Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse.
BACKGROUND
Intimate partner abuse is common in all societies and damages the health of survivors and their children in the short and long term. Advocacy may decrease the impact of this abuse on women's health.


OBJECTIVE
To assess the effects of advocacy interventions conducted within or outside of health care settings on women who have experienced intimate partner abuse.


METHODS
We searched: CENTRAL and DARE (Cochrane Library Issue 3, 2008), MEDLINE (1966 to 31/7/08), EMBASE (1980 to 2008 week 30), and 11 other databases, to end July 2008. We also searched relevant websites, reference lists and forward citation tracking of included studies, and handsearched six key journals. We contacted principal investigators and experts in the field.


METHODS
Randomised controlled trials comparing advocacy interventions for women with experience of intimate partner abuse against usual care.


METHODS
Two reviewers independently assessed trial quality and undertook data extraction. For binary outcomes we calculated a standardised estimation of the odds ratio (OR) and for continuous data we calculated either a standardised mean difference (SMD) or a weighted mean difference (WMD), both with a 95% confidence interval.


RESULTS
We included ten trials involving 1527 participants. The studies were heterogeneous in respect of: intensity of advocacy, outcome measures and duration of follow-up (immediately post-intervention to three years), permitting meta-analysis for only a minority of outcomes. Intensive advocacy (12 hours or more duration) may help terminate physical abuse in women leaving domestic violence shelters or refuges at 12-24 months follow-up (OR 0.43, 95% CI 0.23 to 0.80), but not at up to 12 months follow-up. The evidence indicates that intensive advocacy may improve quality of life at up to 12 months follow-up, but the confidence intervals included zero (WMD 0.23, 95% CI 0.00 to 0.46). Depression did not improve following intensive advocacy at up to 12 months follow-up (WMD -0.05, 95% CI -0.19 to 0.09), nor did psychological distress (SMD -0.16, 95% CI -0.39 to 0.06). Only two meta-analyses of brief advocacy interventions (less than 12 hours duration) were possible; an increased use of safety behaviours was consistent with the receipt of brief advocacy both at up to 12 months (WMD 0.60, 95% CI 0.14 to 1.06) and at 12-24 months (WMD 0.48, 95% CI 0.04 to 0.92) follow up.


CONCLUSIONS
Based on the evidence reviewed, it is possible that intensive advocacy for women recruited in domestic violence shelters or refuges reduces physical abuse one to two years after the intervention but we do not know if it has a beneficial effect on their quality of life and mental health. Similarly, there is insufficient evidence to show if less intensive interventions in healthcare settings for women who still live with the perpetrators of violence are effective.
Ramsay
Jean
J
Institute of Health Sciences Education, Centre for Health Sciences, Barts and the London, Queen Mary's School of Medicine and Dentistry, University of London, 2 Newark Street, London, UK, E1 2AT.
Carter
Yvonne
Y
Davidson
Leslie
L
Dunne
Danielle
D
Eldridge
Sandra
S
Feder
Gene
G
Hegarty
Kelsey
K
Rivas
Carol
C
Taft
Angela
A
Warburton
Alison
A
D003376:Counseling; D005260:Female; D006801:Humans; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012449:Safety; D012946:Social Welfare; D012947:Social Work; D013179:Spouse Abuse / Q000517:prevention & control* / Q000523:psychology / Q000628:therapy; D013997:Time Factors