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Young F, Hameed M, Hooker L, Taft A, Hegarty K. Training Australian general practitioners to counsel women experiencing intimate partner abuse (WEAVE): a pre-post training analysis. BMC PRIMARY CARE 2024; 25:93. [PMID: 38509459 PMCID: PMC10953085 DOI: 10.1186/s12875-024-02337-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Evaluations of Intimate Partner Abuse training for general practitioners is limited. The Women's Evaluation of Abuse and Violence Care study trialled in Australia was a primary care intervention that included delivering the Health Relationships training, a program that educates practitioners on how to provide supportive counselling and assistance to women afraid of an intimate partner. We report on effectiveness of the Healthy Relationships training program within a cluster-randomised controlled trial. METHODS General practitioners filled out a baseline survey and surveys before and after training, including quantitative and open-text questions on barriers and enablers to supporting victim-survivors. The Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) tool, a validated measure, was included to assess practitioner knowledge, skills, confidence, and attitudes. General linear model repeated analysis of variance tested the difference between trial groups over time. RESULTS Fifty-two general practitioners completed the baseline demographic survey, with 65% (19 intervention, 18 comparison) completing both pre-and-post-training surveys. There were no between-group differences in baseline characteristics. Post-training, the intervention group had significantly higher average scores than the comparison on perceived preparation to address abuse (p = .000), perceived knowledge (p = .000), actual knowledge (p = .03), and greater awareness of practice-related issues (p = .000). There were no between-group differences in PREMIS opinion domain scores on workplace issues, self-efficacy and understanding of victims. Post-training, the qualitative data indicated that the intervention practitioners (n = 24) reported increased knowledge, awareness, and confidence, while time pressures and lack of referral options impeded addressing abuse. CONCLUSION The Healthy Relationships Training program for general practitioners increased aspects of practitioner knowledge, skills, and confidence. However, more support is needed to change opinions and support victim-survivors sustainably. TRIAL REGISTRATION The WEAVE trial was registered on 21/01/2008 with the Australian New Zealand Clinical Trial Registry, number ACTRN12608000032358.
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Affiliation(s)
- Felicity Young
- La Trobe Rural Health School, La Trobe University, Bendigo, VIC, 3552, Australia.
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, 3086, Australia.
| | - Mohajer Hameed
- The Bouverie Centre, La Trobe University, Brunswick, VIC, 3056, Australia
| | - Leesa Hooker
- La Trobe Rural Health School, La Trobe University, Bendigo, VIC, 3552, Australia
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Angela Taft
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Vic, 3053, Australia
- The Royal Women's Hospital, 20 Flemington Road, Parkville, Vic, 3052, Australia
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Lu C, Georgousopoulou E, Baloch S, Walton-Sonda D, Hegarty K, Sethna F, Brown NAT. Identifying the barriers faced by obstetricians and registrars in screening or enquiry of intimate partner violence in pregnancy: A systematic review of the primary evidence. Aust N Z J Obstet Gynaecol 2024; 64:19-27. [PMID: 37786258 DOI: 10.1111/ajo.13747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/10/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Intimate partner violence (IPV) disproportionally affects women compared to men. The impact of IPV is amplified during pregnancy. Screening or enquiry in the antenatal outpatient setting regarding IPV has been fraught with barriers that prevent recognition and the ability to intervene. AIMS The aim of this systematic review was to determine the barriers that face obstetricians/gynaecologists regarding enquiry of IPV in antenatal outpatient settings. The secondary objective was to determine facilitators. METHODS Primary evidence was searched using Ovid MEDLINE, Ovid Maternity and Infant Care, PubMed and Proquest from 1993 to May 2023. The included studies comprised empirical studies published in English language targeting a population of doctors providing antenatal outpatient care. The review was PROSPERO-registered (CRD42020188994). Independent screening and review was performed by two authors. The findings were analysed thematically. RESULTS Nine studies addressing barriers and two studies addressing facilitators were included: three focus-group or semi-structured interviews, six surveys and two randomised controlled trials. Barriers for providers centred at the system level (time, training), provider level (personal beliefs, cultural bias, experience) and provider-perceived patient level (fear of offending, patient readiness to disclose). Increased experience and the use of validated tools were strong facilitators. CONCLUSION Barriers to screening reflect multi-level obstruction to the identification of women exposed to IPV. Although the antenatal outpatient clinic setting addresses a particular population vulnerable to IPV, the barriers for obstetricians are not unique. The use of validated cueing tools provides an evidence-based method to facilitate enquiry of IPV among antenatal women, assisting in identification by clinicians. Together with education and human resources, such aids build capacity in women and obstetric providers.
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Affiliation(s)
- Corrine Lu
- Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | | | - Surriya Baloch
- University of Melbourne Royal Women's Hospital, Parkville, Victoria, Australia
| | | | - Kelsey Hegarty
- University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Farah Sethna
- Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Nick A T Brown
- Canberra Health Services, Canberra, Australian Capital Territory, Australia
- University of Canberra, Canberra, Australian Capital Territory, Australia
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Rathnayake JC, Mat Pozian N, Carroll JA, King J. Barriers Faced by Australian and New Zealand Women When Sharing Experiences of Family Violence with Primary Healthcare Providers: A Scoping Review. Healthcare (Basel) 2023; 11:2486. [PMID: 37761683 PMCID: PMC10531433 DOI: 10.3390/healthcare11182486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Despite the Australian Government's attempts to reduce domestic violence (DV) incidences, impediments within the social and health systems and current interventions designed to identify DV victims may be contributing to female victims' reluctance to disclose DV experiences to their primary healthcare providers. This scoping review aimed to provide the state of evidence regarding reluctance to disclose DV incidents, symptoms and comorbidities that patients present to healthcare providers, current detection systems and interventions in clinical settings, and recommendations to generate more effective responses to DV. Findings revealed that female victims are reluctant to disclose DV because they do not trust or believe that general practitioners can help them to solve their issues, and they do not acknowledge that they are in an abusive relationship, and are unaware that they are in one, or have been victims of DV. The most common symptoms and comorbidities victims present with are sleep difficulties, substance use and anxiety. Not all GPs are equipped with knowledge about comorbidities signalling cases of DV. These DV screening programs are the most prominent intervention types within Australian primary health services and are currently not sufficiently nuanced nor sensitive to screen with accuracy. Finally, this scoping review provides formative evidence that in order for more accurate and reliable data regarding disclosure in healthcare settings to be collected, gender power imbalances in the health workforce should be redressed, and advocacy of gender equality and the change of social structures in both Australia and New Zealand remain the focus for reducing DV in these countries.
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Affiliation(s)
| | | | - Julie-Anne Carroll
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove Campus, Victoria Park Road, Kelvin Grove, QLD 5069, Australia; (J.C.R.); (N.M.P.); (J.K.)
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Dowrick A, Feder G, Kelly M. Boundary-Work and the Distribution of Care for Survivors of Domestic Violence and Abuse in Primary Care Settings: Perspectives From U.K. Clinicians. QUALITATIVE HEALTH RESEARCH 2021; 31:1697-1709. [PMID: 33749389 PMCID: PMC8438775 DOI: 10.1177/1049732321998299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Health care encounters are opportunities for primary care practitioners to identify women experiencing domestic violence and abuse (DVA). Increasing DVA support in primary care is a global policy priority but discussion about DVA during consultations remains rare. This article explores how primary care teams in the United Kingdom negotiate the boundaries of their responsibilities for providing DVA support. In-depth interviews were undertaken with 13 general practitioners (GPs) in two urban areas of the United Kingdom. Interviews were analyzed thematically. Analysis focused on the boundary practices participants undertook to establish their professional remit regarding abuse. GPs maintained permeable boundaries with specialist DVA support services. This enabled ongoing negotiation of the role played by clinicians in identifying DVA. This permeability was achieved by limiting the boundaries of the GP role in the care of patients with DVA to identification, with the work of providing support distributed to local specialist DVA agencies.
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Affiliation(s)
- Anna Dowrick
- Queen Mary University of London, London, United Kingdom
| | - Gene Feder
- University of Bristol, Bristol, United Kingdom
| | - Moira Kelly
- Queen Mary University of London, London, United Kingdom
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Kalra N, Hooker L, Reisenhofer S, Di Tanna GL, García-Moreno C. Training healthcare providers to respond to intimate partner violence against women. Cochrane Database Syst Rev 2021; 5:CD012423. [PMID: 34057734 PMCID: PMC8166264 DOI: 10.1002/14651858.cd012423.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) includes any violence (physical, sexual or psychological/emotional) by a current or former partner. This review reflects the current understanding of IPV as a profoundly gendered issue, perpetrated most often by men against women. IPV may result in substantial physical and mental health impacts for survivors. Women affected by IPV are more likely to have contact with healthcare providers (HCPs) (e.g. nurses, doctors, midwives), even though women often do not disclose the violence. Training HCPs on IPV, including how to respond to survivors of IPV, is an important intervention to improve HCPs' knowledge, attitudes and practice, and subsequently the care and health outcomes for IPV survivors. OBJECTIVES To assess the effectiveness of training programmes that seek to improve HCPs' identification of and response to IPV against women, compared to no intervention, wait-list, placebo or training as usual. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and seven other databases up to June 2020. We also searched two clinical trials registries and relevant websites. In addition, we contacted primary authors of included studies to ask if they knew of any relevant studies not identified in the search. We evaluated the reference lists of all included studies and systematic reviews for inclusion. We applied no restrictions by search dates or language. SELECTION CRITERIA All randomised and quasi-randomised controlled trials comparing IPV training or educational programmes for HCPs compared with no training, wait-list, training as usual, placebo, or a sub-component of the intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures outlined by Cochrane. Two review authors independently assessed studies for eligibility, undertook data extraction and assessed risks of bias. Where possible, we synthesised the effects of IPV training in a meta-analysis. Other analyses were synthesised in a narrative manner. We assessed evidence certainty using the GRADE approach. MAIN RESULTS We included 19 trials involving 1662 participants. Three-quarters of all studies were conducted in the USA, with single studies from Australia, Iran, Mexico, Turkey and the Netherlands. Twelve trials compared IPV training versus no training, and seven trials compared the effects of IPV training to training as usual or a sub-component of the intervention in the comparison group, or both. Study participants included 618 medical staff/students, 460 nurses/students, 348 dentists/students, 161 counsellors or psychologists/students, 70 midwives and 5 social workers. Studies were heterogeneous and varied across training content delivered, pedagogy and time to follow-up (immediately post training to 24 months). The risk of bias assessment highlighted unclear reporting across many areas of bias. The GRADE assessment of the studies found that the certainty of the evidence for the primary outcomes was low to very low, with studies often reporting on perceived or self-reported outcomes rather than actual HCPs' practices or outcomes for women. Eleven of the 19 included studies received some form of research grant funding to complete the research. Within 12 months post-intervention, the evidence suggests that compared to no intervention, wait-list or placebo, IPV training: · may improve HCPs' attitudes towards IPV survivors (standardised mean difference (SMD) 0.71, 95% CI 0.39 to 1.03; 8 studies, 641 participants; low-certainty evidence); · may have a large effect on HCPs' self-perceived readiness to respond to IPV survivors, although the evidence was uncertain (SMD 2.44, 95% CI 1.51 to 3.37; 6 studies, 487 participants; very low-certainty evidence); · may have a large effect on HCPs' knowledge of IPV, although the evidence was uncertain (SMD 6.56, 95% CI 2.49 to 10.63; 3 studies, 239 participants; very low-certainty evidence); · may make little to no difference to HCPs' referral practices of women to support agencies, although this is based on only one study (with 49 clinics) assessed to be very low certainty; · has an uncertain effect on HCPs' response behaviours (based on two studies of very low certainty), with one trial (with 27 participants) reporting that trained HCPs were more likely to successfully provide advice on safety planning during their interactions with standardised patients, and the other study (with 49 clinics) reporting no clear impact on safety planning practices; · may improve identification of IPV at six months post-training (RR 4.54, 95% CI 2.5 to 8.09) as in one study (with 54 participants), although three studies (with 48 participants) reported little to no effects of training on identification or documentation of IPV, or both. No studies assessed the impact of training HCPs on the mental health of women survivors of IPV compared to no intervention, wait-list or placebo. When IPV training was compared to training as usual or a sub-component of the intervention, or both, no clear effects were seen on HCPs' attitudes/beliefs, safety planning, and referral to services or mental health outcomes for women. Inconsistent results were seen for HCPs' readiness to respond (improvements in two out of three studies) and HCPs' IPV knowledge (improved in two out of four studies). One study found that IPV training improved HCPs' validation responses. No adverse IPV-related events were reported in any of the studies identified in this review. AUTHORS' CONCLUSIONS Overall, IPV training for HCPs may be effective for outcomes that are precursors to behaviour change. There is some, albeit weak evidence that IPV training may improve HCPs' attitudes towards IPV. Training may also improve IPV knowledge and HCPs' self-perceived readiness to respond to those affected by IPV, although we are not certain about this evidence. Although supportive evidence is weak and inconsistent, training may improve HCPs' actual responses, including the use of safety planning, identification and documentation of IPV in women's case histories. The sustained effect of training on these outcomes beyond 12 months is undetermined. Our confidence in these findings is reduced by the substantial level of heterogeneity across studies and the unclear risk of bias around randomisation and blinding of participants, as well as high risk of bias from attrition in many studies. Further research is needed that overcomes these limitations, as well as assesses the impacts of IPV training on HCPs' behavioral outcomes and the well-being of women survivors of IPV.
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Affiliation(s)
- Naira Kalra
- Gender Innovation Lab, Office of the Chief Economist, Africa Region, World Bank, Washington, DC, USA
| | - Leesa Hooker
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Sonia Reisenhofer
- College of Science, Health & Engineering, La Trobe University, Bundoora, Australia
| | - Gian Luca Di Tanna
- Statistics Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Claudia García-Moreno
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Soh HJ, Grigg J, Gurvich C, Gavrilidis E, Kulkarni J. Family Violence: An Insight Into Perspectives and Practices of Australian Health Practitioners. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP2391-NP2409. [PMID: 29580196 DOI: 10.1177/0886260518760609] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Family violence is threatening behavior carried out by a person to coerce or control another member of the family or causes the family member to be fearful. Health practitioners are well placed to play a pivotal role in identifying and responding to family violence; however, their perceived capacity to respond to patients experiencing family violence is not well understood. We aim to explore Australian health practitioners' current perspectives, practices, and perceived barriers in working with family violence, including perceived confidence in responding effectively to cases of family violence encountered during their work with patients. A total of 1,707 health practitioners primarily practicing in the wider Melbourne region were identified, and 114 health practitioners participated in the study between March 2016 and August 2016 by completing an investigator-developed questionnaire. Descriptive, qualitative, and thematic analyses were performed. The majority of participants recognized family violence to be a health issue and that family violence would impact the mental health of afflicted persons. Despite this, only a fifth of participants felt they were very confident in screening, supporting, and referring patients with family violence experiences. Perceived barriers to inquire about family violence included time constraints and greater importance placed on screening for other health issues. Health practitioners reported that additional training on screening, supporting, and referring patients would be beneficial. Australian health practitioners need to be upskilled. Recently, in Australia, state-relevant toolkits have been developed to provide succinct information about responding to initial patient presentations of family violence, how to inquire about family violence, and how to handle disclosures (and nondisclosures) by patients. Further resources could be developed to aid health practitioners in providing assistance to their patients as indicated. These initiatives would be a step toward addressing the concerns with regard to the lack of training and could possibly optimize outcomes for patients experiencing family violence.
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Affiliation(s)
- Han Jie Soh
- Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Jasmin Grigg
- Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Emmy Gavrilidis
- Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Monash University, Melbourne, Australia
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Hegarty K, Valpied J, Taft A, Brown SJ, Gold L, Gunn J, O'Doherty L. Two-year follow up of a cluster randomised controlled trial for women experiencing intimate partner violence: effect of screening and family doctor-delivered counselling on quality of life, mental and physical health and abuse exposure. BMJ Open 2020; 10:e034295. [PMID: 33303427 PMCID: PMC7733186 DOI: 10.1136/bmjopen-2019-034295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This was a 2-year follow-up study of a primary care-based counselling intervention (weave) for women experiencing intimate partner violence (IPV). We aimed to assess whether differences in depression found at 12 months (lower depression for intervention than control participants) would be sustained at 24 months and differences in quality in life, general mental and physical health and IPV would emerge. DESIGN Cluster randomised controlled trial. Researchers blinded to allocation. Unit of randomisation: family doctors. SETTING Fifty-two primary care clinics, Victoria, Australia. PARTICIPANTS Baseline: 272 English-speaking, female patients (intervention n=137, doctors=35; control n=135, doctors=37), who screened positive for fear of partner in past 12 months. Twenty-four-month response rates: intervention 59% (81/137), control 63% (85/135). INTERVENTIONS Intervention doctors received training to deliver brief, woman-centred counselling. Intervention patients were invited to receive this counselling (uptake rate: 49%). Control doctors received standard IPV information; delivered usual care. PRIMARY AND SECONDARY OUTCOME MEASURES Twenty-four months primary outcomes: WHO Quality of Life-Bref dimensions, Short-Form Health Survey (SF-12) mental health. SECONDARY OUTCOMES SF-12 physical health and caseness for depression and anxiety (Hospital Anxiety Depression Scale), post-traumatic stress disorder (Check List-Civilian), IPV (Composite Abuse Scale), physical symptoms (≥6 in last month). Data collected through postal survey. Mixed-effects regressions adjusted for location (rural/urban) and clustering. RESULTS No differences detected between groups on quality of life (physical: 1.5, 95% CI -2.9 to 5.9; psychological: -0.2, 95% CI -4.8 to 4.4,; social: -1.4, 95% CI -8.2 to 5.4; environmental: -0.8, 95% CI -4.0 to 2.5), mental health status (-1.6, 95% CI -5.3 to 2.1) or secondary outcomes. Both groups improved on primary outcomes, IPV, anxiety. CONCLUSIONS Intervention was no more effective than usual care in improving 2-year quality of life, mental and physical health and IPV, despite differences in depression at 12 months. Future refinement and testing of type, duration and intensity of primary care IPV interventions is needed. TRIAL REGISTRATION NUMBER ACTRN12608000032358.
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Affiliation(s)
- Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Family Violence Prevention, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Jodie Valpied
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Angela Taft
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Stephanie Janne Brown
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Lisa Gold
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Jane Gunn
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lorna O'Doherty
- Faculty of Health and Life Sciences, Coventry University, Coventry, West Midlands, UK
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Hameed M, O'Doherty L, Gilchrist G, Tirado-Muñoz J, Taft A, Chondros P, Feder G, Tan M, Hegarty K. Psychological therapies for women who experience intimate partner violence. Cochrane Database Syst Rev 2020; 7:CD013017. [PMID: 32608505 PMCID: PMC7390063 DOI: 10.1002/14651858.cd013017.pub2] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) against women is prevalent and strongly associated with mental health problems. Women experiencing IPV attend health services frequently for mental health problems. The World Health Organization recommends that women who have experienced IPV and have a mental health diagnosis should receive evidence-based mental health treatments. However, it is not known if psychological therapies work for women in the context of IPV and whether they cause harm. OBJECTIVES To assess the effectiveness of psychological therapies for women who experience IPV on the primary outcomes of depression, self-efficacy and an indicator of harm (dropouts) at six- to 12-months' follow-up, and on secondary outcomes of other mental health symptoms, anxiety, quality of life, re-exposure to IPV, safety planning and behaviours, use of healthcare and IPV services, and social support. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR), CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, and three other databases, to the end of October 2019. We also searched international trials registries to identify unpublished or ongoing trials and handsearched selected journals, reference lists of included trials and grey literature. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, cluster-RCTs and cross-over trials of psychological therapies with women aged 16 years and older who self-reported recent or lifetime experience of IPV. We included trials if women also experienced co-existing mental health diagnoses or substance abuse issues, or both. Psychological therapies included a wide range of interventions that targeted cognition, motivation and behaviour compared with usual care, no treatment, delayed or minimal interventions. We classified psychological therapies according to Cochrane Common Mental Disorders's psychological therapies list. DATA COLLECTION AND ANALYSIS Two review authors extracted data and undertook 'Risk of Bias' assessment. Treatment effects were compared between experimental and comparator interventions at short-term (up to six months post-baseline), medium-term (six to under 12 months, primary outcome time point), and long-term follow-up (12 months and above). We used standardised mean difference (SMD) for continuous and odds ratio (OR) for dichotomous outcomes, and used random-effects meta-analysis, due to high heterogeneity across trials. MAIN RESULTS We included 33 psychological trials involving 5517 women randomly assigned to experimental (2798 women, 51%) and comparator interventions (2719 women, 49%). Psychological therapies included 11 integrative therapies, nine humanistic therapies, six cognitive behavioural therapy, four third-wave cognitive behavioural therapies and three other psychologically-orientated interventions. There were no trials classified as psychodynamic therapies. Most trials were from high-income countries (19 in USA, three in Iran, two each in Australia and Greece, and one trial each in China, India, Kenya, Nigeria, Pakistan, Spain and UK), among women recruited from healthcare, community, shelter or refuge settings, or a combination of any or all of these. Psychological therapies were mostly delivered face-to-face (28 trials), but varied by length of treatment (two to 50 sessions) and staff delivering therapies (social workers, nurses, psychologists, community health workers, family doctors, researchers). The average sample size was 82 women (14 to 479), aged 37 years on average, and 66% were unemployed. Half of the women were married or living with a partner and just over half of the participants had experienced IPV in the last 12 months (17 trials), 6% in the past two years (two trials) and 42% during their lifetime (14 trials). Whilst 20 trials (61%) described reliable low-risk random-sampling strategies, only 12 trials (36%) described reliable procedures to conceal the allocation of participant status. While 19 trials measured women's depression, only four trials measured depression as a continuous outcome at medium-term follow-up. These showed a probable beneficial effect of psychological therapies in reducing depression (SMD -0.24, 95% CI -0.47 to -0.01; four trials, 600 women; moderate-certainty evidence). However, for self-efficacy, there may be no evidence of a difference between groups (SMD -0.12, 95% CI -0.33 to 0.09; one trial with medium-term follow-up data, 346 women; low-certainty evidence). Further, there may be no difference between the number of women who dropped out from the experimental or comparator intervention groups, an indicator of no harm (OR 1.04, 95% CI 0.75 to 1.44; five trials with medium-term follow-up data, 840 women; low-certainty evidence). Although no trials reported adverse events from psychological therapies or participation in the trial, only one trial measured harm outcomes using a validated scale. For secondary outcomes, trials measured anxiety only at short-term follow-up, showing that psychological therapies may reduce anxiety symptoms (SMD -0.96, 95% CI -1.29 to -0.63; four trials, 158 women; low-certainty evidence). However, within medium-term follow-up, low-certainty evidence revealed that there may be no evidence between groups for the outcomes safety planning (SMD 0.04, 95% CI -0.18 to 0.25; one trial, 337 women), post-traumatic stress disorder (SMD -0.24, 95% CI -0.54 to 0.06; four trials, 484 women) or re-exposure to any form of IPV (SMD 0.03, 95% CI -0.14 to 0.2; two trials, 547 women). AUTHORS' CONCLUSIONS There is evidence that for women who experience IPV, psychological therapies probably reduce depression and may reduce anxiety. However, we are uncertain whether psychological therapies improve other outcomes (self-efficacy, post-traumatic stress disorder, re-exposure to IPV, safety planning) and there are limited data on harm. Thus, while psychological therapies probably improve emotional health, it is unclear if women's ongoing needs for safety, support and holistic healing from complex trauma are addressed by this approach. There is a need for more interventions focused on trauma approaches and more rigorous trials (with consistent outcomes at similar follow-up time points), as we were unable to synthesise much of the research.
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Affiliation(s)
- Mohajer Hameed
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Lorna O'Doherty
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Judit Tirado-Muñoz
- Addiction Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Angela Taft
- The Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Patty Chondros
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Gene Feder
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Melissa Tan
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Melbourne, Australia
- The Royal Women's Hospital, Victoria, Australia
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Valpied J, Hegarty K, Brown S, O'doherty L. Self-efficacy and doctor support as mediators of depression outcomes following counselling by family doctors for intimate partner violence. Fam Pract 2020; 37:255-262. [PMID: 31715628 DOI: 10.1093/fampra/cmz067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous research shows counselling delivered by trained family doctors reduces depression for women experiencing intimate partner violence (IPV). However, the potential for self-efficacy, doctor support and safety enquiry to mediate these effects has not been examined. OBJECTIVES To assess whether (i) women experiencing IPV and counselled by a trained family doctor report greater self-efficacy, perceived doctor support and enquiry about safety than those receiving usual care and (ii) whether self-efficacy, doctor support and enquiry mediate effects of counselling on depression for these women. METHODS Quantitative analysis as part of a process evaluation of data from a cluster randomized controlled trial of 272 female IPV survivors attending 52 Australian primary care clinics. Intervention group doctors were trained to deliver brief counselling. Comparison group doctors received standard IPV information. Intervention patients were invited to receive counselling from their trained doctor. Comparison patients received usual care. Data were collected at baseline, 6 and 12 months. Path analysis tested mediation effects from trial arm to depression via self-efficacy, doctor support and safety enquiry at 6 and 12 months, controlling for baseline and abuse level. RESULTS At 6 months, mean perceived doctor support was higher for intervention than comparison patients and mediated depression effect. At 12 months, mean self-efficacy was higher for intervention than comparison patients and mediated depression effect. Mediation effects for doctor enquiry were non-significant. CONCLUSIONS Counselling by trained family doctors can help increase support and self-efficacy of women who have experienced IPV, mediating reduced depression.
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Affiliation(s)
- Jodie Valpied
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Melbourne, Australia.,Centre for Family Violence Prevention, The Royal Women's Hospital and The University of Melbourne, Melbourne, Australia
| | - Stephanie Brown
- Department of General Practice, The University of Melbourne, Melbourne, Australia.,Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Lorna O'doherty
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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10
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Danitz SB, Stirman SW, Grillo AR, Dichter ME, Driscoll M, Gerber MR, Gregor K, Hamilton AB, Iverson KM. When user-centered design meets implementation science: integrating provider perspectives in the development of an intimate partner violence intervention for women treated in the United States' largest integrated healthcare system. BMC Womens Health 2019; 19:145. [PMID: 31771557 PMCID: PMC6880505 DOI: 10.1186/s12905-019-0837-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 10/31/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) against women is a global health problem that is a substantial source of human suffering. Within the United States (US), women veterans are at high risk for experiencing IPV. There is an urgent need for feasible, acceptable, and patient-centered IPV counseling interventions for the growing number of women treated in the US's largest integrated healthcare system, the Veterans Health Administration (VHA). Implementation science and user-centered-design (UCD) can play an important role in accelerating the research-to-practice pipeline. Recovering from IPV through Strengths and Empowerment (RISE) is a flexible, patient-centered, modular-based program that holds promise as a brief counseling intervention for women veterans treated in VHA. We utilized a UCD approach to develop and refine RISE (prior to formal effectiveness evaluations) by soliciting early feedback from the providers where the intervention will ultimately be implemented. The current study reports on the feedback from VHA providers that was used to tailor and refine RISE. METHOD We conducted and analyzed semi-structured, key-informant interviews with VHA providers working in clinics relevant to the delivery of IPV interventions (n = 23) at two large medical centers in the US. Participants' mean age was 42.6 years (SD = 11.6), they were predominately female (91.3%) and from a variety of relevant disciplines (39.1% psychologists, 21.7% social workers, 17.4% physicians, 8.7% registered nurses, 4.3% psychiatrists, 4.3% licensed marriage and family therapists, 4.3% peer specialists). We conducted rapid content analysis using a hybrid inductive-deductive approach. RESULTS Providers perceived RISE as highly acceptable and feasible, noting strengths including RISE's structure, patient-centered agenda, and facilitation of provider comfort in addressing IPV. Researchers identified themes related to content and context modifications, including requests for additional safety check-ins, structure for goal-setting, and suggestions for how to develop and implement RISE-specific trainings. CONCLUSIONS These findings have guided refinements to RISE prior to formal effectiveness testing in VHA. We discuss implications for the use of UCD in intervention development and refinement for interventions addressing IPV and other trauma in health care settings globally. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03261700; Date of registration: 8/25/2017, date of enrollment of first participant in trial: 10/22/2018. Unique Protocol ID: IIR 16-062.
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Affiliation(s)
- Sara B. Danitz
- Women’s Health Sciences Division of the National Center for PTSD (116B-3), VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130 USA
| | - Shannon Wiltsey Stirman
- Dissemination and Training Division of the National Center for PTSD, VA Palo Alto Healthcare System, Menlo Park, CA USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA USA
| | - Alessandra R. Grillo
- Women’s Health Sciences Division of the National Center for PTSD (116B-3), VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130 USA
| | - Melissa E. Dichter
- VA Center for Health Equity Research and Promotion (CHERP), Philadelphia, PA USA
- Temple University, School of Social Work, Philadelphia, PA USA
| | - Mary Driscoll
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME), VA Connecticut Healthcare System, West Haven, CT USA
- Yale School of Medicine, New Haven, CT USA
| | - Megan R. Gerber
- VA Boston Healthcare System, Boston, MA USA
- Boston University School of Medicine, Boston, MA USA
| | - Kristin Gregor
- VA Boston Healthcare System, Boston, MA USA
- Boston University School of Medicine, Boston, MA USA
| | - Alison B. Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA USA
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA USA
| | - Katherine M. Iverson
- Women’s Health Sciences Division of the National Center for PTSD (116B-3), VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130 USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA USA
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11
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Donnelly S, Dean S, Razavy S, Levett-Jones T. Measuring the impact of an interdisciplinary learning project on nursing, architecture and landscape design students' empathy. PLoS One 2019; 14:e0215795. [PMID: 31661491 PMCID: PMC6818785 DOI: 10.1371/journal.pone.0215795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 09/29/2019] [Indexed: 12/01/2022] Open
Abstract
Domestic violence and refuge services in Australia In Australia and internationally, domestic violence is a major cause of homelessness for women and children and yet provision for accommodation for this user-group is not well documented or understood. When designing emergency accommodation, the concerns, preferences, and perspectives of individuals who access refuge services must be sought in order to create spaces that are conducive to the needs of this diverse and vulnerable group. An empathic ‘lens’ can provide meaningful insights that can inform the design of refuge services specifically targeted at addressing these needs. This paper describes an authentic interdisciplinary learning experience for nursing, architecture and landscape students at a university in Sydney, Australia, and presents the results of a study designed to measure the impact of this initiative on participants’ empathy towards women and children who access refuge services as a result of homelessness and/or domestic violence. Empathy levels were measured using the Comprehensive State Empathy Scale, a validated measurement tool. An authentic interdisciplinary learning experience The learning experience consisted of collaborative meetings with stakeholders from the refuge sector, fieldwork, individual research, exchanging ideas and problem-solving in teams. Students then developed design guides for refuges that demonstrated their emerging understanding of the specific needs and perspectives of the issues faced by women and children who had experienced violence and found themselves homeless. Pre-post Comprehensive State Empathy Scale results indicated that the empathy levels of nursing and landscape students increased and those of architecture students decreased, however, these results were not statistically significant. Building empathy in teaching and learning The significance of the results from this study include an ability to compare the changes in empathy in students working collaboratively on a project and to ascertain possible reasons for this using a validated measurement tool. As empathy is one of the strongest negative correlates of prejudice, authentic teaching and learning activities, such as the one described in this paper, have the potential to positively impact the lived experience of women and children leaving situations of domestic violence.
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Affiliation(s)
- Samantha Donnelly
- School of Architecture, Department of Design, Architecture and Building, University of Technology, Sydney, Australia
| | - Suzanne Dean
- School of Nursing, Faculty of Health, University of Technology, Sydney, Australia
- * E-mail:
| | - Shohreh Razavy
- School of Life Science, Faculty of Science, University of Technology, Sydney, Australia
| | - Tracy Levett-Jones
- School of Nursing, Faculty of Health, University of Technology, Sydney, Australia
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12
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Intimate partner violence management and referral practices of primary care workers in a selected population in Turkey. Prim Health Care Res Dev 2019; 20:e96. [PMID: 32799995 PMCID: PMC8060826 DOI: 10.1017/s1463423619000288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Violence against women is a significant public health problem and primary care workers (PCWs) have a crucial role in managing violence against women. However, though intimate partner violence (IPV) is frequently seen in primary care, most cases remain unreported. Aims: This study aims to investigate family physicians’ (FPs’) and co-working midwifes/nurses’ (M/Ns’) explanations about their responses to women disclosing IPV and the reasons for their actions. Methods: We conducted a cross-sectional survey via a face-to-face administered questionnaire interview involving 266 PCWs in a selected area in Turkey. We questioned the reasoning behind inappropriate responses such as not examining the patient and document findings, not recording a code of violence, and not notifying the police in the case of a disclosure of IPV. Results: We surveyed 129 FPs and 137 M/Ns. We found that the disclosure of IPV in primary care is very high, but more than one-third of physicians and half of M/Ns respond inappropriately. Reasons for inappropriate response varied. The majority believed that the victim would continue to live with her batterer, making any report ineffective. Some expressed concern for the women’s and their own personal safety, citing an increase in assault cases by perpetrators in the last few years. Many indicated a lack of knowledge about management of violence cases. Conclusion: Multiple barriers challenge PCWs in helping abused women. Common behaviours, safety concerns, and a lack of knowledge seem to be the major barriers to responding appropriately to IPV. To address this issue appropriately, protective measures for both parties – PCWs and violence victims – need to be enacted and a supportive constitutional and societal organization is required. Screening and identification should lead to interventions that benefit the victims rather than harming them.
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13
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Sapkota D, Baird K, Saito A, Rijal P, Pokharel R, Anderson D. 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. BMJ Open 2019; 9:e027436. [PMID: 31015275 PMCID: PMC6500424 DOI: 10.1136/bmjopen-2018-027436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Diksha Sapkota
- School of Nursing and Midwifery, Griffith University, Loganlea, Queensland, Australia
- Women's Wellness Research Program, Menzies Health Institute Queensland, Nathan, Queensland, Australia
- Department of Nursing, Kathmandu University School of Medical Sciences, Dhulikhel, Province 3, Nepal
| | - Kathleen Baird
- School of Nursing and Midwifery, Griffith University, Loganlea, Queensland, Australia
- Women, Newborn and Children's Services, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Amornrat Saito
- School of Nursing and Midwifery, Griffith University, Loganlea, Queensland, Australia
- Women's Wellness Research Program, Menzies Health Institute Queensland, Nathan, Queensland, Australia
| | - Pappu Rijal
- BP Koirala Institute of Health Sciences, Dharan, Kathmandu, Nepal
| | - Rita Pokharel
- BP Koirala Institute of Health Sciences, Dharan, Kathmandu, Nepal
| | - Debra Anderson
- School of Nursing and Midwifery, Griffith University, Loganlea, Queensland, Australia
- Women's Wellness Research Program, Menzies Health Institute Queensland, Nathan, Queensland, Australia
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14
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Coker AL, Bush HM, Brancato CJ, Sprang G. Can the Impact of Interpersonal Violence on Current Health-Related Quality of Life Be Mitigated? J Womens Health (Larchmt) 2019; 28:1355-1367. [PMID: 30882265 DOI: 10.1089/jwh.2018.7017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Background: Interpersonal violence continues to affect health long after violence has ended. This analysis investigated stress, support, and health behaviors as mediators potentially explaining persistent health impacts of violence. Methods: Using a cross-sectional analysis of 12,594 women "Wellness, Health & You" (WHY) participants, authors measured violence as intimate partner violence (IPV), sexual assaults (SA), and childhood abuse (CA) by recency (current, past as an adult, or child) and number of violence forms. Current health-related quality of life (HR-QOL) was defined using the most recent survey as physical and mental health limiting usual activities for at least 4 days in the past 30 days. Adjusted prevalence rate ratios (aPRRs) for violence and HR-QOL were obtained using multiple variable log binomial regression where each mediator was included in separate models with demographic attributes. Results: In this sample of middle-aged women, half (n = 6307) had ever experienced violence (38.3% IPV, 12.9% SA, and 24.6% CA) and 19.9% reported multiple forms. IPV, SA, and CA were each associated with poorer current HR-QOL, yet, WHY participants experiencing all three forms had a sixfold increased rate of poor mental HR-QOL (Model 1: aPRRs = 6.23 [95% confidence interval, 95% CI: 4.87-7.97]) versus no violence. Stress was the mediator associated with the greatest change in aPRRs (-34.7%; Model 2: aPRR = 4.07 [95% CI: 3.13-5.30]). When all mediators were included (Model 5: aPRR = 3.01 [95% CI: 2.29-3.96]), partial mediation was observed, evidenced by nonoverlapping CIs between Models 1 and 5. Conclusions: Of relevance for interventions are findings that current health impacts of past violence may be mitigated through reducing current stress.
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Affiliation(s)
- Ann L Coker
- Center for Research on Violence Against Women, University of Kentucky, Lexington, Kentucky.,Department of Obstetrics and Gynecology, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Heather M Bush
- Center for Research on Violence Against Women, University of Kentucky, Lexington, Kentucky.,Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Candace J Brancato
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Ginny Sprang
- Center for Research on Violence Against Women, University of Kentucky, Lexington, Kentucky.,Department of Obstetrics and Gynecology, College of Medicine, University of Kentucky, Lexington, Kentucky.,Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, Kentucky.,Center on Trauma and Children, University of Kentucky, Lexington, Kentucky
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15
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Howarth E, Moore THM, Stanley N, MacMillan HL, Feder G, Shaw A. Towards an ecological understanding of readiness to engage with interventions for children exposed to domestic violence and abuse: Systematic review and qualitative synthesis of perspectives of children, parents and practitioners. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:271-292. [PMID: 29989258 PMCID: PMC6392107 DOI: 10.1111/hsc.12587] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/05/2018] [Accepted: 05/07/2018] [Indexed: 05/16/2023]
Abstract
Children who grow up in homes affected by domestic violence and abuse (DVA) are at risk of poor outcomes across the lifespan, yet there is limited evidence on the acceptability and effectiveness of interventions for them. A recent review of child-focused interventions highlighted a gap in understanding the factors influencing the willingness of parents and children to engage with these programmes. We conducted a systematic review of qualitative evidence on the experiences of receiving and delivering interventions with the aim of identifying factors at different levels of the social-ecological context that may influence parent and child readiness to take up interventions. We searched literature till April 2016 and found 12 reports of eight programmes. Two authors independently screened papers for inclusion, extracted data and identified the first- and second-order constructs. The third-order constructs were derived and fitted to the ecological framework to inform a picture of readiness to engage with interventions. Three key findings emerged from this review: (a) parent and child readiness is influenced by a complex interplay of individual, relationship and organisational factors, highlighting that individual readiness to take up child-focussed interventions must be viewed in an ecological context; (b) the specific process through which women become ready to engage in or facilitate child-focussed interventions may differ from that related to uptake of safety-promoting behaviours and requires parents to be aware of the impact of DVA on children and to focus on children's needs; (c) there are distinct but interlinked processes through which parents and children reach a point of readiness to engage in an interventions aimed at improving child outcomes. We discuss the implications of these findings for both practice and research.
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Affiliation(s)
- Emma Howarth
- National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Care (CLAHRC) East of England, Cambridge Institute of Public HealthUniversity of CambridgeCambridgeUK
| | - Theresa HM Moore
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Collaboration for Leadership in Applied Health Care (CLAHRC) WestWhitefriarsUK
| | - Nicky Stanley
- School of Social Work, Care and CommunityUniversity of Central LancashirePrestonUK
| | | | - Gene Feder
- NIHR Collaboration for Leadership in Applied Health Care (CLAHRC) WestWhitefriarsUK
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Alison Shaw
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
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16
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Reisenhofer SA, Hegarty K, Valpied J, Watson LF, Davey MA, Taft A. Longitudinal Changes in Self-Efficacy, Mental Health, Abuse, and Stages of Change, for Women Fearful of a Partner: Findings From a Primary Care Trial (WEAVE). JOURNAL OF INTERPERSONAL VIOLENCE 2019; 34:337-365. [PMID: 27036157 DOI: 10.1177/0886260516640781] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Women seeking healthcare while experiencing intimate partner violence (IPV) often report a mismatch between healthcare received and desired. An increase in detection of women experiencing IPV through routine screening has not consistently shown a parallel increase in uptake of referrals or decreased abuse. This study investigates relationships between women's stage of change (SOC), mental health, abuse, social support, and self-efficacy. This study used data from a randomized-controlled trial (RCT) of an intervention to improve outcomes for women afraid of their partners ( n = 225; WEAVE). Women's progress toward change was categorized into pre-contemplation/contemplation (pre-change SOC) or preparation/action/maintenance of change (change-related SOC). Characteristics of women ending the 2-year study in pre-change SOC were compared with those always in change-related and those ending in change-related SOC. Variables were analyzed using multinomial logistic regressions at baseline, 6, 12, and 24 months. Compared with women in pre-change SOC, women always in change-related SOC or ending in change-related SOC are significantly more likely to have higher levels of self-efficacy at 6 (AdjOR = 1.19, confidence interval [CI] = [1.08, 1.30]) and 24 months (AdjOR = 1.21, CI = [1.04, 1.40]). Women always in change-related SOC are always significantly less likely to live with an intimate partner. Women ending in change-related SOC are less likely to live with a partner at 12 (AdjOR = 0.30, CI = [0.12, 0.75]) and 24 (AdjOR = 0.22, CI = [0.06, 0.80]) months. Clinicians should focus on enhancing abused women's self-efficacy, supporting them to create and maintain positive changes.
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Affiliation(s)
| | | | | | | | | | - Angela Taft
- 1 La Trobe University, Bundoora, Victoria, Australia
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17
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Riedl D, Exenberger S, Daniels JK, Böttcher B, Beck T, Dejaco D, Lampe A. Domestic violence victims in a hospital setting: prevalence, health impact and patients' preferences - results from a cross-sectional study. Eur J Psychotraumatol 2019; 10:1654063. [PMID: 31497261 PMCID: PMC6719257 DOI: 10.1080/20008198.2019.1654063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Domestic violence (DV) is a widespread yet commonly underdetected problem with severe impact on physical and mental health. To date, only limited information is available on prevalence and detection-rates of victims of DV in hospital settings. Objective: The aim of this study was (a) to assess the prevalence and impact of DV on physical and mental health as well as risk-factors associated with it, (b) to determine how many patients had been asked directly about DV in the hospital and (c) to investigate patients' preferences about being asked about DV in a hospital setting. Methods: Adult inpatients and outpatients at seven somatic departments at the University Hospital Innsbruck (Austria) were included consecutively in this ad-hoc, cross-sectional paper-and-pencil questionnaire-based study. In total, n = 2,031 patients were assessed regarding their experiences with DV. They also reported on whether they had been asked about DV at the hospital and whether they would mind being asked about it. To evaluate the impact of DV on patients' self-reported physical and mental health, odds ratios were calculated using binary logistic regression. Results: DV was reported by 17.4% of patients, with 4.0% indicating current DV exposure. Lifetime DV exposure was associated with a significant risk for both physical and mental health-problems. Only 4.8% of patients with DV exposure had ever been asked about it by hospital staff. While patients with a history of DV were more open to being asked about DV than patients without DV (78.2% vs. 72.9%), overall acceptance was still high (74%). Conclusion: DV is a frequently overlooked problem with detrimental effects on physical and mental health. While high acceptance of DV assessment was found, only a small proportion of affected patients had indeed been assessed for DV. Screening for DV in hospitals may thus increase the number of identified patients.
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Affiliation(s)
- David Riedl
- University Clinic of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Silvia Exenberger
- University Clinic of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Judith K Daniels
- Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands
| | - Bettina Böttcher
- Department of Gynaecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Beck
- University Clinic of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Dejaco
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Astrid Lampe
- University Clinic of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
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18
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Po-Yan Leung T, Phillips L, Bryant C, Hegarty K. How family doctors perceived their 'readiness' and 'preparedness' to identify and respond to intimate partner abuse: a qualitative study. Fam Pract 2018; 35:517-523. [PMID: 29300886 DOI: 10.1093/fampra/cmx109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There are few existing studies which have investigated the meanings of 'readiness' and 'preparedness' among family doctors working with female patients who experience intimate partner abuse (IPA). OBJECTIVES We aimed to explore how doctors perceived the concepts of readiness and preparedness to identify and respond to IPA against female patients. METHODS We adopted purposive sampling and conducted individual semi-structured interviews with 19 doctors (11 females and 8 males) practising in primary care. Thematic analysis identified dominant and associated themes, and the coding framework was transformed into a thematic map. We further applied cross-coding and code-confirming procedures in analysing the transcripts. RESULTS Participants described differences in the meanings of readiness and preparedness when responding to IPA, though they considered that these two concepts were inter-related. The findings revealed four themes of doctors' perceived 'readiness' to identify and respond to IPA: self-efficacy, emotional readiness, motivational readiness and attitudinal readiness, whereas doctors' perceived 'preparedness' comprise two themes: IPA knowledge and communication skills. CONCLUSION Whether doctors are ready to identify and respond to IPA might be influenced by their emotional concerns as well as individual motivational beliefs and values, in addition to their attitudes and perceived self-efficacy, revealing a multidimensional concept. Besides enhancing doctors' preparedness by means of IPA knowledge and communication skills, training and IPA research could address further their emotional readiness and legitimize doctors' role to intervene in IPA cases.
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Affiliation(s)
- Traci Po-Yan Leung
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Lisa Phillips
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Kelsey Hegarty
- Department of General Practice, University of Melbourne, Victoria, Australia
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19
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Van Parys AS, Deschepper E, Roelens K, Temmerman M, Verstraelen H. The impact of a referral card-based intervention on intimate partner violence, psychosocial health, help-seeking and safety behaviour during pregnancy and postpartum: a randomized controlled trial. BMC Pregnancy Childbirth 2017; 17:346. [PMID: 28985722 PMCID: PMC6389099 DOI: 10.1186/s12884-017-1519-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/19/2017] [Indexed: 11/23/2022] Open
Abstract
Background We aimed to investigate the impact of a referral-based intervention in a prospective cohort of women disclosing intimate partner violence (IPV) on the prevalence of violence, and associated outcomes psychosocial health, help-seeking and safety behaviour during and after pregnancy. Methods Women seeking antenatal care in eleven Belgian hospitals were consecutively invited from June 2010 to October 2012, to participate in a single-blind randomized controlled trial (RCT) and handed a questionnaire. Participants willing to be interviewed and reporting IPV victimisation were randomised. In the Intervention Group (IG) participants received a referral card with contact details of services providing assistance and tips to increase safety behaviour. Participants in the Control Group (CG) received a “thank you” card. Follow-up data were obtained through telephone interview at an average of 10 months after receipt of the card. Results At follow-up (n = 189), 66.7% (n = 126) of the participants reported IPV victimisation. Over the study-period, the prevalence of IPV victimisation decreased by 31.4% (P < 0.001), psychosocial health increased significantly (5.4/140, P < 0.001), 23.8% (n = 46/193) of the women sought formal help, 70.5% (n = 136/193) sought informal help, and 31.3% (n = 60/192) took at least one safety measure. We observed no statistically significant differences between the IG and CG, however. Adjusted for psychosocial health at baseline, the perceived helpfulness of the referral card seemed to be larger in the IG. Both the questionnaire and the interview were perceived to be significantly more helpful than the referral card itself (P < 0.001). Conclusions Asking questions can be helpful even for types of IPV of low severity, although simply distributing a referral card may not qualify as the ideal intervention. Future interventions should be multifaceted, delineate different types of violence, controlling for measurement reactivity and designing a tailored intervention programme adjusted to the specific needs of couples experiencing IPV. Trial registration The trial was registered with the U.S. National Institutes of Health ClinicalTrials.gov registry on July 6, 2010 under identifier NCT01158690). Electronic supplementary material The online version of this article (10.1186/s12884-017-1519-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- An-Sofie Van Parys
- Department of Obstetrics and Gynaecology, International Centre for Reproductive Health, Ghent University, Faculty of Medicine and Health Sciences, De Pintelaan 185, UZP 114, 9000, Ghent, Belgium.
| | - Ellen Deschepper
- Department of Public Health, Biostatistics Unit, Ghent University, Faculty of Medicine and Health Sciences, De Pintelaan 185, 3K3, 9000, Ghent, Belgium
| | - Kristien Roelens
- Department of Obstetrics and Gynaecology, International Centre for Reproductive Health, Ghent University, Faculty of Medicine and Health Sciences, De Pintelaan 185, P4, 9000, Ghent, Belgium
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, International Centre for Reproductive Health, Ghent University, Faculty of Medicine and Health Sciences, De Pintelaan 185, P4, 9000, Ghent, Belgium
| | - Hans Verstraelen
- Department of Obstetrics and Gynaecology, International Centre for Reproductive Health, Ghent University, Faculty of Medicine and Health Sciences, De Pintelaan 185, P4, 9000, Ghent, Belgium
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Comparing Levels of Domestic Abuse and Emotional Regulation of Normal Women and Women Exposed to Violence. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2017. [DOI: 10.5812/rijm.61402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Di Giacomo P, Cavallo A, Bagnasco A, Sartini M, Sasso L. Violence against women: knowledge, attitudes and beliefs of nurses and midwives. J Clin Nurs 2017; 26:2307-2316. [PMID: 27805756 DOI: 10.1111/jocn.13625] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe the knowledge, attitudes and beliefs of nurses and midwives who have attended to women who suffered violence. This study further analyses the possible changes of attitude that have occurred over the past five years. BACKGROUND Gender violence or violence against women is the largest problem with regard to public health and violated human rights all over the world. In Italy, it is estimated that 31·5% of women suffer physical or sexual violence during their life. Healthcare operators play a crucial role in recognising the signs of the violence suffered when taking care of victims. DESIGN A cross-sectional study was conducted. METHODS A questionnaire was administered; this was used in a previous survey of a convenience sample of 51 nurses and midwives who work in an emergency room or in an obstetrics emergency room and gynaecological ward. RESULTS Of the respondents, 51 (80·4%) have taken care of women who suffered violence, and 25 (49%) believe they can detect violence. The relational/communicative approach presents the most difficulty, and all the operators believe they need more knowledge. The number of operators who suggest women be observed in an emergency room and file a complaint or who primarily consider listening to women has decreased. A tendency to 'blame' women, although decreasing, persists; it is higher among male nurses and, in general, among male operators. CONCLUSION Knowledge of this issue has not been completely recognised among operators despite training and the emergence of the phenomenon in the mass media. Difficulties in receiving and in relational procedures continue to exist, in addition to 'blaming' the woman. RELEVANCE TO CLINICAL PRACTICE Awareness paths and cultural changes regarding the phenomenon of violence need to be developed, as does a specific training programme on the approach to and assessment of the abused woman.
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Affiliation(s)
- Patrizia Di Giacomo
- University of Bologna, Campus of Rimini and Health Company Romagna, Rimini, Italy
| | | | | | - Marina Sartini
- Health Sciences Department, University of Genoa, Genoa, Italy
| | - Loredana Sasso
- Health Sciences Department, University of Genoa, Genoa, Italy
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Wilson IM, Graham K, Taft A. Living the cycle of drinking and violence: A qualitative study of women's experience of alcohol-related intimate partner violence. Drug Alcohol Rev 2016; 36:115-124. [DOI: 10.1111/dar.12405] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/21/2016] [Accepted: 02/09/2016] [Indexed: 11/27/2022]
Affiliation(s)
| | - Kathryn Graham
- Centre for Addiction and Mental Health; Toronto Canada
- Department of Psychology; Western University; London Canada
- Dalla Lana School of Public Health; University of Toronto; Toronto Canada
- National Drug Research Institute; Curtin University; Perth Australia
- School of Psychology, Faculty of Health; Deakin University; Melbourne Australia
| | - Angela Taft
- Judith Lumley Centre; La Trobe University; Melbourne Australia
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O'Doherty L, Taket A, Valpied J, Hegarty K. Receiving care for intimate partner violence in primary care: Barriers and enablers for women participating in the weave randomised controlled trial. Soc Sci Med 2016; 160:35-42. [PMID: 27208669 DOI: 10.1016/j.socscimed.2016.05.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 04/21/2016] [Accepted: 05/09/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Interventions in health settings for intimate partner violence (IPV) are being increasingly recognised as part of a response to addressing this global public health problem. However, interventions targeting this sensitive social phenomenon are complex and highly susceptible to context. This study aimed to elucidate factors involved in women's uptake of a counselling intervention delivered by family doctors in the weave primary care trial (Victoria, Australia). METHODS We analysed associations between women's and doctors' baseline characteristics and uptake of the intervention. We interviewed a random selection of 20 women from an intervention group women to explore cognitions relating to intervention uptake. Interviews were audio-recorded, transcribed, coded in NVivo 10 and analysed using the theory of planned behaviour (TPB). RESULTS Abuse severity and socio-demographic characteristics (apart from current relationship status) were unrelated to uptake of counselling (67/137 attended sessions). Favourable doctor communication was strongly associated with attendance. Eight themes emerged, including four sets of beliefs that influenced attitudes to uptake: (i) awareness of the abuse and readiness for help; (ii) weave as an avenue to help; (iii) doctor's communication; and (iv) role in providing care for IPV; and four sets of beliefs regarding women's control over uptake: (v) emotional health, (vi) doctors' time, (vii) managing the disclosure process and (viii) viewing primary care as a safe option. CONCLUSIONS This study has identified factors that can promote the implementation and evaluation of primary care-based IPV interventions, which are relevant across health research settings, for example, ensuring fit between implementation strategies and characteristics of the target group (such as range in readiness for intervention). On practice implications, providers' communication remains a key issue for engaging women. A key message arising from this work concerns the critical role of primary care and health services more broadly in reaching victims of domestic violence, and providing immediate and ongoing support (depending on the healthcare context).
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Affiliation(s)
- Lorna O'Doherty
- Centre for Research in Psychology, Behaviour and Achievement, Coventry University, Priory Street, Coventry CV1 5FB, UK; General Practice and Primary Care Academic Centre, The University of Melbourne, 200 Berkeley Street, Carlton, Victoria, Australia.
| | - Ann Taket
- School of Health and Social Development, Deakin University, Victoria, Australia.
| | - Jodie Valpied
- General Practice and Primary Care Academic Centre, The University of Melbourne, 200 Berkeley Street, Carlton, Victoria, Australia.
| | - Kelsey Hegarty
- General Practice and Primary Care Academic Centre, The University of Melbourne, 200 Berkeley Street, Carlton, Victoria, Australia.
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Rivas C, Ramsay J, Sadowski L, Davidson LL, Dunne D, Eldridge S, Hegarty K, Taft A, Feder G. Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse. Cochrane Database Syst Rev 2015; 2015:CD005043. [PMID: 26632986 PMCID: PMC9392211 DOI: 10.1002/14651858.cd005043.pub3] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Carol Rivas
- University of SouthamptonFaculty of Health SciencesRoom 67/20209Highfield CampusSouthamptonUKS017 1BJ
| | - Jean Ramsay
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry58 Turner StreetWhitechapelLondonUKE1 2AB
| | - Laura Sadowski
- Stroger Hospital of Cook CountyDepartment of Medicine1900 W. Polk Street, 16th floorChicagoMIUSA60612
| | - Leslie L Davidson
- Columbia UniversityDepartment of Epidemiology, Mailman School of Public HealthRoom 1613, 722 W 168 StNew YorkNYUSA10032
| | - Danielle Dunne
- Department for International DevelopmentEvaluation Department22 WhitehallLondonUKSW1A 2EG
| | - Sandra Eldridge
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry58 Turner StreetWhitechapelLondonUKE1 2AB
| | - Kelsey Hegarty
- The University of MelbourneDepartment of General Practice200 Berkeley StreetParkvilleMelbourneVictoriaAustralia3010
| | - Angela Taft
- La Trobe UniversityThe Judith Lumley Centre215 Franklin StreetMelbourneVictoriaAustralia3000
| | - Gene Feder
- University of BristolCentre for Academic Primary Care, School of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
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Van Parys AS, Deschepper E, Michielsen K, Galle A, Roelens K, Temmerman M, Verstraelen H. Intimate partner violence and psychosocial health, a cross-sectional study in a pregnant population. BMC Pregnancy Childbirth 2015; 15:278. [PMID: 26554901 PMCID: PMC4641387 DOI: 10.1186/s12884-015-0710-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 10/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this paper is to explore whether IPV 12 months before and/or during pregnancy is associated with poor psychosocial health. METHODS From June 2010 to October 2012, a cross-sectional study was conducted in 11 antenatal care clinics in Belgium. Consenting pregnant women were asked to complete a questionnaire on socio-demographics, psychosocial health and violence in a separate room. Overall, 2586 women were invited to participate and we were able to use data from 1894 women (73.2%) for analysis. Ethical clearance was obtained in all participating hospitals. RESULTS We found a significant correlation between IPV and poor psychosocial health: within the group of women who reported IPV, 53.2% (n = 118) had poor psychosocial health, as compared to 21% (n = 286) in the group of women who did not report IPV (P < 0.001). Lower psychosocial health scores were associated with increased odds of reporting IPV (aOR 1.55; 95% CI 1.39-1.72), with adjustments made for the language in which the questionnaire was filled out, civil/marital status, education and age. In other words, a decrease of 10 points on the psychosocial health scale (total of 140) increased the odds of reporting IPV by 55 %. When accounting for the 6 psychosocial health subscales, the analysis revealed that all subscales (depression, anxiety, self-esteem, mastery, worry and stress) are strongly correlated to reporting IPV. However, when accounting for all subscales simultaneously in a logistic regression model, only depression (aOR 0.87; 95 % CI 0.84-0.91) and stress (aOR 0.85; 95 % CI 0.77-095) remained significantly associated with IPV. The association between overall psychosocial health and IPV remained significant after adjusting for socio-demographic status. CONCLUSION Our research corroborated that IPV and psychosocial health are strongly associated. Due to the limitations of our study design, we believe that future research is needed to deepen understanding of the multitude of factors involved in the complex interactions between IPV and psychosocial health.
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Affiliation(s)
- An-Sofie Van Parys
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP 114, 9000, Ghent, Belgium.
| | - Ellen Deschepper
- Department of Public Health, Biostatistics Unit, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Kristien Michielsen
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP 114, 9000, Ghent, Belgium.
| | - Anna Galle
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP 114, 9000, Ghent, Belgium.
| | - Kristien Roelens
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP 114, 9000, Ghent, Belgium.
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP 114, 9000, Ghent, Belgium.
| | - Hans Verstraelen
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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O'Doherty LJ, Taft A, McNair R, Hegarty K. Fractured Identity in the Context of Intimate Partner Violence: Barriers to and Opportunities for Seeking Help in Health Settings. Violence Against Women 2015; 22:225-48. [PMID: 26337674 DOI: 10.1177/1077801215601248] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intimate partner violence has profound effects on women's identities. However, detailed examination of how abuse affects identity is lacking. We interviewed 14 diverse women (Australia), applying social identity theory to analyze their experiences of identity and help-seeking in health settings. The destabilizing effect of violence on social identities was strongly supported. Women concealed abuse to preserve a public identity. However, when the violence threatened the most integrated identities, women unveiled an abuse identity, receiving mixed responses from health providers. A healing context where a woman can display an abuse identity safely is crucial to enable her to rebuild an integrated self-concept.
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Affiliation(s)
| | - Angela Taft
- La Trobe University, Melbourne, Victoria, Australia
| | - Ruth McNair
- The University of Melbourne, Victoria, Australia
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Rees K, Zweigenthal V, Joyner K. Health sector responses to intimate partner violence: a literature review. Afr J Prim Health Care Fam Med 2014; 6:E1-8. [PMID: 26245388 PMCID: PMC4564897 DOI: 10.4102/phcfm.v6i1.712] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 10/19/2014] [Accepted: 08/21/2014] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is a common and serious public health concern, particularly in South Africa, but it is not well managed in primary care. AIM This review aims to summarise the current state of knowledge regarding health sector-based interventions for IPV, their integration into health systems and services and the perspectives of service users and healthcare workers on IPV care, focusing on the South African context. METHOD PubMed, CINAHL, PsycINFO and Google Scholar were searched between January 2012 and May 2014. All types of study design were included, critically appraised and summarised. RESULTS Exposure to IPV leads to wide-ranging and serious health effects. There is sufficient evidence that intervening in IPV in primary care can improve outcomes. Women who have experienced IPV have described an appropriate response by healthcare providers to be non-judgmental, understanding and empathetic. IPV interventions that are complex, comprehensive and utilise systems-wide approaches have been most effective, but system- and society-level barriers hamper implementation. Gender inequities should not be overlooked when responding to IPV. CONCLUSION Further evaluations of health sector responses to IPV are needed, in order to assist health services to determine the most appropriate models of care, how these can be integrated into current systems and how they can be supported in managing IPV. The need for this research should not prevent health services and healthcare providers from implementing IPV care, but rather should guide the development of rigorous contextually-appropriate evaluations.
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Affiliation(s)
- Kate Rees
- Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town.
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Van Parys AS, Deschepper E, Michielsen K, Temmerman M, Verstraelen H. Prevalence and evolution of intimate partner violence before and during pregnancy: a cross-sectional study. BMC Pregnancy Childbirth 2014; 14:294. [PMID: 25169813 PMCID: PMC4159505 DOI: 10.1186/1471-2393-14-294] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 08/19/2014] [Indexed: 11/13/2022] Open
Abstract
Background Intimate partner violence (IPV) before and during pregnancy is associated with a broad range of adverse health outcomes. Describing the extent and the evolution of IPV is a crucial step in developing interventions to reduce the health impact of IPV. The objectives are to study the prevalence of psychological abuse, as well as physical & sexual violence, and to provide insight into the evolution of IPV 12 months before and during pregnancy. Methods Between June 2010 and October 2012, a cross-sectional study was conducted in 11 antenatal care clinics in Belgium. Consenting pregnant women were asked to complete a questionnaire (available in Dutch, French and English) in a separate room. Ethical clearance was obtained in all participating hospitals. Results The overall percentage of IPV was 14.3% (95% CI: 12.7 - 16.0) 12 months before pregnancy and 10.6% (95% CI: 9.2 - 12.1) during pregnancy. Physical partner violence before as well as during pregnancy was reported by 2.5% (95% CI: 1.7 - 3.3) of the respondents (n = 1894), sexual violence by 0.9% (95% CI 0.5 - 1.4), and psychological abuse by 14.9% (95% CI: 13.3 - 16.7). Risk factors identified for IPV were being single or divorced, having a low level of education, and choosing another language than Dutch to fill out the questionnaire. The adjusted analysis showed that physical partner violence (aOR 0.35, 95% CI: 0.22 - 0.56) and psychological partner abuse (aOR 0.7, 95% CI: 0.63 - 0.79) were significantly lower during pregnancy compared to the period of 12 months before pregnancy. The difference between both time periods is greater for physical partner violence (65%) compared to psychological partner abuse (30%). The analysis of the frequency data showed a similarly significant evolution for physical partner violence and psychological partner abuse, but not for sexual violence. Conclusion The IPV prevalence rates in our study are slightly lower than what can be found in other Western studies, but even so IPV is to be considered a prevalent problem before and during pregnancy. We found evidence, however, that physical partner violence and psychological partner abuse are significantly lower during pregnancy. Electronic supplementary material The online version of this article (doi:10.1186/1471-2393-14-294) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- An-Sofie Van Parys
- Faculty of Medicine and Health Sciences, Department of Obstetrics and Gynaecology, Ghent University, International Centre for Reproductive Health, Belgium, De Pintelaan 185, UZP 114, 9000 Gent, Belgium.
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Prosman GJ, Lo Fo Wong SH, Lagro-Janssen ALM. Support by trained mentor mothers for abused women: a promising intervention in primary care. Fam Pract 2014; 31:71-80. [PMID: 24132592 DOI: 10.1093/fampra/cmt058] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) against women is a major health problem and negatively affects the victim's mental and physical health. Evidence-based interventions in family practice are scarce. OBJECTIVE We aimed to evaluate a low threshold home-visiting intervention for abused women provided by trained mentor mothers in family practice. The aim was to reduce exposure to IPV, symptoms of depression as well as to improve social support, participation in society and acceptance of mental health care. METHODS A pre-post study of a 16-week mentoring intervention with identified abused women with children was conducted. After referral by a family doctor, a mentor mother visited the abused woman weekly. Primary outcomes are IPV assessed with the Composite Abuse Scale (CAS), depressive symptoms using the Symptom Checklist (SCL 90) and social support by the Utrecht Coping List. Secondary outcomes are analysed qualitatively: participation in society defined as employment and education and the acceptance of mental health care. RESULTS At baseline, 63 out of 66 abused women were referred to mentor support. Forty-three participants completed the intervention programme. IPV decreased from CASt otal 46.7 (SD 24.7) to 9.0 (SD 9.1) (P ≤ 0.001) after the mentor mother support programme. Symptoms of depression decreased from 53.3 (SD 13.7) to 34.8 (SD 11.5) (P ≤ 0.001) and social support increased from 13.2 (SD 4.0) to 15.2 (SD 3.5) (P ≤ 0.001). Participation in society and the acceptance of mental health for mother and child improved. CONCLUSIONS Sixteen weekly visits by trained mentor mothers are a promising intervention to decrease exposure to IPV and symptoms of depression, as well as to improve social support, participation in society and the acceptance of professional help for abused women and their children.
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Affiliation(s)
- Gert-Jan Prosman
- Department of Primary and Community Care, Unit Gender & Women's Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Intimate partner violence and pregnancy: a systematic review of interventions. PLoS One 2014; 9:e85084. [PMID: 24482679 PMCID: PMC3901658 DOI: 10.1371/journal.pone.0085084] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/22/2013] [Indexed: 11/19/2022] Open
Abstract
Background Intimate partner violence (IPV) around the time of pregnancy is a widespread global health problem with many negative consequences. Nevertheless, a lot remains unclear about which interventions are effective and might be adopted in the perinatal care context. Objective The objective is to provide a clear overview of the existing evidence on effectiveness of interventions for IPV around the time of pregnancy. Methods Following databases PubMed, Web of Science, CINAHL and the Cochrane Library were systematically searched and expanded by hand search. The search was limited to English peer-reviewed randomized controlled trials published from 2000 to 2013. This review includes all types of interventions aiming to reduce IPV around the time of pregnancy as a primary outcome, and as secondary outcomes to enhance physical and/or mental health, quality of life, safety behavior, help seeking behavior, and/or social support. Results We found few randomized controlled trials evaluating interventions for IPV around the time of pregnancy. Moreover, the nine studies identified did not produce strong evidence that certain interventions are effective. Nonetheless, home visitation programs and some multifaceted counseling interventions did produce promising results. Five studies reported a statistically significant decrease in physical, sexual and/or psychological partner violence (odds ratios from 0.47 to 0.92). Limited evidence was found for improved mental health, less postnatal depression, improved quality of life, fewer subsequent miscarriages, and less low birth weight/prematurity. None of the studies reported any evidence of a negative or harmful effect of the interventions. Conclusions and implications Strong evidence of effective interventions for IPV during the perinatal period is lacking, but some interventions show promising results. Additional large-scale, high-quality research is essential to provide further evidence about the effect of certain interventions and clarify which interventions should be adopted in the perinatal care context.
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Hegarty K, O'Doherty L, Taft A, Chondros P, Brown S, Valpied J, Astbury J, Taket A, Gold L, Feder G, Gunn J. Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trial. Lancet 2013; 382:249-58. [PMID: 23598181 DOI: 10.1016/s0140-6736(13)60052-5] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Evidence for a benefit of interventions to help women who screen positive for intimate partner violence (IPV) in health-care settings is limited. We assessed whether brief counselling from family doctors trained to respond to women identified through IPV screening would increase women's quality of life, safety planning and behaviour, and mental health. METHODS In this cluster randomised controlled trial, we enrolled family doctors from clinics in Victoria, Australia, and their female patients (aged 16-50 years) who screened positive for fear of a partner in past 12 months in a health and lifestyle survey. The study intervention consisted of the following: training of doctors, notification to doctors of women screening positive for fear of a partner, and invitation to women for one-to-six sessions of counselling for relationship and emotional issues. We used a computer-generated randomisation sequence to allocate doctors to control (standard care) or intervention, stratified by location of each doctor's practice (urban vs rural), with random permuted block sizes of two and four within each stratum. Data were collected by postal survey at baseline and at 6 months and 12 months post-invitation (2008-11). Researchers were masked to treatment allocation, but women and doctors enrolled into the trial were not. Primary outcomes were quality of life (WHO Quality of Life-BREF), safety planning and behaviour, mental health (SF-12) at 12 months. Secondary outcomes included depression and anxiety (Hospital Anxiety and Depression Scale; cut-off ≥8); women's report of an inquiry from their doctor about the safety of them and their children; and comfort to discuss fear with their doctor (five-point Likert scale). Analyses were by intention to treat, accounting for missing data, and estimates reported were adjusted for doctor location and outcome scores at baseline. This trial is registered with the Australian New Zealand Clinical Trial Registry, number ACTRN12608000032358. FINDINGS We randomly allocated 52 doctors (and 272 women who were eligible for inclusion and returned their baseline survey) to either intervention (25 doctors, 137 women) or control (27 doctors, 135 women). 96 (70%) of 137 women in the intervention group (seeing 23 doctors) and 100 (74%) of 135 women in the control group (seeing 26 doctors) completed 12 month follow-up. We detected no difference in quality of life, safety planning and behaviour, or mental health SF-12 at 12 months. For secondary outcomes, we detected no between-group difference in anxiety at 12 months or comfort to discuss fear at 6 months, but depressiveness caseness at 12 months was improved in the intervention group compared with the control group (odds ratio 0·3, 0·1-0·7; p=0·005), as was doctor enquiry at 6 months about women's safety (5·1, 1·9-14·0; p=0·002) and children's safety (5·5, 1·6-19·0; p=0·008). We recorded no adverse events. INTERPRETATION Our findings can inform further research on brief counselling for women disclosing intimate partner violence in primary care settings, but do not lend support to the use of postal screening in the identification of those patients. However, we suggest that family doctors should be trained to ask about the safety of women and children, and to provide supportive counselling for women experiencing abuse, because our findings suggest that, although we detected no improvement in quality of life, counselling can reduce depressive symptoms. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Kelsey Hegarty
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, VIC, Australia.
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Taft A, O'Doherty L, Hegarty K, Ramsay J, Davidson L, Feder G. Screening women for intimate partner violence in healthcare settings. Cochrane Database Syst Rev 2013:CD007007. [PMID: 23633338 DOI: 10.1002/14651858.cd007007.pub2] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) damages individuals, their children, communities, and the wider economic and social fabric of society. Some governments and professional organisations recommend screening all women for intimate partner violence rather than asking only women with symptoms (case-finding); however, what is the evidence that screening interventions will increase identification, and referral to support agencies, or improve women's subsequent wellbeing and not cause harm? OBJECTIVES To assess the effectiveness of screening for intimate partner violence conducted within healthcare settings for identification, referral to support agencies and health outcomes for women. SEARCH METHODS We searched the following databases in July 2012: CENTRAL (2012, Issue 6), MEDLINE (1948 to September Week June Week 3 2012), EMBASE (1980 to Week 28 2012), MEDLINE In-Process (3 July 2012), DARE (2012, Issue 2), CINAHL (1937 to current), PsycINFO (1806 to June Week 4 2012), Sociological Abstracts (1952 to current) and ASSIA (1987 to October 2010). In addition we searched the following trials registers: metaRegister of Controlled Trials (mRCT) (to July 2012), and International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, Australian New Zealand Clinical Trials Registry and the International Standard Randomised Controlled Trial Number Register to August 2010. We also searched the reference lists of articles and websites of relevant organisations. SELECTION CRITERIA Randomised or quasi-randomised trials assessing the effectiveness of IPV screening where healthcare professionals screened women face-to-face or were informed of results of screening questionnaires, compared with usual care ( which included screening for other purposes). DATA COLLECTION AND ANALYSIS Two review authors independently assessed the risk of bias in the trials and undertook data extraction. For binary outcomes, we calculated a standardised estimation of the risk ratio (RR) and for continuous data, either a mean difference (MD) or standardised mean difference (SMD). All are presented with a 95% confidence interval (CI). MAIN RESULTS We included 11 trials that recruited 13,027 women overall. Six of 10 studies were assessed as being at high risk of bias.When data from six comparable studies were combined (n = 3564), screening increased identification of victims/survivors (RR 2.33; 95% CI 1.40 to 3.89), particularly in antenatal settings (RR 4.26; 95% CI 1.76 to 10.31).Only three studies measured referrals to support agencies (n = 1400). There is no evidence that screening increases such referrals, as although referral numbers increased in the screened group, actual numbers were very small and crossed the line of no effect (RR 2.67; 95% CI 0.99 to 7.20).Only two studies measured women's experience of violence after screening (one at three months, the other at six, 12 and 18 months after screening) and found no significant reduction of abuse.Only one study measured adverse effects and data from this study suggested that screening may not cause harm. This same study showed a trend towards mental health benefit, but the results did not reach statistical significance.There was insufficient evidence on which to judge whether screening increases take up of specialist services, and no studies included economic evaluation. AUTHORS' CONCLUSIONS Screening is likely to increase identification rates but rates of referral to support agencies are low and as yet we know little about the proportions of false measurement (negatives or positives). Screening does not appear to cause harm, but only one study examined this outcome. As there is an absence of evidence of long-term benefit for women, there is insufficient evidence to justify universal screening in healthcare settings. Studies comparing screening versus case finding (with or without advocacy or therapeutic interventions) for women's long-term wellbeing would better inform future policies in healthcare settings.
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Affiliation(s)
- Angela Taft
- Mother and Child Health Research, La Trobe University, Victoria, Australia.
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Hegarty KL, O'Doherty LJ, Chondros P, Valpied J, Taft AJ, Astbury J, Brown SJ, Gold L, Taket A, Feder GS, Gunn JM. Effect of type and severity of intimate partner violence on women's health and service use: findings from a primary care trial of women afraid of their partners. JOURNAL OF INTERPERSONAL VIOLENCE 2013; 28:273-294. [PMID: 22929341 DOI: 10.1177/0886260512454722] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Intimate partner violence (IPV) has major affects on women's wellbeing. There has been limited investigation of the association between type and severity of IPV and health outcomes. This article describes socio-demographic characteristics, experiences of abuse, health, safety, and use of services in women enrolled in the Women's Evaluation of Abuse and Violence Care (WEAVE) project. We explored associations between type and severity of abuse and women's health, quality of life, and help seeking. Women (aged 16-50 years) attending 52 Australian general practices, reporting fear of partners in last 12 months were mailed a survey between June 2008 and May 2010. Response rate was 70.5% (272/386). In the last 12 months, one third (33.0%) experienced Severe Combined Abuse, 26.2% Physical and Emotional Abuse, 26.6% Emotional Abuse and/or Harassment only, 2.7% Physical Abuse only and 12.4% scored negative on the Composite Abuse Scale. A total of 31.6% of participants reported poor or fair health and 67.9% poor social support. In the last year, one third had seen a psychologist (36.6%) or had 5 or more general practitioner visits (34.3%); 14.7% contacted IPV services; and 24.4% had made a safety plan. Compared to other abuse groups, women with Severe Combined Abuse had poor quality of life and mental health, despite using more medications, counseling, and IPV services and were more likely to have days out of role because of emotional issues. In summary, women who were fearful of partners in the last year, have poor mental health and quality of life, attend health care services frequently, and domestic violence services infrequently. Those women experiencing severe combined physical, emotional, and sexual abuse have poorer quality of life and mental health than women experiencing other abuse types. Health practitioners should take a history of type and severity of abuse for women with mental health issues to assist access to appropriate specialist support.
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Ramsay J, Rutterford C, Gregory A, Dunne D, Eldridge S, Sharp D, Feder G. Domestic violence: knowledge, attitudes, and clinical practice of selected UK primary healthcare clinicians. Br J Gen Pract 2012; 62:e647-55. [PMID: 22947586 PMCID: PMC3426604 DOI: 10.3399/bjgp12x654623] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 02/02/2012] [Accepted: 03/28/2012] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Domestic violence affects one in four women and has significant health consequences. Women experiencing abuse identify doctors and other health professionals as potential sources of support. Primary care clinicians agree that domestic violence is a healthcare issue but have been reluctant to ask women if they are experiencing abuse. AIM To measure selected UK primary care clinicians' current levels of knowledge, attitudes, and clinical skills in this area. DESIGN AND SETTING Prospective observational cohort in 48 general practices from Hackney in London and Bristol, UK. METHOD Administration of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS), comprising five sections: responder profile, background (perceived preparation and knowledge), actual knowledge, opinions, and practice issues. RESULTS Two hundred and seventy-two (59%) clinicians responded. Minimal previous domestic violence training was reported by participants. Clinicians only had basic knowledge about domestic violence but expressed a positive attitude towards engaging with women experiencing abuse. Many clinicians felt poorly prepared to ask relevant questions about domestic violence or to make appropriate referrals if abuse was disclosed. Forty per cent of participants never or seldom asked about abuse when a woman presented with injuries. Eighty per cent said that they did not have an adequate knowledge of local domestic violence resources. GPs were better prepared and more knowledgeable than practice nurses; they also identified a higher number of domestic violence cases. CONCLUSION Primary care clinicians' attitudes towards women experiencing domestic violence are generally positive but they only have basic knowledge of the area. Both GPs and practice nurses need more comprehensive training on assessment and intervention, including the availability of local domestic violence services.
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Affiliation(s)
- Jean Ramsay
- Centre for Primary Care and Public Health, Barts and the London, School of Medicine and Dentistry, Queen Mary University of London, London
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Signorelli MC, Taft A, Pereira PPG. Intimate partner violence against women and healthcare in Australia: charting the scene. CIENCIA & SAUDE COLETIVA 2012; 17:1037-48. [PMID: 22534857 DOI: 10.1590/s1413-81232012000400025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 06/22/2011] [Indexed: 11/22/2022] Open
Abstract
Intimate partner violence against women is a common problem in all countries and generates a challenging agenda for the health sector. Exchanging experiences between different countries, specifically strategies to respond to this problem, can constitute a tool for stimulating debate and promoting reflection. The scope of this article is to present and reflect on aspects of the Australian health sector response to intimate partner violence, and chart the scenario that surrounds this issue. We draw on a range of methods, combining a literature review and a dialogue with different stakeholders and site visits. We describe historical, contemporary and conceptual aspects of healthcare responses to intimate partner violence in Australia. Further we present some of the strategies, public policies and innovative projects that have been developed in this field in Australia. Some of the strategies include: screening vs. case-finding; primary care approaches for dealing with all family members; respect for diversity; and new randomized trials aiming for sustainable health system change for enhanced health professional care of people experiencing intimate partner violence. Despite the limitations of this approach to such a complex theme, we hope to stimulate thinking and discussion.
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Moynihan RN. Domestic violence: can doctors do more to help? Med J Aust 2012; 197:75. [DOI: 10.5694/mja12.10949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ray N Moynihan
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD
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Hegarty K. Gender, alcohol and intimate partner violence: how to respond in primary care? ADVANCES IN DUAL DIAGNOSIS 2012. [DOI: 10.1108/17570971211241930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gold L, Norman R, Devine A, Feder G, Taft AJ, Hegarty KL. Cost-Effectiveness of Health Care Interventions to Address Intimate Partner Violence: What Do We Know and What Else Should We Look for? Violence Against Women 2011; 17:389-403. [PMID: 21343165 DOI: 10.1177/1077801211398639] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intimate partner violence (IPV) creates a substantial burden of disease and significant costs to families, communities, and governments. Building the evidence for effective interventions to reduce violence and its sequelae requires increased use of economic evaluation to inform policy through the analysis of costs and potential savings of interventions. The authors review existing economic evaluations and present case studies of current research from the United Kingdom and Australia to illustrate the strengths and limitations of two approaches to generating economic evidence: economic evaluation alongside randomized controlled trials and economic modeling. Economic evaluation should always be considered in the design of IPV intervention research.
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Affiliation(s)
- Lisa Gold
- Deakin University, Burwood, Victoria, Australia,
| | - Richard Norman
- University of Technology, Sydney, New South Wales, Australia
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