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Psychology of Violence A Systematic Review of Community-Based Research Interventions for Domestic Violence Survivors Maya I. Ragavan, Kristie Thomas, Julia Medzhitova, Nathan Brewer, Lisa A. Goodman, and Megan Bair-Merritt Online First Publication, February 19, 2018. http://dx.doi.org/10.1037/vio0000183
CITATION Ragavan, M. I., Thomas, K., Medzhitova, J., Brewer, N., Goodman, L. A., & Bair-Merritt, M. (2018, February 19). A Systematic Review of Community-Based Research Interventions for Domestic Violence Survivors. Psychology of Violence. Advance online publication. http://dx.doi.org/10.1037/vio0000183
A Systematic Review of Community-Based Research Interventions for Domestic Violence Survivors
Maya I. Ragavan Boston Medical Center, Boston, Massachusetts
Kristie Thomas Simmons College
Julia Medzhitova Boston College
Nathan Brewer Simmons College
Lisa A. Goodman Boston College
Megan Bair-Merritt Boston Medical Center, Boston, Massachusetts
Objectives: Community-based research is a broad approach in which researchers work closely with practi- tioners and community members to enhance the understanding of a given phenomenon and promote positive outcomes. In the domestic violence (DV) field, community-based research is a particularly useful strategy to develop and evaluate interventions that address unique community needs. Despite the potential benefits of this approach, to our knowledge, no systematic review has synthesized DV-focused interventions and evaluations designed using a community-based research approach. This study aimed to fill that gap. Method: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review of the literature, retrieving articles that described the collaborative development and evaluation of interventions for DV survivors residing in the United States. Articles were identified from peer-reviewed databases, bibliographies, and experts. Twenty of the 199 articles assessed for eligibility were included. Results: Interventions primarily consisted of small-group sessions focusing on survivors’ mental health and safety needs. Evaluations focused on process metrics, although approximately half reported changes in survivors’ outcomes. Collaboration generally occurred between DV advocates and applied health care academic teams. Authors described the promotion of collaboration in multiple ways and to varying degrees. Common examples included shared decision-making, recognizing and addressing potential power imbalances, longitudinal relationship building, changing programs based on stakeholder feedback, and co-owned project outputs including coauthorship of manuscripts. Conclusions: This is the first systematic review of interventions to support DV survivors, developed using a community-based research approach. Implications include promoting community-based outcome evaluations and developing guidelines for teams publishing community-based research in the peer-reviewed literature.
Keywords: domestic violence, interventions, community-based research, evaluation, systematic review
Domestic violence (DV), defined as physical violence, psycho- logical aggression, sexual violence, or stalking perpetrated within an intimate relationship, is a public health epidemic (Breiding, Chen, & Black, 2014). Women who experience DV are at an increased risk for physical and sexual health morbidities, psycho-
logical concerns, and economic and housing instability (Campbell, 2002; Goodman & Epstein, 2008; Goodman, Smyth, Borges, & Singer, 2009). Over the past 4 decades, a vast array of agencies, programs, and services have been developed to meet the needs of DV survivors. Although DV advocates and researchers both have played a critical role in these efforts, the two groups have worked largely in their own silos (Yuan et al., 2016). Such separation occurs at a great cost to survivors. On the one hand, programs and services have been cut off from empirical evidence and rigorous evaluation, which are critical to effectiveness; on the other hand, time and money have been poured into research studies that would be more relevant if informed by practitioner wisdom and survi- vors’ lived experiences.
Fortunately, a substantial minority of DV researchers and advo- cates have defied this trend by embracing community-based research approaches (Edleson & Bible, 2001; Perilla, 1999; Sullivan & Bybee, 1999). The published literature describing community-based research in the DV field, however, is relatively sparse and disjointed in focus,
Maya I. Ragavan, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; Kristie Thomas, School of Social Work, Simmons College; Julia Medzhitova, Department of Counseling Psychology, Boston College; Nathan Brewer, School of Social Work, Simmons College; Lisa A. Goodman, Department of Counseling Psychology, Boston College; Megan Bair-Merritt, Department of Pediatrics, Boston Medical Center.
We thank Cris Sullivan and Nkiru Nnawulezi for reviewing our initial list of articles and providing feedback on additional articles to consider.
Correspondence concerning this article should be addressed to Maya I. Ragavan, Department of Pediatrics, Boston Medical Center, Vose Hall 3, 88 East Newton Street, Boston, MA 02118. E-mail: [email protected]
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Psychology of Violence © 2018 American Psychological Association 2018, Vol. 1, No. 2, 000 2152-0828/18/$12.00 http://dx.doi.org/10.1037/vio0000183
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especially for studies that involve program evaluation. The current article presents the findings of a systematic review of the extant literature to determine the extent to which community-based research has been used in the design and evaluation of interventions for DV survivors, the nature of those collaborations, and the findings on program effectiveness.
An Overview of Community-Based Research
Community-based research is an approach that emphasizes “the participation and influence of nonacademic researchers in the process of knowledge construction” (Israel, Schulz, Parker, & Becker, 1998, p. 177). Community-based research exists on a continuum, meaning that each project may vary in the collabora- tion’s strength and intensity (Hacker & Taylor, 2011). As a reflec- tion of this continuum, many terms can describe this approach, including community-wide research, community-engaged re- search, community-centered research, participatory action re- search, action research, and cooperative inquiry (Israel et al., 1998; Goodman et al., 2017; Minkler, 2004). Similarly, the community of focus also varies, and its composition can be somewhat amor- phous. According to Israel et al. (1998), the term “community” is characterized “by a sense of identification and emotional connec- tion to other members, common symbol systems, shared values and norms, mutual influence, common interests, and a commit- ment to meeting shared needs” (p. 178). Regardless of these variations, community-based research must be distinguished from community-placed work, which occurs in the community without the input of community members (Harris, Pensa, Redlich, Pisani, & Rosenthal, 2016; Minkler, 2004).
Increasingly, the term community-based participatory research (CBPR) has gained popularity. This approach demands a high level of engagement between the community and the academic partner and is unique in that it focuses on collaboration, shared decision-making, and power sharing during every stage of the research process. According to Goodman et al. (2017), CBPR must be guided by a commitment to six core values: (a) creating rela- tionships of transparency and trust; (b) building on each party’s strengths, resources, and interests; (c) attending to equal distribu- tion of structural and individual power; (d) equitable decision- making and mutual accountability; (e) fostering responsiveness to the ongoing and evolving needs and priorities of all stakeholders; and (f) promoting shared ownership of project products. Guided by these values, CBPR partnerships can help create interventions, raise com- munity awareness, increase practitioner and researcher skills, foster connections between academics and marginalized communities, and limit the possibility that research findings have unintended negative consequences for the community (Israel et al., 1998). However, true CBPR is challenging and time intensive; therefore, the level of en- gagement may vary depending on the specific project and needs of the academic and community partners.
History and Evolution of Community-Based Research in the DV Field
Community-based research has had a consistent presence in the DV field. Since the 1970s, a handful of researchers have worked to develop genuine partnerships with practitioners, survivors, and communities. Edleson and Bible (2001) outlined several early
community-based projects (which they described as “collaborative research”) that ranged in focus and composition. For example, they highlighted a collaboration in which an academic psychologist worked with staff members to develop and evaluate an advocacy program for women transitioning out of the DV shelter.
These partnerships have served as a counterpoint to the negative interactions between the DV community and researchers. Richie (2012) described how some early researchers ignored the expertise of activists and advocates without giving them credit. For example, she noted how several fundamental tenets driving how we understand DV (such as the link between control and violence) were originally elucidated by activists not academics. Other researchers chose to not address issues of power, oppression, and context in their studies, which had negative consequences for survivors’ and advocates’ hard- earned progress (Schechter, 1990). This historical memory, combined with continued experiences of researchers using the community for data collection and then disappearing (i.e., community-placed or “drive-by” research), has led many DV advocates to be wary and distrusting of researchers, especially those who are unwilling to share power at every stage of the research process (Edleson & Bible, 2001; Mouradian, Mechanic, & Williams, 2001; Sullivan, Price, McPart- land, Hunter, & Fisher, 2017).
Advantages and Challenges of Community-Based Research in the DV Field
As awareness of community-based research and its many ad- vantages has increased, so has interest among DV researchers and funders (Tendulkar et al., 2011; Yuan et al., 2016). One particular advantage stems from prioritizing community expertise, thus en- abling research that is rooted in the needs of survivors and their children, highly responsive to local contexts and more likely to lead to effective and sustainable interventions (Burke et al., 2013). Such outcomes are a win for all involved, as DV advocates are eager for research that has practical and tangible applications (Mouradian et al., 2001).
Although there are many advantages to community-based re- search, there also are challenges to using this approach. All community-based work, but particularly CBPR with power sharing during every step of the research process, is often labor- and time-intensive, especially in a DV context (Israel et al., 1998; White, Yuan, Cook, & Abbey, 2013). DV programs come into collaborative projects with a host of unique needs that require researcher sensitivity and patience. DV programs are often under- funded, understaffed, and focused on crisis management (Moura- dian et al., 2001). Secondary traumatization is common among staff and contributes to high rates of turnover (Edleson & Bible, 2001; Sullivan et al., 2017). All of these factors can hinder pro- gram participation, delay timelines, and interfere with researcher productivity, thus threatening attainment of benchmarks such as achieving tenure or publishing in high-impact journals (Kennedy, Vogel, Goldberg-Freeman, Kass, & Farfel, 2009).
Evaluation of Community-Based Work in the DV Field
In recent years, there has been a movement to not only create partnerships but also evaluate their effectiveness through rigorous research that leverages the expertise of both the community and
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2 RAGAVAN ET AL.
academic partners. As outlined by Sullivan (2011), there is in- creasing pressure from funders, without supplemental funding or resources, for DV agencies to demonstrate programmatic effec- tiveness. She goes on to describe the concerns of DV advocates, arguing that when particular outcomes are externally mandated, they may not accurately reflect the work of the organization or the diversity of the survivors’ lived experiences.
Although evaluating collaborative work is challenging, it is essential for ensuring that programs align with the principles of evidenced-based practice. Scholars have noted that community involvement and input is fundamental to the process of evaluating DV interventions (Murray & Smith, 2009). Serrata et al. (2017) provides a theoretical model to reconcile these two principles, conveying the dual importance of both providing DV survivors evidence-based programming and including community input in the evaluation process. Therefore, to appreciate the impact of DV interventions, it is important to examine not only the outcomes themselves but also the extent to which community-based research principles guide evaluation design, methods, and results.
Gaps in the Literature
Over the years, a range of interventions to support DV survivors have been cocreated and evaluated by community–academic part- nerships. The extant literature, however, has yet to systematically review these community-based interventions, the extent to which they are evaluated using a community-based approach, or the findings of such evaluation efforts (Sullivan et al., 2017). Such a review can help synthesize the process of collaboration used during intervention development— useful information for both ac- ademics and practitioners engaged in collaborative research. It can also illuminate how teams are using a community-based approach to develop programs and evaluate their work in ways that mean- ingfully impact survivors and improve outcomes.
Study Aim
The aim of the current study was to conduct a systematic literature review of articles within the past 20 years (1996 –2016) that used a community-based research approach to develop and evaluate an intervention to support DV survivors. We were spe- cifically interested in understanding (a) the type of intervention, (b) program evaluation design and results, and (c) the extent of the community–academic collaboration, using the six core values of CBPR as a guide to assess the level of community engagement.
Method
Study Design
We conducted a systematic review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) 2009 checklist as a guide. See Figure 1 for an overview of the search strategy.
Eligibility Criteria
Studies were included if they used a community-based research approach, defined to include authors’ use of the terms CBPR,
action research, participatory action research, community– academic partnership, or a description of a collaborative relation- ship. We included articles that used a variety of terms because, as highlighted in the introduction, community-based research has been described in multiple ways (Israel et al., 1998; Minkler, 2004). Articles that used community-placed research, or research conducted in the community without community involvement, were not included.
Additional inclusion criteria included articles that (a) described an intervention designed to support DV survivors; (b) partnered with DV advocates, DV survivors, or staff at other community- based agencies who support women who have experienced DV (this criterion was only used if the study was deemed to be community based); (c) outlined qualitative or quantitative results of an evaluation; and (d) occurred in the United States. Given that our focus was on interventions for DV survivors published in peer-reviewed journals, we excluded community-based research without intervention development, articles related to people who use violence or children exposed to DV, articles related to sexual assault survivors or prevention-focused initiatives for the general community, and studies published as reports, abstracts, disserta- tions, or PowerPoint presentations.
Search Strategy
Maya I. Ragavan searched four electronic databases (PubMed, Web of Science, PsycInfo, and CINAHL) from October to December 2016 using the search terms “intimate partner violence” OR “domes- tic violence” OR “spouse abuse” OR “partner abuse” OR “partner violence” OR “domestic abuse” AND “community-based participa- tory research” OR “community OR participatory OR action re- search.”. The research team decided on these databases because it was believed they were the most likely to contain articles from multiple disciplines that met the inclusion criteria. The search returned 3,335 articles from PubMed, 3,391 from Web of Science, 5,614 from PsycInfo, and 2,810 from CINAHL. After excluding duplicate arti- cles, 6,516 articles remained. MR reviewed each title and abstract carefully to determine whether the article met the inclusion criteria. The majority did not, which is not surprising, given that the search terms were purposefully broad. A total of 180 full texts were selected for the next round of review.
Study Selection
Two reviewers (Maya I. Ragavan and either Kristie Thomas, Julia Medzhitova, or Nathan Brewer) independently reviewed the 180 articles to determine whether they met all of the inclusion criteria. Articles that met only some of the criteria were excluded. In the few instances where the reviewers disagreed, they discussed the article with a third abstractor until consensus was reached. Eighteen articles were included.
After the completion of the initial search, Maya Ragavan re- viewed the bibliographies of the included articles and related review articles. Twelve additional articles were identified from this search; however, after a close review by Kristie Thomas, none was deemed to meet inclusion criteria. Finally, two community-based research experts in the DV field reviewed the list of included articles. They suggested seven additional articles, which were reviewed in the same manner as stated in the abovementioned text.
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3COMMUNITY-BASED RESEARCH INTERVENTIONS
Two were deemed eligible and added to the original 18 articles for a total of 20 included articles.
Data Abstraction
M.R. developed the codebook to guide the abstraction process, which was then iteratively revised by all of the abstractors until consensus was reached. The codebook focused on five key do- mains: (a) information about the intervention (participants, type of intervention, length, etc.), (b) information about the evaluation (evaluation design, methods, process results, and outcomes), (c) information about the community-based research process and ex- tent of the community–academic collaboration, (d) authors’ affil- iations, and (e) abstractors’ reflections. For the third domain, we focused on articles’ description of the six core values for conduct- ing CBPR in the DV field (Goodman et al., 2017).
M.R. abstracted the 20 included articles, and another abstractor (K.T., J.M., or N.B.) checked each abstraction for accuracy. M.R. had individual phone conversations with the abstractors to discuss any disagreements in coding. During these meetings, the two
abstractors reviewed the articles again and discussed discrepancies in coding until a consensus was reached.
Results
In the following section, we start by briefly reviewing the interventions and evaluations discussed in the included articles. Table 1 provides further description about program implementa- tion and evaluation. Next, we use the six core values of CBPR as a framework to synthesize the collaborations described in the included articles (Goodman et al., 2017).
Interventions
Description of interventions. Nineteen distinct interventions were described in the 20 included articles; two articles described different components of the same intervention (Nicolaidis, Wahab, et al., 2013; Wahab et al., 2014). The interventions varied in length, with the majority comprising five to 12 group sessions over a 1- to 6-month period. Interventions addressing mental health
Records identified through database searching
PubMed (n=3,335) PsycInfo (n=5,614)
Web of Science (n=3,391) CINAHL (n=2,810)
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References (n=12)
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Total records: 15,169 Records screened after duplicates removed: 6,516
Full-text articles assessed for eligibility
Databases (n =180)
Bibliographies (n=12) Experts (n= 7)
Full-text articles excluded for not meeting inclusion criteria
Databases (n = 162)a 87 not community-based 92 not interventions for DV survivors 7 due to partnership type 47 did not provide outcomes 7 not in the US References (n=12)a 11 not community-based 11 not interventions for DV survivors 1 due to partnership type 1 did not provide outcomes Experts (n=5) 3 already excluded 1 did not provide outcomes 1 not in the US a) In some cases, articles were excluded for two or more reasons
Studies included in qualitative synthesis
Database (n =18) Bibliographies (n=0)
Experts (n=2)
TOTAL INCLUDED: n=20
Figure 1. Search Strategy. See the online article for the color version of this figure.
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se st
ud ie
s Q
ua li
ta ti
ve :
ge ne
ra ll
y po
si ti
ve fe
ed ba
ck .
Id ea
s fo
r im
pr ov
em en
t: C
ou ns
el or
s w
er e
to o
yo un
g, an
d m
or e
fo ll
ow -u
p ap
po in
tm en
ts an
d su
st ai
na bi
li ty
C la
rk et
al .
(2 01
4) 12
, 30
- to
40 -m
in tr
au m
a- in
fo rm
ed yo
ga ex
er ci
se s
at th
e en
d of
th er
ap y
se ss
io ns
. Y
og a
de ve
lo pe
d by
th e
T ra
um a
Ju st
ic e
In st
it ut
e Im
pl em
en te
r: ce
rt if
ie d
yo ga
in st
ru ct
or
17 w
om en
ha d
pa rt
ic ip
at ed
(e ig
ht re
ce iv
ed th
e in
te rv
en ti
on )
M ea
n ag
e: 43
ye ar
s 71
% W
hi te
94 %
gr ad
ua te
d hi
gh sc
ho ol
41 %
se pa
ra te
d N
o em
pl oy
m en
t or
ch il
d da
ta re
po rt
ed
R an
do m
iz ed
co nt
ro ll
ed tr
ia l
(c on
tr ol
gr ou
p re
ce iv
ed th
er ap
y w
it ho
ut yo
ga )
Q ua
nt it
at iv
e 30
% at
tr it
io n
ra te
10 0%
of th
e pa
rt ic
ip an
ts de
sc ri
be d
en jo
yi ng
th e
pr og
ra m
(m ul
ti pl
e fe
as ib
il it
y ou
tc om
es re
po rt
ed su
ch as
tr us
t, tr
ea te
d w
it h
re sp
ec t,
an d
fo un
d pa
rt ic
ip at
io n
m ea
ni ng
fu l)
G al
an o,
G ro
ga n-
K ay
lo r,
S te
in ,
C la
rk ,
an d
G ra
ha m
-B er
m an
n (2
01 7)
C ul
tu ra
ll y
ta il
or ed
th e
M om
’s E
m po
w er
m en
t P
ro gr
am fo
r L
at in
a w
om en
10 -s
es si
on gr
ou p
tr ea
tm en
t fo
cu se
d on
em po
w er
m en
t, pa
re nt
in g
se lf
- ef
fi ca
cy ,
an d
sa fe
en vi
ro nm
en ts
Im pl
em en
te rs
: th
er ap
is ts
93 w
om en
ha d
pa rt
ic ip
at ed
M ea
n ag
e: 35
.6 ye
ar s
10 0%
L at
in a
89 %
ha d
hi gh
sc ho
ol ed
uc at
io n
or le
ss 10
% w
er e
li vi
ng w
it h
an ab
us iv
e pa
rt ne
r 83
% w
er e
si ng
le ,
se pa
ra te
d, or
di vo
rc ed
46 %
w er
e em
pl oy
ed N
o ch
il d
da ta
re po
rt ed
C on
tr ol
le d
tr ia
l w
it h
bl oc
k as
si gn
m en
ts Q
ua nt
it at
iv e
W om
en in
th e
tr ea
tm en
t gr
ou p
ha d
si gn
if ic
an t
im pr
ov em
en t
in po
st tr
au m
at ic
st re
ss di
so rd
er sy
m pt
om s,
pa rt
ic ul
ar ly
re ex
pe ri
en ci
ng th
e sy
m pt
om s
(t a b le
co n ti
n u es
)
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
5COMMUNITY-BASED RESEARCH INTERVENTIONS
T ab
le 1
(c o n ti
n u ed
)
A ut
ho r
an d
ye ar
D es
cr ip
ti on
of in
te rv
en ti
on P
ar ti
ci pa
nt de
m og
ra ph
ic s
E va
lu at
io n
de si
gn R
es ul
ts
G il
be rt
et al
. (2
01 5)
O ne
se ss
io n
fo cu
se d
on D
V sc
re en
in g,
ed uc
at io
n, ri
sk as
se ss
m en
t, so
ci al
su pp
or t,
an d
id en
ti fi
ca ti
on of
se rv
ic e
ne ed
s/ re
fe rr
al s
fo r
su bs
ta nc
e us
in g
w om
en Im
pl em
en te
rs :
co m
pu te
ri ze
d vs
. ca
se m
an ag
er
19 1
w om
en ha
d pa
rt ic
ip at
ed (9
4 co
m pu
te ri
ze d
an d
97 by
ca se
m an
ag er
) M
ea n
ag e:
34 ye
ar s
66 %
A fr
ic an
A m
er ic
an an
d 30
% L
at in
a 71
% si
ng le
N o
em pl
oy m
en t,
ed uc
at io
n, or
ch il
d da
ta re
po rt
ed
R an
do m
iz ed
co nt
ro ll
ed tr
ia l
(c om
pu te
r vs
. ca
se m
an ag
er ),
w it
h a
3- m
on th
fo ll
ow -u
p
Q ua
nt it
at iv
e 99
% co
m pl
et ed
co m
pu te
ri ze
d, an
d 98
% co
m pl
et ed
ca se
m an
ag er
88 %
co m
pu te
ri ze
d an
d 84
% ca
se m
an ag
er w
er e
ve ry
sa ti
sf ie
d N
o ad
ve rs
e ef
fe ct
s B
ot h
gr ou
ps w
it h
si gn
if ic
an t
in cr
ea se
in th
e re
ce ip
t of
D V
se rv
ic es
, so
ci al
su pp
or t,
D V
se lf
-e ff
ic ac
y, an
d th
e nu
m be
r of
da ys
w it
ho ut
su bs
ta nc
e us
e K
el ly
& P
ic h
(2 01
4) 6–
10 w
ee kl
y, 90
-m in
th er
ap y
se ss
io ns
fo cu
se d
on po
st tr
au m
at ic
st re
ss di
so rd
er ,
se lf
-c ar
e, ch
il dr
en ,
m in
df ul
ea ti
ng ,
fa m
il y,
fa it
h, an
d ex
er ci
se Im
pl em
en te
rs :
ad va
nc ed
pr ac
ti ce
nu rs
es w
it h
in te
rp re
te rs
27 w
om en
ha d
en ro
ll ed
, an
d 22
ha d
pa rt
ic ip
at ed
M ea
n ag
e: 37
ye ar
s G
ro up
1: S
pa ni
sh -s
pe ak
in g
im m
ig ra
nt s
G ro
up s
2/ 3:
L at
in a
w om
en A
ve ra
ge 10
ye ar
s of
ed uc
at io
n S
ep ar
at ed
fr om
th e
ab us
er fo
r a
m ea
n of
9. 3
m on
th s
E m
pl oy
m en
t da
ta no
t re
po rt
ed 10
0% w
it h
ch il
dr en
P re
/p os
t te
st s
(b as
el in
e, 2
w ee
ks ,
3 m
on th
s, an
d 6
m on
th s)
In te
rv ie
w s
Q ua
nt it
at iv
e S
ig ni
fi ca
nt im
pr ov
em en
t in
po st
tr au
m at
ic st
re ss
di so
rd er
, se
lf -
ef fi
ca cy
, pe
rc ei
ve d
ge ne
ra l
he al
th ,
an d
se lf
-c ar
e fr
om ba
se li
ne to
6 m
on th
s S
ta ti
st ic
al ly
si gn
if ic
an t
im pr
ov em
en t
in m
en ta
l he
al th
qu al
it y
of li
fe at
al l
po in
ts A
t 6
m on
th s,
15 ou
t of
16 w
om en
w er
e us
in g
st ra
te gi
es th
ey le
ar ne
d Q
ua li
ta ti
ve R
eq ue
st ed
m or
e m
in df
ul ne
ss ,
w hi
ch w
as ad
de d
to th
e th
ir d
it er
at io
n; pa
rt ic
ip an
ts ap
pr ec
ia te
d th
e se
ss io
ns w
it h
an in
te rp
re te
r, th
ou gh
t th
e ex
pe ri
en ce
of D
V w
as m
or e
un if
yi ng
th an
be lo
ng in
g to
th e
sa m
e cu
lt ur
al gr
ou p,
an d
en jo
ye d
so ci
al su
pp or
t; at
te nd
an ce
w as
ch al
le ng
in g
du e
to sc
he du
li ng
re st
ra in
ts (t
a b le
co n ti
n u es
)
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
6 RAGAVAN ET AL.
T ab
le 1
(c o n ti
n u ed
)
A ut
ho r
an d
ye ar
D es
cr ip
ti on
of in
te rv
en ti
on P
ar ti
ci pa
nt de
m og
ra ph
ic s
E va
lu at
io n
de si
gn R
es ul
ts
K ra
m er
, N
os bu
sc h,
an d
R ic
e (2
01 2)
P ro
gr am
fo r
pr eg
na nt
w om
en ex
pe ri
en ci
ng D
V .
N ur
se ca
se m
an ag
er re
ce iv
ed re
fe rr
al s,
w ou
ld co
ns ul
t w
it h
th e
D V
su rv
iv or
to id
en ti
fy ne
ed s,
fo ll
ow ed
by a
co m
pr eh
en si
ve as
se ss
m en
t P
ar ti
ci pa
nt s
re ce
iv ed
se rv
ic es
th ro
ug ho
ut th
e pr
og ra
m su
ch as
cr is
is in
te rv
en ti
on ,
su pp
or t,
m en
ta l
he al
th ,
ad vo
ca cy
, le
ga l
he lp
, an
d ba
si c
ne ed
s Im
pl em
en te
rs :
nu rs
e ca
se m
an ag
er an
d D
V ad
vo ca
te
P ar
ti ci
pa nt
s: 41
8 re
fe rr
al s;
37 3
w om
en w
er e
gi ve
n in
it ia
l co
ns ul
ta ti
on ;
an d
20 1
(5 9%
) co
m pl
et ed
th e
pr og
ra m
S pe
ci fi
c de
m og
ra ph
ic da
ta no
t re
po rt
ed .
T he
ar ti
cl e
de sc
ri be
d th
e pa
rt ic
ip an
ts to
be lo
w -
in co
m e,
no n-
W hi
te w
om en
li vi
ng in
hi gh
in fa
nt m
or ta
li ty
zi p
co de
s
P re
/p os
t su
rv ey
s an
d in
te rv
ie w
s Q
ua nt
it at
iv e
51 %
of th
e re
fe rr
al s
ca m
e fr
om he
al th
ca re
pr ov
id er
s, 39
% fr
om cl
ie nt
s of
th e
D V
ag en
cy ,
an d
10 %
w er
e se
lf -r
ef er
re d
H al
f re
ce iv
ed tw
o- to
-t hr
ee ti
m es
/w ee
k co
nt ac
t, an
d ha
lf re
ce iv
ed tw
o- to
-t hr
ee ti
m es
/m on
th co
nt ac
t M
or e
th an
ha lf
of th
e pa
rt ic
ip an
ts pr
og re
ss ed
on e-
to -f
ou r
le ve
ls to
w ar
d ac
ti on
an d
m ai
nt en
an ce
of vi
ol en
ce fr
ee re
la ti
on sh
ip s
us in
g a
re ad
in es
s to
ch an
ge in
de x
S af
et y
be ha
vi or
: 22
.8 at
ba se
li ne
an d
27 .8
at th
e en
d (r
an ge
fr om
0– 31
; hi
gh er
is sa
fe r)
C om
pa ra
bl e
bi rt
h ou
tc om
es (e
.g .,
pr em
at ur
it y
an d
lo w
-b ir
th w
ei gh
t in
fa nt
) Q
ua li
ta ti
ve :
T he
m os
t us
ef ul
as pe
ct w
as be
in g
ab le
to sp
ea k
ca nd
id ly
; th
e pa
rt ic
ip an
ts ap
pr ec
ia te
d th
e st
af f’
s he
lp an
d w
er e
hi gh
ly sa
ti sf
ie d
w it
h th
ei r
ex pe
ri en
ce s
L ev
in (2
00 1)
T A
N F
w or
ke rs
sc re
en ed
an d
re fe
rr ed
w om
en to
D V
ad vo
ca te
s fo
r se
rv ic
es S
er vi
ce s
in cl
ud ed
on -s
it e
co un
se li
ng ,
pr ob
le m
-s ol
vi ng
, st
ra te
gi zi
ng ,
an d
go al
se tt
in g
Im pl
em en
te rs
: T
A N
F w
or ke
rs an
d ad
vo ca
te s
N o
sp ec
if ic
de m
og ra
ph ic
da ta
re po
rt ed
. T
he ar
ti cl
e st
at es
th at
th e
pa rt
ne ri
ng D
V ag
en ci
es w
or k
w it
h A
fr ic
an A
m er
ic an
/L at
in a
w om
en
Q ua
li ta
ti ve
Q ua
nt it
at iv
e: O
f w
om en
w ho
re qu
es te
d se
rv ic
es ,
35 %
re ce
iv ed
se rv
ic es
Q ua
li ta
ti ve
: M
ul ti
pl e
ch al
le ng
es di
sc us
se d,
in cl
ud in
g th
e qu
al it
y of
th e
D V
sc re
en in
g fo
rm ,
po or
co m
m un
ic at
io n,
un cl
ea r
ro le
of th
e T
A N
F w
or ke
rs ,
an d
T A
N F
w or
ke rs
’ at
ti tu
de s
to w
ar d
D V
M ac
y, E
rm en
tr ou
t, an
d R
iz o
(2 01
2) 12
gr ou
p w
or ks
ho ps
on pa
re nt
in g,
D V
, an
d sa
fe ty
fo r
w om
en w
ho bo
th ex
pe ri
en ce
d an
d pe
rp et
ra te
d D
V Im
pl em
en te
rs :
tw o
so ci
al w
or ke
rs
31 w
om en
ha d
pa rt
ic ip
at ed
(1 6
co m
pl et
ed su
rv ey
s) M
ea n
ag e:
28 ye
ar s
63 %
A fr
ic an
A m
er ic
an an
d 31
% W
hi te
44 %
ha d
co m
pl et
ed hi
gh sc
ho ol
50 %
w er
e si
ng le
, se
pa ra
te d,
or di
vo rc
ed 56
% w
er e
em pl
oy ed
M ea
n nu
m be
r of
ch il
dr en
: 2.
25
Q ua
li ta
ti ve
(s ta
ff an
d w
om en
) Q
ua li
ta ti
ve :
pe ss
im is
ti c
at th
e st
ar t
bu t
w er
e po
si ti
ve by
th e
en d,
un de
rs to
od th
e im
po rt
an ce
of en
vi ro
nm en
t, en
jo ye
d co
nt en
t on
sa fe
ty pl
an ni
ng an
d re
so ur
ce s,
w an
te d
m or
e on
D V
, an
d un
de rs
to od
im po
rt an
ce of
su pp
or t
fr om
th e
gr ou
p
(t a b le
co n ti
n u es
)
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
7COMMUNITY-BASED RESEARCH INTERVENTIONS
T ab
le 1
(c o n ti
n u ed
)
A ut
ho r
an d
ye ar
D es
cr ip
ti on
of in
te rv
en ti
on P
ar ti
ci pa
nt de
m og
ra ph
ic s
E va
lu at
io n
de si
gn R
es ul
ts
M cW
hi rt
er (2
01 1)
C om
pa ri
so n
of th
e fo
ll ow
in g
tw o
gr ou
ps to
ad dr
es s
no na
da pt
iv e
co pi
ng :
(a )
go al
or ie
nt ed
, w
he re
w om
en go
t in
tr od
uc ed
to co
pi ng
st ra
te gi
es ,
ch os
e a
go al
, an
d di
sc us
se d
ho w
to re
ac h
it an
d (b
) em
ot io
n fo
cu se
d, w
he re
w om
en fo
cu se
d on
he al
th y
re la
ti on
sh ip
s C
hi ld
re n’
s pr
og ra
m s
oc cu
rr ed
co nc
ur re
nt ly
Im pl
em en
te rs
: th
er ap
is ts
(t w
o m
as te
r’ s-
le ve
l th
er ap
is ts
an d
tw o
tr ai
ne es
)
46 w
om en
ha d
pa rt
ic ip
at ed
(2 2
em ot
io n
an d
24 go
al )
M ea
n ag
e: 30
ye ar
s 47
% W
hi te
, 20
% L
at in
o, an
d 16
% A
fr ic
an A
m er
ic an
65 %
ha d
co m
pl et
ed hi
gh sc
ho ol
R el
at io
ns hi
p st
at us
no t
re po
rt ed
E m
pl oy
m en
t da
ta no
t re
po rt
ed 10
0% w
er e
w it
h ch
il dr
en
C om
pa ri
so n
tr ia
l be
tw ee
n th
e tw
o gr
ou ps
Q ua
nt it
at iv
e: B
ot h
gr ou
ps ha
d si
gn if
ic an
t im
pr ov
em en
t in
de pr
es si
on ,
fa m
il y
bo nd
in g,
se lf
-e ff
ic ac
y, an
d re
ad in
es s
in di
ca to
rs G
re at
er de
cr ea
se s
in fa
m il
y co
nf li
ct fo
r go
al gr
ou p
vs .
em ot
io n
gr ou
p G
re at
er in
cr ea
se in
qu al
it y
of so
ci al
su pp
or t
fo r
em ot
io n
gr ou
p vs
. go
al gr
ou p
G oa
l gr
ou p
ha d
de cr
ea se
d al
co ho
l us
e
N ic
ol ai
di s,
M ej
ia ,
et al
. (2
01 3)
12 -s
es si
on ,
cu lt
ur al
ly se
ns it
iv e
de pr
es si
on m
an ag
em en
t gr
ou p
pr og
ra m
fo r
L at
in a
w om
en Im
pl em
en te
r: p ro
m o to
ra (c
om m
un it
y he
al th
w or
ke r)
10 w
om en
ha d
pa rt
ic ip
at ed
M ea
n ag
e: 38
ye ar
s 10
0% L
at in
a 10
% ha
d gr
ad ua
te d
hi gh
sc ho
ol 50
% w
er e
m ar
ri ed
E m
pl oy
m en
t an
d ch
il d
da ta
no t
re po
rt ed
P re
/p os
t ev
al ua
ti on
an d
ex it
in te
rv ie
w s
Q ua
nt it
at iv
e: 83
% fo
un d
th e
pr og
ra m
ve ry
us ef
ul S
ig ni
fi ca
nt de
cr ea
se in
de pr
es si
on se
ve ri
ty S
ig ni
fi ca
nt in
cr ea
se in
se lf
-e ff
ic ac
y an
d se
lf -e
st ee
m A
cc ep
ta bi
li ty
of an
ti de
pr es
sa nt
s in
cr ea
se d
fr om
60 %
to 80
% Q
ua li
ta ti
ve :
P ar
ti ci
pa nt
s en
jo ye
d th
e pr
og ra
m ;
th e
pr og
ra m
w as
pr ac
ti ca
l an
d su
pp or
ti ve
. T
he m
ai n
di sl
ik e
w as
th at
th e
pr og
ra m
w as
to o
sh or
t N
ic ol
ai di
s, W
ah ab
, et
al .
(2 01
3) 6-
m on
th ,
cu lt
ur al
ly se
ns it
iv e
gr ou
p se
ss io
ns on
de pr
es si
on m
an ag
em en
t us
in g
m ot
iv at
io na
l in
te rv
ie w
in g,
ca se
m an
ag em
en t,
an d
re fe
rr al
s fo
r A
fr ic
an A
m er
ic an
w om
en Im
pl em
en te
rs :
A fr
ic an
A m
er ic
an D
V ad
vo ca
te an
d su
rv iv
or
59 w
om en
ha d
pa rt
ic ip
at ed
M ea
n ag
e: 38
ye ar
s 10
0% A
fr ic
an A
m er
ic an
89 %
gr ad
ua te
d hi
gh sc
ho ol
59 %
ha d
ne ve
r m
ar ri
ed E
m pl
oy m
en t
an d
ch il
d da
ta no
t re
po rt
ed
P re
/p os
t su
rv ey
s In
te rv
ie w
s Q
ua nt
it at
iv e:
92 %
at te
nd ed
at le
as t
on e
se ss
io n;
94 %
fo un
d th
e pr
og ra
m us
ef ul
S ig
ni fi
ca nt
de cr
ea se
in de
pr es
si on
se ve
ri ty
S ig
ni fi
ca nt
im pr
ov em
en t
in vi
ew s
ab ou
t de
pr es
si on
, se
lf -e
ff ic
ac y,
de pr
es si
on se
lf -m
an ag
em en
t, se
lf -e
st ee
m ,
an d
st re
ss N
o ch
an ge
s in
th e
us e
of an
ti de
pr es
sa nt
s or
ca re
-s ee
ki ng
be ha
vi or
s Q
ua li
ta ti
ve :
Im po
rt an
ce of
A fr
ic an
A m
er ic
an fo
cu s
an d
co m
m un
it y
se tt
in g;
va lu
ed tr
us t
bu il
di ng
; pr
ac ti
ca l
in fo
rm at
io n
an d
st ra
te gi
es ;
m ul
ti pl
e ba
rr ie
rs to
pa rt
ic ip
at in
g (e
.g .,
po ve
rt y,
m en
ta l
he al
th sy
m pt
om s)
(t a b le
co n ti
n u es
)
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
8 RAGAVAN ET AL.
T ab
le 1
(c o n ti
n u ed
)
A ut
ho r
an d
ye ar
D es
cr ip
ti on
of in
te rv
en ti
on P
ar ti
ci pa
nt de
m og
ra ph
ic s
E va
lu at
io n
de si
gn R
es ul
ts
R ag
av an
et al
. (2
01 7)
12 gr
ou p
se ss
io ns
fo cu
se d
on he
al th
ed uc
at io
n (n
ut ri
ti on
, ph
ys ic
al ac
ti vi
ty ,
ch il
d de
ve lo
pm en
t, se
lf -c
ar e,
an d
he al
th re
so ur
ce s)
Im pl
em en
te rs
: ac
ad em
ic te
am an
d D
V ad
vo ca
te co
fa ci
li ta
te d
37 w
om en
ha d
pa rt
ic ip
at ed
A ge
s: 35
% ,
26 –3
5 ye
ar s;
32 %
, 36
–4 5
ye ar
s 62
% L
at in
a an
d 19
% W
hi te
74 %
ha d
re ce
iv ed
hi gh
sc ho
ol ed
uc at
io n
R el
at io
ns hi
p st
at us
no t
re po
rt ed
54 %
w er
e em
pl oy
ed 92
% ha
d ch
il dr
en
Q ua
li ta
ti ve
Q ua
li ta
ti ve
: sa
ti sf
ac ti
on w
it h
w or
ks ho
ps ,
im po
rt an
ce of
bu il
di ng
a su
pp or
ti ve
co m
m un
it y,
ch al
le ng
es in
de ve
lo pi
ng su
rv iv
or –f
ac il
it at
or re
la ti
on sh
ip s,
ba rr
ie rs
to at
te nd
an ce
, li
ng ui
st ic
se ns
it iv
it y,
in co
rp or
at in
g ch
il dr
en ,
an d
su st
ai na
bi li
ty R
en ze
tt i
& F
ol li
ng st
ad (2
01 5)
D ev
el op
m en
t of
a fa
rm (t
he ra
pe ut
ic ho
rt ic
ul tu
re )
at a
D V
ag en
cy Im
pl em
en te
r: a
fa rm
er an
d D
V su
rv iv
or s
D em
og ra
ph ic
da ta
no t
re po
rt ed
Q ua
li ta
ti ve
Q ua
li ta
ti ve
: st
af f
pe rc
ep ti
on s
of fa
rm be
ne fi
ts an
d co
nc er
ns ,
an d
re co
nc il
in g
th e
fa rm
pr og
ra m
w it
h sh
el te
r m
is si
on
S er
ra ta
, H
er na
nd ez
- M
ar ti
ne z,
an d
M ac
ia s
(2 01
6)
5- w
ee k
pe er
le ad
er sh
ip in
te rv
en ti
on pr
og ra
m fo
r L
at in
a w
om en
ad ap
te d
fr om
th e
L id
er es
pr og
ra m
Im pl
em en
te rs
: tw
o S
pa ni
sh -
sp ea
ki ng
D V
ad vo
ca te
s
E ig
ht w
om en
ha d
pa rt
ic ip
at ed
M ea
n ag
e: 36
ye ar
s 10
0% L
at in
a 50
% ha
d gr
ad ua
te d
hi gh
sc ho
ol 50
% w
er e
si ng
le ,
di vo
rc ed
, or
se pa
ra te
d 10
0% w
er e
em pl
oy ed
10 0%
w er
e w
it h
ch il
dr en
P re
/p os
t (i
m m
ed ia
te ly
, 3
w ee
ks ,
an d
3 m
on th
s) In
te rv
ie w
s an
d jo
ur na
li ng
Q ua
nt it
at iv
e Im
pr ov
ed le
ad er
sh ip
kn ow
le dg
e an
d be
ha vi
or fo
r al
l pa
rt ic
ip an
ts Im
pr ov
ed le
ad er
sh ip
co m
pe te
nc y
fo r
fi ve
pa rt
ic ip
an ts
Q ua
li ta
ti ve
: tr
ai ni
ng ac
ti vi
ti es
ti ed
to le
ad er
sh ip
em er
ge nc
e an
d th
e fe
el in
g of
in di
vi du
al an
d gr
ou p
tr an
sf or
m at
io n
S ul
li va
n (2
00 3)
10 -w
ee k
ad vo
ca cy
pr og
ra m
fo cu
se d
on sa
fe ty
pl an
ni ng
, fi
nd in
g re
so ur
ce s,
an d
so ci
al su
pp or
t Im
pl em
en te
rs :
tr ai
ne d
fe m
al e
un de
rg ra
du at
e st
ud en
ts
27 8
w om
en ha
d pa
rt ic
ip at
ed (1
43 in
th e
in te
rv en
ti on
gr ou
p) M
ea n
ag e:
29 ye
ar s
45 %
A fr
ic an
A m
er ic
an ,
42 %
W hi
te ,
an d
7% L
at in
a T
w o
th ir
ds ha
d co
m pl
et ed
hi gh
sc ho
ol or
G E
D N
o re
la ti
on sh
ip st
at us
da ta
re po
rt ed
59 %
w er
e un
em pl
oy ed
74 %
ha d
on e
ch il
d re
si di
ng w
it h
th em
R an
do m
iz ed
co nt
ro ll
ed tr
ia l
(c on
tr ol
gr ou
p re
ce iv
ed se
rv ic
es as
us ua
l)
Q ua
nt it
at iv
e: ph
ys ic
al vi
ol en
ce ,
ps yc
ho lo
gi ca
l ab
us e,
an d
de pr
es si
on lo
w er
in tr
ea tm
en t
gr ou
p Q
ua li
ty of
li fe
an d
so ci
al su
pp or
t hi
gh er
in tr
ea tm
en t
gr ou
p W
om en
in th
e tr
ea tm
en t
gr ou
p re
po rt
ed hi
gh er
qu al
it y
of li
fe ov
er ti
m e
an d
ex pe
ri en
ce d
le ss
vi ol
en ce
S ul
li va
n, B
om st
a, an
d H
ac sk
ay lo
(2 01
6) F
le xi
bl e
fu nd
in g
fo r
D V
su rv
iv or
s to
m ai
nt ai
n em
pl oy
m en
t, pa
y m
ov in
g or
st or
ag e
fe es
, ch
an ge
lo ck
s, pa
y se
cu ri
ty de
po si
ts ,
et c.
Im pl
em en
te rs
: D
V ad
vo ca
te s
10 9
pa rt
ic ip
an ts
(5 5
ha d
pa rt
ic ip
at ed
in th
e ev
al ua
ti on
) 96
% w
om en
M ea
n ag
e: 34
.8 ye
ar s
93 %
A fr
ic an
A m
er ic
an 84
% ha
d on
e to
fo ur
ch il
dr en
R el
at io
ns hi
p st
at us
, ed
uc at
io n,
an d
em pl
oy m
en t
da ta
no t
re po
rt ed
Q ua
li ta
ti ve
Q ua
nt it
at iv
e: 94
% ho
us ed
6 m
on th
s af
te r
re ce
iv in
g fu
nd in
g Q
ua li
ta ti
ve :
fl ex
ib le
fu nd
in g
an d
st ab
il iz
ed ho
us in
g T
he im
po rt
an ce
of gr
an ts
be in
g fl
ex ib
le ,
th e
ef fe
ct of
gr an
ts be
yo nd
ho us
in g
in st
ab il
it y—
st re
ss re
li ef
, ef
fe ct
on pa
re nt
in g,
an d
ge tt
in g
ba ck
on tr
ac k
W ah
ab et
al .
(2 01
4) 6-
m on
th ,
cu lt
ur al
ly ta
il or
ed pr
og ra
m fo
cu se
d on
M I
an d
ca se
m an
ag em
en t
to re
du ce
de pr
es si
on se
ve ri
ty fo
r A
fr ic
an A
m er
ic an
w om
en Im
pl em
en te
r: pe
er D
V ad
vo ca
te
P ar
ti ci
pa nt
s: 59
w om
en O
th er
de m
og ra
ph ic
s ar
e no
t de
sc ri
be d
in th
is ar
ti cl
e bu
t ar
e de
sc ri
be d
in N
ic ol
ai di
s, W
ah ab
, et
al .
(2 01
3)
E va
lu at
io n
fo cu
se d
on M
I— re
co rd
ed an
d co
de d
10 %
of M
I se
ss io
ns to
as se
ss fi
de li
ty us
in g
th e
M ot
iv at
io na
l In
te rv
ie w
in g
T re
at m
en t
In te
gr it
y S
ca le
Q ua
nt it
at iv
e: P
ar ti
ci pa
nt s
en ga
ge d
in 0–
39 hr
of in
di vi
du al
M I
co un
se li
ng (m
ea n
8 hr
) 90
% fo
un d
th e
pr og
ra m
ve ry
us ef
ul ,
an d
90 %
w ou
ld re
co m
m en
d th
e pr
og ra
m M
I ad
he re
nc e:
83 %
Q ua
li ta
ti ve
: to
pi cs
di sc
us se
d w
er e
de pr
es si
on ,
D V
, he
al th
, em
pl oy
m en
t, an
d su
bs ta
nc e
us e.
D id
no t
fr eq
ue nt
ly di
sc us
s an
ti de
pr es
sa nt
m ed
ic at
io ns
or m
en ta
l he
al th
E nj
oy ed
ta lk
in g
to so
m eo
ne th
ey co
ul d
tr us
t an
d ap
pr ec
ia te
d M
I
N o te
. D
V �
do m
es ti
c vi
ol en
ce ;
G E
D �
G en
er al
E du
ca ti
on al
D ev
el op
m en
t; T
A N
F �
T em
po ra
ry A
ss is
ta nc
e fo
r N
ee dy
F am
il ie
s; M
I �
m ot
iv at
io na
l in
te rv
ie w
in g.
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
9COMMUNITY-BASED RESEARCH INTERVENTIONS
symptoms were most commonly described, such as a 10-session depression management program, 90-min therapy sessions focus- ing on decreasing posttraumatic stress disorder symptoms and promoting self-care, and goal- and emotion-focused therapy ses- sions (Kelly & Pich, 2014; McWhirter, 2011; Nicolaidis, Mejia, et al., 2013; Nicolaidis, Wahab, et al., 2013; Wahab et al., 2014). Three interventions focused on the intersection of mental health, self-care, and parenting (Galano, Grogan-Kaylor, Stein, Clark, & Graham-Bermann, 2017; Macy, Ermentrout, & Rizo, 2012; Raga- van et al., 2017).
Other interventions emphasized professional development and crisis management, such as flexible funding for survivors, leader- ship training, career counseling, and safety planning (Blodgett, Behan, Erp, Harrington, & Souers, 2008; Bloom et al., 2014; Chronister, Harley, Aranda, Barr, & Luginbuhl, 2012; Serrata, Hernandez-Martinez, & Macias, 2016; Sullivan, 2003; Sullivan, Bomsta, & Hacskaylo, 2016). Two interventions (one through Temporary Assistance for Needy Families [TANF] and another for pregnant women) provided referrals to DV advocates (Kramer, Nosbusch, & Rice, 2012; Levin, 2001). One intervention empha- sized survivor-centered legal advocacy through collaboration among advocates, lawyers, and prosecutors (Cattaneo, Goodman, Epstein, Kohn, & Zanville, 2009). Two interventions emphasized integrative or complementary medicine, including adding trauma- informed yoga to therapy sessions and having women participate in therapeutic horticulture through working on a farm (Clark et al., 2014; Renzetti & Follingstad, 2015). One article described a one-session workshop providing DV education, referrals, and safety planning for substance-using women (Gilbert et al., 2015).
Sixteen interventions provided in-person workshops or services; 10 occurred in small groups, and six were individualized (Blodgett et al., 2008; Cattaneo et al., 2009; Chronister et al., 2012; Clark et al., 2014; Galano et al., 2017; Kelly & Pich, 2014; Kramer et al., 2012; Levin, 2001; Macy et al., 2012; McWhirter, 2011; Nicolai- dis, Mejia, et al., 2013; Nicolaidis, Wahab, et al., 2013; Ragavan et al., 2017; Serrata et al., 2016; Sullivan, 2003; Wahab et al., 2014). Additional approaches to interventions included funding for survivors, ongoing opportunities to work on a farm at a DV agency, and computer/technology-based services (Bloom et al., 2014; Gilbert et al., 2015; Renzetti & Follingstad, 2015; Sullivan et al., 2017).
Evaluation
Evaluation design. Authors described a variety of evaluation designs. About half were process evaluations (determining whether programs were implemented as intended), with the rest including some outcome measures (examining program effects; Royse, Thyer, & Padgett, 2016). Qualitative and mixed methods studies were heavily represented, as were pre- and postsurveys. Seven evaluations included comparison groups (Bloom et al., 2014; Cattaneo et al., 2009; Clark et al., 2014; Galano et al., 2017; Gilbert et al., 2015; McWhirter, 2011; Sullivan, 2003). Sixteen articles reported at least one quantitative result (Table 1). The types of quantitative results varied and included both process metrics (e.g., participant satisfaction and number of women served) and changes in outcomes such as mental health symptoms, help-seeking behaviors, knowledge, and attitudes. Overall, the articles reported that interventions positively affected participants’
lives. When participant satisfaction was reported, it ranged from 80% to 100%.
Process evaluation results. Process metrics are described in detail in Table 1 and include participant satisfaction, number of women served, adverse events, completion of each component of the intervention, and attrition. Twelve articles also described qual- itative themes. The majority of the qualitative themes emphasized strengths of the interventions, lessons learned during development and implementation, and ideas for intervention refinement, dis- semination, or expansion. Participants relayed several strengths, including the content of the workshops, the interventions’ focus on helping survivors develop social networks, and supportive facili- tators. For example, Sullivan et al. (2016) highlighted participants’ perspectives that flexible funding led to long-term housing stabil- ity, and Macy et al. (2012) noted participants’ appreciation of the support they received from the group. Common programmatic challenges included attendance barriers, programs being too short or unsustainable, and staff being overworked. Four studies also described the importance of bilingual staff (Nicolaidis, Mejia, et al., 2013; Nicolaidis, Wahab, et al., 2013; Ragavan et al., 2017; Wahab et al., 2014). Two studies highlighted participants’ per- spectives that experiencing DV was more unifying than belonging to the same cultural group (Kelly & Pich, 2014; Ragavan et al., 2017).
Outcome evaluation results. Quantitative changes in outcomes (attitudes, knowledge, behaviors, or help seeking) were highlighted in 11 articles, as outlined in Table 1. To measure outcomes, authors used validated surveys, measures created for the study, or did not specify how the measure was created (Blodgett et al., 2008; Cattaneo et al., 2009; Galano et al., 2017; Gilbert et al., 2015; Kelly & Pich, 2014; Kramer et al., 2012; McWhirter, 2011; Ni- colaidis, Mejia, et al., 2013; Nicolaidis, Wahab, et al., 2013; Serrata et al., 2016; Sullivan, 2003). Changes in outcomes were generally positive. Articles described improvements in depression and posttraumatic stress disorder (Galano et al., 2017; Kelly & Pich, 2014; McWhirter, 2011; Nicolaidis, Mejia, et al., 2013; Nicolaidis, Wahab, et al., 2013; Sullivan, 2003). Gilbert et al. (2015) and Cattaneo et al. (2009) both found that participating in the intervention was associated with improved receipt of services. In terms of changes in knowledge or attitudes, articles reported improved feelings of safety, changes in leadership knowledge, and acceptance of antidepressants (Kramer et al., 2012; Nicolaidis, Mejia, et al., 2013; Serrata et al., 2016). Blodgett et al. (2008) found that improved outcomes in safety and functional adjustment were related to frequency of participant engagement.
Community Partnerships
Description of partnerships. Six articles explicitly described using a CBPR approach, one noted use of participatory action research, and one followed an “Experimental Social Innovation and Dissemination” approach (Clark et al., 2014; Kelly & Pich, 2014; McWhirter, 2011; Nicolaidis, Mejia, et al., 2013; Nicolaidis, Wahab, et al., 2013; Ragavan et al., 2017; Sullivan, 2003; Wahab et al., 2014). Articles that did not use those terms instead described a collaborative process in the methods section. For example, Renzetti and Follingstad (2015) wrote how community members and academics formed a committee to collaboratively decide how to best cultivate land near a DV agency.
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
10 RAGAVAN ET AL.
Team members. Community team members in 17 articles included DV advocates or staff (Bloom et al., 2014; Cattaneo et al., 2009; Chronister et al., 2012; Clark et al., 2014; Gilbert et al., 2015; Kelly & Pich, 2014; Kramer et al., 2012; Levin, 2001; Macy et al., 2012; Nicolaidis, Mejia, et al., 2013; Nicolaidis, Wahab, et al., 2013; Ragavan et al., 2017; Renzetti & Follingstad, 2015; Serrata et al., 2016; Sullivan, 2003; Sullivan et al., 2016; Wahab et al., 2014). DV survivors were included in different capacities such as participants in needs assessments that guided project design, reviewers of project materials, members of community advisory boards or teams, and program implementers (Bloom et al., 2014; Gilbert et al., 2015; Kelly & Pich, 2014; McWhirter, 2011; Nico- laidis, Mejia, et al., 2013; Nicolaidis, Wahab, et al., 2013; Ragavan et al., 2017; Renzetti & Follingstad, 2015; Sullivan, 2003; Sullivan et al., 2016; Wahab et al., 2014). Other community partners included staff at other community-based agencies, public health or governmental organizations, and general community members (Blodgett et al., 2008; Cattaneo et al., 2009; Chronister et al., 2012; Galano et al., 2017; Gilbert et al., 2015; Levin, 2001; Macy et al., 2012; McWhirter, 2011; Nicolaidis, Mejia, et al., 2013; Ragavan et al., 2017; Renzetti & Follingstad, 2015; Sullivan et al., 2016). Academic team members generally represented applied health care fields such as psychologists, social workers, nurses, and physi- cians; other academic representatives included lawyers and agri- cultural experts.
CBPR Value 1: Creating relationships of transparency and trust. Seven authors conveyed trust building through the process of developing the community–academic partnership (Chronister et al., 2012; Galano et al., 2017; Kelly & Pich, 2014; Nicolaidis, Mejia, et al., 2013; Nicolaidis, Wahab, et al., 2013; Sullivan, 2003; Wahab et al., 2014). Chronister et al. (2012) wrote how the first author started volunteering at a DV agency and then, after she had a chance to understand the needs of the community, worked with agency staff members to design the intervention. Likewise, Sulli- van (2003) described hours of conversation and engagement with DV advocates and survivors before deciding on an intervention topic, and Galano et al. (2017) wrote how “the research team worked closely with the community service agencies and stake- holders for several years to establish rapport and learn from the women and providers” (p. 346). Two articles discussed optimizing coordination in an effort to provide survivor-centered care (Catta- neo et al., 2009; Kramer et al., 2012).
Six articles also highlighted how trust building both with com- munity practitioners and DV survivors may have played a role in the success of the project (Clark et al., 2014; Galano et al., 2017; Macy et al., 2012; Nicolaidis, Wahab, et al., 2013; Sullivan, 2003; Wahab et al., 2014). For example, Galano et al. (2017) noted how a strong relationship with the community agency may have im- proved participation. Nicolaidis, Wahab, et al., (2013) and Wahab et al. (2014; describing different components of the same inter- vention) shared that African American DV survivors felt the program “engendered an important sense of trust” (p. 534), espe- cially because the program was led by an African American woman and “women overwhelmingly felt the advocate was a safe and productive person to communicate with” (p. 297). Sullivan (2003) reflected on how the intervention’s success in part was due to the fact that “the researcher is accepted as an advocate in the domestic violence community” (p. 301).
Finally, three articles discussed challenges with the intervention due to a lack of trust. Levin (2001) highlighted how communica- tion barriers between DV advocates and TANF frontline workers led to dissatisfaction in the first few years of the program. Ragavan et al. (2017) described the challenges DV survivors and academic workshop facilitators faced in developing a trusting and therapeu- tic relationship during health education workshops. Macy et al. (2012) found that participants did not trust the program initially due to a lack of understanding of the “program’s purpose, format, or potential outcomes” (p. 458).
CBPR Value 2: Building on each party’s strengths, re- sources, and interests. Ten articles described ways in which they incorporated the skills and experiences of the community– academic team. Two teams asked advocates, survivors, or both to review program materials before implementation (Bloom et al., 2014; Ragavan et al., 2017). Four articles reported using the expertise of DV advocates when developing recruitment and safety protocols (Clark et al., 2014; Macy et al., 2012; Nicolaidis, Mejia, et al., 2013; Sullivan, 2003). Authors working with specific cul- tural groups leveraged community partners’ cultural and linguistic expertise (Galano et al., 2017; Kelly & Pich, 2014; Nicolaidis, Mejia, et al., 2013; Serrata et al., 2016). For example, both Serrata et al. (2016) and Nicolaidis, Mejia, et al. (2013) used a promotora or a culturally specific community health worker as the interven- tion facilitator, noting how promotoras possess expertise about the Latina community. Galano et al., 2017; Kelly and Pich (2014), Kramer et al. (2012), Nicolaidis, Mejia, et al. (2013), Nicolaidis, Wahab, et al. (2013), and Serrata et al. (2016) described how they purposefully used bilingual and/or bicultural facilitators.
In terms of utilizing the strengths of the academic team, four articles noted the inclusion of students or trainees as intervention facilitators (Cattaneo et al., 2009; Chronister et al., 2012; Mc- Whirter, 2011; Sullivan, 2003). Trainees, who are unique to aca- demic institutions, provided supervised services that both sup- ported the intervention and gave trainees an invaluable learning experience. Three articles described how academic team members with specific expertise contributed to the program. Renzetti and Follingstad (2015) relayed that a therapeutic horticulture program was struggling until a farmer decided to lead the project. Clark et al. (2014) discussed that specialists in trauma-informed yoga led the initial pilot intervention. Ragavan et al. (2017) described the use of academic experts as workshop facilitators and noted how DV survivors and advocates preferred topic experts to lead the workshops.
Finally, four articles outlined ways in which they incorporated the unique needs of DV survivors. Two articles described being mindful of participants’ busy schedules, childcare, transportation costs, and financial barriers (Chronister et al., 2012; Macy et al., 2012). Three articles also described how survivors themselves used their unique skills and experiences to support each other during workshops (Galano et al., 2017; Macy et al., 2012; Ragavan et al., 2017). Ragavan et al. (2017) highlighted how women thought the health education curriculum facilitated supportive re- lationships between DV survivors.
Three articles reflected on the challenges inherent in utilizing the expertise of different members of the community–academic team. Wahab et al. (2014) noted the benefits of having an African American DV advocate and survivor facilitate the intervention; however, it also led to countertransference and complicated her
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relationship with some participants in cases where she knew them or the abusers. Levin (2001) similarly noted that TANF workers, many of whom may have experienced DV, “may feel resentful that they need to make special allowances for the needs of domestic violence victims . . . when their own conditions are not being addressed” (p. 218). Ragavan et al. (2017) described the challenges inherent in using separate topic-specific experts for each work- shop, primarily due to insufficient time for relationship building.
CBPR Value 3: Attending to equal distribution of structural and individual power. Articles described power sharing in two ways: (a) highlighting purposeful instances in which the team tried to equalize power and (b) reflecting on circumstances that may have exacerbated power imbalances. The primary technique used to address potential power imbalances was the development of a community advisory board (sometimes referred to as a team or committee). These boards consisted of DV advocates, academic researchers, and other interested community members who met regularly to discuss project progress and sustainability (Chronister et al., 2012; Gilbert et al., 2015; Kramer et al., 2012; Nicolaidis, Mejia, et al., 2013; Nicolaidis, Wahab, et al., 2013; Renzetti & Follingstad, 2015; Sullivan, 2003). Nicolaidis, Mejia, et al. (2013) explained how the “group collaboratively discussed priorities, brainstormed solutions, thought through pitfalls, discussed issues of cultural relevance and scientific validity, made choices, and decided on next steps” (p. 396). Three boards also focused on sustainability and capacity building (Chronister et al., 2012; Ni- colaidis, Mejia, et al., 2013; Nicolaidis, Wahab, et al., 2013). For example, members of the career development services board de- scribed by Chronister et al. (2012) would inform each other of collaboration opportunities in addition to discussing project prog- ress and reviewing evaluation data.
Three articles explicitly discussed sharing power with DV survi- vors. For example, Chronister et al. (2012) noted how DV survivors who participated in the program would serve as role models for other survivors. Kramer et al. (2012) emphasized a survivor-centered ap- proach, writing that “The client is in charge of the process, with the client’s autonomy and strengths acknowledged and respected” (p. 311). Cattaneo et al. (2009) described their program was carried out “in accordance with victims’ goals and concerns . . . aimed to amplify the voice of the victim” (p. 1228).
In three instances, authors reflected on potential power imbal- ances. Chronister et al. (2012) highlighted how the identities of the career counselors afforded them privileges different from those of the DV survivors. They also reflected on how their own implicit biases could lead to power imbalances and discussed actions they took to counter these biases. Levin (2001) expressed power im- balances between program conceptualizers and implementers, which made the implementers reluctant to fully engage. Finally, Wahab et al. (2014) shared that although using a DV survivor as a facilitator helped leverage community expertise and experience, it also led to some instances of power imbalances between the participants and facilitator.
CBPR Value 4: Equitable decision-making and mutual accountability. There was considerable variability in how au- thors described shared decision-making in the different phases of the research process— conceptualization, intervention, and evalu- ation. Twelve articles described jointly identifying the need for the project (conceptualization) through the conversations between ac- ademic and community team members, development of a project
team or advisory board, and/or through a formal needs assessment of DV survivors (Blodgett et al., 2008; Chronister et al., 2012; Gilbert et al., 2015; Kelly & Pich, 2014; Kramer et al., 2012; McWhirter, 2011; Nicolaidis, Mejia, et al., 2013; Nicolaidis, Wa- hab, et al., 2013; Ragavan et al., 2017; Renzetti & Follingstad, 2015; Sullivan, 2003; Wahab et al., 2014). For example, Kelly and Pich (2014) described identifying the project topic through con- versations with the community partner and a preintervention needs assessment. McWhirter (2011) highlighted community practitio- ners’ request that the intervention focus on skills to address non- adaptive coping.
In one case, the academic researcher decided on the research topic, but DV survivors and experts reviewed the program imple- mentation tool; in another case, the program was primarily con- ceptualized by community practitioners (Bloom et al., 2014; Macy et al., 2012). In four articles, academic and community members’ contributions to program conceptualization were not explicitly described (Cattaneo et al., 2009; Clark et al., 2014; Galano et al., 2017; Levin, 2001). For example, Levin (2001) stated that the Illinois Department of Public Health and two DV agencies collab- orated but did not specify how this was implemented. Finally, in six circumstances, the intervention was originally conceptualized by another group but adapted to best fit community needs (Blodgett et al., 2008; Bloom et al., 2014; Clark et al., 2014; Galano et al., 2017; Serrata et al., 2016; Sullivan et al., 2016).
In terms of program implementation, a DV advocate or another community team member assumed the role of the program facil- itator in seven interventions (Kramer et al., 2012; Levin, 2001; Nicolaidis, Mejia, et al., 2013; Nicolaidis, Wahab, et al., 2013; Serrata et al., 2016; Sullivan et al., 2016; Wahab et al., 2014). Two studies relied on the expertise of a promotora (Nicolaidis, Mejia, et al., 2013; Serrata et al., 2016). In nine interventions, a repre- sentative from the academic team—including licensed mental health professionals, students, attorneys, advanced practices nurses, physicians, or certified yoga instructors—led the interven- tion (Blodgett et al., 2008; Chronister et al., 2012; Clark et al., 2014; Galano et al., 2017; Gilbert et al., 2015; Kelly & Pich, 2014; Macy et al., 2012; McWhirter, 2011; Sullivan, 2003). Four inter- ventions were coimplemented by both the community and aca- demic teams (Cattaneo et al., 2009; Kramer et al., 2012; Ragavan et al., 2017; Renzetti & Follingstad, 2015). One intervention was computer-based and did not require program facilitators (Bloom et al., 2014).
Ten articles described collaboration between the community partner and academic researchers during program evaluation through the joint interpretation of data analysis, codevelopment of the evaluation design, or review of final evaluation data with community partners (Cattaneo et al., 2009; Chronister et al., 2012; Kramer et al., 2012; McWhirter, 2011; Nicolaidis, Mejia, et al., 2013; Nicolaidis, Wahab, et al., 2013; Ragavan et al., 2017; Sullivan, 2003; Sullivan et al., 2016; Wahab et al., 2014). Mc- Whirter (2011), Nicolaidis, Mejia, et al. (2013), Nicolaidis, Wa- hab, et al. (2013), and Sullivan (2003) described how the evalua- tion outcomes were chosen collaboratively to ensure that they were meaningful to the entire research team. In two articles, data were analyzed by academic researchers but periodically shared with the community team for their feedback (Ragavan et al., 2017; Sullivan et al., 2016). In two articles, the authors noted that the research team primarily played a role in program evaluation (Macy et al.,
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2012; Sullivan et al., 2016). In only one article did authors include a measurement of collaboration as an evaluation outcome (Catta- neo et al., 2009).
CBPR Value 5: Fostering responsiveness to the ongoing and evolving needs and priorities of all stakeholders. Eight articles described how the community–academic team modified the inter- vention to respond to the needs of participants, staff, and, in some cases, academic researchers. Three articles generally mentioned the use of an iterative process. Chronister et al. (2012) described regular meetings with career counselors and DV advocates for feedback on how the program could be optimized to best meet the needs of all stakeholders. Nicolaidis, Wahab, et al. (2013) wrote how “given the developmental nature of the project, we used an iterative process, intermittently assessing process data and refining the intervention to better meet participant needs” (p. 531). Sullivan (2003) highlighted how the intervention itself was flexible and could be adapted at any point to address participants’ needs.
Five articles gave specific examples of program modifications. Kelly and Pich (2014) expanded the target population of the intervention to include English-speaking Latina women at behest of the community partner and added more mindfulness modules based on feedback from participants. Macy et al. (2012) added an orientation session and provided referral sources more information about the program to respond to women’s feedback that they did not understand the purpose of the program before participating. Levin (2001) explained how TANF workers’ dissatisfaction with the program led to several changes, including retraining of TANF workers and new mechanisms for program referrals. She also described a reduction in the number of group sessions for DV survivors based on participant feedback. Nicolaidis, Wahab, et al. (2013) changed the structure of the program from group work- shops to individual sessions on motivational interviewing due to initial challenges with workshop attendance and retention. Finally, Renzetti and Follingstad (2015) explained that the therapeutic horticulture program was struggling until a highly engaged farmer was hired.
CBPR Value 6: Promoting shared ownership of project products. Product ownership is multifaceted and includes ownership of reports, manuscripts, and curricula, as well as decisions about programmatic sustainability and capacity building. In terms of scholarly ownership, 10 of the articles contained an author with a nonacademic affiliation (Clark et al., 2014; Gilbert et al., 2015; Kelly & Pich, 2014; Kramer et al., 2012; Nicolaidis, Mejia, et al., 2013; Nicolaidis, Wahab, et al., 2013; Ragavan et al., 2017; Serrata et al., 2016; Sullivan et al., 2016; Wahab et al., 2014). In all but one article, the first author held an academic affiliation (Kramer et al., 2012). Three articles included community partners in the publication process (Nicolaidis, Mejia, et al., 2013; Nico- laidis, Wahab, et al., 2013; Ragavan et al., 2017).
Sustainability was described in six articles. Chronister et al. (2012) created a resource file, career packets, and collaboration with the company Career Information System to connect women to employment opportunities. Ragavan et al. (2017) codeveloped a facilitator’s manual, which provided details on how to lead each workshop. Sullivan (2003) described replication and expansion of the program (including funding for a program coordinator posi- tion), explaining that “social action researchers have a responsi- bility to disseminate innovations that have shown to be effec- tive. . .” (p. 300). Renzetti and Follingstad (2015) described
concerns with sustainability due to rapid programmatic growth and staffing barriers. Securing additional funding for sustainability or expanded services was mentioned in four articles (Chronister et al., 2012; Kelly & Pich, 2014; Kramer et al., 2012; Sullivan, 2003).
Five articles described capacity building and particularly fo- cused on training community partners. Clark et al. (2014) noted how therapists incorporated trauma-based yoga into their clinical activities; Nicolaidis, Mejia, et al. (2013) conducted a training for both the promotora leading the intervention, as well as other DV advocates, and Wahab et al. (2014) engaged DV advocates in a training session on motivational interviewing. Chronister et al. (2012) reflected on challenges training the community partners to independently implement the intervention due to the agency’s multiple responsibilities. Ragavan et al. (2017) shared participants’ and DV advocates’ perspectives on capacity building, expressing that a volunteer or DV advocate should be trained to facilitate workshops because it was unrealistic to assume a topic-specific expert from an academic center would be available in the future.
Discussion
This systematic review of the literature summarized and syn- thesized research that used a community-based approach to de- velop and evaluate interventions for DV survivors. The key ob- jectives of this review were to briefly describe the interventions, outline the evaluation design and results, and synthesize the extent of the collaboration. A total of 20 articles describing 19 unique interventions met the inclusion criteria. Interventions, the majority of which were small-group sessions, primarily focused on crisis management and mental health. Most authors conducted process evaluations using both qualitative and quantitative approaches, but many did not assess changes in collaboratively chosen outcomes. There was considerable variability in how frequently and in how much detail the CBPR values were mentioned in articles. Many articles also reflected on program sustainability and dissemination efforts.
The majority of interventions focused on DV survivors’ mental health and safety planning needs, with the content often delivered via small group workshops. The focus on mental health is not surprising, as a plethora of literature has outlined both how expe- riencing DV negatively affects mental health and the importance of addressing mental health to promote resilience and wellness (Campbell, 2002; Goodman & Epstein, 2008). Additionally, small- group sessions may be a useful approach to build survivors’ supportive networks, which can help improve mental health symp- toms and support recovery from past trauma (Kamimura, Parekh, & Olson, 2013; Zapor, Wolford-Clevenger, & Johnson, 2015). However, survivors have a diverse array of needs and situations, which may make small-group sessions focused on mental health less relevant to some women who have experienced DV (Good- man et al., 2009; Yuan et al., 2016). For example, only two programs were computer based, which, in some circumstances, may be the safest and most accessible way for survivors to par- ticipate. To provide survivor-centered care, it may be helpful for future community–academic teams to consider other intervention topics and approaches that were less commonly described by articles in the review, such as interventions focused on poverty, housing insecurity, legal advocacy, or those that incorporate tech- nology.
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Authors in the included studies primarily reported process and qualitative evaluation results as opposed to measuring outcomes. Process metrics are important to illuminate the com- plexities of conducting community-based research and under- standing community-identified needs. However, outcome eval- uations are also important, given that the findings are of particular interest to funders (Sullivan, 2011). It is promising that the majority of the 11 articles that measured outcomes did note improvements after program participation. This suggests that a community-based approach may be useful in both addressing community needs and creating programs that directly improve outcomes for DV survivors. To further its promising role as a way to rigorously address community-designed research questions, fu- ture program evaluations should also consider assessments of outcomes.
Only four of the 11 articles measuring outcomes discussed choosing the outcomes with community input, none of which described the codevelopment of a tool specifically for the com- munity in which the study took place (McWhirter, 2011; Nicolai- dis, Mejia, et al., 2013; Nicolaidis, Wahab, et al., 2013; Sullivan, 2003). Much has been written on how outcomes used to evaluate programs in the DV field may not measure meaningful changes or provide a complete picture of how an intervention affects DV survivors (Goodman & Epstein, 2008; Sullivan, 2011). Shared decision-making about included outcomes may help bridge the gap between the pressure to measure the effectiveness of the programs and the importance of meeting each survivor’s specific needs. Likewise, when outcomes are collaboratively developed, they may be both more meaningful for the community and stronger metrics to assess potential changes (Serrata et al., 2017; Sullivan, 2011). To our knowledge only one such measure—a tool developed by a community–academic team to assess DV survivors’ perceived empowerment— exists in the extant literature (Goodman et al., 2015). This review suggests the need for more collaboratively developed measures and shared decision-making during evaluation design.
There was variability in how frequently each CBPR value was mentioned in the included articles, with shared decision-making described most frequently and flexibility to evolving needs de- scribed least frequently. It is interesting that authors in only eight of the articles discussed iterative changes to the interventions that reflected team members’ feedback and evolving priorities. Itera- tion based on participant need is itself novel to the research world, as the traditional research paradigm prioritizes consistency to maintain scientific rigor. Although it is difficult to determine exactly why iterative changes were not described by some authors, a potential reason may be peer-reviewed articles’ emphasis on methodologic consistency aligned with traditional research ap- proaches. Therefore, just as community-based research demands a shift in power from the researcher to the community, it also may challenge the traditional view that discourages the flexibility of program design and evaluation. A greater emphasis on iteration in articles describing community-based research may help demon- strate the interventions’ direct and tangible impact on the commu- nity.
We also found considerable differences in the level of detail authors provided regarding the CBPR values. For example, in some articles, authors stated they used CBPR without providing further detail. Others outlined the specific ways in which they
emphasized each CBPR value, with some even sharing specific examples of collaboration. One example is power sharing. Al- though many articles described thoughtfully developed community advisory boards, the extent of power imbalances inherent in those boards was not clearly expressed (e.g., how members made deci- sions in cases of disagreements). Understanding such nuances is fundamental to the process of community-based research. It is unclear whether the omission of details was due to author choice, journal word-length restrictions, or a lack of specific standards regarding how to write about community-based re- search. Community-based research also falls on a spectrum; thus, it is possible that some researchers were less engaged with the community as compared with others (Goodman et al., 2017; Israel et al., 1998). Regardless, it is important for journals to encourage and support community–academic teams in describing the details of their collaborations as a way to advance the field of community-based research.
Articles provided several innovative solutions to address co- ownership of project outputs, another fundamental tenet of community-based research. Examples include coauthoring manu- scripts with community practitioners, training community mem- bers to implement interventions, and developing written materials to promote sustainability. Some of these practices are similar to those discussed by Israel et al. (2006), who provided several recommendations on preserving community ownership of projects. One interesting gap is that only four articles described plans to obtain further funding to sustain the intervention. Shared access to funding is an important part of power sharing and co-ownership of project products, so it may be useful for further studies to discuss funding when describing sustainability.
Limitations
We recognize several limitations with this article. This review likely is an underestimate of the extent of community-based re- search in the DV field. Although we attempted to cast a wide net by following the Preferred Reporting Items for Systematic Re- views and Meta-Analyses guidelines for systematic reviews, it is possible that other community-based studies exist beyond what we found in our search. It is also possible that this review failed to capture community-based work being conducted by DV agencies, whose results were not published but rather given back to the community or used internally. Moreover, our findings speak only to community-based research that describes an intervention and evaluation. Finally, we recognize that the community–academic teams may have collaborated in ways not described in the included articles due to journal word limits or other restrictions. However, in our opinion, this review synthesizes aspects of the collabora- tions that were deemed most critical to the authors.
Research Implications
Despite its limitations, the results of this review set the stage for further research. It may be useful to explore how best to incorporate community members, especially DV survivors, into intervention im- plementation and evaluation without adding undue burden. Research examining DV survivors’ perspectives on the community-based re- search process and reflections on strengths and barriers of community–academic partnerships does not seem to exist but would
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be valuable. More collaboratively developed and validated measures (such as what is described by Goodman et al. (2015)) may be helpful for community–academic teams attempting to evaluate programs in ways that are meaningful to all team members. In addition, exploring DV advocates’ opinions about dissemination practices and challenges is critical to ensure that community-based work is published and available in peer-reviewed literature. Finally, there is a need for additional systematic reviews to understand the extent to which community-based research is used in needs assessments and to eval- uate interventions for children exposed to DV and people who use violence.
Clinical and Policy Implications
Several practice-focused recommendations also emerged. Col- laboratively developed interventions that use novel approaches beyond small-group sessions, including those that emphasize use of technology, should be considered. It may be useful for trainees from multiple disciplines to learn community-based research as part of encouraging a movement toward research that is codevel- oped and co-owned by the community. In fact, the National Academy of Medicine has named community-based research as a new competency recommended for all health trainees (Wallerstein & Duran, 2010). There are several guidelines on how to conduct community-based work, including a recent collaboratively written toolkit focused on training new DV researchers on the complexi- ties of CBPR (Goodman et al., 2017), a study by Sullivan et al. (2017) on how to create collaborative partnerships within the legal system, and recommendations by Israel et al. (2006) on addressing sustainability in community-based work. However, to our knowl- edge, there are no recommendations on the best ways to include DV survivors in community-based work; development of these guidelines may be useful for teams looking to actively engage survivors.
Journals with wider audiences should consider prioritizing community-based work and should apply universal standards guiding authors on how best to write about community-based research. These standards should potentially emphasize inclusion of details about the collaborative process, so the reader can apply aspects of the partnership development to their own collaborative work. Having extended page limits for studies using a community- based approach may help encourage authors to include more description about the collaborative process. Furthermore, articles that describe the use of a community-based research approach should include community partners as both authors and potentially reviewers to ensure that power sharing extends through analysis and dissemination. Finally, it may be helpful to develop databases outside of the peer-reviewed literature that provide a forum to publish community-based work. This may allow community part- ners easy access to studies, especially when they do not hold affiliations with academic libraries.
Conclusions
This systematic review of the literature describes an array of interventions, collaborations, and evaluation results, and highlights several thoughtful partnerships developed to address community need. Areas for further research include promoting outcome eval- uations using a community-based research approach, as well as
developing guidelines for teams publishing community-based re- search in peer-reviewed literature. Community-based research is a promising and needed approach to create programs that support DV survivors in ways that celebrates the strengths, wisdom, and lived experiences of survivors, advocates, and other community members.
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Received June 1, 2017 Revision received December 5, 2017
Accepted December 14, 2017 �
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17COMMUNITY-BASED RESEARCH INTERVENTIONS
- A Systematic Review of Community-Based Research Interventions for Domestic Violence Survivors
- An Overview of Community-Based Research
- History and Evolution of Community-Based Research in the DV Field
- Advantages and Challenges of Community-Based Research in the DV Field
- Evaluation of Community-Based Work in the DV Field
- Gaps in the Literature
- Study Aim
- Method
- Study Design
- Eligibility Criteria
- Search Strategy
- Study Selection
- Data Abstraction
- Results
- Interventions
- Description of interventions
- Evaluation
- Evaluation design
- Process evaluation results
- Outcome evaluation results
- Community Partnerships
- Description of partnerships
- Team members
- CBPR Value 1: Creating relationships of transparency and trust
- CBPR Value 2: Building on each party’s strengths, resources, and interests
- CBPR Value 3: Attending to equal distribution of structural and individual power
- CBPR Value 4: Equitable decision-making and mutual accountability
- CBPR Value 5: Fostering responsiveness to the ongoing and evolving needs and priorities of all s ...
- CBPR Value 6: Promoting shared ownership of project products
- Discussion
- Limitations
- Research Implications
- Clinical and Policy Implications
- Conclusions
- References
