventions on obstetrical, neonatal or child health outcomes.

Authors' Conclusions

The majority of intervention studies for perinatal IPV focus on reducing revictimization and improving mental health outcomes, very few included obstetrical, neonatal, and other physical health outcomes. Future interventions should place a larger emphasis on targeting maternal and neonatal outcomes to have the largest possible impact on the lives and families of IPV survivors and their infants.

Integrated domestic violence and reproductive health interventions in India: a systematic review

BACKGROUND

Domestic violence is a leading cause of poor health outcomes during pregnancy and the postpartum period. Therefore, there is a need for integrated domestic violence interventions in reproductive health care settings. India has one of the highest maternal and child mortality rates. This review aimed to identify characteristics of existing evidence-based integrated domestic violence and reproductive healthcare interventions in India to identify gaps and components of interventions that demonstrate effectiveness for addressing domestic violence.

METHODS

A systematic review of intervention studies was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Three research team members performed independent screening of title, abstracts and full-texts.

RESULTS

The search resulted in 633 articles, of which 13 articles met inclusion criteria for full text screening and analysis. Common components of integrated violence and reproductive health interventions that were effective in addressing domestic violence included: psychoeducation/education (n = 5), skill building (n = 5), counseling (n = 5), engaging stakeholders with use of trained lay peer facilitators (n = 3), and engaging male spouses (n = 3).

CONCLUSIONS

Interventions in India for domestic violence that are integrated with reproductive health care remain few, and there are fewer with effective outcomes for domestic violence. Of those with effective outcomes, all of the interventions utilized psychoeducation/education, skill building, and counseling as part of the intervention.

Systematic Review of Intimate Partner Violence Interventions for Latinas in the U.S

Despite increased risks associated with intimate partner violence (IPV) among Latinas, there is limited knowledge about interventions focused on preventing and responding to IPV among this group or the culturally relevant components of these interventions. To address this gap, we conducted a systematic review of IPV interventions for Latinas. To be included in the review, articles had to be peer-reviewed and available in English or Spanish; evaluate an IPV intervention conducted in the U.S. (including Puerto Rico); include Latinas; and quantitatively report at least one outcome. Our initial search yielded 3,344 unduplicated peer-reviewed articles, of which 20 met the inclusion criteria. The 20 resultant articles evaluated 14 unique interventions among 16 different study samples. Half of the studies focused on interventions that aimed to prevent IPV, whereas the other half focused on interventions that aimed to respond to IPV (i.e., provide services to those who had experienced or were experiencing IPV). Eight of the 14 interventions integrated culturally specific elements. While six studies were randomized controlled trials, most were pre-experimental in design. Interventions generally demonstrated positive outcomes on various measures. However, nine interventions reported mixed findings, emphasizing the complex factors influencing IPV among Latinas. Findings suggest the need for more mechanistic and nuanced research on potentially relevant culturally responsive content and approaches in IPV programming with Latinas, focusing on cultural strengths and structural challenges. Policies are needed to expand funding for innovative and rigorous IPV intervention research to further advance and strengthen existing practice options for Latina survivors.

Cultural Sensitivity in Interventions Aiming to Reduce or Prevent Intimate Partner Violence During Pregnancy: A Scoping Review

Intimate partner violence (IPV) around the time of pregnancy is a recognized global health problem. Ethnic minorities and immigrant pregnant women experiencing IPV require culturally responsive health services. The aim of this scoping review was to identify aspects of cultural sensitivity in interventions to prevent or reduce IPV among ethnic minorities and immigrant pregnant women in high-income countries. Eight databases were searched in November 2019. Any type of scientific research, quantitative, qualitative, or mixed methods studies regarding interventions against IPV among pregnant women were considered for inclusion. Resnicow et al.'s definition of cultural sensitivity was used to identify aspects of cultural sensitivity. Ten papers relating to nine interventions/studies met our inclusion criteria. These studies, which included randomized controlled trials, a mixed methods study, a program evaluation, and a longitudinal study, were conducted in Australia, Belgium, Norway, and the United States. Aspects of surface cultural sensitivity, including the translation of intervention content into the language of the target group(s) and the involvement of bilingual staff to recruit participants, were identified in eight studies. Deep structure aspects of cultural sensitivity were identified in one study, where the intervention content was pretested among the target group(s). Results that could be related to the culture-sensitive adaptions included successful recruitment of the target population. Three studies were planning to investigate women's experiences of interventions, but no publications were yet available. This scoping review provides evidence that culturally sensitive interventions to reduce or prevent IPV among immigrant pregnant women are limited in number and detail.

Safety Planning With Marginalized Survivors of Intimate Partner Violence: Challenges of Conducting Safety Planning Intervention Research With Marginalized Women

Intimate partner violence (IPV) disproportionately affects marginalized women in the United States. This calls for effective safety planning strategies to reduce the risk for future revictimization and address safety needs of survivors from marginalized groups. This review identified types of interventions that incorporated safety planning and were successful in reducing the risk for future revictimization among IPV survivors from diverse groups, examined elements of safety planning in effective interventions, and described challenges or limitations in safety planning intervention research with marginalized women. A systematic search of five databases was performed. The search resulted in inclusion of 17 studies for synthesis. The included studies were quantitative, U.S.-based, evaluated interventions with a safety planning component, and had an outcome of change in IPV. Effective interventions that incorporated safety planning were empowerment and advocacy focused. Elements included were comprehensive assessments of survivors' unique needs and situations, educating them about IPV, helping them identify threats to safety, developing a concrete safety plan, facilitating linkage with resources, providing advocacy services as needed, and conducting periodic safety check-ins. For survivors with mental and behavioral health issues, effective interventions included psychotherapeutic approaches along with safety planning to address survivors' co-occurring health care needs. Although most studies reported positive findings, there were limitations related to designs, methods, adequate inclusion, and representation of marginalized women and cultural considerations. This calls for additional research using rigorous and culturally informed approaches to establish an evidence base for effective interventions that specifically address the safety planning needs of marginalized survivors of IPV.

Safe Pregnancy intervention for intimate partner violence: a randomised controlled trial in Norway among culturally diverse pregnant women

Background

Intimate partner violence (IPV) during pregnancy is a global health problem with adverse consequences for mothers, infants and families. We hypothesise that information about IPV and safety behaviours during pregnancy has the potential to increase quality of life and the use of safety behaviours and prevent IPV.

Methods

A multicentre randomised controlled trial among culturally diverse pregnant women in Norway, to test the effect of a tablet-based video intervention about IPV and safety behaviours. Women attending routine antenatal check-ups alone (baseline) were screened for violence (Abuse Assessment Screen) by responding to questions on a tablet, and randomised (1:1) by computer to receive an intervention or a control video. The intervention video presented information about IPV and safety behaviours. The controls viewed a video promoting healthy pregnancy in general. Outcome measures were assessed three months post-partum: The World Health Organization Quality of Life-BREF, the Composite Abuse Scale on violence during the last 12 months and use of safety behaviours based on a 15-item checklist. A general linear model for repeated measures was used to examine the intervention’s effect. The analyses were conducted by intention to treat.

Results

Among 1818 eligible women, 317 reported IPV and were randomised to an intervention (157) or a control group (160). A total of 251 (79.2%) women completed the follow-up questionnaire: 120 (76.4%) in the intervention group and 131 (81.9%) in the control group. At follow-up, 115 (45.8%) women reported a history of IPV. Few women (n = 39) reported IPV during the last 12 months. No differences in quality-of-life domains and overall quality of life and health were found between the intervention and the control groups. We detected no differences between the use of safety behaviours or IPV frequency and severity during the last 12 months.

Conclusion

Our intervention did not improve women’s quality of life, use of safety behaviours or exposure to violence. Nevertheless, a tablet-based tool may motivate women experiencing IPV to seek help and support. More research is needed regarding tablet-based interventions for women experiencing IPV, particularly culturally sensitive interventions.

Trial registration

NCT03397277 registered in clinicaltrials.gov on 11/01/2018.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04400-z.

Interventions Addressing Social Needs in Perinatal Care: A Systematic Review

Introduction: Health is impacted by a wide range of nonmedical factors, collectively termed the social determinants of health (SDoH). As the mechanisms by which these factors influence wellness and disease continue to be uncovered, health systems are beginning to assess their roles in addressing patient's social needs. This study seeks to identify and analyze clinic-based interventions aimed at addressing patients' social needs in perinatal care, including prenatal, antepartum, and postpartum care.

Methods: We conducted a search of six databases through May 2020 for articles describing screening or intervention activities addressing social needs in at least one SDoH domain as defined by Healthy People 2020. We required that studies include pregnant or postpartum women and be based in a clinical setting.

Results: Thirty-one publications describing 26 unique studies were identified. Most studies were either randomized-controlled trials (n=10) or observational studies (n=7) and study settings were both public and private. The mean age of women ranged from 17.4 to 34.1 years. Most studies addressed intimate partner violence (n=19). The next most common need addressed was social support (n=5), followed by food insecurity (n=3), and housing (n=2). Types of interventions varied from simple screening to ongoing counseling and case management. There was wide heterogeneity in outcomes investigated. Most IPV interventions that included counseling or ongoing support resulted in reduced IPV recurrence and severity. No intervention with only screening showed a reduction in rate of IPV.

Conclusion: This systematic review shines light on several avenues to support pregnant and postpartum women through interventions that embed acknowledgment of social needs and actions addressing these needs into the clinical environment. The results of this review suggest that interventions with counseling or ongoing support may show promise in alleviating social risk factors and improving some clinical outcomes. However, the strength of this evidence is limited by the paucity of studies. More rigorous research is imperative to augment the knowledge of social needs interventions, especially in domains outside of IPV.

Intimate Partner Violence: A Bibliometric Review of Literature

Intimate partner violence (IPV) is a worldwide public health problem. Here, a bibliometric analysis is performed to evaluate the publications in the Intimate Partner Violence (IPV) field from 2000 to 2019 based on the Science Citation Index (SCI) Expanded and the Social Sciences Citation Index (SSCI) databases. This work presents a detailed overview of IPV from aspects of types of articles, citations, h-indices, languages, years, journals, institutions, countries, and author keywords. The results show that the USA takes the leading position in this research field, followed by Canada and the U.K. The University of North Carolina has the most publications and Harvard University has the first place in terms of h-index. The London School of Hygiene and Tropical Medicine leads the list of average citations per paper. The Journal of Interpersonal Violence, Journal of Family Violence and Violence Against Women are the top three most productive journals in this field, and Psychology is the most frequently used subject category. Keywords analysis indicates that, in recent years, most research focuses on the research fields of "child abuse", "pregnancy", "HIV", "dating violence", "gender-based violence" and "adolescents".

[Perinatal and postnatal treatment of traumatized parents with mental disorders: impact on parents and their children]

BACKGROUND

In traumatized parents with mental disorders, pregnancy and related medical examinations can lead to high emotional distress and flashbacks and increase the already tense emotional situation. Besides psychiatric burdens, parental insecurity concerning dealing with and reduced sensitivity for the child often exist. The children themselves have a higher risk of being neglected or abused and to also develop mental disorders.

OBJECTIVE

How does interventional research take the special needs of traumatized parents with mental disorders into account? What kind of interventions predominate and what impact do they have on parents and children?

MATERIAL AND METHODS

Publications on perinatal and postnatal interventions for traumatized and mentally disordered parents were included in the review if at least one intervention was explicitly described, a parental trauma was discussed and the impact of the intervention on the parents and children was analyzed.

RESULTS

A total of 2 reviews and 10 interventional studies were included. Interventions were primarily based on professional educational counseling, psychoeducation, nurse home visits, individual and group therapies and inpatient mother-baby units. The interventions led to reduced psychiatric symptoms, enhanced parental sensitivity for the child's needs, enhanced quality of nurturing and care and an improved mother-child bonding.

CONCLUSION

Although only few studies focused on the special needs of traumatized, mentally disordered parents, the described interventions show promising effect sizes, especially in combination with several kinds of interventions. Nevertheless, an adequate integration of fathers into the therapies has so far been neglected.

A realist review of which advocacy interventions work for which abused women under what circumstances

BACKGROUND

Intimate partner abuse (including coercive control, physical, sexual, economic, emotional and economic abuse) is common worldwide. Advocacy may help women who are in, or have left, an abusive intimate relationship, to stop or reduce repeat victimisation and overcome consequences of the abuse. Advocacy primarily involves education, safety planning support and increasing access to different services. It may be stand-alone or part of other services and interventions, and may be provided within healthcare, criminal justice, social, government or specialist domestic violence services. We focus on the abuse of women, as interventions for abused men require different considerations.

OBJECTIVES

To assess advocacy interventions for intimate partner abuse in women, in terms of which interventions work for whom, why and in what circumstances.

SEARCH METHODS

In January 2019 we searched CENTRAL, MEDLINE, 12 other databases, two trials registers and two relevant websites. The search had three phases: scoping of articles to identify candidate theories; iterative recursive search for studies to explore and fill gaps in these theories; and systematic search for studies to test, confirm or refute our explanatory theory.

SELECTION CRITERIA

Empirical studies of any advocacy or multi-component intervention including advocacy, intended for women aged 15 years and over who were experiencing or had experienced any form of intimate partner abuse, or of advocates delivering such interventions, or experiences of women who were receiving or had received such an intervention. Partner abuse encompasses coercive control in the absence of physical abuse. For theory development, we included studies that did not strictly fit our original criteria but provided information useful for theory development.

DATA COLLECTION AND ANALYSIS

Four review authors independently extracted data, with double assessment of 10% of the data, and assessed risk of bias and quality of the evidence. We adopted RAMESES (Realist and meta-narrative evidence syntheses: evolving standards) standards for reporting results. We applied a realist approach to the analysis.

MAIN RESULTS

We included 98 studies (147 articles). There were 88 core studies: 37 focused on advocates (4 survey-based, 3 instrument development, 30 qualitative focus) and seven on abused women (6 qualitative studies, 1 survey); 44 were experimental intervention studies (some including qualitative evaluations). Ten further studies (3 randomised controlled trials (RCTs), 1 intervention process evaluation, 1 qualitative study, 2 mixed methods studies, 2 surveys of women, and 1 mixed methods study of women and staff) did not fit the original criteria but added useful information, as befitting a realist approach. Two studies are awaiting classification and three are ongoing.Advocacy interventions varied considerably in contact hours, profession delivering and setting.We constructed a conceptual model from six essential principles based on context-mechanism-outcome (CMO) patterns.We have moderate and high confidence in evidence for the importance of considering both women's vulnerabilities and intersectionalities and the trade-offs of abuse-related decisions in the contexts of individual women's lives. Decisions should consider the risks to the woman's safety from the abuse. Whether actions resulting from advocacy increase or decrease abuse depends on contextual factors (e.g. severity and type of abuse), and the outcomes the particular advocacy intervention is designed to address (e.g. increasing successful court orders versus decreasing depression).We have low confidence in evidence regarding the significance of physical dependencies, being pregnant or having children. There were links between setting (high confidence), and potentially also theoretical underpinnings of interventions, type, duration and intensity of advocacy, advocate discipline and outcomes (moderate and low confidence). A good therapeutic alliance was important (high confidence); this alliance might be improved when advocates are matched with abused women on ethnicity or abuse experience, exercise cultural humility, and remove structural barriers to resource access by marginalised women. We identified significant challenges for advocates in inter-organisational working, vicarious traumatisation, and lack of clarity on how much support to give a woman (moderate and high confidence). To work effectively, advocates need ongoing training, role clarity, access to resources, and peer and institutional support.Our provisional model highlights the complex way that factors combine and interact for effective advocacy. We confirmed the core ingredients of advocacy according to both women and advocates, supported by studies and theoretical considerations: education and information on abuse; rights and resources; active referral and liaising with other services; risk assessment and safety planning. We were unable to confirm the impact of complexity of the intervention (low confidence). Our low confidence in the evidence was driven mostly by a lack of relevant studies, rather than poor-quality studies, despite the size of the review.

AUTHORS' CONCLUSIONS

Results confirm the core ingredients of advocacy and suggest its use rests on sound theoretical underpinnings. We determined the elements of a good therapeutic alliance and how it might be improved, with a need for particular considerations of the factors affecting marginalised women. Women's goals from advocacy should be considered in the contexts of their personal lives. Women's safety was not necessarily at greatest risk from staying with the abuser. Potentially, if undertaken for long enough, advocacy should benefit an abused woman in terms of at least one outcome providing the goals are matched to each woman's needs. Some outcomes may take months to be determined. Where abuse is severe, some interventions may increase abuse. Advocates have a challenging role and must be supported emotionally, through provision of resources and through professional training, by organisations and peers.Future research should consider the different principles identified in this review, and study outcomes should be considered in relation to the mechanisms and contexts elucidated. More longitudinal evidence is needed. Single-subject research designs may help determine exactly when effect no longer increases, to determine the duration of longitudinal work, which will likely differ for vulnerable and marginalised women. Further work is needed to ascertain how to tailor advocacy interventions to cultural variations and rural and resource-poor settings. The methods used in the included studies may, in some cases, limit the applicability and completeness of the data reported. Economic analyses are required to ascertain if resources devoted to advocacy interventions are cost-effective in healthcare and community settings.

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.

Willing but Not Able: Patient and Provider Receptiveness to Addressing Intimate Partner Violence in Johannesburg Antenatal Clinics

Intimate partner violence (IPV) during pregnancy is associated with maternal and infant health. However, in South Africa, where 20% to 35% of pregnant women report experiencing IPV, antenatal care rarely addresses violence. Little research has explored how clinic staff, community members, or pregnant women themselves view IPV. We conducted formative, qualitative research with 48 participants in urban Johannesburg. Focus group discussions with pregnant women ( n = 13) alongside qualitative interviews with health providers ( n = 10), managers and researchers ( n = 10), non-governmental organizations ( n = 6), community leaders ( n = 4), and pregnant abused women ( n = 5) explored the context of IPV and health care response. Data were analyzed using a team approach to thematic coding in NVivo 10. We found that pregnant women in the urban Johannesburg setting experience multiple forms of IPV, but tend not to disclose violence to antenatal care providers. Providers are alert to physical injuries or severe outcomes from IPV, but miss subtler cues, such as emotional distress or signs of poor mental health. Providers are uncertain how to respond to IPV, and noted few existing tools, training, or referral systems. Nevertheless, providers were supportive of addressing IPV, as they noted this as a common condition in this setting. Providers and managers considered the safety and well-being of mother and infant to be a strong rationale for the identification of IPV. Pregnant women were receptive to being asked about violence in a kind and confidential way. Understaffing, insufficient training, and poorly developed referral systems were noted as important health system problems to address in future interventions. South African patients and providers are receptive to the identification of and response to IPV in antenatal care, but require tools and training to be able to safely address violence in the health care setting. Future interventions should consider the urban South African antenatal clinic a supportive, if under-resourced, entry point for improving the health of pregnant women experiencing violence.

Effect of a Qigong Intervention on Telomerase Activity and Mental Health in Chinese Women Survivors of Intimate Partner Violence: A Randomized Clinical Trial

IMPORTANCE

Qigong is a mind-body exercise that may be an effective self-care intervention for improving the well-being of women survivors of intimate partner violence.

OBJECTIVE

To test whether a qigong intervention would increase telomerase activity and improve mental health in Chinese women who survived intimate partner violence.

DESIGN, SETTING, AND PARTICIPANTS

A single-blind randomized clinical trial among Chinese women (N = 271) who survived intimate partner violence in the past 2 years recruited from a community center in Hong Kong, China. The trial was conducted from March 12, 2014, to May 26, 2016. Data analysis was by intention to treat and performed from June 7 to August 24, 2018.

INTERVENTIONS

Randomization (1:1) to a 22-week qigong intervention (n = 136) that included 22 weeks of Baduanjin qigong group training (1-6 weeks: 2-hour sessions biweekly; 7-22 weeks: 1-hour follow-up sessions weekly) and self-practice (30 minutes per day for 22 weeks) or to a wait-list control group (n = 135) that received optional monthly health education sessions unrelated to qigong after 6 weeks (posttraining period) and qigong training after 22 weeks (postintervention period).

MAIN OUTCOMES AND MEASURES

The primary outcome was telomerase activity in peripheral blood mononuclear cells. The secondary outcomes included levels of proinflammatory cytokines (tumor necrosis factor and interleukin 6) in peripheral blood plasma, depressive symptoms (Beck Depression Inventory II score; score range, 0-63; higher scores represent more severe depressive symptoms), perceived stress (Perceived Stress Scale; score range, 0-40; higher scores represent higher stress), and perceived coping (Perceived Coping Scale; score range, 0-13; higher scores represent use of more coping strategies).

RESULTS

From 1611 Chinese women screened (mean [SD] age, 42.0 [8.8] years), 247 of 271 randomized participants completed the study (intervention group, 120; wait-list control group, 127). Telomerase activity of the intervention group participants after 22 weeks was not significantly different from that of the wait-list control group participants (5.18 U [95% CI, 5.05-5.31 U] in the intervention group vs 5.14 U [95% CI, 5.01-5.27 U] in the wait-list control group; P = .66). The mean change in telomerase activity from baseline was marginally significant in the intervention group (effect size [d], 0.13; 95% CI, 0.001-0.27) but not in the wait-list control group (d, -0.03; 95% CI, -0.16 to 0.10). Perceived stress and depressive symptoms were significantly lower in the intervention group than in the wait-list control group after 6 weeks (between-group differences: perceived stress: d,  -1.81; 95% CI, -3.27 to -0.34; depressive symptoms: d,  -3.57; 95% CI, -6.25 to -0.90), but not after 22 weeks (between-group differences: perceived stress: d, -1.03; 95% CI, -2.50 to 0.43; depressive symptoms: d,  -1.78; 95% CI, -4.26 to 0.70).

CONCLUSIONS AND RELEVANCE

The findings of this study do not support a significant benefit of Baduanjin qigong on telomerase activity in women who have survived intimate partner violence. However, outcomes related to mental health seem to be improved, which should be confirmed by additional studies.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02060123.

The Potential for Screening for Intimate Partner Violence in Community Pharmacies: An Exploratory Study of Female Consumers' Perspectives

Intimate partner violence (IPV) is a substantial public health problem. The U.S. Preventive Services Task Force recently updated guidelines to recommend IPV screening for all women of childbearing age. Expansion of screening efforts to the community pharmacy setting could provide an opportunity to substantially impact the health of consumers. To date, no research has explored consumers' perspective on IPV screening in the community pharmacy environment. To address this gap, a descriptive survey research study was conducted to examine female consumers' attitudes and preferences for IPV screening in community pharmacies. Female pharmacy customers ( N = 60) completed an online survey assessing knowledge of and attitudes about community pharmacies as sources of health care advice, beliefs about IPV and IPV screening, and perspectives on IPV screening in the community pharmacy environment. Consumers who utilized pharmacies with more patient care services were more likely to report interest in IPV screening in the pharmacy environment. The majority of respondents thought IPV screening is an important thing to do (85.0%), and 33.3% agreed that it should happen in a pharmacy. A statistically significant relationship between the belief that the pharmacy is a good place for health education and preference for IPV screening in the community pharmacy environment was found, r(58) = .43, p < .001. Concern regarding the time required to conduct screenings and about the availability of appropriate space were identified as potential barriers to screening in the pharmacy environment.

Improving Quality of Care in Hospitals for Victims of Elder Mistreatment: Development of the Vulnerable Elder Protection Team

PROBLEM DEFINITION

Hospitals have an opportunity to improve the quality of care provided to a particularly vulnerable population: victims of elder mistreatment. Despite this, no programs to prevent or stop elder abuse in the acute care hospital have been reported. An innovative, multidisciplinary emergency department (ED)-based intervention for elder abuse victims, the Vulnerable Elder Protection Team (VEPT), was developed at NewYork-Presbyterian / Weill Cornell Medical Center (New York City).

APPROACH

The VEPT is a consultation service available 24 hours a day/7 days a week to improve identification, comprehensive assessment, and treatment for potential victims of elder abuse or neglect. All ED providers have been trained on how to recognize signs of elder mistreatment. Any provider can activate the VEPT via a single page/telephone call, which triggers the VEPT's often time-consuming, complex assessment of the potential mistreatment victim. First, the ED social worker on duty performs the initial bedside assessment and separately interviews the potential perpetrator and/or caregiver. He or she then contacts the on-call VEPT medical provider to discuss next steps and other team members' potential involvement. For patients admitted to the hospital, the VEPT connects with the inpatient social workers and medical team to ensure appropriate follow-up and care planning.

NEXT STEPS/PLANNED EVALUATION

The VEPT program was launched in April 2017 after comprehensive training. Its impact will be measured by tracking the short-term and long-term mistreatment-related outcomes, as well as medical, mental health, functional, psychosocial, and legal outcomes of the vulnerable ED patients for whom the team provides care.

The Effectiveness of Empowerment Program on Increasing Self-Esteem, Learned Resourcefulness, and Coping Ways in Women Exposed to Domestic Violence

This study was conducted to assess the effectiveness of empowerment program on increasing self-esteem, learned resourcefulness, and coping ways in women exposed to domestic violence. This experimental study was conducted between October 2012 and June 2014 in the obstetrics and gynaecology departments of the Giresun Maternity Hospital, and at the Family Counseling Center (FCC) in Turkey. Sixty women who agreed to participate in the study were randomly assigned into two groups. Data were collected by the Coopersmith Self-Esteem Inventory (SEI), The Rosenbaum's Learned Resourcefulness Scale (RLRS), and the Ways of Coping Inventory (WCI). The assessment of the women before and after the empowerment program showed that women in the intervention group showed significant improvements in the SEI, RLRS, and WCI scores compared with controls. These results suggest that the empowerment program is an effective practice for increasing the levels of self-esteem, learned resourcefulness, and coping ways of women exposed to domestic violence.

A psychosocial intervention to reduce gender-based violence and antepartum depressive symptoms in pregnant women in Kisumu County, Kenya: a quasi-experimental study

Introduction

Gender-based violence during pregnancy and its associated adverse health effects are disproportionately higher in developing countries like Kenya where screening for and management of gender-based violence is currently not part of routine antenatal care. This study assessed the effect of a psychosocial intervention on gender-based violence and antepartum depressive symptoms in pregnant women.

Methods

This quasi-experimental study compared gender-based violence and antepartum depression scores of 288 pregnant women in the two arms; one exposed to a psychosocial intervention and another receiving usual antenatal care. We used analysis of covariance to estimate the intervention effect and Chi-square to test the equality of proportions.

Results

The difference between the psychosocial intervention and the usual antenatal care group in the total intimate partner violence and physical violence scores was a significant, with small effect sizes of partial eta = 0.196 and 0.305 respectively. The two arms did not differ in terms of the proportion of women reporting other acts of gender-based violence by intimate and non-intimate partners post-intervention. The intervention group had significantly lower mean depression scores compared to the usual care group, post-intervention, with a medium effect size of 0.500.

Conclusion

This intervention aimed at reduction of gender-based violence and improvement of mental health of pregnant women is promising. Primary health care facilities in resource-constrained settings can take advantage of local capacity to deliver focused non-specialized psychosocial support to pregnant women experiencing violence.

Outcome Measures for Evaluating Intimate Partner Violence Programs Within Clinical Settings: A Systematic Review of the Literature

BACKGROUND

Multiple intimate partner violence (IPV) identification and assistance programs have been implemented across clinical settings. The results of these studies are inconclusive and frequently conflicting, resulting in clinical uncertainty and controversy regarding the merits of IPV identification and assistance programs. We aimed to describe the choice of outcome measures used in previously published randomized trials of IPV identification and assistance programs.

METHOD

A comprehensive literature search was conducted in the Medline, Embase, PyscInfo, and CENTRAL databases. The outcomes assessed in each included study were extracted and categorized, and the methodological quality of each eligible study was assessed using the Cochrane Risk of Bias tool.

RESULTS

Of 20 eligible studies, 6 evaluated IPV identification programs and 14 studies examined IPV assistance programs. The included studies used 48 different outcomes that we classified into 10 categories. For identification studies, the most commonly used outcome categories were IPV disclosure (66.7%) and resource use (66.7%). The most commonly used outcome categories for the IPV assistance studies included IPV recurrence and severity (64.3%) and health outcomes (50%). The included studies demonstrated a number of methodological limitations as identified by the Cochrane Risk of Bias instrument.

CONCLUSIONS

IPV identification and assistance programs are evaluated using many different outcome measures. Although this diversity enriches the IPV literature, it makes it challenging to compare studies. The results of this review highlight the challenges of conducting research in the field of IPV and the complexity of selecting, measuring, and interpreting outcomes.

Intimate partner violence and pregnancy: screening and intervention

In the first part of this review, we provided currently accepted definitions of categories and subcategories of intimate partner violence and discussed the prevalence and health impacts of intimate partner violence in nonpregnant and pregnant women. Herein we review current recommendations for intimate partner violence screening and the evidence surrounding the effectiveness of intimate partner violence interventions. Screening for intimate partner violence may include exclusively identification of victims of intimate partner violence or both the identification of and intervention for victims. Until recently, many professional organizations did not recommend universal screening for intimate partner violence because of a lack of evidence of effectiveness of screening, lack of evidence demonstrating that screening is not harmful, and/or a lack of consensus regarding the most effective screening tool. The lack of evidence supporting an intervention posed an additional barrier to screening. The American College of Obstetricians and Gynecologists has been a staunch advocate for universal intimate partner violence screening, even when other groups either did not endorse screening or recommended it only for high-risk women. Recent published data confirm that screening is more reliable than usual care in identifying victims of intimate partner violence, both during pregnancy and in nonpregnant women. Likewise, recent published data show that there are no apparent harms of screening for intimate partner violence and that the act of screening may have an empowering effect on women and improve their relationship with and trust in their health care providers. Despite these findings, the implementation rate of intimate partner violence screening remains low. Most encouraging are the recent data showing that interventions performed after screening for intimate partner violence are effective in reducing depression symptoms and episodes of violence as well as improving some outcomes of pregnancy. Although there remains a lack of consensus regarding which screening tool may be the most effective, we exhort all obstetrician-gynecologists to screen all women for intimate partner violence at regular intervals and to familiarize themselves with available community resources to assist those women who have been identified as experiencing intimate partner violence through screening.

What survivors want: Understanding the needs of sexual assault survivors

OBJECTIVE

Sexual assault is a pervasive crime on our college campuses and many survivors do not seek post-assault resources. This study will explore components of alternative interventions to consider in the development of campus-based interventions for sexual assault survivors.

PARTICIPANTS

Three stakeholder groups including survivors (n = 8), healthcare providers (n = 6), and advocates (n = 19) were recruited from May 2014 to December 2014 from two university campus communities using flyers and purposive sampling.

METHODS

A qualitative study design utilized semi-structured interviews and semi-structured focus groups with survivors, healthcare providers, and advocates.

RESULTS

Five themes emerged to consider for future campus-based sexual assault interventions: (a) culture of caring, (b) one-stop shop, (c) validation, (d) survivor control and agency, and (e) confidentiality.

CONCLUSIONS

Although accessible and effective options for post-assault care do currently exist, participants described alternative future interventions that were either (a) print materials or (b) technology-based.

A scoping review of intimate partner violence assistance programmes within health care settings

Background: The lifetime prevalence of intimate partner violence (IPV) for women presenting to health care settings is estimated to be 38-59%. With the goal of providing help to victims of abuse, numerous IPV assistance programmes have been developed and evaluated across multiple health care settings. Objective: Our scoping review provides an overview of this literature to identify key areas for potential evidence-based recommendations and to focus research priorities. Methods: We conducted a search of MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and psycINFO. We used broad eligibility criteria to identify studies that evaluated the effectiveness of IPV assistance programmes delivered within health care settings. We completed all screening and data extraction independently and in duplicate. We used descriptive statistics to summarize all data. Results: Forty-three studies met all eligibility criteria and were included in our scoping review. Nine categories of assistance programmes were identified: counselling/advocacy, safety assessment/planning, referral, providing IPV resources, home visitation, case management, videos, provider cueing, and system changes. Characteristics of programmes amongst studies frequently reporting positive results included those in which one type of active assistance was used (77.8% of studies reported positive results), a counsellor, community worker, or case manager provided the intervention (83.3% of studies reported positive results), and programmes that were delivered over more than five sessions (100.0% of studies reported positive results). Conclusions: IPV assistance programmes are heterogeneous with regards to the types of assistance they include and how they are delivered and evaluated. This heterogeneity creates challenges in identifying which IPV assistance programmes, and which aspects of these programmes, are effective. However, it appears that many different types of IPV assistance programmes can have positive impacts on women.

Testing a counselling intervention in antenatal care for women experiencing partner violence: a study protocol for a randomized controlled trial in Johannesburg, South Africa

BACKGROUND

Intimate partner violence (IPV) during or before pregnancy is associated with many adverse health outcomes. Pregnancy-related complications or poor infant health outcomes can arise from direct trauma as well as physiological effects of stress, both of which impact maternal health and fetal growth and development. Antenatal care can be a key entry point within the health system for many women, particularly in low-resource settings. Interventions to identify violence during pregnancy and offer women support and counselling may reduce the occurrence of violence and mitigate its consequences.

METHODS

Following a formative research phase, a randomized controlled trial will be conducted to test a nurse-led empowerment counselling intervention, originally developed for high-income settings and adapted for urban South Africa. The primary outcome is reduction of partner violence, and secondary outcomes include improvement in women's mental health, safety and self-efficacy. The study aims to recruit 504 pregnant women from three antenatal clinics in Johannesburg who will be randomized to the nurse-led empowerment arm (two 30-min counselling sessions) or enhanced control condition (a referral list) to determine whether participants in the intervention arm have better outcomes as compared to the those in the control arm.

DISCUSSION

This research will provide much needed evidence on whether a short counselling intervention delivered by nurses is efficacious and feasible in low resource settings that have high prevalence of IPV and HIV.

TRIAL REGISTRATION

The study was registered in the South African Clinical Trials Registry (DOH-27-0414-4720) on 11 August 2014 and in the ISRCTN Registry ( ISRCTN35969343 ) on 23 May 2016).

Prenatal stress and hemodynamics in pregnancy: a systematic review

Maternal prenatal stress is associated with preterm birth, intrauterine growth restriction, and developmental delay. However, the impact of prenatal stress on hemodynamics during pregnancy remains unclear. This systematic review was conducted in order to assess the quality of the evidence available to date regarding the relationship between prenatal stress and maternal-fetal hemodynamics. The PubMed/Medline, EMBASE, PsycINFO, Maternity and Infant Care, Trip, Cochrane Library, and CINAHL databases were searched using the search terms pregnancy; stress; fetus; blood; Doppler; ultrasound. Studies were eligible for inclusion if prenatal stress was assessed with standardized measures, hemodynamics was measured with Doppler ultrasound, and methods were adequately described. A specifically designed data extraction form was used. The methodological quality of included studies was assessed using well-accepted quality appraisal guidelines. Of 2532 studies reviewed, 12 met the criteria for inclusion. Six reported that prenatal stress significantly affects maternal or fetal hemodynamics; six found no significant association between maternal stress and circulation. Significant relationships between prenatal stress and uterine artery resistance (RI) and pulsatility (PI) indices, umbilical artery RI, PI, and systolic/diastolic ratio, fetal middle cerebral artery PI, cerebroplacental ratio, and umbilical vein volume blood flow were found. To date, there is limited evidence that prenatal stress is associated with changes in circulation. More carefully designed studies with larger sample sizes, repeated assessments across gestation, tighter control for confounding factors, and measures of pregnancy-specific stress will clarify this relationship.

‘Opening the door’: A qualitative interpretive study of women’s experiences of being asked about intimate partner violence and receiving an intervention during perinatal home visits in rural and urban settings in the USA

This study explored women’s experiences of being screened for intimate partner violence and receiving an intervention during perinatal home visits in urban and rural settings in the USA. Twenty-six women were recruited from the DOVE (Domestic Violence Enhanced Home Visit) intervention trial to participate in a nested qualitative interpretive study. Women valued the opportunity to discuss their intimate partner violence experiences and access support. Disclosure was a staged process and home visitor communication style and the development of a trusting relationship were influencing factors. Safety planning was an important feature of the DOVE intervention, whether the abuse was past or ongoing. Women highlighted the need for post-abuse support services. Perinatal home visitors require training in intimate partner violence that supports the development of good communication skills and provides opportunities for experiential learning and feedback with regards to asking about and responding to intimate partner violence. Reinforcement training activities are necessary in order to enhance home visitor’s confidence and comfort, and sustain practice. Rigorous protocols are needed to ensure the safety of home visitors and women.

Associations between intimate partner violence (IPV) during pregnancy, mother-to-infant bonding failure, and postnatal depressive symptoms

This study examined the associations between intimate partner violence (IPV) during pregnancy, mother-to-infant bonding failure, and postnatal depressive symptoms at 1 month postnatal. This study also examined if these relationships would be mediated by antenatal depressive symptoms. This study was a prospective cohort study that investigated effects between the third trimester of pregnancy and 1 month after childbirth. The Japanese version of the Index of Spouse Abuse (ISA), the Japanese version of the Mother-Infant Bonding Scale (MIBS), and the Japanese version of the Hospital Anxiety and Depression Scale (HADS) were used to measure IPV during pregnancy, bonding failure with infants, and depressive symptoms during pregnancy and the postnatal period respectively. Structural equation modeling (SEM) was used to find the associations between those four variables. The final path model of the SEM showed good fit with the data. IPV during pregnancy was associated with mother-to-infant bonding failure at 1 month postnatal, whereas IPV during pregnancy was not significantly associated with postnatal depressive symptoms at 1 month postnatal. In addition, this study demonstrated that the associations between IPV during pregnancy, mother-to-infant bonding failure, and postnatal depressive symptoms at 1 month postnatal were mediated by antenatal depressive symptoms. The results of this study indicated the need for interventions for IPV and psychological health care for abused pregnant women to prevent antenatal depressive symptoms in prenatal health settings. Those interventions by perinatal health professionals would help to prevent bonding failure with infants and postnatal depressive symptoms after childbirth.

Translation of Domestic Violence Instruments for Use in Research

The Abuse Assessment Screen, Severity of Violence Against Women Scales, and Appraisal of Violent Situations scales were translated into versions for women originating from Brazil, Haiti, the Dominican Republic, and Puerto Rico. The procedure of back translation was chosen as the most reliable method for translation of these three instruments. The translated instruments were used to screen women for abuse during pregnancy and to determine the prevalence and severity of that abuse. This article discusses the translation process and illustrate with versions of the instruments for use with pregnant women from Puerto Rico.

Domestic Violence Enhanced Perinatal Home Visits: The DOVE Randomized Clinical Trial

BACKGROUND

Perinatal intimate partner violence (IPV) is common and has significant negative health outcomes for mothers and infants. This study evaluated the effectiveness of an IPV intervention in reducing violence among abused women in perinatal home visiting programs.

MATERIALS AND METHODS

This assessor-blinded multisite randomized control trial of 239 women experiencing perinatal IPV was conducted from 2006 to 2012 in U.S. urban and rural settings. The Domestic Violence Enhanced Home Visitation Program (DOVE) intervention group (n = 124) received a structured abuse assessment and six home visitor-delivered empowerment sessions integrated into home visits. All participants were screened for IPV and referred appropriately. IPV was measured by the Conflicts Tactics Scale2 at baseline through 24 months postpartum.

RESULTS

There was a significant decrease in IPV over time (F = 114.23; p < 0.001) from baseline to 1, 3, 6, 12, 18, and 24 months postpartum (all p < 0.001). Additional models examining change in IPV from baseline indicated a significant treatment effect (F = 6.45; p < 0.01). Women in the DOVE treatment group reported a larger mean decrease in IPV scores from baseline compared to women in the usual care group (mean decline 40.82 vs. 35.87). All models accounted for age and maternal depression as covariates.

CONCLUSIONS

The DOVE intervention was effective in decreasing IPV and is brief, thereby facilitating its incorporation within well-woman and well-child care visits, as well as home visiting programs, while satisfying recommendations set forth in the Affordable Care Act for IPV screening and brief counseling.

What Works to Reduce Victimization? Synthesizing What We Know and Where to Go From Here

While some attention has been paid to "what works" to reduce crime, little is known about the effectiveness of programs designed to reduce victimization. This study systematically reviews 83 program evaluations to identify what works to (a) reduce victimization, (b) enhance beliefs/attitudes about victims, and (c) improve knowledge/awareness of victimization issues. Evidence-based findings are organized around 4 major forms of victimization, including bullying, intimate partner violence, sexual abuse, and other general forms of victimization. Determining whether certain types of programs can reduce the risk of victimization has important implications for improving people's quality of life. Based on our findings, we offer several promising directions for the next generation of research on evaluating victimization programs. The goal of this study is to improve the strength of future program evaluations, replications, and other systematic reviews as researchers and practitioners continue to learn what works to reduce victimization.

Integrating intimate partner violence assessment and intervention into healthcare in the United States: a systems approach

The Institute of Medicine, United States Preventive Services Task Force (USPSTF), and national healthcare organizations recommend screening and counseling for intimate partner violence (IPV) within the US healthcare setting. The Affordable Care Act includes screening and brief counseling for IPV as part of required free preventive services for women. Thus, IPV screening and counseling must be implemented safely and effectively throughout the healthcare delivery system. Health professional education is one strategy for increasing screening and counseling in healthcare settings, but studies on improving screening and counseling for other health conditions highlight the critical role of making changes within the healthcare delivery system to drive desired improvements in clinician screening practices and health outcomes. This article outlines a systems approach to the implementation of IPV screening and counseling, with a focus on integrated health and advocacy service delivery to support identification and interventions, use of electronic health record (EHR) tools, and cross-sector partnerships. Practice and policy recommendations include (1) ensuring staff and clinician training in effective, client-centered IPV assessment that connects patients to support and services regardless of disclosure; (2) supporting enhancement of EHRs to prompt appropriate clinical care for IPV and facilitate capturing more detailed and standardized IPV data; and (3) integrating IPV care into quality and meaningful use measures. Research directions include studies across various health settings and populations, development of quality measures and patient-centered outcomes, and tests of multilevel approaches to improve the uptake and consistent implementation of evidence-informed IPV screening and counseling guidelines.

Systematic Review of ED-based Intimate Partner Violence Intervention Research

INTRODUCTION

Assessment reactivity may be a factor in the modest results of brief interventions for substance use in the emergency department (ED). The presence of assessment reactivity in studies of interventions for intimate partner violence (IPV) has not been studied. Our objectives were to identify ED IPV intervention studies and evaluate the presence of a consistently positive effect on the control groups.

METHODS

We performed a systematic search of electronic databases for English=language intervention studies addressing IPV in the ED published since 1990. Study selection and assessment of methodologic quality were performed by two independent reviewers. Data extraction was performed by one reviewer and then independently checked for completeness and accuracy by a second reviewer.

RESULTS

Of 3,620 unique manuscripts identified by database search, 667 underwent abstract review and 12 underwent full-text review. Only three met full eligibility criteria; data on the control arm were available for two studies. In these two studies, IPV-related outcomes improved for both the experimental and control condition.

CONCLUSION

The paucity of controlled trials of IPV precluded a robust evaluation for assessment reactivity. This study highlighted a critical gap in ED research on IPV.

Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse

BACKGROUND

Intimate partner abuse is common worldwide, damaging the short- and long-term physical, mental, and emotional health of survivors and children. Advocacy may contribute to reducing abuse, empowering women to improve their situation by providing informal counselling and support for safety planning and increasing access to different services. Advocacy may be a stand-alone service, accepting referrals from healthcare providers, or part of a multi-component (and possibly multi-agency) intervention provided by service staff or others.

OBJECTIVES

To assess the effects of advocacy interventions within or outside healthcare settings in women who have experienced intimate partner abuse.

SEARCH METHODS

In April 2015, we searched CENTRAL, Ovid MEDLINE, EMBASE, and 10 other databases. We also searched WHO ICTRP, mRCT, and UK Clinical Research Network (UKCRN), and examined relevant websites and reference lists with forward citation tracking of included studies. For the original review we handsearched six key journals. We also contacted first authors of eligible papers and experts in the field.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials comparing advocacy interventions for women with experience of intimate partner abuse versus no intervention or usual care (if advocacy was minimal and fewer than 20% of women received it).

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed risk of bias and undertook data extraction. We contacted authors for missing information needed to calculate statistics for the review and looked for adverse events.

MAIN RESULTS

We included 13 trials involving 2141 participants aged 15 to 65 years, frequently having low socioeconomic status.The studies were quite heterogeneous in terms of methodology, study processes and design, including with regard to the duration of follow-up (postintervention to three years), although this was not associated with differences in effect. The studies also had considerable clinical heterogeneity in relation to staff delivering advocacy; setting (community, shelter, antenatal, healthcare); advocacy intensity (from 30 minutes to 80 hours); and abuse severity. Three trials evaluated advocacy within multi-component interventions. Eleven measured some form of abuse (eight scales), six assessed quality of life (three scales), and six measured depression (three scales). Countries and ethnic groups varied (one or more minority ethnic groups in the USA or UK, and local populations in Hong Kong and Peru). Setting was associated with intensity and duration of advocacy.Risk of bias was high in five studies, moderate in five, and low in three. The quality of evidence (considering multiple factors such as risk of bias, study size, missing data) was moderate to low for brief advocacy and very low for intensive advocacy. Incidence of abuse Physical abuseModerate quality pooled data from two healthcare studies (moderate risk of bias) and one community study (low risk of bias), all with 12-month follow-up data, showed no effect on physical abuse for brief (< 12 hours) advocacy interventions (standardised mean difference (SMD) 0.00, 95% confidence interval (CI) - 0.17 to 0.16; n = 558). One antenatal study (low risk of bias) showed an association between brief advocacy and reduced minor physical abuse at one year (mean difference (MD) change - 1.00, 95% CI - 1.82 to - 0.18; n = 110). An antenatal, multi-component study showed a greater likelihood of physical abuse ending (odds ratio (OR) 0.42, 95% CI 0.23 to 0.75) immediately after advocacy (number needed to treat (NNT) = 8); we cannot exclude impact from other components.Low to very low quality evidence from two intensive advocacy trials (12 hours plus duration) showed reduced severe physical abuse in women leaving a shelter at 24 months (OR 0.39, 95% CI 0.20 to 0.77; NNT = 8), but not at 12 or 36 months. Sexual abuseMeta-analysis of two studies (n = 239) showed no effect of advocacy on sexual abuse (SMD - 0.12, 95% CI - 0.37 to 0.14), agreeing with the change score (MD - 0.07, 95% CI - 0.30 to 0.16) from a third study and the OR (0.96, 95% CI 0.44 to 2.12) from a fourth antenatal, multi-component study. Emotional abuseOne study in antenatal care, rated at low risk of bias, showed reduced emotional abuse at ≤ 12-month follow-up (MD (change score) - 4.24, 95% CI - 6.42 to - 2.06; n = 110). Psychosocial health Quality of lifeMeta-analysis of two studies (high risk of bias) showed intensive advocacy slightly improved overall quality of life of women recruited from shelters (MD 0.23, 95% CI 0.00 to 0.46; n = 343) at 12-month follow-up, with greater improvement in perceived physical quality of life from a primary care study (high risk of bias; MD 4.90, 95% CI 0.98 to 8.82) immediately postintervention. Depression Meta-analysis of two studies in healthcare settings, one at high risk of bias and one at moderate risk, showed that fewer women developed depression (OR 0.31, 95% CI 0.15 to 0.65; n = 149; NNT = 4) with brief advocacy. One study at high risk of bias reported a slight reduction in depression in pregnant women immediately after the intervention (OR 0.51, 95% CI 0.20 to 1.29; n = 103; NNT = 8).There was no evidence that intensive advocacy reduced depression at ≤ 12-month follow-up (MD - 0.14, 95% CI - 0.33 to 0.05; 3 studies; n = 446) or at two years (SMD - 0.12, 95% CI - 0.36 to 0.12; 1 study; n = 265). Adverse effectsTwo women died, one who was murdered by her partner and one who committed suicide. No evidence links either death to study participation.

AUTHORS' CONCLUSIONS

Results suggest some benefits from advocacy. However, most studies were underpowered. Clinical and methodological heterogeneity largely precluded pooling of trials. Therefore, there is uncertainty about the magnitude of benefit, the impact of abuse severity, and the setting.Based on the evidence reviewed, intensive advocacy may improve short-term quality of life and reduce physical abuse one to two years after the intervention for women recruited from domestic violence shelters or refuges. Brief advocacy may provide small short-term mental health benefits and reduce abuse, particularly in pregnant women and for less severe abuse.

Expectations and satisfaction with antenatal care among pregnant women with a focus on vulnerable groups: a descriptive study in Ghent

Background

Previous studies demonstrate that people’s satisfaction with healthcare influences their further use of that healthcare system. Satisfied patients are more likely to take part in the decision making process and to complete treatment. One of the important determinants of satisfaction is the fulfillment of expectations. This study aims to analyse both expectations and satisfaction with antenatal care among pregnant women, with a particular focus on vulnerable groups.

Methods

A quantitative descriptive study was conducted in 155 women seeking antenatal care at the University Hospital of Ghent (Belgium), of whom 139 completed the questionnaire. The statistical program SPSS-21 was used for data analysis.

Results

Women had high expectations relating to continuity of care and women-centered care, while expectations regarding availability of other services and complete care were low. We observed significantly lower expectations among women without higher education, with low income, younger than 26 years and women who reported intimate partner violence. General satisfaction with antenatal care was high. Women were satisfied with their relationship with the healthcare worker, however ; they evaluated the information received during the consultation and the organizational aspects of antenatal care as less satisfactory.

Conclusions

In order to improve satisfaction with antenatal care, organizational aspects of antenatal care (e.g. reducing waiting times and increasing accessibility) need to be improved. In addition, women would appreciate a better provision of information during consultation. More research is needed for an in-depth understanding of the determinants of satisfaction and the relationship with low socio economic status (SES).

Electronic supplementary material

The online version of this article (doi:10.1186/s12905-015-0266-2) contains supplementary material, which is available to authorized users.

Abortion legislation, maternal healthcare, fertility, female literacy, sanitation, violence against women and maternal deaths: a natural experiment in 32 Mexican states

OBJECTIVE

To test whether there is an association between abortion legislation and maternal mortality outcomes after controlling for other factors thought to influence maternal health.

DESIGN

Population-based natural experiment.

SETTING AND DATA SOURCES

Official maternal mortality data from 32 federal states of Mexico between 2002 and 2011.

MAIN OUTCOMES

Maternal mortality ratio (MMR), MMR with any abortive outcome (MMRAO) and induced abortion mortality ratio (iAMR).

INDEPENDENT VARIABLES

Abortion legislation grouped as less (n=18) or more permissive (n=14); constitutional amendment protecting the unborn (n=17); skilled attendance at birth; all-abortion hospitalisation ratio; low birth weight rate; contraceptive use; total fertility rates (TFR); clean water; sanitation; female literacy rate and intimate-partner violence.

MAIN RESULTS

Over the 10-year period, states with less permissive abortion legislation exhibited lower MMR (38.3 vs 49.6; p<0.001), MMRAO (2.7 vs 3.7; p<0.001) and iAMR (0.9 vs 1.7; p<0.001) than more permissive states. Multivariate regression models estimating effect sizes (β-coefficients) for mortality outcomes showed independent associations (p values between 0.001 and 0.055) with female literacy (β=-0.061 to -1.100), skilled attendance at birth (β=-0.032 to -0.427), low birth weight (β=0.149 to 2.166), all-abortion hospitalisation ratio (β=-0.566 to -0.962), clean water (β=-0.048 to -0.730), sanitation (β=-0.052 to -0.758) and intimate-partner violence (β=0.085 to 0.755). TFR showed an inverse association with MMR (β=-14.329) and MMRAO (β=-1.750) and a direct association with iAMR (β=1.383). Altogether, these factors accounted for (R(2)) 51-88% of the variance among states in overall mortality rates. No statistically independent effect was observed for abortion legislation, constitutional amendment or other covariates.

CONCLUSIONS

Although less permissive states exhibited consistently lower maternal mortality rates, this finding was not explained by abortion legislation itself. Rather, these differences were explained by other independent factors, which appeared to have a more favourable distribution in these states.

Brief sexuality communication--a behavioural intervention to advance sexually transmitted infection/HIV prevention: a systematic review

BACKGROUND

Throughout the last decade substantial research has been undertaken to develop evidence-based behaviour change interventions for sexual health promotion. Primary care could provide an opportunistic entry for brief sexual health communication.

OBJECTIVES

We conducted a systematic review to explore opportunistic sexual and reproductive health services for sexual health communication delivered at primary health care level.

SEARCH STRATEGY

We searched for studies on PubMed, ProQuest, CINAHL, Jstor, Scopus/Science Direct, Cochrane database of systematic reviews, EBSCO, CINAHL, PsychoInfo, and Web of Knowledge. Both published and unpublished articles were reviewed.

SELECTION CRITERIA

All randomised controlled trials and controlled clinical trials were included. Participants of all ages, from adolescence onwards were included. Brief (10-60 minutes) interventions including some aspect of communication on sexual health issues were included.

DATA COLLECTION AND ANALYSIS

Data were extracted by two reviewers independently using a standardised form. Interventions differed from each other, hence meta-analysis was not performed, and results are presented individually.

MAIN RESULTS

A total of 247 articles were selected for full-text evaluation, 31 of which were included. Sexually transmitted infections (STIs)/HIV were less often reported in the intervention group compared with the control group. Condom use was higher in most studies in the intervention group. Numbers of sexual partners and unprotected sexual intercourse were lower in the intervention groups.

CONCLUSIONS

There is evidence that brief counselling interventions have some effect in the reduction and prevention of STIs/HIV. Some questions could not be answered, such as the effect over time and in different settings and population groups.

The efficacy of cognitive behavioural therapy and advocacy interventions for women who have experienced intimate partner violence: a systematic review and meta-analysis

OBJECTIVE

To determine the efficacy of Advocacy and Cognitive Behavioural Therapy interventions (CBT) in reducing physical, psychological, sexual, or any intimate partner violence (IPV).

METHODS

A systematic review and meta-analysis were conducted using randomized control trials (RCTs) published in MEDLINE, PsycINFO, Scopus, Cochrane, and Clinical trials. The occurrence of physical, psychological, sexual, and/or any IPV measured efficacy.

RESULTS

Twelve RCTs involving 2666 participants were included. Advocacy interventions resulted in significant reductions in physical (standardized mean difference (SMD) -0.13; 95% confidence interval (CI) -0.25, -0.00) and psychological (SMD -0.19; 95% CI -0.32, -0.05) but not in sexual (SMD -0.20; 95% CI -0.43, 0.02) or any IPV (SMD -0.32; 95% CI -0.69, 0.04). CBT interventions showed a significant reduction in physical (SMD -0.79; 95% CI -1.26, -0.33) and psychological (SMD -0.80; 95% CI -1.25, -0.36) but not sexual (SMD -0.35; 95% CI -1.73, 1.03) or any IPV (SMD 0.09; 95% CI -0.05, 0.23).

CONCLUSIONS

Both advocacy and CBT interventions reduced physical and psychological IPV but not sexual or any IPV. Limitations include the low number of studies and the heterogeneity of interventions.

Interventions for preventing or reducing domestic violence against pregnant women

BACKGROUND

Domestic violence during pregnancy is a major public health concern. This preventable risk factor threatens both the mother and baby. Routine perinatal care visits offer opportunities for healthcare professionals to screen and refer abused women for effective interventions. It is, however, not clear which interventions best serve mothers during pregnancy and postpartum to ensure their safety.

OBJECTIVES

To examine the effectiveness and safety of interventions in preventing or reducing domestic violence against pregnant women.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014), scanned bibliographies of published studies and corresponded with investigators.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) including cluster-randomised trials, and quasi-randomised controlled trials (e.g. where there was alternate allocation) investigating the effect of interventions in preventing or reducing domestic violence during pregnancy.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.

MAIN RESULTS

We included 10 trials with a total of 3417 women randomised. Seven of these trials, recruiting 2629 women, contributed data to the review. However, results for all outcomes were based on single studies. There was limited evidence for the primary outcomes of reduction of episodes of violence (physical, sexual, and/or psychological) and prevention of violence during and up to one year after pregnancy (as defined by the authors of trials). In one study, women who received the intervention reported fewer episodes of partner violence during pregnancy and in the postpartum period (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.43 to 0.88, 306 women, moderate quality). Groups did not differ for Conflict Tactics Score - the mean partner abuse scores in the first three months postpartum (mean difference (MD) 4.20 higher, 95% CI -10.74 to 19.14, one study, 46 women, very low quality). The Current Abuse Score for partner abuse in the first three months was also similar between groups (MD -0.12 lower, 95% CI -0.31 lower to 0.07 higher, one study, 191 women, very low quality). Evidence for the outcomes episodes of partner abuse during pregnancy or episodes during the first three months postpartum was not significant (respectively, RR 0.50, 95% CI 0.25 to 1.02, one study with 220 women, very low quality; and RR 0.60, 95% CI 0.35 to 1.04, one study, 271 women, very low quality). Finally, the risk for low birthweight (< 2500 g) did not differ between groups (RR 0.74, 95 % CI 0.41 to 1.32, 306 infants, low quality).There were few statistically significant differences between intervention and control groups for depression during pregnancy and the postnatal period. Only one study reported findings for neonatal outcomes such as preterm delivery and birthweight, and there were no clinically significant differences between groups. None of the studies reported results for other secondary outcomes: Apgar score less than seven at one minute and five minutes, stillbirth, neonatal death, miscarriage, maternal mortality, antepartum haemorrhage, and placental abruption.

AUTHORS' CONCLUSIONS

There is insufficient evidence to assess the effectiveness of interventions for domestic violence on pregnancy outcomes. There is a need for high-quality, RCTs with adequate statistical power to determine whether intervention programs prevent or reduce domestic violence episodes during pregnancy, or have any effect on maternal and neonatal mortality and morbidity outcomes.

Intimate partner violence during pregnancy and adverse neonatal outcomes in low-income women

BACKGROUND

Intimate partner violence (IPV) affects an estimated 1.5 million U.S. women annually. IPV impacts maternal and neonatal health with higher rates of depression and low birth weight (LBW). Less studied is experiencing IPV and delivering a small for gestational age (SGA) baby. SGA neonates are at increased risk of developmental and behavioral problems. The negative sequelae persist into adulthood with increased rates of diabetes mellitus and coronary heart disease.

METHODS

In a sample of 239 pregnant women experiencing IPV, in urban and rural settings, we examined cross-sectional associations of severity of IPV and neonatal outcomes (i.e., birth weight and gestational age). Severity of IPV was measured by the Conflict Tactics Scale 2 and neonatal outcomes were collected at the time of delivery.

RESULTS

Outcomes were collected on 194 neonates; 14.9% (n=29) were classified as LBW, 19.1% (n=37) classified as SGA, and 9.8% (n=19) as LBW and SGA. Women reporting higher severity of IPV during pregnancy had a greater likelihood of delivering an SGA neonate (odds ratio [OR] 4.81; 95% confidence interval [95% CI] 1.86-12.47), and LBW neonate (OR 4.20; 95% CI 1.46-12.10).

CONCLUSIONS

In a sample of pregnant women experiencing perinatal IPV, women experiencing greater severities of IPV were more likely to deliver a neonate with an adverse outcome. Early recognition and intervention of IPV is essential to reduce disparities in birth outcomes and long-term health outcomes for these neonates.

Coordinated Community Response Components for Victims of Intimate Partner Violence: A Review of the Literature

Intimate partner violence (IPV) against women is a serious problem throughout the world. Each year a substantial number of women experience psychological, physical, and sexual aggression from an intimate partner, with many women experiencing serious mental and physical health outcomes as a result of their victimization. A number of services are available to women who sustain IPV (e.g., shelters, advocacy, legal protection), and the combination of these services has been termed a Coordinated Community Response (CCR) to IPV. The purpose of the present manuscript is to review the individual components of CCRs for IPV victims, examine the extant literature on a number of the individual CCR components, and suggest directions for future research on CCRs for IPV victims. Our review demonstrates that there is a significant lack of research on various CCR components, that research on the integration of CCR services is limited, and that theoretical guidance for CCR programs is almost non-existent. Directions for improving research on CCR components are suggested.

Effect of abuse during pregnancy on maternal and child safety and functioning for 24 months after delivery

OBJECTIVE

To evaluate the long-term safety and functioning outcomes for abused women reporting abuse during pregnancy and their children's behavior compared with abused women who do not report abuse during pregnancy.

METHODS

Forty-six abused women seeking assistance for partner abuse and reporting being pregnant during the preceding 4 months were evaluated every 4 months for 24 months to compare levels of abuse, danger for murder, anxiety, depression, somatization, and posttraumatic stress disorder (PTSD) for abused women who report abuse during pregnancy (n=24) compared with abused women reporting abuse only outside of pregnancy (n=22). Internalizing and externalizing behavior scores were evaluated for the children.

RESULTS

At entry into the study, abused women reporting abuse during pregnancy reported significantly greater (P<.05) threats of abuse, sexual abuse, physical abuse, danger for murder, and PTSD compared with abused women not reporting abuse during pregnancy. Effect sizes were large. When evaluated over the course of 24 months after delivery, risk for murder remained higher for women reporting abuse during pregnancy for 8 months after delivery, depression was higher at 4, 8, 16, and 20 months after delivery, and PTSD was appreciably higher for 24 months. Children living with mothers abused during pregnancy displayed more behavioral problems for the entire 24-month period, especially problems of depression and anxiety.

CONCLUSION

The study documents the negative safety and function effects of abuse in pregnant women that remain for at least 24 months after delivery. This warrants incorporating abuse screening during the antenatal and postdelivery periods and a protocol of care during the antenatal period and beyond.

Policymaking Under Uncertainty: Routine Screening for Intimate Partner Violence

Intimate partner violence (IPV) is a significant public health issue affecting around three million U.S. women during their lifetimes; this article provides guidance to policymakers on addressing IPV. In 2011, an Institute of Medicine panel recommended routine IPV screening for women and adolescents as part of comprehensive preventive care services, which is in conflict with the 2004 U.S. Preventive Services Task Force recommendations. The current evidence base for policymaking suffers weaknesses related to study design, which should be addressed in future research. Meanwhile, policymakers should consider available evidence in their settings, assess local needs, and make recommendations where appropriate.

Primary care-based interventions for intimate partner violence: a systematic review

CONTEXT

Primary care providers are uniquely positioned to respond to patients' disclosure of intimate partner violence (IPV). However, the research on primary care-based IPV interventions has not been systematically synthesized, making it difficult for providers, policymakers, and researchers to understand how to effectively intervene in the primary care setting. This systematic review summarizes primary care-based interventions for patients experiencing IPV.

EVIDENCE ACQUISITION

PubMed, PsycINFO, and CINAHL were searched from their start through September 2012; this search was augmented by bibliographic review and consultation with experts. Eligible studies included English-language, peer-reviewed articles that assessed patient-level impact of IPV interventions that originated from patients' visits to a primary care provider.

EVIDENCE SYNTHESIS

Of 80 potentially eligible studies, 17 met eligibility criteria. The majority of interventions recruited women from reproductive care sites. Interventions tended to be brief, delivered by nonphysicians, and focused on empowerment, empathetic listening, discussion of the cycle of violence and safety, and referral to community-based resources. Thirteen studies demonstrated at least one intervention-related benefit. Six of 11 articles measuring IPV persistence found reductions in future violence; two of five measuring safety-promoting behaviors found increases; and six of ten measuring IPV/community resource referrals found enhanced use. Some studies also documented health improvements.

CONCLUSIONS

The majority of studies demonstrated patient-level benefit subsequent to primary care IPV interventions, with IPV/community referrals the most common positively affected outcome.

Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis

Background

Community engagement has been advanced as a promising way of improving health and reducing health inequalities; however, the approach is not yet supported by a strong evidence base.

Objectives

To undertake a multimethod systematic review which builds on the evidence that underpins the current UK guidance on community engagement; to identify theoretical models underpinning community engagement; to explore mechanisms and contexts through which communities are engaged; to identify community engagement approaches that are effective in reducing health inequalities, under what circumstances and for whom; and to determine the processes and costs associated with their implementation.

Data sources

Databases including the Cochrane Database of Systematic Reviews (CDSR), The Campbell Library, the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment (HTA) database, the NHS Economic Evaluation Database (NHS EED) and EPPI-Centre’s Trials Register of Promoting Health Interventions (TRoPHI) and Database of Promoting Health Effectiveness Reviews (DoPHER) were searched from 1990 to August 2011 for systematic reviews and primary studies. Trials evaluating community engagement interventions reporting health outcomes were included.

Review methods

Study eligibility criteria: published after 1990; outcome, economic, or process evaluation; intervention relevant to community engagement; written in English; measured and reported health or community outcomes, or presents cost, resource, or implementation data characterises study populations or reports differential impacts in terms of social determinants of health; conducted in an Organisation for Economic Co-operation and Development (OECD) country. Study appraisal: risk of bias for outcome evaluations; assessment of validity and relevance for process evaluations; comparison against an economic evaluation checklist for economic evaluations. Synthesis methods: four synthesis approaches were adopted for the different evidence types: theoretical, quantitative, process, and economic evidence.

Results

The theoretical synthesis identified key models of community engagement that are underpinned by different theories of changes. Results from 131 studies included in a meta-analysis indicate that there is solid evidence that community engagement interventions have a positive impact on health behaviours, health consequences, self-efficacy and perceived social support outcomes, across various conditions. There is insufficient evidence – particularly for long-term outcomes and indirect beneficiaries – to determine whether one particular model of community engagement is likely to be more effective than any other. There are also insufficient data to test the effects on health inequalities, although there is some evidence to suggest that interventions that improve social inequalities (as measured by social support) also improve health behaviours. There is weak evidence from the effectiveness and process evaluations that certain implementation factors may affect intervention success. From the economic analysis, there is weak but inconsistent evidence that community engagement interventions are cost-effective. By combining findings across the syntheses, we produced a new conceptual framework.

Limitations

Differences in the populations, intervention approaches and health outcomes made it difficult to pinpoint specific strategies for intervention effectiveness. The syntheses of process and economic evidence were limited by the small (generally not rigorous) evidence base.

Conclusions

Community engagement interventions are effective across a wide range of contexts and using a variety of mechanisms. Public health initiatives should incorporate community engagement into intervention design. Evaluations should place greater emphasis on long-term outcomes, outcomes for indirect beneficiaries, process evaluation, and reporting costs and resources data. The theories of change identified and the newly developed conceptual framework are useful tools for researchers and practitioners. We identified trends in the evidence that could provide useful directions for future intervention design and evaluation.

Funding

The National Institute for Health Research Public Health Research programme.

Intimate partner violence, depressive symptoms, and immigration status: does existing advocacy intervention work on abused immigrant women in the Chinese community?

Advocacy intervention has been shown to be efficacious at reducing depressive symptoms in women who suffer from intimate partner violence (IPV). However, the intervention effect among abused immigrant women has not been well studied. This study compares the demographic and psychosocial characteristics between abused immigrant and nonimmigrant women, and evaluates the impact of immigration status on the efficacy of an advocacy intervention in reducing depressive symptoms and improving perceived social support. Two hundred abused Chinese women recruited from a local community center in Hong Kong were randomized to receive either the advocacy intervention or usual care. The advocacy intervention was found to be effective at reducing depressive symptoms and improving social support for abused Chinese nonimmigrant women, but the same effects were not seen for abused immigrant women. The findings provide essential insights into the need for developing targeted and efficacious advocacy interventions for abused immigrant women. Effective services to address abused immigrant women's needs were also suggested.

Violence-related coping, help-seeking and health care-based intervention preferences among perinatal women in Mumbai, India

Domestic violence is a significant public health issue. India is uniquely affected with an estimated 1 in 3 women facing abuse at the hands of a partner. The current mixed-methods study describes violence-related coping and help-seeking, and preferences for health care-based intervention, among perinatal women residing in low-income communities in Mumbai, India. In-depth interviews were conducted with women who had recently given birth and self-reported recent violence from husbands (n = 32), followed by survey data collection (n = 1,038) from mothers seeking immunization for their infants ages 6 months or younger at 3 large urban health centers in Mumbai, India. Participants described fears and other barriers to abuse disclosure, and there was a low level of awareness of formal support services related to violence. Qualitative and quantitative findings indicated that formal help-seeking is uncommon and that informal help sources are most frequently sought. Quantitative results revealed that, while few (<5%) women had been screened for violence in the health care setting, most (67%) would be willing to disclose abuse if asked. When presented with a list of possible clinic-based violence support interventions, participants endorsed crisis counseling and safety planning as most helpful (90.9%). Findings provide direction for violence-related intervention services for perinatal women. A multipronged approach that includes strengthening the informal support system, for example, neighbors and family members, as well as facilitating access to formal services building on the health care system, warrants exploration in this context.

Interventions for preventing or reducing domestic violence against pregnant women

BACKGROUND

Domestic violence during pregnancy is a major public health concern. This preventable risk factor threatens both the mother and baby. Routine perinatal care visits offer opportunities for healthcare professionals to screen and refer abused women for effective interventions. It is, however, not clear which interventions best serve mothers during pregnancy and postpartum to ensure their safety.

OBJECTIVES

To examine the effectiveness and safety of interventions in preventing or reducing domestic violence against pregnant women.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (19 June 2012), scanned bibliographies of published studies and corresponded with investigators.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) including cluster-randomised trials, and quasi-randomised controlled trials (e.g. where there was alternate allocation) investigating the effect of interventions in preventing or reducing domestic violence during pregnancy.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial quality and extracted data.

MAIN RESULTS

We included nine trials with a total of 2391 women; however, for most outcomes very few studies contributed data and results were predominantly based on findings from single studies. There was evidence from one study that the total number of women reporting episodes of partner violence during pregnancy, and in the postpartum period was reduced for women receiving a psychological therapy intervention (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.48 to 0.88). There were few statistically significant differences between intervention and control groups for depression during pregnancy and the postnatal period. Only one study reported findings for neonatal outcomes such as preterm delivery and birthweight, and there were no clinically significant differences between groups. None of the studies reported results for other secondary outcomes: Apgar score less than seven at one minute and five minutes, stillbirth, neonatal death, miscarriage, maternal mortality, antepartum haemorrhage, and placental abruption.

AUTHORS' CONCLUSIONS

There is insufficient evidence to assess the effectiveness of interventions for domestic violence on pregnancy outcomes. There is a need for high-quality, RCTs with adequate statistical power to determine whether intervention programs prevent or reduce domestic violence episodes during pregnancy, or have any effect on maternal and neonatal mortality and morbidity outcomes.

Applying Effective Corrections Principles (RNR) to Partner Abuse Interventions

Results of outcome evaluations of the domestic violence (DV) programs are not encouraging. Overall, the most optimistic conclusion is that these programs have only a modest impact on reducing repeat partner violence. Recently, there are calls for DV programs to “grow up,” adapt a paradigm shift, shed ideology, and determine how the maximum impact can be realized from work to reduce intimate partner violence (IPV). The following review examines why program results are so unconvincing and proposes a comprehensive framework to advance the field. Specifically, it recommends that applying the risk-need-responsivity (RNR) principles of effective corrections could substantially improve treatment results. Using this framework, the article identifies selected risk assessment tools to screen offenders into appropriate levels of service (the risk principle) and provides an extensive review of the literature on appropriate targets for change (the need principle). Problems with substance use (particularly alcohol abuse), emotion management, self-regulation, and attitudes supportive of partner abuse have substantial empirical support as factors related to IPV. There is weaker but promising support for targeting the impact of association with peers who are supportive of abuse of women, poor communication skills, and motivation to change abusive behavior patterns. Responsivity could be enhanced through incorporation of motivational interviewing techniques, the processes of change identified in the Transtheoretical Model, solution-focused and strength-based approaches, and attention to identity change and cultural issues. In addition, the review describes strategies to insure ongoing program integrity, a key factor in implementing effective interventions.

An exploratory analysis of intimate partner violence and postpartum depression in an impoverished urban population

Research on the relationship between intimate partner violence (IPV) and postpartum depression (PPD) is limited. Numerous antecedents and consequences of both IPV and PPD are noted in the literature; however, understanding the mechanisms by which intimate partner violence impacts the postpartum mood are not clearly understood. This study utilized retrospective chart reviews from a pediatric/perinatal social work outreach program to explore urban minority women experiences with IPV and depression both during pregnancy and after. Findings do not suggest a direct relationship between IPV and PPD; however, there was a high co-occurrence of prenatal depression and PPD. The severity of IPV appears to influence the occurrence and acuity of prenatal depression suggesting an indirect relationship. Implications for health and social work practitioners are discussed.

Referral to health and social services for intimate partner violence in health care settings: a realist scoping review

Efficient and coordinated health care responses to intimate partner violence (IPV) are essential, given that health care settings are a major entry point for abused women who seek professional services. However, there is a lack of evidence on how IPV referrals are effectively made within health care settings. In order to help program planners and providers across sectors to address the complex and chronic issue of IPV, a greater understanding of the post-IPV identification referral process is essential. A scoping review of the evidence on IPV referral programs and processes in health care settings was undertaken to provide an overview of the state of evidence and identify pertinent gaps in existing research. The scoping review identified 13 evaluative studies and 6 qualitative, primarily nonevaluative studies that examined IPV referral programs and processes. Evaluative studies involved a variety of designs and IPV referral outcomes. Rich descriptions of barriers and facilitators to seeking referrals by victims and making referrals by health care providers emerged from the evaluative and qualitative studies, but were explored more in depth in the qualitative studies. This scoping review provides guidance on what is currently known about IPV referral programs in health care settings and provides a starting point for further research on effectiveness of referral processes.

Safe mom, safe baby: a collaborative model of care for pregnant women experiencing intimate partner violence

Violence during pregnancy is a national and global health-related problem. Intimate partner violence significantly increases the risk of maternal and neonatal morbidity and mortality. Abused pregnant women are 1.4 times more likely to deliver a preterm or low-birth-weight infant requiring extended and resource-intense care in tertiary settings. Despite the prevalence of intimate partner violence during pregnancy, very little is written about established clinical programs designed to address this problem. This article presents the design, implementation, and evaluation of a nurse-led, evidence-based initiative respected for enhancing the health and safety of abused pregnant women. This interdisciplinary program combines registered nurse case management, the advocacy services of a community-based domestic violence agency, and perinatal care into a seamless continuum of professional services. Program interventions focus on helping clients navigate (1) their perinatal experiences across healthcare settings and (2) the complexities of criminal justice, legal, and social service systems within the community. Program-related data collected and evaluated for performance improvement purposes are discussed, and innovative educational programming is described.

Effect of an In-Clinic IPV Advocate Intervention to Increase Help Seeking, Reduce Violence, and Improve Well-Being

This quasi-experimental study investigated the efficacy of clinic-based advocacy for intimate partner violence (IPV) to increase help seeking, reduce violence, and improve women’s well-being. Eligible and consenting women attending one of six selected clinics in the rural Southern United States were assessed for IPV. Consenting women disclosing IPV were offered either an in-clinic advocate intervention or usual care, depending on the clinic they attended and were followed for up to 24 months. Over follow-up time both IPV scores and depressive symptoms trended toward greater decline among women in the advocate intervention clinics relative to the usual care (business card referral only).