Factors mediating the impacts of child abuse and intimate partner violence on chronic pain: A cross-sectional study 11 Medical and Health Sciences 1117 Public Health and Health Services 17 Psychology and Cognitive Sciences 1701 Psychology

Background: Most research on the health impacts of intimate partner violence (IPV) and child abuse has been conducted in Western countries and may not be generalizable to women living in different contexts, such as Saudi Arabia. Chronic pain, a disabling health issue associated with experiences of both child abuse and IPV among women, negatively impacts women\u27s well-being, quality of life, and level of functioning. Yet, the psychosocial mechanisms that explain how abuse relates to chronic pain are poorly understood. We developed and tested a theoretical model that explains how both IPV and child abuse are related to chronic pain. Methods: We recruited a convenience sample of 299 Saudi women, who had experienced IPV in the past 12 months, from nine primary health care centers in Saudi Arabia between June and August 2015. Women completed a structured interview comprised of self-report measures of IPV, child abuse, PTSD, depressive symptoms, chronic pain, and social support. Using Structural equation modeling (SEM), we analyzed the proposed model twice with different mental health indicators as mediators: PTSD symptoms (Model 1) and depressive symptoms (Model 2). Results: Both models were found to fit the data, accounting for 31.6% (Model 1) and 32.4% (Model 2) of the variance in chronic pain severity. In both models, mental health problems (PTSD and depressive symptoms) fully mediated the relationship between severity of IPV and child abuse and chronic pain severity. Perceived family support partially mediated the relationship between abuse severity and depressive symptoms. Conclusions: These results underscore the significance of considering lifetime abuse, women\u27s mental health (depressive and PTSD symptoms) and their social resources in chronic pain management and treatment

The Association between Intimate Partner Violence and Functional Gastrointestinal Disorders and Symptoms among Adult Women: Systematic Review

Functional gastrointestinal disorders (FGIDs) and symptoms have been identified as possible health consequences of intimate partner violence (IPV). However, whether specific types of abuse (i.e., psychological, physical and sexual) are associated with FGIDs and the implications of FGIDs for women’s quality of life (QOL) in the context of IPV are not well understood. This systematic review examined the association between the different types of IPV and the risk of FGIDs and symptoms among adult women and assessed the impact of FGIDs and symptoms on women’s QOL. Seven electronic databases were searched using the following criteria: English language studies of adult women (15 years or older) who had experienced IPV and reported FGIDs and symptoms; both quantitative and qualitative studies were included, and no time frame for publication was specified. A total of 15 studies (14 quantitative, 1 qualitative) conducted in 9 countries satisfied our inclusion criteria. IPV was associated with increased odds (1.6 to 2.7) of reporting a FGID. Each type of IPV (physical, sexual, psychological) was associated with FGIDs, alone or in combination. FGIDs were associated with some aspects of women’s QOL in the context of IPV (specifically seeking health care). Attention to the association between IPV and FGIDs could help strengthen health care for women who have experienced IPV and are suffering from FGIDs and inform future research to understanding this association in more depth

The process, outcomes, and challenges of feasibility studies conducted in partnership with stakeholders: A health intervention for women survivors of intimate partner violence

Feasibility studies play a crucial role in determining whether complex, community-based interventions should be subject to efficacy testing. Reports of such studies often focus on efficacy potential but less often examine other elements of feasibility, such as acceptance by clients and professionals, practicality, and system integration, which are critical to decisions for proceeding with controlled efficacy testing. Although stakeholder partnership in feasibility studies is widely suggested to facilitate the research process, strengthen relevance, and increase knowledge transfer, little is written about how this occurs or its consequences and outcomes. We began to address these gaps in knowledge in a feasibility study of a health intervention for women survivors of intimate partner violence (IPV) conducted in partnership with policy, community and practitioner stakeholders. We employed a mixed-method design, combining a single-group, pre-post intervention study with 52 survivors of IPV, of whom 42 completed data collection, with chart review data and interviews of 18 purposefully sampled participants and all 9 interventionists. We assessed intervention feasibility in terms of acceptability, demand, practicality, implementation, adaptation, integration, and efficacy potential. Our findings demonstrate the scope of knowledge attainable when diverse elements of feasibility are considered, as well as the benefits and challenges of partnership. The implications of diverse perspectives on knowledge transfer are discussed. Our findings show the importance of examining elements of feasibility for complex community-based health interventions as a basis for determining whether controlled intervention efficacy testing is justified and for refining both the intervention and the research design

Patterns and Predictors of Service Use Among Women Who Have Separated from an Abusive Partner

Using baseline data from a survey of 309 Canadian women recently separated from an abusive partner, we investigated patterns of access to health, social, legal, and violence-specific services and whether abuse history and social and health variables predict service use. We compared rates of service use to population rates, and used logistic regression to identify determinants of use. Service use rates were substantially higher than population estimates in every category, particularly in general and mental health sectors. Although women were confident in their ability to access services, they reported substantial unmet need, difficulty accessing services, and multiple barriers. The strongest unique predictors of use varied across service type. Health variables (high disability chronic pain, symptoms of depression and PTSD), low income, and mothering were the most consistent predictors. Service providers and policy makers must account for social location, abuse history, and health status of Intimate Violence (IPV) survivors. Strategies to enhance access to primary health care services, and to create a system of more integrated, accessible services, are required

What About the Men? A Critical Review of Men’s Experiences of Intimate Partner Violence

Intimate partner violence (IPV) is a health problem affecting people of all genders and other social locations. While IPV victimization of cis-gendered women has been widely researched, how men conceptualized or experience IPV victimization, and the variations in their experiences of IPV, has not been thoroughly examined. In this critical review of men’s experiences of IPV, an extensive search of peer reviewed literature was conducted using multiple database (Cochrane database, MEDLINE, CINAHL, Embase, PsycgINFO, and Google Scholar) as well as the gray literature. We critically reviewed examining the conceptual foundations of IPV victimization among men. The influence or gender roles and societal expectation on men’s experiences and perceptions of IPV victimization and their help-seeking behavior are explored. Current knowledge about types, tactics, and patterns of IPV against men and the health and social consequences of IPV are addresses. Additionally, the conceptual and empirical limitations of current research are discussed, including the tendency to compare only the prevalence rates of discrete incidents of abuse among women versus men; the use of IPV measures not designed to capture men’s conceptualizations of IPV; and the lack of attention given to sex and gender identity of both the victim and perpetrator. Future research priorities that address these limitations and seek to strengthen and deepen knowledge about IPV among men are identified

Self-reported oral health among a community sample of people experiencing social and health inequities: Cross-sectional findings from a study to enhance equity in primary healthcare settings

Objective: To describe the self-reported oral health issues among a community sample of primary care clients experiencing socioeconomic disadvantages. Methods: As part of a larger mixed-methods, multiple case study evaluating an equity-oriented primary healthcare intervention, we examined the oral health of a sample of 567 people receiving care at four clinics that serve marginalised populations in two Canadian provinces. Data collected included self-rated oral health and experiences accessing and receiving healthcare, standard self-report measures of health and quality of life, and sociodemographic information. Results: The prevalence of self-rated poor oral health was high, with almost half (46.3%) of the participants reporting poor or fair oral health. Significant relationships were observed between poor oral health and vulnerabilities related to mental health, trauma and housing instability. Our findings suggest that the oral health of some Canadian populations may be dramatically worse than what is reported in existing population health surveys. Conclusions: Our findings reinforce the importance of addressing oral health as part of health equity strategies. The health and oral health issues experienced by this client cohort highlight the need for interdisciplinary, team-based care that can address the intersections among people\u27s health status, oral health and social issues

Development of a brief measure of intimate partner violence experiences: The Composite Abuse Scale (Revised)-Short Form (CAS\u3csub\u3eR\u3c/sub\u3e-SF)

Objectives: Approaches to measuring intimate partner violence (IPV) in populations often privilege physical violence, with poor assessment of other experiences. This has led to underestimating the scope and impact of IPV. The aim of this study was to develop a brief, reliable and valid self-report measure of IPV that adequately captures its complexity. Design: Mixed-methods instrument development and psychometric testing to evolve a brief version of the Composite Abuse Scale (CAS) using secondary data analysis and expert feedback. Setting: Data from 5 Canadian IPV studies; feedback from international IPV experts. Participants: 31 international IPV experts including academic researchers, service providers and policy actors rated CAS items via an online survey. Pooled data from 6278 adult Canadian women were used for scale development. Primary/secondary outcome measures: Scale reliability and validity; robustness of subscales assessing different IPV experiences. Results: A 15-item version of the CAS has been developed (Composite Abuse Scale (Revised)-Short Form, CASR-SF), including 12 items developed from the original CAS and 3 items suggested through expert consultation and the evolving literature. Items cover 3 abuse domains: physical, sexual and psychological, with questions asked to assess lifetime, recent and current exposure, and abuse frequency. Factor loadings for the final 3-factor solution ranged from 0.81 to 0.91 for the 6 psychological abuse items, 0.63 to 0.92 for the 4 physical abuse items, and 0.85 and 0.93 for the 2 sexual abuse items. Moderate correlations were observed between the CASR-SF and measures of depression, post-traumatic stress disorder and coercive control. Internal consistency of the CASR-SF was 0.942. These reliability and validity estimates were comparable to those obtained for the original 30-item CAS. Conclusions: The CASR-SF is brief self-report measure of IPV experiences among women that has demonstrated initial reliability and validity and is suitable for use in population studies or other studies. Additional validation of the 15-item scale with diverse samples is required

Reclaiming our spirits: Development and pilot testing of a health promotion intervention for indigenous women who have experienced intimate partner violence

Indigenous women are subjected to high rates of multiple forms of violence, including intimate partner violence (IPV), in the context of ongoing colonization and neo-colonization. Health promotion interventions for women who experience violence have not been tailored specifically for Indigenous women. Reclaiming Our Spirits (ROS) is a health promotion intervention designed for Indigenous women living in an urban context in Canada. In this paper, we describe the development of the intervention, results of a pilot study, and the revised subsequent intervention. Building on a theory-based health promotion intervention (iHEAL) showing promising results in feasibility studies, ROS was developed using a series of related approaches including (a) guidance from Indigenous women with research expertise specific to IPV and Indigenous women’s experiences; (b) articulation of an Indigenous lens, including using Cree (one of the largest Indigenous language groups in North America) concepts to identify key aspects; and (c) interviews with Elders (n10) living in the study setting. Offered over 6-8 months, ROS consists of a Circle, led by an Indigenous Elder, and 1:1 visits with a Registered Nurse, focused on six areas for health promotion derived from previous research. Pilot testing with Indigenous women (n21) produced signs of improvement in most measures of health from pre- to post-intervention. Women found the pilot intervention acceptable and helpful but also offered valuable suggestions for improvement. A revised intervention, with greater structure within the Circle and nurses with stronger knowledge of Indigenous women’s experience and community health, is currently undergoing testing

The Efficacy of a Health Promotion Intervention for Indigenous Women: Reclaiming Our Spirits

Indigenous women globally are subjected to high rates of multiple forms of violence, including intimate partner violence (IPV), yet there is often a mismatch between available services and Indigenous women’s needs and there are few evidence-based interventions specifically designed for this group. Building on an IPV-specific intervention (Intervention for Health Enhancement After Leaving [iHEAL]), “Reclaiming Our Spirits” (ROS) is a health promotion intervention developed to address this gap. Offered over 6 to 8 months in a partnership between nurses and Indigenous Elders, nurses worked individually with women focusing on six areas for health promotion and integrated health-related workshops within weekly Circles led by an Indigenous Elder. The efficacy of ROS in improving women’s quality of life and health was examined in a community sample of 152 Indigenous women living in highly marginalizing conditions in two Canadian cities. Participants completed standard self-report measures of primary (quality of life, trauma symptoms) and secondary outcomes (depressive symptoms, social support, mastery, personal agency, interpersonal agency, chronic pain disability) at three points: preintervention (T1), postintervention (T2), and 6 months later (T3). In an intention-to-treat (ITT) analysis, Generalized Estimating Equations (GEE) were used to examine hypothesized changes in outcomes over time. As hypothesized, women’s quality of life and trauma symptoms improved significantly pre- to postintervention and these changes were maintained 6 months later. Similar patterns of improvement were noted for five of six secondary outcomes, although improvements in interpersonal agency were not maintained at T3. Chronic pain disability did not change over time. Within a context of extreme poverty, structural violence, and high levels of trauma and substance use, some women enrolled but were unable to participate. Despite the challenging circumstances in the women’s lives, these findings suggest that this intervention has promise and can be effectively tailored to the specific needs of Indigenous women

Development of a nurse home visitation intervention for intimate partner violence

Background: Despite an increase in knowledge about the epidemiology of intimate partner violence (IPV), much less is known about interventions to reduce IPV and its associated impairment. One program that holds promise in preventing IPV and improving outcomes for women exposed to violence is the Nurse-Family Partnership (NFP), an evidence-based nurse home visitation program for socially disadvantaged first-time mothers. The present study developed an intervention model and modification process to address IPV within the context of the NFP. This included determining the extent to which the NFP curriculum addressed the needs of women at risk for IPV or its recurrence, along with client, nurse and broader stakeholder perspectives on how best to help NFP clients cope with abusive relationships. Methods. Following a preliminary needs assessment, an exploratory multiple case study was conducted to identify the core components of the proposed IPV intervention. This included qualitative interviews with purposeful samples of NFP clients and community stakeholders, and focus groups with nurse home visitors recruited from four NFP sites. Conventional content analysis and constant comparison guided data coding and synthesis. A process for developing complex interventions was then implemented. Results: Based on data from 69 respondents, an IPV intervention was developed that focused on identifying and responding to IPV; assessing a client\u27s level of safety risk associated with IPV; understanding the process of leaving and resolving an abusive relationship and system navigation. A need was identified for the intervention to include both universal elements of healthy relationships and those tailored to a woman\u27s specific level of readiness to promote change within her life. A clinical pathway guides nurses through the intervention, with a set of facilitators and corresponding instructions for each component. Conclusions: NFP clients, nurses and stakeholders identified the need for modifications to the existing NFP program; this led to the development of an intervention that includes universal and targeted components to assist NFP nurses in addressing IPV with their clients. Plans for feasibility testing and evaluation of the effectiveness of the IPV intervention embedded within the NFP, and compared to NFP-only, are discussed. © 2012 Jack et al; licensee BioMed Central Ltd