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

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Review Question IV
woman’s needs and to coordinate support services
so that the woman could remain independent
and safe. Tutty found that this programme of
advocacy resulted in significant improvements
over baseline scores for physical abuse and for
‘appraisal support’ (the availability of someone to
talk to about one’s problems). However, there was
no significant improvement for ‘belonging support’
(obtaining support from friends and family) or
perceived stress levels.
In our previous review 11 we found that evidence
regarding the effectiveness of advocacy
interventions is weakest for women who are still
in an abusive relationship and there was little
evidence that women identified through screening
had improved outcomes from advocacy. In this
update we found one well-executed study 121
showing that an advocacy intervention may be
effective for women who disclose current abuse
as a result of screening in an antenatal clinic,
and a fairly well-executed study in primary care
public health clinics and women, infants and
children clinics 123 showing no difference between
intervention and control arms. The strongest
evidence for advocacy-based interventions,
emerging from the relatively well-executed trials of
Sullivan and colleagues, is for an intensive advocacy
programme for women leaving a refuge. The
evidence for the effectiveness of advocacy with a
less intensive intervention or for women identified
in health-care settings is less robust, either because
study designs were more prone to bias or because
the execution of the studies was flawed. Yet most
studies show some benefit from advocacy for some
outcomes and therefore this is a legitimate referral
option for health-care professionals. Evidence
from advocacy studies suggests that this form of
intervention, particularly for women who have
actively sought help from professional services,
can reduce abuse, increase social support and
quality of life, and lead to increased usage of safety
behaviours and accessing of community resources.
Five of the studies 121–124,130 were well-executed
studies of good or fair design. Considering only
these high-quality studies did not alter the overall
findings, although two of the less well conducted
studies 134,137 showed less effect of advocacy.
Continued severe abuse or revictimisation was the
outcome most resistant to advocacy, although this
may partly be a function of short follow-up, as one
of Sullivan’s trials showed no decrease in abuse at 4
months follow-up, 124 but did find it at 2 years after
the advocacy intervention. 125–129 Moreover, abuse
is a factor over which the survivor has least direct
control.
Support group interventions
with abused women
Two studies (one from our previous review and
one newly reviewed) evaluated support groups
for abused women; both of these were based in
Canada.
Study published since
our previous review
The study reported by Fry and Barker 139 after
our previous review was published had a case–
control design and compared the effectiveness
of a story-telling intervention with minimal
care where women attended information-giving
support groups. The geographical setting
was not reported. The intervention group
participated in 30–90-minute sessions in which
each woman was given an opportunity to narrate
a story about six salient events that she had
experienced in the previous 4–6 months and that
she believed had had the strongest impact on
her self-confidence, self-esteem and self-worth.
A group facilitator attempted to put relevant
structure on the reminiscence process by offering
encouragement, directing questions and steering
the contents. At the 4-month follow-up, women
who had received the intervention demonstrated
significant reductions in depression, and significant
improvements in self-esteem, global self-efficacy
scores, the ability to share feelings, feelings of
personal adequacy and a sense of reality.
Study included in our
previous review
The study included in our previous review 11 had
a before-and-after design and was reported in
two papers by Tutty and colleagues. 140,141 They
evaluated 12 feminist-informed support groups
for survivors of partner violence, as part of a
community family violence programme. The goals
of the groups were to stop violence by educating
participants about male/female socialisation,
building self-esteem and helping group members
to develop concrete plans. The groups were
facilitated by professionals over a 10–12-week
period. A number of statistically significant
benefits were observed immediately after the end
of the intervention, including improvements in
all physical and non-physical abuse measures,
perceived belonging support, locus of control,
self-esteem, and perceived stress and coping. At 6
months’ follow-up, there were continued reductions
in physical abuse and one measure of non-physical