亲密伴侣虐待(包括强制控制,物理,性,经济,情感和经济虐待)在世界范围内很普遍。倡导可能会帮助女性,或者已经离开了,虐待的亲密关系,停止或减少重复受害,并克服虐待的后果。宣传主要涉及教育,安全规划支持和增加对不同服务的访问。它可能是独立的,也可能是其他服务和干预的一部分,并且可以在医疗保健中提供,刑事司法,社会,政府或专业家庭暴力服务。我们专注于虐待妇女,因为对受虐男性的干预需要不同的考虑。
为了评估针对女性亲密伴侣虐待的宣传干预措施,就哪些干预措施对谁起作用而言,为什么和在什么情况下。
2019年1月,我们搜索了CENTRAL,MEDLINE,其他12个数据库,两个试验登记簿和两个相关网站。搜索分为三个阶段:确定文章范围以确定候选理论;迭代递归搜索研究以探索和填补这些理论的空白;系统搜索要测试的研究,证实或反驳我们的解释性理论。
任何倡导或多成分干预的实证研究,包括倡导,适用于正在经历或曾经历过任何形式的亲密伴侣虐待的15岁及以上女性,或提供此类干预措施的倡导者,或正在接受或曾经接受过这种干预的妇女的经历。伴侣虐待包括在没有身体虐待的情况下的强制性控制。为了理论发展,我们纳入的研究不完全符合我们的原始标准,但提供了对理论发展有用的信息.
四位综述作者独立提取数据,对10%的数据进行双重评估,并评估偏倚风险和证据质量。我们采用了RAMESES(现实主义和元叙事证据综合:不断发展的标准)标准来报告结果。我们采用了现实主义的方法进行分析。
我们纳入了98项研究(147篇文章)。共有88项核心研究:37项侧重于倡导者(4项基于调查,3仪器开发,30项定性重点)和7项关于受虐待妇女(6项定性研究,1项调查);44项是实验性干预研究(有些包括定性评估)。10项进一步研究(3项随机对照试验(RCT),1干预过程评估,1项定性研究,2混合方法研究,2对妇女的调查,和1个妇女和工作人员的混合方法研究)不符合原始标准,但增加了有用的信息,符合现实主义的方法。两项研究正在等待分类,三项正在进行中。宣传干预措施在接触时间上差异很大,专业交付和设置。我们根据上下文-机制-结果(CMO)模式从六个基本原则构建了一个概念模型。我们对证据的重要性有中等和高度的信心,即在女性个体生活的背景下,考虑女性的脆弱性和交叉性以及与虐待相关的决定的权衡。决策应考虑虐待对妇女安全的风险。宣传导致的行动是否增加或减少滥用取决于背景因素(如滥用的严重程度和类型),以及特定倡导干预旨在解决的结果(例如,增加成功的法院命令与减少抑郁)。我们对物理依赖的重要性缺乏信心,怀孕或生孩子。设置(高置信度)之间有联系,以及潜在的干预措施的理论基础,type,宣传的持续时间和强度,倡导纪律和结果(中等和低信心)。良好的治疗联盟很重要(高信心);当倡导者在种族或虐待经历上与受虐待妇女相匹配时,这种联盟可能会得到改善,锻炼文化谦逊,消除边缘化妇女获得资源的结构性障碍。我们确定了组织间工作中倡导者面临的重大挑战,替代的创伤,和缺乏明确的多少支持给一个女人(适度和高度的信心)。为了有效地工作,倡导者需要持续的培训,角色清晰,访问资源,以及同行和机构支持。我们的临时模型强调了因素结合和相互作用以进行有效宣传的复杂方式。根据女性和倡导者的说法,我们确认了倡导的核心要素,在研究和理论考虑的支持下:关于虐待的教育和信息;权利和资源;积极转诊和与其他服务联络;风险评估和安全规划。我们无法确认干预措施复杂性的影响(低置信度)。我们对证据的信心不足主要是由于缺乏相关研究,而不是低质量的研究,尽管审查的规模很大。
结果证实了倡导的核心成分,并建议其使用基于合理的理论基础。我们确定了一个良好的治疗联盟的要素以及如何改进它,需要特别考虑影响边缘化妇女的因素。女性倡导的目标应该在其个人生活的背景下考虑。与施虐者呆在一起的妇女的安全不一定面临最大的风险。有可能,如果进行足够长的时间,如果目标与每个妇女的需求相匹配,则倡导应在至少一个结果方面使受虐妇女受益。一些结果可能需要几个月才能确定。在虐待严重的地方,一些干预措施可能会增加滥用。倡导者有一个具有挑战性的角色,必须在情感上得到支持,通过提供资源和专业培训,组织和同行。未来的研究应该考虑本综述中确定的不同原则,和研究结果应与阐明的机制和背景联系起来考虑。需要更多的纵向证据。单主题研究设计可以帮助确定确切的效果何时不再增加,为了确定纵向工作的持续时间,对于弱势和边缘化女性来说,这可能会有所不同。需要进一步的工作来确定如何针对文化差异以及农村和资源贫乏的环境调整宣传干预措施。纳入研究中使用的方法可以,在某些情况下,限制报告数据的适用性和完整性。需要进行经济分析,以确定用于倡导干预的资源在医疗保健和社区环境中是否具有成本效益。
Intimate partner abuse (including coercive control, physical, sexual, economic, emotional and economic abuse) is common worldwide. Advocacy may help women who are in, or have left, an abusive intimate relationship, to stop or reduce repeat victimisation and overcome consequences of the abuse. Advocacy primarily involves education, safety planning support and increasing access to different services. It may be stand-alone or part of other services and interventions, and may be provided within healthcare, criminal justice, social, government or specialist domestic violence services. We focus on the abuse of women, as interventions for abused men require different considerations.
To assess advocacy interventions for intimate partner abuse in women, in terms of which interventions work for whom, why and in what circumstances.
In January 2019 we searched CENTRAL, MEDLINE, 12 other databases, two trials registers and two relevant websites. The search had three phases: scoping of articles to identify candidate theories; iterative recursive search for studies to explore and fill gaps in these theories; and systematic search for studies to test, confirm or refute our explanatory theory.
Empirical studies of any advocacy or multi-component intervention including advocacy, intended for women aged 15 years and over who were experiencing or had experienced any form of intimate partner abuse, or of advocates delivering such interventions, or experiences of women who were receiving or had received such an intervention. Partner abuse encompasses coercive control in the absence of physical abuse. For theory development, we included studies that did not strictly fit our original criteria but provided information useful for theory development.
Four
review authors independently extracted data, with double assessment of 10% of the data, and assessed risk of bias and quality of the evidence. We adopted RAMESES (Realist and meta-narrative evidence syntheses: evolving standards) standards for reporting results. We applied a realist approach to the analysis.
We included 98 studies (147 articles). There were 88 core studies: 37 focused on advocates (4 survey-based, 3 instrument development, 30 qualitative focus) and seven on abused women (6 qualitative studies, 1 survey); 44 were experimental intervention studies (some including qualitative evaluations). Ten further studies (3 randomised controlled trials (RCTs), 1 intervention process evaluation, 1 qualitative study, 2 mixed methods studies, 2 surveys of women, and 1 mixed methods study of women and staff) did not fit the original criteria but added useful information, as befitting a realist approach. Two studies are awaiting classification and three are ongoing.Advocacy interventions varied considerably in contact hours, profession delivering and setting.We constructed a conceptual model from six essential principles based on context-mechanism-outcome (CMO) patterns.We have moderate and high confidence in evidence for the importance of considering both women\'s vulnerabilities and intersectionalities and the trade-offs of abuse-related decisions in the contexts of individual women\'s lives. Decisions should consider the risks to the woman\'s safety from the abuse. Whether actions resulting from advocacy increase or decrease abuse depends on contextual factors (e.g. severity and type of abuse), and the outcomes the particular advocacy intervention is designed to address (e.g. increasing successful court orders versus decreasing depression).We have low confidence in evidence regarding the significance of physical dependencies, being pregnant or having children. There were links between setting (high confidence), and potentially also theoretical underpinnings of interventions, type, duration and intensity of advocacy, advocate discipline and outcomes (moderate and low confidence). A good therapeutic alliance was important (high confidence); this alliance might be improved when advocates are matched with abused women on ethnicity or abuse experience, exercise cultural humility, and remove structural barriers to resource access by marginalised women. We identified significant challenges for advocates in inter-organisational working, vicarious traumatisation, and lack of clarity on how much support to give a woman (moderate and high confidence). To work effectively, advocates need ongoing training, role clarity, access to resources, and peer and institutional support.Our provisional model highlights the complex way that factors combine and interact for effective advocacy. We confirmed the core ingredients of advocacy according to both women and advocates, supported by studies and theoretical considerations: education and information on abuse; rights and resources; active referral and liaising with other services; risk assessment and safety planning. We were unable to confirm the impact of complexity of the intervention (low confidence). Our low confidence in the evidence was driven mostly by a lack of relevant studies, rather than poor-quality studies, despite the size of the
review.
Results confirm the core ingredients of advocacy and suggest its use rests on sound theoretical underpinnings. We determined the elements of a good therapeutic alliance and how it might be improved, with a need for particular considerations of the factors affecting marginalised women. Women\'s goals from advocacy should be considered in the contexts of their personal lives. Women\'s safety was not necessarily at greatest risk from staying with the abuser. Potentially, if undertaken for long enough, advocacy should benefit an abused woman in terms of at least one outcome providing the goals are matched to each woman\'s needs. Some outcomes may take months to be determined. Where abuse is severe, some interventions may increase abuse. Advocates have a challenging role and must be supported emotionally, through provision of resources and through professional training, by organisations and peers.Future research should consider the different principles identified in this
review, and study outcomes should be considered in relation to the mechanisms and contexts elucidated. More longitudinal evidence is needed. Single-subject research designs may help determine exactly when effect no longer increases, to determine the duration of longitudinal work, which will likely differ for vulnerable and marginalised women. Further work is needed to ascertain how to tailor advocacy interventions to cultural variations and rural and resource-poor settings. The methods used in the included studies may, in some cases, limit the applicability and completeness of the data reported. Economic analyses are required to ascertain if resources devoted to advocacy interventions are cost-effective in healthcare and community settings.