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Interventions for violence against women: scientific review |
Wathen C N, MacMillan H L |
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CRD summary This review assessed the effectiveness of interventions for women identified as experiencing intimate partner violence (IPV). The authors concluded that information about evidence-based approaches for preventing IPV in the primary care setting is seriously lacking. It is difficult to assess whether the authors' conclusions were justified, given that the majority of the results from the included primary studies were not discussed.
Authors' objectives To assess, from the perspective of primary health care, the effectiveness of treatment interventions for women identified as at risk of or experiencing intimate partner violence (IPV). IPV was defined as physical and psychological abuse of women by their male partners, including sexual abuse and abuse experienced during pregnancy.
Searching MEDLINE, PsycINFO, CINAHL, HealthSTAR and Sociological Abstracts were searched (from database inception until March 2001); the search terms were reported. The search was updated in December 2002. In addition, the reference lists of key articles were handsearched and articles were identified by external reviewers.
Study selection Study designs of evaluations included in the reviewNo inclusion criteria were stated in relation to the study designs. The review included systematic reviews, randomised controlled trials (RCTs), non-randomised controlled trials and uncontrolled studies.
Specific interventions included in the reviewStudies that assessed any intervention for women, batterers and/or couples to which a primary care clinician could refer a patient were eligible for inclusion. The comparison group could be a no intervention control, a usual care control, or a group receiving an alternative intervention. The specific interventions assessed in the review were: advocacy counselling following at least one night's stay in a shelter; staying in a shelter; a programme of personal and vocational counselling for abused women; prenatal counselling designed to reduce further abuse; and batterer and/or couples programmes.
Participants included in the reviewStudies that included women who were at risk of or experiencing IPV, or male batterers and their partners, were eligible for inclusion.
Outcomes assessed in the reviewStudies that reported any outcome related to the physical or psychological morbidity of abuse, or rates of re-abuse, were eligible for inclusion. The specific outcome measures reported varied across the studies, but they included rates of re-abuse, independence from assailant, level of social support, use of safety behaviours or planning safety, quality of life, and rates of depression.
How were decisions on the relevance of primary studies made?Two reviewers independently assessed the quality of the primary studies.
Assessment of study quality The quality of the primary studies was assessed according to study design-specific criteria developed by the U.S. Preventive Services Task Force (see Other Publications of Related Interest). The studies were classified as good, fair, or poor. Two reviewers independently assessed the quality of the primary studies.
Data extraction The authors did not state how the data were extracted for the review, or how many reviewers performed the data extraction. Data were extracted on the study demographics, study design, interventions, number of participants, outcomes and timing of the outcome assessments.
Methods of synthesis How were the studies combined?The studies classified as at least fair quality were grouped by intervention and combined in a narrative. Details of the other studies were reported on the JAMA website. See Web Address at end of abstract.
How were differences between studies investigated?Differences between the studies were discussed in relation to the type of intervention and different study designs.
Results of the review The authors stated that 22 articles were included in the review. It appears that these were based on 16 studies (approximate overall n=5,084): one systematic review, 6 RCTs, 3 quasi-randomised RCTs, one controlled clinical trial, 4 cohort studies and one non-equivalent control group study.
Interventions for women (6 studies).
No high-quality studies assessing the effectiveness of a shelter stay as a means of decreasing the incidence of violence were identified. For women who had spent at least one night in a shelter, there was evidence from one RCT that those who received a specific programme of advocacy counselling reported a decreased rate of re-abuse and improved quality of life during the 2-year follow-up in comparison with those receiving normal care (76% versus 89%). No high-quality studies assessing any other types of interventions for women were identified.
Interventions for batterers and/or couples (10 studies and 1 systematic review).
Only one high-quality RCT was identified that assessed an intervention programme for batterers and/or their female partners in comparison with a no treatment control group. The results showed that, compared with no treatment, the intervention programme did not significantly reduce domestic violence rates.
Authors' conclusions Information about evidence-based approaches for preventing IPV in the primary care setting was seriously lacking. The evaluation of interventions to improve the health and well-being of abused women remains a key research priority.
CRD commentary This was a broad review question that was only loosely defined in terms of the interventions, participants and outcome measures. A number of sources were searched to identify potentially relevant studies, but it was unclear whether any language restrictions were applied. No efforts were made to search for unpublished material and, therefore, other relevant studies might have been missed. Screening the studies for inclusion in the review, and assessing the quality of the included studies, was undertaken in duplicate, thus minimising reviewer errors and bias. The validity assessment tool used to assess the quality of the included studies appears to have been adequate.
The reporting of the number of studies included in the review was confusing, with the inclusion of both a systematic review (that included primary studies that were also reported elsewhere) and a secondary analysis of data (that were also reported prospectively). In addition, the authors appear to have used the terms 'article' and 'studies' synonymously. The authors only discussed the results of the higher quality studies, but failed to state a priori that quality level would be used to determine inclusion in the review discussion. Overall, the authors' conclusions regarding the lack of adequate evidence appeared reliable.
Implications of the review for practice and research Practice: The authors did not state any implications for practice.
Research: The authors stated that there was an urgent need for additional research using rigorous designs to test the effectiveness of IPV interventions on important clinical outcomes. Chief among the questions that need to be addressed was whether screening in health care settings, coupled with appropriate effective treatments, reduced physical injury and psychological abuse. Research is also required to determine whether batterer interventions are effective with men who have not been mandated to treatment, and who are not monitored by the courts or other authorities. The authors also stated that such research was presently on-going, and it may help to answer some of these questions.
Funding Canadian Institutes of Health Research.
Bibliographic details Wathen C N, MacMillan H L. Interventions for violence against women: scientific review. JAMA 2003; 289(5): 589-600 Other publications of related interest Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al. Current methods of the U.S. Preventive Services Task Force: a review of the process. Am J Prev Med 2001;20 Suppl 3:21-35.
Indexing Status Subject indexing assigned by NLM MeSH Behavior Therapy; Counseling; Emergency Medical Services; Female; Health Education; Humans; Male; Spouse Abuse /prevention & Women's Health; control AccessionNumber 12003008087 Date bibliographic record published 31/07/2005 Date abstract record published 31/07/2005 Record Status This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn. |
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