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A nurse-delivered, clinic-based intervention to address intimate partner violence among low-income women in Mexico City: findings from a cluster randomized controlled trial.

ABSTRACT: BACKGROUND:Rigorous evaluations of health sector interventions addressing intimate partner violence (IPV) in low- and middle-income countries are lacking. We aimed to assess whether an enhanced nurse-delivered intervention would reduce IPV and improve levels of safety planning behaviors, use of community resources, reproductive coercion, and mental quality of life. METHODS:We randomized 42 public health clinics in Mexico City to treatment or control arms. In treatment clinics, women received the nurse-delivered session (IPV screening, supportive referrals, health/safety risk assessments) at baseline (T1), and a booster counselling session after 3 months (T2). In control clinics, women received screening and a referral card from nurses. Surveys were conducted at T1, T2, and T3 (15 months from baseline). Our main outcome was past-year physical and sexual IPV. Intent-to-treat analyses were conducted via three-level random intercepts models to evaluate the interaction term for treatment status by time. RESULTS:Between April and October 2013, 950 women (480 in control clinics, 470 in treatment clinics) with recent IPV experiences enrolled in the study. While reductions in IPV were observed for both women enrolled in treatment (OR, 0.40; 95% CI, 0.28-0.55; P?

SUBMITTER: Gupta J

PROVIDER: S-EPMC5506677 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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A nurse-delivered, clinic-based intervention to address intimate partner violence among low-income women in Mexico City: findings from a cluster randomized controlled trial.

Gupta Jhumka J Falb Kathryn L KL Ponta Oriana O Xuan Ziming Z Campos Paola Abril PA Gomez Annabel Arellano AA Valades Jimena J Cariño Gisele G Olavarrieta Claudia Diaz CD

BMC medicine 20170712 1

<h4>Background</h4>Rigorous evaluations of health sector interventions addressing intimate partner violence (IPV) in low- and middle-income countries are lacking. We aimed to assess whether an enhanced nurse-delivered intervention would reduce IPV and improve levels of safety planning behaviors, use of community resources, reproductive coercion, and mental quality of life.<h4>Methods</h4>We randomized 42 public health clinics in Mexico City to treatment or control arms. In treatment clinics, wom ...[more]

PMID: 28697769

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Project description:Intimate partner violence (IPV) victimization is a prevalent issue among women residing in Mexico City. Comprehensive and integrated health care provider (HCP) delivered programs in clinic-settings are needed, yet few have been evaluated in Latin America, including Mexico. In addition, there has been minimal attention to interventions among lower income women presenting at settings outside of antenatal care clinics. The current randomized controlled trial seeks to increase midlevel HCPs' capacity, specifically nurses, who are often the first point of contact in this setting, to identify women presenting at health clinics with experiences of IPV and to assist these women with health risk mitigation. Specific outcomes include changes in past-year IPV (physical and/or sexual), reproductive coercion, safety planning, use of community resources, and quality of life.Forty-two public health clinics in Mexico City were randomized to treatment or control clinics. Nurses meeting eligibility criteria in treatment groups received an intensive training on screening for IPV, providing supportive referrals, and assessing for health and safety risks. Nurses meeting eligibility criteria at control clinics received the standard of care which included a one-day training focused on sensitizing staff to IPV as a health issue and referral cards to give to women. Women were screened for eligibility (currently experiencing abuse in a heterosexual relationship, 18-44 years of age, non-pregnant or in first trimester) by research assistants in private areas of waiting rooms in health clinics. Consenting women completed a baseline survey and received the study protocol for that clinic. In treatment clinics, women received the nurse delivered session at baseline and received a follow-up counseling session after three months. Surveys are conducted at baseline, three months, and fifteen months from baseline.This study will provide important insight into whether a nurse-delivered program can assist women currently experiencing abuse in a Latin American context. Findings can be used to inform IPV programs and policies in Mexico City's public health clinics.NCT01661504.

Project description:BACKGROUND: Violence against women is a worldwide problem and serious human rights abuse that occurs among all social, cultural, economic and religious groups. There is a paucity of research on intimate partner violence against women in Iraq, particularly in the Kurdistan region. This study assessed the prevalence of emotional, physical and sexual intimate partner violence against women and the impact of physical violence in Erbil, the main city of the Iraqi Kurdistan region. METHODS: A cross-sectional study was carried out on a convenience sample of 800 Kurdish ever married women. Women (aged 16 to 65 years) attending two public hospitals in Erbil city for reproductive health problems were included in the study. The study was conducted between 1st of October 2009 and 30th of March 2011. Each woman was seen only once. Intimate partner violence was assessed by administering a modified version of the World Health Organization's domestic violence questionnaire through direct interview by a female doctor. Prevalence of intimate partner violence was assessed by timing (lifetime or past year), frequency (once, 2-5 times, > 5 times), and type (emotional, physical, and sexual violence). Descriptive statistical analysis was conducted with calculation of frequencies and percentages of women who reported different types, severities and impact of intimate partner violence. RESULTS: The prevalence of the overall lifetime and the overall past year intimate partner violence against women was 58.6% and 45.3%, respectively. The proportions of women experienced at least one form of lifetime intimate partner violence were: 52.6% for emotional abuse; 38.9% for physical violence; and 21.1% for sexual violence, while 43.3%, 15.1%, and 12.1% of women experienced at least one form of past year emotional, physical and sexual violence, respectively. Among those with lifetime physical violence, 11.6% were subjected to more serious injuries like stab wound, broken teeth or broken bones. CONCLUSIONS: There is a high prevalence of intimate partner violence, in particular emotional abuse behavior, against the women attending hospitals in Erbil. Physical violence is also a significant problem particularly in terms of its consequences.

Project description:BACKGROUND:Intimate partner violence (IPV) is a significant public health problem with many negative consequences, particularly for pregnant women. This randomized trial investigated the effectiveness of an IPV preventive intervention embedded within the Nurse Family Partnership (NFP) program. MATERIALS AND METHODS:Participants enrolled over a 20-month period and were interviewed at baseline and 1- and 2-year follow-up. Eligibility criteria included first pregnancy, eligible for the nutrition program Women, Infants, and Children (WIC), English or Spanish speaking, and at least 15 years of age. All women initially referred and screened were randomized to either intervention (NFP+) or control (NFP only) condition. The final sample consisted of 238 women completing baseline assessments; retention was 81% at 2-year follow-up. RESULTS:Analyses indicated that there were no main effects: the intervention affected participants differently depending on their baseline experience with IPV. For physical violence victimization, an interaction between baseline victimization and treatment was found; the intervention reduced victimization at 1 year (and approached significance at 2 years), but only among women who had not experienced past-year physical victimization at baseline. For sexual violence victimization, another interaction emerged; women in the intervention group were more likely to report sexual violence victimization at 2-year follow-up, but only among participants who had reported sexual victimization at baseline. The only effect on IPV perpetration was psychological perpetration at 2-year follow-up; again, the treatment effect was moderated by baseline perpetration. The intervention reduced psychological perpetration for participants who were nonperpetrators at baseline, but had no effect on those reporting perpetration. CONCLUSIONS:Overall, findings suggest that the intervention was effective in reducing some forms of violence among those not experiencing IPV at baseline, but was ineffective or potentially harmful for those already experiencing IPV.

Project description:BackgroundIntimate partner violence (IPV) during pregnancy is associated with adverse maternal and child health outcomes, including poor mental health. Previous IPV research has largely focused on women's victimization experiences; however, evidence suggests young women may be more likely to engage in bilateral violence (report both victimization and perpetration) or perpetrate IPV (unilateral perpetration) during pregnancy than to report being victimized (unilateral victimization). This study examined prevalence of unilateral victimization, unilateral perpetration, and bilateral violence, and the association between these IPV profiles and mental health outcomes during pregnancy among young, low-income adolescents.MethodsSurvey data were collected from 930 adolescents (14-21 years; 95.4% Black and Latina) from fourteen Community Health Centers and hospitals in New York City during second and third trimester of pregnancy. Multivariable regression models tested the association between IPV profiles and prenatal depression, anxiety, and distress, adjusting for known predictors of psychological morbidity.ResultsThirty-eight percent of adolescents experienced IPV during their third trimester of pregnancy. Of these, 13% were solely victims, 35% were solely perpetrators, and 52% were engaged in bilateral violence. All women with violent IPV profiles had significantly higher odds of having depression and anxiety compared to individuals reporting no IPV. Adolescents experiencing bilateral violence had nearly 4-fold higher odds of depression (OR = 3.52, 95% CI: 2.43, 5.09) and a nearly 5-fold increased likelihood of anxiety (OR = 4.98, 95% CI: 3.29, 7.55). Unilateral victims and unilateral perpetrators were also at risk for adverse mental health outcomes, with risk of depression and anxiety two- to three-fold higher, compared to pregnant adolescents who report no IPV. Prenatal distress was higher among adolescents who experienced bilateral violence (OR = 2.84, 95% CI: 1.94, 4.16) and those who were unilateral victims (OR = 2.21, 95% CI: 1.19, 4.12).ConclusionsAll violent IPV profiles were associated with adverse mental health outcomes among pregnant adolescents, with bilateral violence having the most detrimental associations. Comprehensive IPV screening for both victimization and perpetration experiences during pregnancy is warranted. Clinical and community prevention efforts should target pregnant adolescents and their partners to reduce their vulnerability to violence and its adverse consequences.Trial registrationClinicalTrials.gov, NCT00628771 . Registered 29 February 2008.

Dataset Information

A nurse-delivered, clinic-based intervention to address intimate partner violence among low-income women in Mexico City: findings from a cluster randomized controlled trial.

Publications

A nurse-delivered, clinic-based intervention to address intimate partner violence among low-income women in Mexico City: findings from a cluster randomized controlled trial.

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