Longitudinal effectiveness of a woman-led, nurse delivered health promotion intervention for women who have experienced intimate partner violence: iHEAL randomized controlled trial.
Chronic pain
Complex interventions
Depression
Domestic violence
Health outcomes
Intimate partner violence
Nursing
Post-traumatic stress disorder
Quality of life
Randomized controlled trial
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
07 Feb 2024
07 Feb 2024
Historique:
received:
11
08
2023
accepted:
25
12
2023
medline:
8
2
2024
pubmed:
8
2
2024
entrez:
7
2
2024
Statut:
epublish
Résumé
Intimate partner violence (IPV) threatens the safety, health and quality of life of women worldwide. Comprehensive IPV interventions that are tailored, take a long-term view of women's needs, including health concerns, and maximize choice and control, have the potential to effectively address heath and safety concerns. Few such interventions have been tested, including in the Canadian context. A parallel randomized controlled trial of adult (age 19 + years), English-speaking, Canadian women with histories of IPV randomized either to iHEAL, a tailored health promotion intervention delivered by Registered Nurses over 6-7 months, or to community service information (usual care control). Primary (Quality of Life, PTSD symptoms) and secondary outcomes (Depression, Confidence in Managing Daily Life, Chronic Pain, IPV Severity) were measured at baseline and 6, 12 and 18 months post-intervention via an online survey. Generalized estimating equations were used to test for differences by study arm in intention-to-treat (full sample) and per protocol (1 + iHEAL visit) analyses focussing on short-term (immediately post-intervention) and longer-term (1 year post-intervention) effects. Selected process evaluation data were summarized using descriptive statistics. Of 331 women enrolled, 175 were randomized to iHEAL (135 who engaged in 1 + visits) and 156 to control. Women who received iHEAL showed significantly greater short-term improvement in Quality of Life compared to the control group, with these effects maintained 1 year later. Changes in PTSD Symptoms also differed significantly by group, with weaker initial effects that were stronger 1 year post-intervention. Significant moderate, short- and longer-term group effects were also observed for Depression and Confidence in Managing Daily Life. IPV Severity decreased for both groups, with significant immediate effects in favour of the intervention group that grew stronger 1 year post-intervention. There were no changes in Chronic Pain. iHEAL is an effective, acceptable and safe intervention for diverse groups of women with histories of IPV. Trial results provide a foundation for implementation and ongoing evaluation in health care settings and systems. Delayed effects noted for PTSD Symptoms and IPV Severity suggest that longer-term assessment of these outcomes may be needed in trials of IPV interventions. Clinicaltrials.gov ID NCT03573778 (Registered on June 29, 2018).
Sections du résumé
BACKGROUND
BACKGROUND
Intimate partner violence (IPV) threatens the safety, health and quality of life of women worldwide. Comprehensive IPV interventions that are tailored, take a long-term view of women's needs, including health concerns, and maximize choice and control, have the potential to effectively address heath and safety concerns. Few such interventions have been tested, including in the Canadian context.
METHODS
METHODS
A parallel randomized controlled trial of adult (age 19 + years), English-speaking, Canadian women with histories of IPV randomized either to iHEAL, a tailored health promotion intervention delivered by Registered Nurses over 6-7 months, or to community service information (usual care control). Primary (Quality of Life, PTSD symptoms) and secondary outcomes (Depression, Confidence in Managing Daily Life, Chronic Pain, IPV Severity) were measured at baseline and 6, 12 and 18 months post-intervention via an online survey. Generalized estimating equations were used to test for differences by study arm in intention-to-treat (full sample) and per protocol (1 + iHEAL visit) analyses focussing on short-term (immediately post-intervention) and longer-term (1 year post-intervention) effects. Selected process evaluation data were summarized using descriptive statistics.
RESULTS
RESULTS
Of 331 women enrolled, 175 were randomized to iHEAL (135 who engaged in 1 + visits) and 156 to control. Women who received iHEAL showed significantly greater short-term improvement in Quality of Life compared to the control group, with these effects maintained 1 year later. Changes in PTSD Symptoms also differed significantly by group, with weaker initial effects that were stronger 1 year post-intervention. Significant moderate, short- and longer-term group effects were also observed for Depression and Confidence in Managing Daily Life. IPV Severity decreased for both groups, with significant immediate effects in favour of the intervention group that grew stronger 1 year post-intervention. There were no changes in Chronic Pain.
CONCLUSION
CONCLUSIONS
iHEAL is an effective, acceptable and safe intervention for diverse groups of women with histories of IPV. Trial results provide a foundation for implementation and ongoing evaluation in health care settings and systems. Delayed effects noted for PTSD Symptoms and IPV Severity suggest that longer-term assessment of these outcomes may be needed in trials of IPV interventions.
TRIAL REGISTRATION
BACKGROUND
Clinicaltrials.gov ID NCT03573778 (Registered on June 29, 2018).
Identifiants
pubmed: 38326832
doi: 10.1186/s12889-023-17578-4
pii: 10.1186/s12889-023-17578-4
doi:
Banques de données
ClinicalTrials.gov
['NCT03573778']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
398Subventions
Organisme : Public Health Agency of Canada
ID : 1617-HQ-000036
Informations de copyright
© 2023. The Author(s).
Références
Ayre J, Lum On M, Webster K, Gourley M, Moon L. Examination of the burden of Disease of intimate partner Violence against women in 2011: final report. [Alexandria]. NSW: Australia’s National Research Organisation for Women’s Safety Limited (ANROWS); 2016.
World Health Organization. Violence Against Women Prevalence Estimates, 2018 Global, regional and national prevalence estimates for intimate partner violence against women and global and regional prevalence estimates for non-partner sexual violence against women [Internet]. World Health Organization. 2021. Available from: https://www.who.int/publications/i/item/9789240022256 .
Cotter A. Intimate partner violence in Canada, 2018: An overview. Juristat. 2021. Statistics Canada Catalogue 85-002-X. ISSN 1209-6393.
Bacchus LJ, Ranganathan M, Watts C, Devries K. Recent intimate partner Violence against women and health: a systematic review and meta-analysis of cohort studies. BMJ Open. 2018;8(7).
Davies L, Ford-Gilboe M, Willson A, Varcoe C, Wuest J, Campbell J, et al. Patterns of Cumulative Abuse among Female Survivors of Intimate Partner Violence Links to women’s Health and Socioeconomic Status. Violence Women. 2015;21(1):30–48.
doi: 10.1177/1077801214564076
Patton S, Szabo Y, Newton T. Mental and Physical Health changes following an abusive intimate Relationship: a systematic review of Longitudinal studies. Trauma Violence Abuse. 2022;23(4):1079–92.
pubmed: 33468040
doi: 10.1177/1524838020985554
Hing N, O’Mullan C, Mainey L, Nuske E, Breen H, Taylor A. Impacts of male intimate Partner Violence on women: a Life Course Perspective. Int J Environ Res Public Health. 2021;18(16):8303.
pubmed: 34444051
pmcid: 8391608
doi: 10.3390/ijerph18168303
Broughton S, Ford-Gilboe M, Varcoe C. Mothering in the context of intimate partner Violence: a Feminist intersectional critique of the nursing literature. J Adv Nurs. 2022;78(12):3974–86.
pubmed: 36196459
doi: 10.1111/jan.15450
Varcoe C, Irwin LG, If I, Killed You. I’d get the kids: women’s survival and Protection Work with Child Custody and Access in the context of woman abuse. Qual Sociol. 2004;27(1):77–99.
doi: 10.1023/B:QUAS.0000015545.82803.90
Ford-Gilboe M, Wuest J, Merritt-Gray M. Strengthening capacity to limit intrusion: theorizing family health promotion in the aftermath of woman abuse. Qual Health Res. 2005;15(4):477–501.
pubmed: 15761094
doi: 10.1177/1049732305274590
Wuest J, Ford-Gilboe M, Merritt-Gray M, Berman H, Intrusion. The Central Problem for Family Health Promotion among Children and Single Mothers after leaving an Abusive Partner. Qual Health Res. 2003;13(5):597–622.
pubmed: 12756683
doi: 10.1177/1049732303013005002
National Inquiry into Missing and Murdered Indigenous Women and Girls (Canada), editor. Reclaiming power and place: the final report of the National Inquiry into Missing and murdered indigenous women and girls. Gatineau: National Inquiry into Missing and Murdered Indigenous Women and Girls; 2019. p. 2.
Pedersen JS, Malcoe LH, Pulkingham J. Explaining Aboriginal/Non-Aboriginal inequalities in Postseparation Violence against Canadian women: application of a Structural Violence Approach. Violence Women. 2013;19(8):1034–58.
doi: 10.1177/1077801213499245
Giesbrecht CJ, Kikulwe D, Watkinson AM, Sato CL, Este DC, Falihi A. Supporting Newcomer women who experience intimate Partner Violence and their children: insights from service providers. Affilia. 2023;38(1):127–48.
doi: 10.1177/08861099221099318
Mantler T, Shillington KJ, Yates J, Tryphonopoulos P, Jackson KT, Ford-Gilboe M. Resilience is more than Nature: An Exploration of the Conditions that Nurture Resilience Among Rural Women who have Experienced IPV. J Fam Violence [Internet]. 2022 Dec 7 [cited 2023 Aug 4]; Available from: https://link.springer.com/ https://doi.org/10.1007/s10896-022-00479-2 .
Varcoe C, Hankivsky O, Ford-Gilboe M, Wuest J, Wilk P, Hammerton J, et al. Attributing selected costs to intimate Partner Violence in a sample of women who have left Abusive partners: a Social determinants of Health Approach. Can Public Policy. 2011;37(3):359–80.
pubmed: 22175082
doi: 10.3138/cpp.37.3.359
Ford-Gilboe M, Varcoe C, Noh M, Wuest J, Hammerton J, Alhalal E, et al. Patterns and predictors of service use among women who have separated from an abusive partner. J Fam Violence. 2015 May;30(4):419–31.
García-Moreno C, Hegarty K, d’Oliveira AFL, Koziol-McLain J, Colombini M, Feder G. The health-systems response to Violence against women. The Lancet. 2015;385(9977):1567–79.
doi: 10.1016/S0140-6736(14)61837-7
Hegarty K, McKibbin G, Hameed M, Koziol-McLain J, Feder G, Tarzia L, et al. Health practitioners’ readiness to address Domestic Violence and abuse: a qualitative meta-synthesis. PLoS ONE. 2020;15(6):e0234067.
pubmed: 32544160
pmcid: 7297351
doi: 10.1371/journal.pone.0234067
O’Doherty L, Hegarty K, Ramsay J, Davidson LL, Feder G, Taft A. Screening women for intimate partner violence in healthcare settings. Cochrane Developmental, Psychosocial and Learning Problems Group, editor. Cochrane Database Syst Rev [Internet]. 2015 Jul 22 [cited 2023 May 11];2015(8). https://doi.org/10.1002/14651858.CD007007.pub3 .
World Health Organization. Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines [Internet]. Geneva: World Health Organization. 2013 [cited 2023 May 11]. Available from: https://apps.who.int/iris/handle/10665/85240 .
Wathen CN, Varcoe C. Implementing trauma- and violence- informed care: a handbook. University of Toronto Press; 2023. p. 392.
Wathen CN, Mantler T. Trauma- and violence-informed care: orienting intimate Partner Violence interventions to Equity. Curr Epidemiol Rep. 2022;9(4):233–44.
pubmed: 36212738
pmcid: 9527731
doi: 10.1007/s40471-022-00307-7
Hameed M, O’Doherty L, Gilchrist G, Tirado-Muñoz J, Taft A, Chondros P et al. Psychological therapies for women who experience intimate partner violence. Cochrane Common Mental Disorders Group, editor. Cochrane Database Syst Rev [Internet]. 2020 Jul 1 [cited 2023 May 11];2020(7). https://doi.org/10.1002/14651858.CD013017.pub2 .
Rivas C, Ramsay J, Sadowski L, Davidson LL, Dunne D, Eldridge S, et al. Advocacy interventions to reduce or eliminate Violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse. Cochrane Database Syst Rev. 2015;2015(12):CD005043.
pubmed: 26632986
pmcid: 9392211
Rivas C, Vigurs C, Cameron J, Yeo L. A realist review of which advocacy interventions work for which abused women under what circumstances. Cochrane Developmental, Psychosocial and Learning Problems Group, editor. Cochrane Database Syst Rev [Internet]. 2019 Jun 29 [cited 2023 May 11];2019(6). https://doi.org/10.1002/14651858.CD013135.pub2 .
Ogbe E, Harmon S, Van Den Bergh R, Degomme O. A systematic review of intimate partner violence interventions focused on improving social support and/ mental health outcomes of survivors. Daoud N, editor. PLOS ONE. 2020;15(6):e0235177.
Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 Diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the global burden of Disease Study 2010. The Lancet. 2012;380(9859):2197–223.
doi: 10.1016/S0140-6736(12)61689-4
Herman JL. Trauma and recovery. New York: HarperCollins; 1992.
Tarzia L, Bohren MA, Cameron J, Garcia-Moreno C, O’Doherty L, Fiolet R, et al. Women’s experiences and expectations after disclosure of intimate partner abuse to a healthcare provider: a qualitative meta-synthesis. BMJ Open. 2020;10(11):e041339.
pubmed: 33247027
pmcid: 7703445
doi: 10.1136/bmjopen-2020-041339
Ford-Gilboe M, Merritt-Gray M, Varcoe C, Wuest J. A theory-based primary Health Care intervention for women who have left Abusive partners. Adv Nurs Sci. 2011;34(3):198–214.
doi: 10.1097/ANS.0b013e3182228cdc
Doane GH, Varcoe C. How to nurse: Relational Inquiry in Action. Wolters Kluwer; 2021. p. 480.
Wuest J, Ford-Gilboe M, Merritt-Gray M, Varcoe C. Building on Grab, attending to fit, and being prepared to Modify: how grounded Theory Works to Guide a Health intervention for abused women. Routledge International Handbook of Qualitative Nursing Research. New York: Routledge; 2013. pp. 32–46.
Wuest J, Merritt-Gray M, Dubé N, Hodgins MJ, Malcolm J, Majerovich JA, et al. The process, outcomes, and challenges of Feasibility studies conducted in Partnership with stakeholders: a Health intervention for women survivors of intimate Partner Violence. Res Nurs Health. 2015;38(1):82–96.
pubmed: 25594917
pmcid: 4305208
doi: 10.1002/nur.21636
Varcoe C, Browne AJ, Ford-Gilboe M, Stout MD, McKenzie H, Price R, et al. Reclaiming our spirits: development and pilot testing of a health promotion intervention for indigenous women who have experienced intimate partner Violence. Res Nurs Health. 2017;40(3):237–54.
pubmed: 28431458
pmcid: 6586042
doi: 10.1002/nur.21795
Varcoe C, Ford-Gilboe M, Browne AJ, Perrin N, Bungay V, McKenzie H, et al. The efficacy of a Health Promotion intervention for Indigenous women: reclaiming our spirits. J Interpers Violence. 2021;36(13–14):NP7086–116.
pubmed: 30646787
doi: 10.1177/0886260518820818
Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015;350(mar19 6):h1258–8.
pubmed: 25791983
pmcid: 4366184
doi: 10.1136/bmj.h1258
Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;8(1):18.
pubmed: 20334633
pmcid: 2860339
doi: 10.1186/1741-7015-8-18
Laughon K, Renker P, Glass N, Parker B. Revision of the abuse assessment screen to address nonlethal Strangulation. JOGNN - J Obstet Gynecol Neonatal Nurs. 2008;37(4):502–7.
pubmed: 18754989
doi: 10.1111/j.1552-6909.2008.00268.x
Ford-Gilboe M, Varcoe C, Scott-Storey K, Perrin N, Wuest J, Wathen CN, et al. Longitudinal impacts of an online safety and health intervention for women experiencing intimate partner Violence: Randomized controlled trial. BMC Public Health. 2020;20(1):260.
pubmed: 32098633
pmcid: 7043036
doi: 10.1186/s12889-020-8152-8
Koziol-McLain J, Vandal AC, Wilson D, Nada-Raja S, Dobbs T, McLean C, et al. Efficacy of a web-based safety decision aid for women experiencing intimate Partner Violence: Randomized Controlled Trial. J Med Internet Res. 2018;19(12):e426.
pubmed: 29321125
pmcid: 6858022
doi: 10.2196/jmir.8617
Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73(1):13–22.
doi: 10.1093/biomet/73.1.13
Heidinger L. Violent victimization and perceptions of safety: experiences of First Nations, Métis and Inuit women in Canada. 2022;(85).
Campbell JC, Webster DW, Glass N. The Danger Assessment: validation of a lethality risk Assessment Instrument for intimate Partner Femicide. J Interpers Violence. 2009;24(4):653–74.
pubmed: 18667689
doi: 10.1177/0886260508317180
Browne AJ, Varcoe C, Ward C. San’yas Indigenous Cultural Safety Training as an Educational intervention: promoting Anti-racism and Equity in Health Systems, policies, and practices. Int Indig Policy J. 2021;12(3):1–26.
doi: 10.18584/iipj.2021.12.3.8204
Sullivan CM, Bybee DI. Reducing Violence using community-based advocacy for women with abusive partners. J Consult Clin Psychol. 1999;67(1):43–53.
pubmed: 10028208
doi: 10.1037/0022-006X.67.1.43
Bybee DI, Sullivan CM. The process through which an advocacy intervention resulted in positive change for battered women over Time. Am J Community Psychol. 2002;30(1):103–32.
pubmed: 11928772
doi: 10.1023/A:1014376202459
Jaradat D, Ford-Gilboe M, Berman H, Wong C. Structural and construct validity of the quality of Life Scale among Canadian women with histories of intimate partner Violence. Womens Health. 2022;18:17455057221125574.
Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA. Psychometric properties of the PTSD checklist (PCL). Behav Res Ther. 1996;34(8):669–73.
pubmed: 8870294
doi: 10.1016/0005-7967(96)00033-2
Conybeare D, Behar E, Solomon A, Newman MG, Borkovec TD. The PTSD Checklist—Civilian Version: reliability, validity, and factor structure in a nonclinical sample. J Clin Psychol. 2012;68(6):699–713.
pubmed: 22517497
doi: 10.1002/jclp.21845
Eaton WW. Center for Epidemiologic Studies Depression Scale: review and revision (CESD and CESD-R). In: Maurish ME, editor. The use of psychological testing for treatment planning and outcomes assessment. Mahwah, NJ: Lawrence Erlbaum Associates, Inc; 2004.
Van Dam NT, Earleywine M. Validation of the Center for epidemiologic studies Depression Scale - revised (CESD-R): pragmatic depression assessment in the general population. Psychiatry Res. 2011;186(1):128–32.
pubmed: 20843557
doi: 10.1016/j.psychres.2010.08.018
Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain. 1992;50(2):133–49.
doi: 10.1016/0304-3959(92)90154-4
Bandura A. Self-efficacy beliefs of adolescents. Guide for constructing self-efficacy scales. Charlotte, NC: Information Age Publishing; 2006. pp. 307–37.
Ford-Gilboe M, Wathen N, Varcoe C, MacMillan HL, Scott-Storey K, Mantler T, et al. Development of a brief measure of intimate partner Violence experiences: the composite abuse scale (Revised)—Short form (CAS
pubmed: 27927659
pmcid: 5168640
doi: 10.1136/bmjopen-2016-012824
Canadian Institute for Health Information (CIHI). Health workforce in Canada: In focus (including nurses and physicians) [Internet]. 2023 [cited 2023 Dec 12]. Available from: https://www.cihi.ca/en/health-workforce-in-canada-in-focus-including-nurses-and-physicians .
World Health Organization. State of the world’s nursing 2020: investing in education, jobs and leadership [Internet]. Geneva: World Health Organization. 2020 [cited 2023 Jul 6]. Available from: https://apps.who.int/iris/handle/10665/331677 .
Carman MJ, Kay-Lambkin F. Long-term recovery from intimate Partner Violence: recovery and hope. Int J Environ Res Public Health. 2022;19(21):13825.
pubmed: 36360705
pmcid: 9654800
doi: 10.3390/ijerph192113825
Sullivan CM. Understanding how Domestic Violence support services promote Survivor Well-being: a conceptual model. J Fam Violence. 2018;33(2):123–31.
pubmed: 29367804
doi: 10.1007/s10896-017-9931-6
Ford-Gilboe M, Varcoe C, Wuest J, Campbell J, Pajot M, Heslop L, et al. Trajectories of Depression, post-traumatic stress, and Chronic Pain among women who have separated from an Abusive Partner: a longitudinal analysis. J Interpers Violence. 2023;38(1–2):1540–68.
doi: 10.1177/08862605221090595
Daly Z, Slemon A, Richardson CG, Salway T, McAuliffe C, Gadermann AM, et al. Associations between periods of COVID-19 quarantine and mental health in Canada. Psychiatry Res. 2021;295:113631.
pubmed: 33310417
doi: 10.1016/j.psychres.2020.113631
Oberth C, Goulter N, McMahon RJ. The comparative and cumulative impact of different forms of Violence exposure during childhood and adolescence on long-term adult outcomes. Dev Psychopathol. 2022;34(4):1313–28.
pubmed: 33779534
doi: 10.1017/S0954579420002254
Chronic pain in Canada: laying a foundation for action: a report by the Canadian Pain Task Force, June 2019 [Internet]. Ottawa, ON: Health Canada = Santé Canada. 2019. Available from: https://www.canada.ca/content/dam/hc-sc/documents/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2019/canadian-pain-task-force-June-2019-report-en.pdf .
Walker N, Beek K, Chen H, Shang J, Stevenson S, Williams K et al. The experiences of Persistent Pain among Women with a history of intimate Partner Violence: a systematic review. Trauma Violence Abuse. 2020;152483802095798.