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

  • Review
  • Intervention

Authors


Abstract

Background

Intimate partner abuse is common in all societies and damages the health of survivors and their children in the short and long term. Advocacy may decrease the impact of this abuse on women's health.

Objectives

To assess the effects of advocacy interventions conducted within or outside of health care settings on women who have experienced intimate partner abuse.

Search methods

We searched: CENTRAL and DARE (Cochrane Library Issue 3, 2008), MEDLINE (1966 to 31/7/08), EMBASE (1980 to 2008 week 30), and 11 other databases, to end July 2008. We also searched relevant websites, reference lists and forward citation tracking of included studies, and handsearched six key journals. We contacted principal investigators and experts in the field.

Selection criteria

Randomised controlled trials comparing advocacy interventions for women with experience of intimate partner abuse against usual care.

Data collection and analysis

Two reviewers independently assessed trial quality and undertook data extraction. For binary outcomes we calculated a standardised estimation of the odds ratio (OR) and for continuous data we calculated either a standardised mean difference (SMD) or a weighted mean difference (WMD), both with a 95% confidence interval.

Main results

We included ten trials involving 1527 participants. The studies were heterogeneous in respect of: intensity of advocacy, outcome measures and duration of follow-up (immediately post-intervention to three years), permitting meta-analysis for only a minority of outcomes. Intensive advocacy (12 hours or more duration) may help terminate physical abuse in women leaving domestic violence shelters or refuges at 12-24 months follow-up (OR 0.43, 95% CI 0.23 to 0.80), but not at up to 12 months follow-up. The evidence indicates that intensive advocacy may improve quality of life at up to 12 months follow-up, but the confidence intervals included zero (WMD 0.23, 95% CI 0.00 to 0.46). Depression did not improve following intensive advocacy at up to 12 months follow-up (WMD -0.05, 95% CI -0.19 to 0.09), nor did psychological distress (SMD -0.16, 95% CI -0.39 to 0.06). Only two meta-analyses of brief advocacy interventions (less than 12 hours duration) were possible; an increased use of safety behaviours was consistent with the receipt of brief advocacy both at up to 12 months (WMD 0.60, 95% CI 0.14 to 1.06) and at 12-24 months (WMD 0.48, 95% CI 0.04 to 0.92) follow up.

Authors' conclusions

Based on the evidence reviewed, it is possible that intensive advocacy for women recruited in domestic violence shelters or refuges reduces physical abuse one to two years after the intervention but we do not know if it has a beneficial effect on their quality of life and mental health. Similarly, there is insufficient evidence to show if less intensive interventions in healthcare settings for women who still live with the perpetrators of violence are effective.

摘要

背景

以支持運動 (Advocacy intervention), 為遭受親密伴侶虐待的女性,減少或除掉暴力行為和增進身體和心理健康

親密伴侶虐待常見於各種社會,倖存者和其小孩的健康長期和短期受到損害.支持運動或許可以減少虐待對女性健康狀態的衝擊.

目標

評估在醫療院所內外,以支持運動治療遭受親密伴侶虐待的女性.

搜尋策略

搜尋資料庫如下:CENTRAL and DARE (Cochrane Library Issue 3, 2008), MEDLINE (1966 to 31/7/08), EMBASE (1980 to 2008 week 30), 和11個其他資料庫,搜尋範圍到2008年七月.也搜尋相關網頁,參考文獻和手動搜尋六個關鍵期刊.我們也連絡此領域的計畫主持人和專家.

選擇標準

隨機對照試驗比較以支持運動介入或一般照護治療遭受親密伴侶虐待的女性

資料收集與分析

兩個檢閱者獨立評估試驗品質和進行資料蒐集.二元結果變項方面,我們計算標準化OR估計值; 連續變項方面:我們計算標準化平均差 (SDM) 或加權平均差 (WMD), 且都有計算95% confidence interval.

主要結論

我們包含10個試驗和1,527位受試者.研究在支持活動強度、結果判定和追蹤期間 (介入後馬上量測結果或等到3年後) 方面具異質性,故統合分析 (metaanalysis) 只能合併少數結果。長時間的支持運動 (12小時或更多) 或許可幫助家暴女性,在離開收容所後12 – 24個月後結束身體的虐待 (OR 0.43, 95% CI 0.23 to 0.80). 但直到第12個月都沒有幫助.證據指出長時間的支持運動或許可於12個月內改進生活品質,但信賴區間包含0 (WMD 0.23, 95% CI 0.00 to 0.46). 12個月內的憂鬱狀態,並沒有隨長時間的支持運動而改進 (WMD −0.05, 95% CI −0.19 to 0.09), 心理憂慮也沒有 (SMD −0.16, 95% CI −0.39 to 0.06). 只有兩個短時間支持運動 (12小時以下) 的統合分析; 接受短時間支持運動12個月內,安全行為一致性的增加 (WMD 0.60, 95% CI 0.14 to 1.06), 12 – 24月後WMD 0.48, 95% CI 0.04 to 0.92).

作者結論

根據證據,長時間支持運動對家暴中心的女性,在一兩年後,可減低身體虐待.但不知是否有益於生活品質和精神健康.同樣地,也沒有足夠證據證明,在醫療機構,對仍和施暴者同住的女性進行短時間支持運動是否有效.

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

世界衛生組織統計指出,10% −50% 的全球女性聲稱一生中曾遭親近伴侶,肢體騷擾或性騷擾.若包含威脅,經濟或情感虐待,盛行率會更高.受虐婦女受到傷害和長期身體及情感的健康問題.支持運動是一種幫助這些女性的介入治療.支持運動是用資訊和支援幫助受虐婦女,讓婦女可使用社區資源.然而,在建議立法前,我們應該知道這些措施是否增進受虐婦女的健康和福祉.換句話說,宣傳介入有效嗎?搜尋過全球研究支持運動對受虐婦女幫助的文獻後,我們找到10個隨機有對照組試驗,包含1,527位女性。這些試驗比較在很多不同場所 (醫療院所內外), 支持運動和 ‘傳統治療’ 的療效.受試者包含不同種族和年紀 (15 – 61 歲). 但很多的社經地位都相對低.大部分當前仍受到嚴重虐待。所有介入藉由幫助她們達成目標來讓女性有自主權.這些介入的期間 (30 分鐘到80小時), 報告的結果變數,追蹤期長短都不同,但一致的證據指出,長時間支持運動於1 – 2年後,減少住在收容所婦女的身體虐待.但精神虐待的正面影響則有不一致證據.同樣的,長時間支持運動對憂鬱、生活品質和精神低潮有正向效果的證據也很模糊。有證據指出短時間支持運動增加受虐婦女的安全行為.總之,我們目前的結論無法證明長時間支持運動對家暴中心或收容所的婦女,是否對她們的身體和精神福祉有助益。而且我們不知道是否在醫療機構,短時間支持運動對仍和施虐者同住的女性有效.試驗的介入強度和期間、結果判定及追蹤期間過於分歧,無法互相比較。

Plain language summary

Advocacy interventions to help women who experience intimate partner abuse

The World Health Organisation estimates that between 10% and 50% of women worldwide report having been assaulted physically or sexually by an intimate partner at some time in their lives, and when threats, financial and emotional abuse are included the prevalence rates are even higher. Abused women can suffer injury and long-lasting physical and emotional health problems. One form of intervention to assist these women is advocacy. Advocacy interventions aim to help abused women directly by providing them with information and support to facilitate access to community resources. However, before recommending them to health policy makers we need to know whether they improve the health and well-being of abused women. In other words, are advocacy interventions effective?

After searching the world literature for randomised controlled trials evaluating advocacy programmes for abused women, we found ten trials, involving 1,527 women. The studies comparing advocacy with "usual care" were conducted in a variety of settings both within and outside of healthcare. Participants were recruited from diverse ethnic populations and across a wide age range (15-61 years), but many had a relatively deprived socioeconomic status. Most were experiencing current, often severe, abuse. All of the interventions sought to empower the women by helping them to achieve their goals. They differed in: duration (from 30 minutes to 80 hours), the outcomes reported, and the length of time the women were followed up.

The evidence is consistent with intensive advocacy decreasing physical abuse more than one to two years after the intervention for women already in refuges, but there is inconsistent evidence for a positive impact on emotional abuse. Similarly, there is equivocal evidence for the positive effects of intensive advocacy on depression, quality of life and psychological distress. There is evidence that brief advocacy increases the use of safety behaviours by abused women.

Taken as a whole, we conclude that at present there is equivocal evidence to determine whether intensive advocacy for women recruited in domestic violence shelters or refuges has a beneficial effect on their physical and psychosocial well-being. Further, we do not know if less intensive interventions in healthcare settings are effective for women who still live with abusive partners. Too few studies evaluated interventions of comparable intensity and duration, measured the same outcomes, or had comparable follow-up periods.

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