Interventions for domestic violence among pregnant women in low- and middle-income countries: a systematic review protocol

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

INTRODUCTION

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

METHODS AND ANALYSIS

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

ETHICS AND DISSEMINATION

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

TRIAL REGISTRATION NUMBER

12618000307202; Pre-results.

Interventions for reducing and/or controlling domestic violence among pregnant women in low- and middle-income countries: a systematic review

BACKGROUND

Domestic violence (DV) during pregnancy is recognized as a global health problem associated with serious health consequences for both the mother and her baby. Several interventions aimed at addressing DV around the time of pregnancy have been developed in the last decade, but they are primarily from developed countries. Low- and middle-income countries (LMICs) are facing both a mounting burden of DV as well as severe resource constraints that keep them from emulating some of the effective interventions implemented in developed settings. A systematic review was conducted to examine the approaches and effects of interventions designed for reducing or controlling DV among pregnant women in LMICs.

METHODS

Electronic databases were systematically searched, and the search was augmented by bibliographic reviews and expert consultations. Two reviewers assessed eligibility and quality of the studies and extracted data independently. The third reviewer was involved to resolve any discrepancies between the reviewers. Due to the limited number of studies and varied outcomes, a meta-analysis was not possible. Primary outcomes of this review included frequency and/or severity of DV and secondary outcomes included mental health, safety behaviours, and use of community resources. In addition, findings from the critical appraisal of studies were utilised to inform the initial draft of Theory of Change (ToC).

RESULTS

Only five studies (two randomized trials and three non-randomized trials) met the eligibility criteria. The interventions consisting of supportive counselling demonstrated a reduction in DV and an improvement in use of safety behaviours. One study has embedded the DV intervention into an existing program on human immunodeficiency virus (HIV). Limited evidence could be drawn for outcomes such as quality of life and the use of community resources.

DISCUSSION

This review attempted to address the knowledge gap by collating evidence on interventions aimed at addressing DV among pregnant women in LMICs. The development of a ToC was critical in understanding how certain activities led to the desired outcomes. This ToC can guide the design of future research and development of practice guidelines. The participatory involvement of the stakeholders is recommended to refine the current ToC to support its further development for practice.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, CRD42017073938.