How far does screening women for domestic (partner) - NIHR Health ...

DOI: 10.3310/hta13160 Health Technology Assessment 2009; Vol. 13: No. 16
© 2009 Queen’s Printer and Controller of HMSO. All rights reserved.
Chapter 7
Are interventions effective once partner
violence is disclosed in a health-care setting?
(Question IV)
We found 33 studies measuring the
effectiveness of interventions for women
who have experienced partner violence and
their children. Nineteen of these studies were
examined in a previous systematic review, 11 and
have been summarised below with the new studies.
Publication dates of the 14 studies not included in
the previous review range from 2000 to 2006. The
majority of these new studies were conducted in
the USA, a few were conducted in Canada, two in
Spain, one in Mexico and one in Hong Kong. The
settings varied and included refuges, community
settings, women’s homes, antenatal clinics, a
methadone maintenance programme and primary
care ‘public health’ clinics. Study designs included
nine randomised controlled trials, two case–control
studies and two before-and-after studies. For details
of the included studies see Appendix 7.1. For
results and quality scores of studies see Appendix
7.2. The assessments of individual studies using the
USPSTF criteria and the Jadad tool are detailed in
Appendices 7.3 and 7.4, respectively.
No qualitative studies were found that explored
what outcomes abused women want for themselves
and their children from programmes that include
screening or other health-care based interventions.
Advocacy interventions
with abused women
Eleven studies (four newly reviewed and seven from
our previous review) evaluated the use of advocacy
for women experiencing partner violence: one in
Hong Kong, one in Canada and nine in the USA.
Studies published since
our previous review
In an individually randomised controlled trial
of an advocacy intervention in an urban public
hospital antenatal ward, conducted by Tiwari et
al., 121 advocacy benefited abused pregnant women
who were still in a relationship with the abuser.
Abused women at less than 30 weeks’ gestation
and identified by screening were randomised to
the intervention group, which received advice on
safety, choice-making and problem-solving, or
to the control group, which received a referral
card listing community resources and sources of
partner violence services. The intervention sessions
lasted about 30 minutes, and afterwards women
were given a brochure reinforcing the information
provided. Follow-up was 6 weeks post-delivery,
and hence ranged from 16 to 34 weeks from the
intervention, depending on gestational age at
recruitment. At follow-up, the intervention group
reported significantly less psychological abuse
and less minor physical abuse; however, the rate
of severe abuse and sexual abuse did not differ
between the groups. The intervention group had
significantly greater physical functioning and
significantly improved scores on role limitation
measures for both physical and emotional
problems. Although the women did not report
any adverse effects as a result of participation in
the study, the intervention group reported more
bodily pain than the control group. There were
no differences between groups on outcomes of
general health, vitality, social functioning and
mental health. Significantly fewer women in the
intervention group had postnatal depression at
follow-up than in the control group.
A pilot study by Constantino and colleagues
of an advocacy intervention with a therapeutic
component was conducted with first-time residents
of an urban domestic violence refuge. 122 This
individually randomised controlled trial compared
a structured nurse-led social support intervention
with unstructured discussion sessions. Both groups
continued to receive standard refuge services. The
intervention comprised eight weekly sessions (each
lasting 90 minutes) and sought to empower abused
women through the provision of four dimensions
of social support: belonging, evaluation, selfesteem
and tangible support (BEST). It provided
resources to the women as well as information
on further resources; it allowed them time to
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