Dataset Information

Trauma-Informed Personalized Scripts to Address Partner Violence and Reproductive Coercion: Preliminary Findings from an Implementation Randomized Controlled Trial.

ABSTRACT: Background: Family planning (FP) providers are in an optimal position to address harmful partner behaviors, yet face several barriers. We assessed the effectiveness of an interactive app to facilitate implementation of patient-provider discussions about intimate partner violence (IPV), reproductive coercion (RC), a wallet-sized educational card, and sexually transmitted infections (STIs). Materials and Methods: We randomized participants (English-speaking females, ages 16-29 years) from four FP clinics to two arms: Trauma-Informed Personalized Scripts (TIPS)-Plus and TIPS-Basic. We developed an app that prompted (1) tailored provider scripts (TIPS-Plus and TIPS-Basic) and (2) psychoeducational messages for patients (TIPS-Plus only). Patients completed pre- and postvisit surveys. We compared mean summary scores of IPV, RC, card, and STI discussions between TIPS-Plus and TIPS-Basic using Wilcoxon rank-sum tests, explored predictors with ordinal regression, and compared implementation with historical data using chi-square. Results: Of the 240 participants, 47.5% reported lifetime IPV, 12.5% recent IPV, and 7.1% recent RC. No statistically significant differences emerged from summary scores between arms for any outcomes. Several significant predictors were associated with higher scores for patient-provider discussions, including race, reason for visit, contraceptive method, and condom nonuse. Implementation of IPV, RC, and STI discussions increased significantly (p?

SUBMITTER: Hill AL

PROVIDER: S-EPMC6590718 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Trauma-Informed Personalized Scripts to Address Partner Violence and Reproductive Coercion: Preliminary Findings from an Implementation Randomized Controlled Trial.

Hill Amber L AL Zachor Hadas H Jones Kelley A KA Talis Janine J Zelazny Sarah S Miller Elizabeth E

Journal of women's health (2002) 20190410 6

Background: Family planning (FP) providers are in an optimal position to address harmful partner behaviors, yet face several barriers. We assessed the effectiveness of an interactive app to facilitate implementation of patient-provider discussions about intimate partner violence (IPV), reproductive coercion (RC), a wallet-sized educational card, and sexually transmitted infections (STIs). Materials and Methods: We randomized participants (English-speaking females, age ...[more]

PMID: 30969147

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Project description:Background: Intimate partner violence (IPV) and reproductive coercion impact women seeking care at family planning (FP) clinics. Interventions to facilitate patient-provider conversations about healthy relationships are needed. We sought to determine the added effect of providing psychoeducational messages to patients compared with tailored provider scripts alone on sexual and reproductive health outcomes at 4-6 months. Materials and Methods: We randomized participants to Trauma-Informed Personalized Scripts (TIPS)-Plus (provider scripts +patient messages) or TIPS-Basic (provider scripts only) at four FP clinics. Eligible patients included English-speaking females aged 16-29 years. Data were collected at initial visits (T1) and 4-6 months (T2) on IPV, reproductive coercion, fear, condom and other contraceptive use, self-efficacy, harm reduction behaviors, and knowledge/use of IPV-related services. We compared frequencies and summary scores between baseline and follow-up with McNemar's test of paired proportions and Signed Rank-Sum, respectively. We compared the difference in differences over time by treatment arm using two-sample t-tests, and used linear, logistic, and ordinal logistic regression to compare intervention effects at follow-up. Results: Two hundred forty patients participated (114 TIPS-Plus, 126 TIPS-Basic), 216 completed follow-up. We detected no differences in outcomes between treatment arms. Between T1 and T2, we observed overall reductions in mean summary scores for reproductive coercion (T1 = 0.08 ± 0.02, T2 = 0.02 ± 0.01, p = 0.028) and increases in contraceptive use (69.6%-87.9%, p < 0.001), long-acting reversible contraceptives (8.3%-20.8%, p < 0.001), and hidden methods (20%-38.5%, p < 0.001). Conclusions: We show no added benefit of patient-activation messages compared with provider scripts alone. Findings suggest potential utility of provider scripts in addressing reproductive coercion and contraceptive uptake (Trial Registration No. NCT02782728).

Project description:Increasing modern contraceptive use and gender equity are major foci of the recently ratified Sustainable Development Goals for 2030 and the Government of India. Coercion and sabotage by husbands and in-laws to inhibit women's access, initiation, continuation, and successful use of modern contraception methods (i.e., reproductive coercion) may contribute to low usage rates and unintended pregnancy in India; however, little is known about the extent of this problem. The current study assesses the prevalence of reproductive coercion, both husband and in-law perpetrated, among a large population-based sample. Data were collected from currently married women of reproductive age (15-49 years; N?=?1770) across 49 districts of Uttar Pradesh as part of an evaluation of a broad effort to improve the public health system in the state. Dependent variables included modern contraceptive use in the past 12 months, unintended pregnancy, and pregnancy termination. Independent variables included ever experiencing reproductive coercion (RC) by a current husband or in-laws and lifetime experience of physical and sexual intimate partner violence (IPV) by a current husband. Approximately 1 in 8 (12%) women reported ever experiencing RC from their current husbands or in-laws; 42% of these women reported RC by husbands only, 48% reported RC by in-laws only, and 10% reported RC by both husbands and in-laws. Among women experiencing RC, more than one-third (36%) reported that their most recent pregnancy was unintended; these women had 4 to 5 times greater odds of unintended pregnancy and a more than 5 times decreased likelihood of recent use of modern contraceptives than women not experiencing RC, after accounting for effects of demographics and physical and sexual IPV. Scalable and sustainable interventions in both clinical and community settings are needed to reduce RC, a potentially key factor in effective strategies for improving women's reproductive autonomy and health in India and globally.

Project description:ObjectivesAmong nationally representative cross-sections of women in need of contraception from Burkina Faso, Côte d'Ivoire and Kenya, we aimed to: (1) examine the intersection of past-year physical/sexual intimate partner violence (IPV), emotional IPV and reproductive coercion (RC) and (2) assess the impact of physical/sexual IPV, emotional IPV and RC on women's contraceptive use outcomes, including current contraceptive use, method type and covert use.DesignThe present analysis uses cross-sectional female data collected in Burkina Faso (December 2020-March 2021), Côte d'Ivoire (October-November 2021) and Kenya (November-December 2020).SettingsBurkina Faso, Côte d'Ivoire and Kenya PARTICIPANTS: Analytical samples were restricted to partnered women with contraceptive need who completed a violence module (Burkina Faso n=1863; Côte d'Ivoire n=1105; Kenya n=3390).Primary and secondary outcome measuresThe exposures of interest-past-year emotional IPV, physical/sexual IPV and RC-were assessed using abridged versions of the Revised Conflict and Tactics Scale-2 and Reproductive Coercion Scale, respectively. Outcomes of interest included current contraceptive use, contraceptive method type (female controlled vs male compliant), and covert contraceptive use, and used standard assessments.ResultsAcross sites, 6.4% (Côte d'Ivoire) to 7.8% (Kenya) of women in need of contraception experienced RC; approximately one-third to one-half of women experiencing RC reported no other violence forms (31.7% in Burkina Faso to 45.8% in Côte d'Ivoire), whereas physical/sexual IPV largely occurred with emotional IPV. In multivariable models, RC was consistently associated with covert use (Burkina Faso: aOR 2.84 (95% CI 1.21 to 6.64); Côte d'Ivoire: aOR 4.45 (95% CI 1.76 to 11.25); Kenya: aOR 5.77 (95% CI 3.51 to 9.46)). Some IPV in some settings was also associated with covert use (emotional IPV, Burkina Faso: aOR 2.99 (95% CI 1.56 to 5.74); physical/sexual, Kenya: aOR 2.35 (95% CI 1.33 to 4.17)).ConclusionsAcross settings, covert use is a critical strategy for women experiencing RC. Country policies must recognise RC as a unique form of violence with profound implications for women's reproductive health.

Project description:ObjectiveWe assessed the effectiveness of a provider-delivered intervention targeting reproductive coercion, an important factor in unintended pregnancy.Study designWe randomized 25 family planning clinics (17 clusters) to deliver an education/counseling intervention or usual care. Reproductive coercion and partner violence victimization at 1 year follow-up were primary outcomes. Unintended pregnancy, recognition of sexual and reproductive coercion, self-efficacy to use and use of harm reduction behaviors to reduce victimization and contraception nonuse, and knowledge and use of partner violence resources were secondary outcomes. Analyses included all available data using an intention-to-treat approach.ResultsAmong 4009 females ages 16 to 29 years seeking care, 3687 completed a baseline survey prior to clinic visit from October 2011 to November 2012; 3017 provided data at 12-20weeks post-baseline (T2) and 2926 at 12months post-baseline (T3) (79% retention). Intervention effects were not significant for reproductive coercion [adjusted risk ratio (ARR) 1.50 (95% confidence interval 0.95-2.35)] or partner violence [ARR 1.07 (0.84-1.38)]. Intervention participants reported improved knowledge of partner violence resources [ARR 4.25 (3.29-5.50)] and self-efficacy to enact harm reduction behaviors [adjusted mean difference 0.06 (0.02-0.10)]. In time point-specific models which included moderating effects of exposure to reproductive coercion at baseline, a higher reproductive coercion score at baseline was associated with a decrease in reproductive coercion 1 year later (T3). Use and sharing of the domestic violence hotline number also increased.ConclusionThis brief clinic intervention did not reduce partner violence victimization. The intervention enhanced two outcomes that may increase safety for women, specifically awareness of partner violence resources and self-efficacy to enact harm reduction behaviors. It also appeared to reduce reproductive coercion among women experiencing multiple forms of such abuse.

Project description:BackgroundEarly research suggests the COVID-19 pandemic worsened intimate partner violence (IPV) in the US. In particular, stay-at-home orders and social distancing kept survivors in close proximity to their abusers and restricted access to resources and care. We aimed to understand and characterize the impact of the pandemic on delivery of IPV care in Boston.MethodsWe conducted individual interviews with providers of IPV care and support in the Greater Boston area, including healthcare workers, social workers, lawyers, advocates, and housing specialists, who continued to work during the COVID-19 pandemic. Using thematic analysis, we identified themes describing the challenges and opportunites providers faced in caring for survivors during the pandemic.ResultsAnalysis of 18 interviews yielded four thematic domains, encompassing 18 themes and nine sub-themes. Thematic analysis revealed that the pandemic posed an increased threat to survivors of IPV by exacerbating external stressors and leading to heightened violence. On a system level, the pandemic led to widespread uncertainty, strained resources, amplified inequities, and loss of community. On an individual level, COVID-19 restrictions limited survivors' abilities to access resources and to be safe, and amplified pre-existing inequities, such as limited technology access. Those who did not speak English or were immigrants experienced even more difficulty accessing resources due to language and/or cultural barriers. To address these challenges, providers utilized video and telephone interactions, and stressed the importance of creativity and cooperation across different sectors of care.ConclusionsWhile virtual care was essential in allowing providers to care for survivors, and also allowed for increased flexibility, it was not a panacea. Many survivors faced additional obstacles to care, such as language barriers, unequal access to technology, lack of childcare, and economic insecurity. Providers addressed these barriers by tailoring services and care modalities to an individual's needs and circumstances. Going forward, some innovations of the pandemic period, such as virtual interactions and cooperation across care sectors, may be utilized in ways that attend to shifting survivor needs and access, thereby improving safe, equitable, and trauma-informed IPV care.

Project description:Intimate partner violence is defined by the World Health Organization as "any behavior within an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship" and it refers to a specific relationship dynamic. In recent decades, an increasing number of studies have focused on this phenomenon, considering its exponential growth over time. Many studies have focused on risk factors for violence within the couple relationship. This paper specifically analyses the association between violence and separation or divorce. Although many interventions have been developed over the years, the effectiveness of extant interventions on violent behaviors is not yet empirically supported. Since clinical experience allows to affirm that both partners can be involved in treatment for intimate partner violence especially during mandated proceedings, the present study focuses on domestic violence in separated couples involved in a child custody evaluation process. In this case, literature supports the need for individualized assessment in order to promote the best intervention according to the specific conditions of each partner, whether the battered one or the perpetrator. However, little research has been done on child custody evaluation in the presence of violent couples. The aim of the present study is to present a model of couple clinical intervention with a separated violent couple in the context of a child custody evaluation. This model can be defined as relational-intergenerational and its main aim is to understand the exchange between familial generations and to search for factors that safeguard and care for family relations. Furthermore, according also to the therapeutic assessment approach, there is an intrinsic connection between assessment and "family transformative potential." This paper presents the specific working methodology underlying this model, through the description of a single clinical case. In particular, the proposed model provides a multi-dimensional assessment comprising three levels: individual, evaluating parents' history through representations, thoughts, and feelings; interpersonal, investigating the different relations; discussion and dialogue with the parental couple about findings.

Dataset Information

Trauma-Informed Personalized Scripts to Address Partner Violence and Reproductive Coercion: Preliminary Findings from an Implementation Randomized Controlled Trial.

Publications

Trauma-Informed Personalized Scripts to Address Partner Violence and Reproductive Coercion: Preliminary Findings from an Implementation Randomized Controlled Trial.

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