"What has it been like for you to talk with me today?": the impact of participating in interview research on rape survivors

Research with women sexual assault survivors presenting for emergency care is safe: Results from a multi-site, prospective observational cohort study

A barrier to research with sexual assault survivors is the concern that research participation might be a negative experience for participants. We report the experiences with research of adult women sexual assault survivors participating in a large-scale, multi-site, prospective observational study that enrolled participants at the time of presentation for emergency care. Participants (n = 706, M = 28 years of age; 57% white, 15% Black) self-reported their experience with research 1 week, 6 weeks, 6 months, and 1 year post-assault. The vast majority rated the research experience as positive (95-97%), reported no drawbacks (84-89%), and felt that participating was worth it (93-95%). Positive experiences with research remained stable across the year, were generally consistent across demographic and clinical groups, and were reflected in qualitative comments. Given the tremendous morbidity experienced by sexual assault survivors and lack of progress in developing improved treatments for this population, ethically-conducted research with sexual assault survivors receiving emergency care should be encouraged.

Constructing Sacred Containers for Participatory Action Research: An Embodied Mindfulness Arts-Based Practice

College campuses are sites of institutional betrayal and interpersonal harm for too many survivors of gender-based violence. In pursuit of change aligned with empowerment frameworks and feminist epistemologies, many of us create spaces for impacted students to engage in participatory action research and learning. This article describes a mindfulness, arts-based embodied practice for transforming settings and positioning participants as visionaries and experts on safety, power, and well-being. Through intentional dyadic and collective discussion, the Sacred Containers form the foundation for a coconstructed community. This article describes the rationale, process, impact, and recommendations via student and faculty reflections across four cohorts.

Gender Differences in Sexual Violence Victimization Experiences and Validity of Victimization Reports: A Think-Aloud Study

This study compared the qualitative nature of women and men's sexual violence (SV) victimization, the types of experiences captured and missed on the Sexual Experiences Survey-Short Form Victimization (SES-SFV) across genders, and common interpretations of the SES-SFV items. Fifty-four university students (31 women, 21 cis men, 2 trans men) who had recent unwanted (but not necessarily nonconsensual) sexual experiences thought out loud while privately completing the SES-SFV. They also typed descriptions of experiences reported on SES-SFV items or similar experiences when nothing was reported on an item. Results indicated that women's victimization was more frequent and severe than cis men's, except when men were victimized by men. Although verbal coercion was common across genders, event descriptions indicated that women's verbal coercion experiences were more often harsh and part of a partner's ongoing SV or coercive control. The findings suggest that quantitative measurement can mask important gender differences in victimization and (based on analysis of false positives and negatives) may underestimate rape and attempted rape experiences, especially women's. Findings suggested that responding to the SES-SFV was not traumatic or distressing. However, participants sometimes expressed confusion about the items and interpreted them in unintended ways.

Method Matters: Integrating Trauma-Informed Principles into Psychiatric and Mental Health Nursing Research

Psychiatric and mental health (PMH) nurses integrate the concept of trauma-informed care into practice, policy, and education. Despite the frequency of PMH nurses practicing in a trauma-informed manner, there is a paucity of literature focused on integrating trauma-informed principles into research methods. Professions outside of the nursing sphere, specifically social work and social sciences, predominate the discourse around trauma-informed research. The authors of this manuscript provide detailed methods on a project using trauma-informed qualitative research methods with a feminist perspective. Semi-structured interviews with ten individuals with an experience of sexual violence answered the research question: what is the retrospective experience of women who encountered sexual violence in post-secondary education? An important part of the research design was an informal debrief with the audio recorder off, after the interview. Field notes were taken within this debrief, and participants reviewed these field notes as part of the member-checking process. By explaining the methods used in detail, referencing the available literature, and using the critical reflection of participants captured in the field notes, the authors of this manuscript explore strengths, conflicts, and boundary issues PMH nurses need to consider when integrating trauma-informed research methods into their research practices.

Beyond the Binary: The Issue of Intra-Minority Hostility and the Need to Challenge Conventional Victim/Perpetrator Frameworks Within Hate Studies

It is well-established within the hate studies literature that the majority of hate crimes and incidents of targeted hostility are perpetrated by those in the "majority" society. In the UK, academic and official research consistently shows that young White, British males are most commonly the culprits of all forms of targeted victimization, especially racist hate. However, urban areas of "super-diversity" offer researchers an opportunity to understand hate crime victimization and perpetration in a more nuanced and comprehensive way. Hate studies research has slowly begun to highlight instances of people from marginalized and stigmatized groups being targeted on the basis of their identity by individuals who are also members of minority groups, sometimes even the same minority group as the victim. Very little is understood about this particular victimizing dynamic other than it appears to be an attempt by minority group members to "fit in" by adopting what they perceive to be majority group values and attitudes. By drawing from 44 qualitative in-depth interviews exploring the experiences of new migrants and refugees and observations from 20 months of grassroots engagement, this article challenges established theories of "othering" that overwhelmingly refer to binary, static majority/minority tensions. The stories of these too-often "hidden" victims of targeted hostility offer a fresh perspective on the relationships between victims of hate and perpetrators. The article also contributes new explanations as to why those who are often targeted go on to target others.

Conducting Virtual Interviews With Sexual Assault Survivors and Their Informal Supports During COVID-19 and Beyond

The current paper describes the author's experience conducting virtual interviews with sexual assault survivors and their informal supports (e.g., family, friend, partner) during the COVID-19 pandemic, drawing on past and present interviewing experiences with this population, and the recent literature on best practices for virtual interviewing and survivor/trauma-informed research methods. The experience of pivoting from past projects using face-to-face interview methods to doing virtual interviews with this population is presented and critically analyzed. Potential advantages and drawbacks of various methods and adaptations for doing virtual interviews in a dyadic sample of survivors and their informal supports are described to facilitate future research using virtual methods with sexual assault survivors and their informal supporters. Issues related to access (e.g., e.g., age, gender, race, ability, poverty) to interview participation are also noted as in need of more consideration. Finally, the impact on interviewers of doing this work in virtual versus face-to-face contexts is discussed.

How Helpful Is Bystander Intervention? Perspectives of Dating and Sexual Violence Survivors

While bystander intervention education has demonstrated promise as a strategy to reduce dating and sexual violence (DSV) on campus, little is known about whether survivors on whose behalf the interventions take place find these helpful. This paper uses qualitative, in-depth interviews with 33 DSV survivors to explore their perspectives on bystander intervention. Results indicate that while some interventions were identified as helpful, especially those that provided support to the survivor, many were not helpful enough or even harmful. Further work is needed to understand the consequences of bystander action.

Help-seeking among college survivors of dating and sexual violence: a qualitative exploration of utilization of university-based victim services

Objective: Study uses qualitative data to examine help-seeking decisions as well as the drivers and barriers to utilization of university-based victim services through the accounts of survivors. Participants: The current study involves the analysis of 33 semi-structured interviews that were conducted with dating and sexual violence (DSV) survivors at a large, Mid-Atlantic University who both did and did not utilize university-based victim services. Methods: Data were analyzed using a thematic analysis approach. Results: Analysis shows that while survivors of DSV undergo a process of help-seeking that is similar to those described in previous help-seeking models, there are additional factors that contribute to a reluctancy to seek services at a university-based victim services center in particular that must be accounted for in the literature. Conclusions: The findings from the current study underscore the importance of understanding the specific drivers and barriers to utilization of university-based victim services.

Adult Sexual Assault Patients' Experience of the Physical Examination Component of the Medical Forensic Examination: A Scoping Review to Identify Gaps in the Research Literature

We undertook a scoping review of published research literature that reported on adult sexual assault patients' experience of the physical examination component of the medical forensic examination (MFE). Eligible papers were those reporting data about the physical examination component of the MFE from the adult patient's perspective, published in the period January 2000 to March 2022 in peer reviewed journals and reports containing original research data published from a tertiary institution. Twelve papers were identified. The review identified a gap in the literature regarding the patient's experience of the physical examination component of the MFE. The existing literature is limited but suggests that some patients find the examination empowering and reassuring, restoring a sense of bodily control; however, for others it is an intrusive, violating experience that they endure. A more patient-centered sexual assault service appears to have a therapeutic value in itself, but more research is warranted as existing research is very limited and often from a proxy. In particular, more research on patients' self-reported experience of the MFE, including specific aspects of the examination and the experience of male and gender nonconforming victim-survivors, is needed. A better understanding, from the point of view of the patient, of the benefits of attending, may encourage victim-survivors to seek a health response and, possibly, report to police. It may also be time to assess the impacts of certain aspects of the forensic examination, rethink standard evidence collection processes, and consider enabling more acceptable options for victim-survivors including self-collection of intimate samples.

Ethical inclusion: Risks and benefits of research from the perspective of perinatal people with opioid use disorders who have experienced incarceration

BACKGROUND

Research ethics guidelines and emphasis on representation in research guide the inclusion of marginalized groups, including people with perinatal opioid use disorders (OUD) and people experiencing incarceration in the United States. However, insights from participants regarding the risks and benefits of participation are not adequately considered. The aim of this study was to examine the risks and benefits of research participation from the perspective of pregnant/postpartum people with OUD who have experienced incarceration.

DESIGN

We recruited people who had experience with perinatal incarceration and were either currently pregnant or postpartum, and at least 18 years old. All participants met the clinical criteria for OUD. Our study did not have exclusion criteria based on gender, race, or ethnicity.

SETTING

Participants were either currently incarcerated at the North Carolina Correctional Institute for Women in Raleigh, North Carolina, United States or had previously experienced perinatal incarceration and were recruited from a perinatal substance use disorder treatment program located in North Carolina.

PARTICIPANTS

Between 9/2021-4/2022, we completed 12 interviews with pregnant/postpartum people with OUD, approximately half who were currently incarcerated and half with a recent history of perinatal incarceration.

INTERVENTION/MEASUREMENT

Interviews were conducted via Webex phone or video. The interviews followed a scripted interview guide and lasted one hour on average. Interview transcripts were analyzed using the Rigorous and Accelerated Data Reduction technique to produce an overarching thematic framework.

FINDINGS

Our analysis identified benefits, including the personal advantage of self-expression, helping others and contributing to change, and financial incentives. Risks included stigma and breach of confidentiality, misunderstanding of the distinction between research and advocacy, and limited ability to share their whole experience.

CONCLUSIONS

Participant-identified benefits of research mirrored those from other marginalized populations, though participant-identified risks were novel and nuanced. Recruitment and consent should move beyond normative research ethics committees protocol language to consider the perspectives of participants.

Improving understandings of trauma and alcohol and other drug-related problems: A social research agenda

Trauma is increasingly understood to shape a range of alcohol and other drug (AOD)-related problems, including addiction, relapse, mental illness and overdose. However, the merits of understanding AOD-related problems as the effect of trauma are uncertain with the nature and implications of such linkages requiring closer scrutiny. Where trauma is linked to AOD-related problems, this relationship is typically treated as self-evident, obscuring the uncertainties in knowledge surrounding the notion of trauma itself. Informed by insights from critical drugs and trauma scholarship that challenge deterministic notions of AOD 'problems' and trauma, this essay identifies key issues for social research in this area that warrant further consideration. We argue that there is a pressing need to acknowledge variation and diversity in the relationship between trauma and AOD-related problems, and the gendered and sexual dynamics shaping the expansion of the trauma paradigm. We then outline how critical Indigenist interdisciplinary work can inform culturally specific knowledge on trauma and AOD-related problems, and also suggest targeted research on the delivery and experience of trauma-informed approaches in the AOD context. To this end, we present several recommendations for a social research agenda underpinned by critical, qualitative research into how people experience and manage trauma and AOD-related problems in their everyday lives.

The Unexpected Benefits of a Decolonized Knowledge Translation Initiative for Indigenous Mother Participants

Western health research's approach to knowledge translation (KT) has been criticized by Indigenous scholars, leaders, and communities for its misalignment with Indigenous ways of knowing and relational approaches to sharing knowledge. Conversely, Indigenous KT is understood as 'sharing what we know about living a good life' (Kaplan-Myrth & Smylie, 2006). Whereas KT in Euro-Western science contexts focuses on closing the know-do gap implying a separation of knowledge and action, knowledge in the Indigenous context is inherently practical and based on centuries old practices including oral traditions, experiential knowledge, and cross-cultural sharing. This article describes the development of a decolonized KT strategy. This community-engaged KT initiative was developed at the suggestion of Indigenous mothers who participated in a research study in Hamilton, Canada, which examined their experiences using health care to meet the health needs of their infants. Indigenous mothers participated in three main roles related to the KT activities: sharing their story in video, participating as team members on an Advisory Board, and directing the creation of a video series and website educational resource (KT strategy). Five Indigenous mothers participated as members of the Advisory Board. The process of participating had positive impacts on the mothers, namely, empowerment, strength, 'I am not alone', and healing. These unexpected findings, which go beyond the original project purpose to create an educational resource, show the significant and important benefits for research participants, particularly those from Indigenous communities, to be involved in decolonized KT strategies.

Evaluating Efforts to Address Campus Sexual Violence: Developing a Data Ecosystem

Sexual violence is well documented as a major problem on college campuses, and the delivery of service and programs at institutions of higher education (IHE) has proliferated over recent years. However, the implementation of these efforts has often outpaced the field's work in developing evaluation models. Many institutions depend on campus climate surveys for data to inform their efforts, yet there are multiple data points that can be accessed to provide a more holistic picture of efforts to address sexual violence on campus. The data ecosystem framework provided by Driver-Linn & Svenson (2017) offers a comprehensive approach for assessing efforts to address campus sexual violence (CSV), but implementation models are needed that connect evaluation and practice, take local context into account, and lead to changes on campus. This paper presents a case study from a multisite university to describe the process of implementing a "data ecosystem" to assess the institutions' efforts to effectively address CSV, and how the data was used by practitioners and administrators. The collaborative, utilization-driven model has provided valuable data to inform the delivery of services and programs across the university yet has limitations and requires a wide range of resources to sustain.

Engagement of Sexual Violence Survivors in Research: Trauma-Informed Research in the THRIVE Study

Given the potential for retraumatization among survivors of sexual violence engaged in research, we aimed to provide pertinent knowledge and exemplification of the integration of trauma-informed practice to research with survivors. Grounded in trauma-informed care, we discuss the need for trauma-informed research, drawing upon experiences and data from a longitudinal case-control study on sexual violence. Through trauma-informed research settings, we can improve research experiences for survivors of sexual violence, as demonstrated by positive experiences of participants in The THRIVE Study. By meeting the needs of survivors, researchers can increase participation while maximizing the research quality and advancement of research.

Safeguarding and Agency: Methodological Tensions in Conducting Research with Survivors of Sexual Violence in Universities

This paper examines the tension between safeguarding measures and participant agency in conducting feminist interviews with survivors of sexual violence in universities. There is a core contradiction inherent in feminist research of gender-related violence, including sexual violence, because participants have been traumatized: Research with survivors of violence must enact appropriate safeguarding measures to ensure their emotional wellbeing, yet in designing these safeguarding measures, researchers must also ensure that survivor participants can exert agency within the research process. These phenomena are often at odds as safeguarding—the work of protecting participants through limiting their exposure to upsetting stimuli—appears to circumscribe participant agency, or a participant’s ability to make informed choices for themselves that respond to and change the structures in which they are situated. Using part of my doctoral thesis research’s methodology, I detail the safeguarding measures I implemented for participants as well as highlight how and where I attempted to build in agential engagement for survivor participants, and whether, or how often, survivors took up these options. The article concludes by suggesting ways gender-related violence research more broadly can reflect on and continue to interrogate how researchers balance safeguarding requirements while enabling survivors to assert their agency in the research process.

Can a Scientist Be a Young, Attractive Woman? The Stereotype of a Scientist and the Lexical Choices of Women and Men

The question of the conformance of a researcher's features to the stereotype of a scientist is rarely addressed in the context of scientific research. We decided to examine its significance in two experiments involving women and men in which the persons conducting the experiment had features respectively conforming and not conforming to the stereotype of a scientist. Both experiments were carried out on an interactive model and the dependent variables were length of utterance and lexical choices. We chose to use linguistic material because, as classical research shows, it is particularly susceptible to the influence of social context and features of the interlocutor. To operationalise the dependent variable, we used Ertel's Speech Style Quotients. The results of both experiments were found to be significant for context comparisons but non-significant for gender, which confirms the importance of features of the interlocutor in determining utterance length and lexical choices.

Intersectional discrimination, gender-based violence, and social participation of women with disabilities in Burkina Faso

This study used in-depth interviews with a diverse sample of women with disabilities in Burkina Faso to explore how discrimination based on gender and disability intersects and influences exposure to violence, as well as the impact of such discrimination on social participation, a theme barely studied in West Africa. The study thematically analysed the narratives of 35 women with disabilities - including mental, physical, auditory and visual - (age range  = 15-53), rural and urban that were collected through four focus groups and eight case stories of rape survivors. As presented in the statements of the women surveyed, the combination of stereotypes and prejudices linked to disability and unequal gender relations make these women predominantly vulnerable to gender-based violence, especially sexual violence. This increased vulnerability to sexual assault emphasises the processes of social exclusion these women experience, at all levels of society, which for most of them results in limited social participation. The findings of this study showed the need for policies related to women's empowerment and inclusion of people with disabilities to adopt an intersectional approach, to better consider the specific issues of women with disabilities.

A systematic review that evaluates the extent and quality of involving childhood abuse survivors in shaping, conducting and disseminating research in the UK

Despite a well-established understanding of the mental and physical health consequences associated with exposure to childhood abuse, the active voices of survivors are rarely present in shaping, conducting and disseminating research. To explore the extent and quality of involvement with adult survivors of childhood abuse in the UK, we performed a systematic review of research conducted ‘with’ or ‘by’ survivors, and analysed involvement against a new instrument, the Survivor Research Involvement Ladder, which was co-produced drawing from the principles of the Survivors Voices Charter. A search of relevant grey and peer-reviewed literature was conducted, which retrieved 662 sources after removing duplicates. Of these, 116 full-text articles on adult survivors of childhood abuse in the UK were subsequently assessed for involvement (beyond participation as ‘subjects’), of which only 15 (12.9 per cent) reported activities led, co-produced, advised or consulted on by survivors, and these were included in the review. From evaluations and analysis using the ladder, consumerist models were found to be the dominant form of involvement, with survivors filling advisory roles at isolated stages. Survivor-led research was scarce but emerged when survivor-researchers planned, conducted and disseminated their work. This review finds considerable opportunity for improvements in the level, quality and subsequent reporting of research activities involving survivors. The use of the instrument needs replication, validation and further field-testing.

Developing Trauma-Informed Research Methods: Using Proxy Respondents to Assess Sexual Assault Survivors' Experiences Seeking Medical Forensic Exams

In research on sexual assault victims' help-seeking, proxy data sources are often utilized because outreach to survivors immediately postassault may increase a study's risk-to-benefit ratio. Victim advocates and services providers are common proxy respondents, but empirical research comparing the accuracy of their information is needed. We collaborated with seven sexual assault nurse examiner (SANE) programs to collect de-identified, paired data from nurses and advocates regarding the help-seeking experiences of N = 744 adult victims. Using pairwise McNemar tests, we found statistically significant agreement on victim demographics, assault characteristics, and victims' decisions regarding medical forensic exams, sexual assault kit (SAK) collection, and release of SAKs for forensic DNA testing. Nurses and advocates had different information regarding victims' disclosure histories and their reasons for seeking SANE care.

#MeToo Online Disclosures: A Survivor-Informed Approach to Open Science Practices and Ethical Use of Social Media Data

With social media data widely available, researchers are increasingly incorporating tweets, posts, and blogs in their work. While easily accessible, the use of “public” posts raises important questions about the ethics of mining, storing, analyzing, and reporting publicly available social media data—especially when gathering sensitive information such as sexual violence disclosures. Online movements including #MeToo and #WhyIDidntReport emerged to shed light on gender-based violence. These movements generate large quantities of data with little consistency and oversight across research groups, disciplines, and review boards on data ethics. With the recent push in social science to publish data to open science databases, the concerns of feminist psychologists and ethical concerns of social media research with survivors have become more salient. In this article, we describe and address these ethical issues by reviewing existing social media sexual assault disclosure research and make concrete recommendations for authors seeking to use social media data. We also seek to address these ethical concerns by noting the work of some feminist researchers, but also by pushing researchers to do more for survivors through a survivor-informed approach to this research in an open science context. We propose four survivor-informed recommendations for research with this vulnerable population: (a) get input from survivors, (b) update ethics review boards, (c) maximize benefits to participants, and (d) utilize study-appropriate datasets with informed consent.

A scoping review of recommendations in the English language on conducting research with trauma-exposed populations since publication of the Belmont report; thematic review of existing recommendations on research with trauma-exposed populations

OBJECTIVE

To identify recommendations for conducting public health research with trauma-exposed populations.

METHODS

Researchers searched Embase, PubMed, Scopus, Web of Science, Open Grey, and Google Scholar for recommendations. Trauma that causes psychological impact was our exposure of interest and we excluded clinical articles on treating physical trauma. We reviewed titles and abstracts of 8,070 articles and full text of 300 articles. We analyzed recommendations with thematic analysis, generated questions from the existing pool of recommendations, and then summarized select gaps.

RESULTS

We abstracted recommendations from 145 articles in five categories: community benefit, participant benefit, safety, researcher well-being, and recommendations for conduct of trauma research.

CONCLUSIONS

Gold standards to guide the conduct of trauma-informed public health research do not yet exist. The literature suggests participation in trauma research is not inherently harmful, and current recommendations concern using research to benefit communities and participants, protecting participants and researchers from harm, and improving professional practice. As public health researchers increasingly analyze trauma as a determinant of health, gold standards for the conduct of trauma-informed public health research would be appropriate and timely.

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

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

Examination of the Transient Changes in Affect Resulting From Participation in Research Addressing Intimate Partner Violence

As a result of the proliferation of data examining intimate partner violence (IPV), there has been an emerging interest in how this research emotionally affects participants, particularly those with a history of personal experience with IPV. While a large body of IPV research suggests that only a small proportion of individuals experience transient emotional distress as the result of participation, this research is limited by examining only the emotional responses at the conclusion of the research, rather than examining changes in affect during the research. Therefore, this research sought to examine negative affect among participants throughout the research to better examine the trajectory of affect during participation in research on IPV. We recruited a sample of 914 college students who completed a measure of negative affect at the beginning, after being exposed to violence questionnaires, and at the conclusion of the research. The findings suggested that among the total sample, negative affect generally declined over the course of the research, although there was a significant interaction for victims of both psychological and physical IPV, such that their negative affect remained stable over participation in the research. Negative affect was significantly correlated with measures of reactions to the research globally, and not significantly related to perceptions of the overall benefits of the research. These data suggest that participation in research on IPV does not increase negative affect, even among those with a history of IPV. Implications of these data for future research on IPV are discussed.

Survivors' Beliefs About the Causes of Sexual Offending: An Australian Study

Policies designed to prevent sexual (re)offending are often proposed on behalf of survivors of sexual violence. However, no research has examined survivors' beliefs about the causes of sexual offending. This is a critical gap, because how individuals understand the causes of sexual offending has long been thought to inform their support for particular policy responses. This article presents findings from the first study to specifically examine survivors' views about the causes of sexual offending, based on interviews with 33 survivors from Australia. It demonstrates that survivors' beliefs are highly complex and multifaceted, and destabilizes the uniform survivor of governmental imagination.

The Challenges of Conducting Qualitative Research on "couples" in Abusive Intimate Partner Relationships Involving Substance Use

Undertaking qualitative dyad or couple interviews involving intimate partner abuse and substance use presents considerable ethical, safeguarding, and theoretical challenges throughout the research process from recruitment to conducting interviews and analysis. These challenges and how they were managed are outlined using the experience from a qualitative study of 14 heterosexual "couples" that explored the complex interplay between intimate partner abuse and substance use. Managing these challenges for participants, their families, and researchers included the use of safeguarding protocols and procedures to manage risk and the provision of clinical support for experienced researchers. Researchers often felt drawn into the conflicts and complex dynamics of opposing accounts from the male and females' relationship which could be emotionally and methodologically taxing. Researchers discussing their analysis and felt experiences with each other provided a reflexive space to manage emotions and stay close to the theoretical underpinnings.

Ambiguous Loss and Embodied Grief Related to Mexican Migrant Disappearances

Since the 1990s, thousands of Latin Americans have died or disappeared along the US-Mexico border, following the funneling of migration through remote desert regions. The families of missing migrants face long-term "ambiguous loss," a lived experience in which a loved one is physically absent but psychologically present. Mexican relatives of the missing in Arizona and Sonora report that these losses produce deep emotional suffering along a timeline - worrying about the crossing, learning of the disappearance, beginning to search, and finally, coping with the long-term impacts of unknowing. Close relatives experience embodied health effects including headaches, insomnia, anxiety, depression, and chronic disease.

Therapist telephone-delivered CBT and web-based CBT compared with treatment as usual in refractory irritable bowel syndrome: the ACTIB three-arm RCT

BACKGROUND

Irritable bowel syndrome (IBS) affects 10-22% of people in the UK. Abdominal pain, bloating and altered bowel habits affect quality of life and can lead to time off work. Current treatment relies on a positive diagnosis, reassurance, lifestyle advice and drug therapies, but many people suffer ongoing symptoms. Cognitive-behavioural therapy (CBT) is recommended in guidelines for patients with ongoing symptoms but its availability is limited.

OBJECTIVES

To determine the clinical effectiveness and cost-effectiveness of therapist telephone-delivered CBT (TCBT) and web-based CBT (WCBT) with minimal therapist support compared with treatment as usual (TAU) in refractory IBS.

DESIGN

This was a three-arm randomised controlled trial.

SETTING

This trial took place in UK primary and secondary care.

PARTICIPANTS

Adults with refractory IBS (clinically significant symptoms for 12 months despite first-line therapies) were recruited from 74 general practices and three gastroenterology centres from May 2014 to March 2016.

INTERVENTIONS

TCBT - patient CBT self-management manual, six 60-minute telephone sessions over 9 weeks and two 60-minute booster sessions at 4 and 8 months (8 hours' therapist time). WCBT - interactive, tailored web-based CBT, three 30-minute telephone sessions over 9 weeks and two 30-minute boosters at 4 and 8 months (2.5 hours' therapist time).

MAIN OUTCOME MEASURES

Primary outcomes - IBS symptom severity score (IBS SSS) and Work and Social Adjustment Scale (WSAS) at 12 months. Cost-effectiveness [quality-adjusted life-years (QALYs) and health-care costs].

RESULTS

In total, 558 out of 1452 patients (38.4%) screened for eligibility were recruited - 186 were randomised to TCBT, 185 were randomised to WCBT and 187 were randomised to TAU. The mean baseline Irritable Bowel Syndrome Symptom Severity Score (IBS SSS) was 265.0. An intention-to-treat analysis with multiple imputation was carried out at 12 months; IBS SSS were 61.6 points lower in the TCBT arm [95% confidence interval (CI) 89.5 to 33.8; p < 0.001] and 35.2 points lower in the WCBT arm (95% CI 57.8 to 12.6; p = 0.002) than in the TAU arm (IBS SSS of 205.6). The mean WSAS score at 12 months was 10.8 in the TAU arm, 3.5 points lower in the TCBT arm (95% CI 5.1 to 1.9; p < 0.001) and 3.0 points lower in the WCBT arm (95% CI 4.6 to 1.3; p = 0.001). For the secondary outcomes, the Subject's Global Assessment showed an improvement in symptoms at 12 months (responders) in 84.8% of the TCBT arm compared with 41.7% of the TAU arm [odds ratio (OR) 6.1, 95% CI 2.5 to 15.0; p < 0.001] and 75.0% of the WCBT arm (OR 3.6, 95% CI 2.0 to 6.3; p < 0.001). Patient enablement was 78.3% (responders) for TCBT, 23.5% for TAU (OR 9.3, 95% CI 4.5 to 19.3; p < 0.001) and 54.8% for WCBT (OR 3.5, 95% CI 2.0 to 5.9; p < 0.001). Adverse events were similar between the trial arms. The incremental cost-effectiveness ratio (ICER) (QALY) for TCBT versus TAU was £22,284 and for WCBT versus TAU was £7724. Cost-effectiveness reduced after imputation for missing values. Qualitative findings highlighted that, in the CBT arms, there was increased capacity to cope with symptoms, negative emotions and challenges of daily life. Therapist input was important in supporting WCBT.

CONCLUSIONS

In this large, rigorously conducted RCT, both CBT arms showed significant improvements in IBS outcomes compared with TAU. WCBT had lower costs per QALY than TCBT. Sustained improvements in IBS symptoms are possible at an acceptable cost. Suggested future research work is longer-term follow-up and research to translate these findings into usual clinical practice.

FUTURE WORK

Longer-term follow-up and research to translate these findings into usual clinical practice is needed.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN44427879.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme and will be published in full in Health Technology Assessment; Vol. 23, No. 17. See the NIHR Journals Library website for further project information. The University of Southampton sponsored this study. Funding was received from the NIHR HTA Board and the NIHR Clinical Research Network and support was received from the NIHR Clinical Research Network.

Barriers in seeking support: Perspectives of service providers who are survivors of sexual violence

Research with survivors of sexual violence suggests that most do not seek supportive services from community organizations. The purpose of this study is to understand the unique barriers that service providers, who are also survivors of sexual violence, may experience and how it informs their work with survivors. We conducted semi-structured interviews with 19 female, trans, and nonbinary survivors of sexual violence who are also employed as domestic violence or sexual assault advocates, community organizers, therapists, health care providers, educators, or substance abuse counselors, and had worked with survivors of sexual violence in their current positions. We coded the data using a multistep strategy derived from grounded theory. Participants indicated sensitivity to community-level barriers including where services are offered, perceived cost of services, and taking time off of work. Internalized blame, shame, minimization of their experiences, and trauma were also mentioned as significant barriers for themselves and impacted their work with survivors. Our findings suggest a need for trauma-informed intervention in community practice and policy.

A Trauma-Informed Approach to Sexual Violence Research Ethics and Open Science

The practice of ethics in social science research is a reflexive process of self-review to define a profession's collective responsibility in the face of changing norms and expectations. In recent years, we have seen transformative changes in how society thinks about supporting sexual assault survivors, and how the scientific community thinks about our obligations to society. Decades of research on trauma and its impact has raised awareness about the needs of victimized individuals, giving rise to the trauma-informed practice movement, which emphasizes that service providers must center survivors' well-being in all interactions, decisions, and program practices. The field of sexual assault research helped give rise to this movement and provides empirical support for its guiding tenets, and in this article, we explore how to bring these ideas full circle to begin articulating trauma-informed principles for research. A trauma-informed perspective on research challenges scientists to go beyond the requirements of the Belmont Report (1979) and institutional review boards' (IRB) regulations to develop research procedures that fully support survivors' choice, control, and empowerment. Such reflection on participants' rights is particularly important given the open science movement sweeping academia, which calls on scientists to share their data publicly to promote transparency, replication, and new discoveries. Disseminating data could pose significant safety, privacy, and confidentiality risks for victims of sexual assault, so we need to evaluate what open science means within a trauma-informed framework. In this article, we examine three key stages of the research process-participant recruitment, data collection, and dissemination-and consider how trauma-informed principles could help, but also could complicate, research practices. We explore these tensions and offer potential solutions so that research on sexual trauma embodies trauma-informed practice.

Incarcerated Women's Experiences and Perceptions of Participating in Research

The research process within prisons has largely considered researchers' perspectives. Only one known study explicitly examined incarcerated persons' perceptions and no known studies have explored incarcerated persons' experiences with research on sensitive topics. This study examines incarcerated women's experiences with participating in research on victimization. A thematic analysis was conducted on responses to open-ended questions about participating in a research study from 227 women in two prisons who participated in a study about victimization. Women prisoners were overwhelmingly positive about participating in the research study with the vast majority willing to participate in a future study. Participants believed participating in the study provided opportunities for them to share their story, heal, reflect, grow, and help others. Some women mentioned that discussing certain topics created uncomfortable emotions and memories. Participants perceived benefits of participating in research. Implications for research in prisons are presented.

For the Good of the Group? Balancing Individual and Collective Risks and Benefits in Community Psychology Research

Balancing risks and benefits is a necessary ethical task for social science researchers. Community psychologists must often consider risks and benefits not just for individual participants, but also for the group, system, or society that those individuals inhabit. Little ethical guidance currently exists for how to navigate this ethical challenge across these multiple levels. In this article, we use a case example of social network research incorporating multiple levels of analysis to identify common risks and benefits and understand their relationship to each other. We conclude by discussing distinctive ethical considerations revealed by this case example.

Seeing How Far I've Come: The Impact of the Digital Sexual Life History Calendar on Young Adult Research Participants

The Digital Sexual Life History Calendar (d/SLHC) is a Web-based platform for collecting young adults' sexual histories. In addition to collecting diverse data, the d/SLHC was designed to benefit participants by enabling reflection on their sexual and relationship experiences in the context of other life events and circumstances. In a pilot study of the d/SLHC, survey data were collected to test whether creating a d/SLHC timeline had any impact on sexual well-being. A sample of 18- to 25-year-old participants recruited through Amazon Mechanical Turk (MTurk) completed an online survey about sexuality and relationships. Of those, 113 also completed d/SLHC timelines and 262 served as a comparison group. Six months later, participants from both groups were invited to complete a follow-up survey (total N = 249). Repeated-measures analysis of variance (ANOVA) results indicated that participants who completed d/SLHC timelines exhibited higher sexual esteem immediately following d/SLHC completion and at follow-up. No changes in sexual esteem were observed in the comparison group, and there were no differences between the groups with regard to sexual health behaviors and outcomes. These findings suggest that sexuality studies may have the potential to yield not only rich data for researchers but also rich experiences for participants.

"It's the Way That You Do It": Developing an Ethical Framework for Community Psychology Research and Action

In the 50 years since the 1965 Swampscott conference, the field of community psychology has not yet developed a well-articulated ethical framework to guide research and practice. This paper reviews what constitutes an "ethical framework"; considers where the field of community psychology is at in its development of a comprehensive ethical framework; examines sources for ethical guidance (i.e., ethical principles and standards) across multiple disciplines, including psychology, evaluation, sociology, and anthropology; and recommends strategies for developing a rich written discourse on how community psychology researchers and practitioners can address ethical conflicts in our work.

"There Are No Known Benefits . . .": Considering the Risk/Benefit Ratio of Qualitative Research

Institutional review boards (IRBs) are responsible for weighing the risks and benefits of research participation. Qualitative researchers note numerous instances where IRB ethical frameworks fail to align with the ethics of their research projects and point out that IRB understandings of the benefits and risks of research often differ from those of the participants they seek to protect. This qualitative cross-case research investigates participants' interview experiences in six qualitative studies that differed in their methods, subject of focus, and populations. Our findings indicate that contemporary IRBs' use of population "vulnerability" and topic "sensitivity" to assess project risk does not adequately determine the benefits, risks, or ethicality of research. We recommend that IRBs treat as real the evidence for benefits in qualitative research, recognize that sensitivity and vulnerability do not predict risk, and encourage researchers to attend to relationships in their projects.

Sexual Assault Victims Participating in Research: Causing Harm When Trying to Help?

For fear of causing unnecessary distress, ethical concerns have been raised in regard to asking vulnerable persons e.g. sexually traumatized victims to participate in scientific research studies. The current study investigates how victims of sexual assault perceived participating in scientific research in regard to victims' psychological and/or physiological distress and potential beneficial outcomes from participation (N=51). Results from interviews with victims indicated that the majority of victims of sexual assault who had taken part in the study considered their participation in research a positive experience causing little short- or long-term psychological or physiological distress. In addition, over half of the respondents reported some benefits from participation.

Reflexivity: The Creation of Liminal Spaces--Researchers, Participants, and Research Encounters

Reflexivity is defined as the constant movement between being in the phenomenon and stepping outside of it. In this article, we specify three foci of reflexivity--the researcher, the participant, and the encounter--for exploring the interview process as a dialogic liminal space of mutual reflection between researcher and participant. Whereas researchers' reflexivity has been discussed extensively in the professional discourse, participants' reflexivity has not received adequate scholarly attention, nor has the promise inherent in reflective processes occurring within the encounter.

A Listening Guide Analysis of Women’s Experiences of Unacknowledged Rape

In the empirical literature, unacknowledged rape has been well documented. But due to ethical and methodological challenges, very few researchers have employed qualitative methods to examine unacknowledged rape. Through pre-screening and careful articulation of interview questions, these barriers were overcome, and 10 undergraduate women from the University of Windsor were interviewed about their experiences of unlabeled sexual assault. I used the Listening Guide to inform both the methodology and the data analysis. I identified three voices pertaining to rape acknowledgment. These voices were labeled the not knowing voice, the knowing voice, and the ambivalent voice, and I illustrate that rape acknowledgment is not dichotomous and that women can both simultaneously recognize and resist the labels of rape and sexual assault. This article addresses the need for a multidimensional understanding of rape acknowledgment. I discuss the implications the findings have for how we understand and respond to women, as they negotiate the labeling of coercive sexual experiences. Online slides for instructors who want to use this article for teaching are available to PWQ subscribers on PWQ's website at http://pwq.sagepub.com/supplemental

Impact of violence research on participants over time: Helpful, harmful, or neither?

OBJECTIVE

To investigate the impact of answering survey questions about experiences of stressful, stigmatizing, potentially traumatic and sexually violating events on well being, defined as reactions to research, anxiety, and positive and negative affect over two weeks.

METHOD

With an ethnically diverse sample of 559 higher education students, we employed a mixed experimental design (with between and within-subjects components) to evaluate changes in positive and negative affect, anxiety, traumatic stress symptoms, and reactions to research. We used multilevel regression models and planned contrasts to determine which, if any, specific characteristics of the survey questions caused changes in well being by comparing the effects of answering a randomly assigned set of survey questions about stressful, stigmatizing, potentially traumatic, or sexually violating life events across a two-week period.

RESULTS

Controlling for baseline post-traumatic stress symptoms and levels of the outcome, we identified few statistically significant effects between conditions or across time. Significant effects included a small decrease in positive affect immediately after responding to questions about sexually violating events, which diminished at two weeks; these same participants perceived fewer drawbacks to research participation. Participants who responded to questions about stressful life events reported greater perceptions of benefits.

CONCLUSIONS

Our data support the safety of survey research on sexual assault or other stressful, stigmatizing, or potentially traumatic events.

Adolescents' and adults' experiences of being surveyed about violence and abuse: a systematic review of harms, benefits, and regrets

The neuroscience and psychological literatures suggest that talking about previous violence and abuse may not only be beneficial, as previously believed, but may also be associated with risks. Thus, studies on such topics introduce ethical questions regarding the risk-benefit ratio of sensitive research. We performed a systematic review of participants' experiences related to sensitive research and compared consequent harms, benefits, and regrets among victims and nonvictims of abuse. Thirty studies were included (4 adolescent and 26 adult studies). In adolescent studies, 3% to 37% of participants (median: 6%) reported harms, but none of these studies measured benefits or regrets. Among adults, 4% to 50% (median: 25%) reported harms, 23% to 100% (median: 92%) reported benefits, and 1% to 6% (median: 2%) reported regrets. Our results suggest that the risk-benefit ratio related to sensitive research is not unfavorable, but there are gaps in the evidence among adolescents.

Reasons for and reservations about research participation in acutely injured adults

PURPOSE

The purpose of this study was to explore the reasons adult patients seeking emergency department care for minor injuries agree to participate in clinical research and to identify their reservations about participating in a research study.

DESIGN AND METHODS

This is a secondary analysis of data from a longitudinal cohort study of 275 adults who sought emergency department care for physical injury and were followed over 12 months. At the final interview, participants were asked open-ended short-answer questions about their perception of participating in the study. Free text responses were analyzed using conventional content analysis.

FINDINGS

The final sample of 214 participants was composed equally of males and females, predominantly Black (54%) and White (42%), with a mean age of 41 years. Six themes about reasons for participation emerged from free text responses: being asked, altruism, potential for personal benefit, financial gain, curiosity, and valuing or knowledge of research. Most did not report reservations. Those reservations identified included time constraints, confidentiality, and whether patients felt well suited to fulfill the study requirements.

CONCLUSIONS

Although injured patients are identified by the research community as vulnerable, they are willing to participate in research studies for diverse reasons, and their participation is commonly associated with positive experiences.

CLINICAL RELEVANCE

Understanding perceptions of participants' experiences of being in a research study after acute injury can guide researchers to improve future study protocols and recruitment strategies in order to optimize participants' experiences. Recruitment and retention into clinical research studies is essential to build nursing science to enhance the recovery of injured individuals.

Impact of daily assessments on distress and PTSD symptoms in trauma-exposed women

As more advanced methodologies are developed for symptom assessment in traumatic stress studies, it is important to examine how these methodologies can exacerbate distress or contribute to symptoms among study participants. Using a sample of 202 female college students, we examined the changes in posttraumatic stress disorder (PTSD) symptoms and general psychological symptomatology among groups of trauma-exposed and non-trauma-exposed women randomly assigned to complete 30 days of daily monitoring of traumatic symptoms and substance use behaviors using personal digital assistants (PDAs). These two groups were compared with a trauma-exposed sample of women who did not complete daily monitoring assessments and only completed pre- and post-monitoring online assessments. While trauma-exposed participants in the monitoring group reported more distress from the daily assessments than those in the monitoring group with no history of trauma, this distress level was relatively low. Online surveys delivered pre- and post-monitoring showed a similar pattern. Trauma-exposed participants in monitoring and no-monitoring groups reported a decrease in general psychological symptoms over the 30 days; however, monitoring participants reported increased levels of PTSD severity over time. Closer examination revealed the observed changes were relatively moderate. Participants expressed benefits and risks regarding study participation supporting the findings that repeated assessments of traumatic symptoms using personal handheld devices may lead to small increases in distress and PTSD symptoms, but that these approaches may be generally well tolerated.

Capturing the Stories behind the Numbers: The Auckland Regional Community Stroke Study (ARCOS IV), a Qualitative Study

Background

Qualitative data can add value and understanding to more traditional epidemiological studies. This study was designed to complement the quantitative data from the incidence study the Auckland Regional Community Stroke Study or ARCOS-IV by using qualitative methods to uncover the richer detail of life as a stroke survivor, thereby extending our understanding of the impact of stroke.

Aims

The aims of the study were to identify how the experience of recovery and adaptation changes over time after stroke; and to elicit the strategies people with stroke and their whānau/family use and find helpful in living life after stroke. The aim of this paper is to describe the methodology and also the challenges and advantages of embedding qualitative research into a large epidemiological study.

Methods

Longitudinal study utilizing a Qualitative Description design in a subset of those taking part in the incidence study. Participants will be interviewed at 6, 12, 24, and 36 months after stroke. Semistructured interviews will explore three key areas: ( 1 ) issues of importance to people following a stroke and their whānau/family; ( 2 ) the perceived impact on people's sense of recovery, adaptation, and hopes; and ( 3 ) key strategies that people with stroke and their whānau/family use and find most helpful in living life after stroke. Thematic analysis will be conducted using iterative constant comparative methods.

Conclusions

This methodology paper demonstrates the application of mixed methods in epidemiology. It also considers some of the practical and methodological issues that have emerged and may provide a useful framework for other qualitative projects in population-based studies.