|A critical review of interventions for the primary prevention of perpetration of partner violence
|Whitaker D J, Morrison S, Lindquist C, Hawkins S R, O'Neil J A, Nesius A M, Mathew A, Reese L R
This well conducted and reported review evaluated interventions for the primary prevention of partner violence. It reported that conclusions on their overall efficacy were premature, but that such programmes are promising. The authors' conclusions are likely to be reliable.
To review adolescent partner violence prevention programmes that specifically target perpetration of partner violence in individuals who have not previously been known to be violent to their partners.
PsycINFO, Sociological Abstracts, MEDLINE, NCJRS, ERIC, Criminal Justice Periodicals Index, ASSIA and Wilson Social Science Abstracts were searched for articles published in the English language between 1990 and March 2003. Some details of the search terms were reported. The reference lists of retrieved studies were screened for additional studies.
Study designs of evaluations included in the review
Randomised controlled trials (RCTs), quasi-RCTs, and before-and-after studies were eligible for inclusion.
Specific interventions included in the review
Studies of primary prevention programmes (i.e. those that target individuals who were not known to have already carried out partner violence) of perpetrated partner violence were eligible for inclusion. All the included studies were of adolescent violence prevention programmes and most were loosely based on a combination of the feminist theory and social-learning therapy. All interventions followed a structured curriculum consisting of presentation, discussion groups and other activities. Teachers or professionals concerned with domestic violence, or both, carried out the interventions.
Participants included in the review
Studies of adolescents were eligible for inclusion. The populations evaluated in the included studies were middle-school students, high-school students or mid-adolescent (aged 14 to 16 years) students. The mean age of the populations was 14.6 years. Most studies that reported ethnic breakdown enrolled predominantly white students; others targeted primarily black students. The programmes were delivered to both males and females in small or large groups. One study targeted children with a family history of violence. Most of the programmes were delivered in schools; one was delivered in a community-based agency.
Outcomes assessed in the review
Inclusion criteria were not specified in terms of the outcomes. The outcomes reported were the effects from primary knowledge, attitude and behaviour measures.
How were decisions on the relevance of primary studies made?
Titles and abstracts were screened and full-text articles were obtained for those that appeared relevant. It was unclear how many reviewers were involved in this process. Two reviewers screened full-text articles for inclusion; it was unclear whether this was done independently.
Assessment of study quality
Validity was assessed through an evaluation of study design, duration of follow-up, sample size, retention rate, programme fidelity, quality of measure and quality of analyses. Two reviewers assessed the validity of the studies, with any disagreements resolved by a third reviewer.
Two reviewers extracted the data, with any disagreements resolved by a third reviewer. Information on the theoretical basis for the intervention, the setting of the intervention, specific goals of the intervention, and types of activities involved in the intervention were extracted. The outcome data were extracted based on measurement constructs, measures, follow-up and results for each outcome measure. For each outcome measure, the impact of the intervention was considered: favourable if the intervention effect was greater than the control effect; no effect if the intervention effect was the same as the control effect; or unfavourable effect if the intervention effect was less than the control effect.
Methods of synthesis
How were the studies combined?
The studies were combined in a narrative and tabulated.
How were differences between studies investigated?
Differences between the studies were discussed in the narrative and were apparent from the tabulated results.
Results of the review
Eleven studies (n=6,379) reported in 15 articles met the inclusion criteria.
Only three studies were considered to be of high quality. Methodological shortcomings included short follow-up period, low or unreported retention rates, lack of behavioural outcomes and not reporting on fidelity. Six studies used a randomised design, three a quasi-randomised design, and two a single-group before- and-after design.
Nine of the 11 studies reported at least one positive outcome, with the majority being on either knowledge or attitudes. Nine studies reported data on attitudes, of which five showed a positive effect of the intervention and three reported no effect. Four studies reported on changes in behaviour, of which two ('Safe Dates' and 'Youth Relationships Project') reported a positive effect. Both were considered to be of a high quality.
Conclusions regarding the effectiveness of school-based dating violence prevention programmes are premature, but such programmes are likely to have an important role in primary prevention strategies for partner violence.
The review addressed a clear research question and, in line with the aim of the review, the inclusion criteria were broadly defined. Several relevant sources were used to identify potential studies. However, the inclusion of only English language articles might have introduced language bias. Methods were used to minimise bias in the study selection, validity assessment and data extraction processes. Adequate details of each included study were presented. The decision to combine the studies in a narrative was appropriate given the differences between them in terms of their designs, interventions evaluated and outcomes assessed. The authors went on to provide a useful overview of considerations for further research. In summary, this review was generally well conducted and the authors' conclusions can be considered reliable.
Implications of the review for practice and research
Practice: The authors did not state any implications for practice.
Research: More data are needed to permit stronger conclusions to be drawn and to understand how the content of programmes change behaviour and the change mechanisms involved. Future research should explore the theoretical basis for interventions and develop targeted and culturally sensitive interventions in settings other than schools.
Whitaker D J, Morrison S, Lindquist C, Hawkins S R, O'Neil J A, Nesius A M, Mathew A, Reese L R. A critical review of interventions for the primary prevention of perpetration of partner violence. Aggression and Violent Behavior 2006; 11(2): 151-166
Subject indexing assigned by CRD
Battered Women; Domestic Violence /prevention & control; Primary Prevention; Sex Offenses /prevention & control; Sexual Partners /psychology; Spouse Abuse /prevention & control; Treatment Outcome; Violence; Women's Health
Database entry date
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.