Understanding Domestic Violence and its Adverse Effects
Domestic violence can be implied as the prevalence of violent acts which exists between two individuals, both of whom had held or have an intimate relationship with each other within the domestic setting. Domestic violence can comprise of sexual, physical and psychological abuse. Additional forms of abuse which can also exist during domestic violence are economic, social, sexual and verbal abuse. According to the Australian Institute of Health and Welfare (AIHW, 2018), one of out of five women (1.7 million) and one out of twenty (428, 000), men have experienced sexual assault or a threat of sexual assault, since the age of fifteen years. Additionally, 9000 men, 34, 000 children and 72, 000 women availed services for homelessness during 2016 to 20167 as a result of domestic or family violence. Further, the AIHW (2018), also observed that intimate partner violence contributes to greater risk of death, illness or disability in comparison to any other risk factor for females in the age group of 25 to 44 years. Such alarming statistics thus warrant the need to take immediate interventions
If not controlled, long term exposure to domestic or sexual violence abuse has the potential to inflict adverse complications in the victims such as poor general health outcomes, bodily pain, and mental health illness like depression and incur higher long term expenditures from availing specialist care services. These risks are further aggravated as a result of a lack of awareness – while individuals agree on the need to provide immediate intervention and protection to victims of domestic, there is often a misunderstanding that certain acts of violence are justified due to the perpetrator experiencing extreme forms of uncontrollable anger. Additionally, there often lie limited understanding concerning the reasons contributing to victims continuing to remain in violent relationships. Such adverse consequences coupled with the previously reviewed statistics of domestic violence further demonstrates the need to research, explore, evaluate the effectiveness of a range of preventive or mitigation programs of domestic violence and implement the same to understand its impact on the prevalence of this issue within the community.
Thus, with this respect, the aim of this scoping review is to examine the various interventions or ways in which, awareness concerning the prevalence and consequences of domestic violence can be disseminated and the key programs which need to be implemented or modified so as to enhance their effectiveness. By reviewing the effectiveness of a range of awareness and intervention programs, this scoping review also examines the impacts of such programs on the prevalence of domestic violence. This scoping review, by evaluating the effectiveness of various intervention programs, also explores the strategies by which victims of domestic violence can cope and develop self-efficacy from the adverse consequences of domestic violence respectively.
Thus, this scoping review aims to understand whether the prevalence of domestic violence remains same, before and after the implementation of such interventions. Thus, the scoping review question which this paper is based upon is, ‘what is the impact of various awareness or intervention programs on the prevalence of domestic violence?’
Lack of Awareness and Understanding of Domestic Violence
As mentioned previously, a scoping review was conducted to critically review and evaluate existing studies relevant to the scoping review question – that is, the effectiveness and impact of various awareness or intervention programs on the prevalence of domestic violence respectively. In comparison to a systematic review which follows a structured form of evidence based literature evaluation in the form of thematic analysis – a scoping review is based on conducting an unstructured analysis of existing studies for the purpose of identifying major concepts, characteristics and limitations in the same. This form of narrative, unstructured yet critical information, obtained from a scoping review, demonstrates useful implications in the form of directing future practices of policy making and therapeutic interventions respectively.
For the purpose of conducting a scoping review, the evidence based articles to be evaluated were selected based on the following eligibility criteria:
- Scholarly, peer reviewed articles, published between 2015 and 2021 and with language limiters such as English, so as to include evidence which is recent.
- Scholarly, peer reviewed articles which explore various interventions or awareness programs of domestic violence, so as to demonstrate coherence and relevance to the scoping review question.
- Scholarly, peer reviewed articles which explore the impact of such interventions of awareness programs as well as recommend coping strategies for victims of domestic violence, so as to demonstrate coherence and relevance to the scoping review question.
An electronic search strategy was undertaken wherein, key words which were relevant to the scoping review question, such as ‘domestic violence’, ‘intervention’, ‘awareness’, program’, ‘impact’ and ‘prevalence’ were used. These key words were also combined with Boolean Operators like ‘AND’ so as to expand upon the search strategy and ensure that only those articles which contained to these keywords were obtain. For example, the phrase containing the keywords and Boolean operators: ‘prevalence’ AND ‘domestic violence’, ‘intervention’, OR ‘program’, AND ‘impact’ ensured that only those articles which contained these keywords were included in the search strategy. Databases like PsycINFO, CINAHL, Google Scholar and PubMed were used for the search strategy since these databases are known to contain a repertoire of peer reviewed articles on subjects which were relevant to the scoping review question – such as health, medicine, biology, psychology and behavioral science. For example, after using a syntax of: (((((domestic violence) AND (intervention)) AND (program)) AND (impact)) AND (awareness)) AND (impact) and a publication limitation of 2015 to 2021 – a total of 23 results were retrieved from PubMed.
After implementation of the search strategy, a total of 5 articles which demonstrated relevance to the scoping review question and the eligibility criteria were selected. The 10 information sources so collected comprised of research designs such as cross sectional studies, mixed methods studies, qualitative studies, quasi-experimental or experimental studies and randomized controlled trials which explored the prevalence of domestic violence as well as various intervention or awareness programs and their effectiveness.
Studies for this paper were selected, based on their relevance or coherence to the scoping review question. For instance, articles which were found to explore findings which were not relevant to the eligibility criteria were excluded. These comprised of articles which were grey literature or not peer review or based on research designs which were of poor methodological quality such as opinion articles. Additionally, articles which were found to explore findings which were beyond the scope of the eligibility criteria, such as psychiatric treatments and assessments for mitigating psychological effects of domestic violence or residential care programs for children who were isolated after witnessing domestic violence, were excluded from this review. These have been represented diagrammatically using a PRISMA flow chart (Annex 1).
Aim of the Scoping Review
Articles were also selected based on the ability of the researcher to critically examine and evaluate the validity, reliability and methodical quality of selected articles. This was done to ensure that the scoping review demonstrates compliance to the reporting requirements enlisted in the ‘Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist’.
Data from the selected 10 articles were extracted or collected and synthesis in the form of a narrative analysis, based on their characteristics such as their methods, results, research aims, population characteristics, critical appraisal of limitations and implications for future practice respectively. These were then synthesized into key themes where articles having similar significant findings were grouped under a particular content, topic or theme. These have been presented narratively in details in the following ‘Results’ section.
The qualitative, focus group study by Purwaningtyas et al., (2019), aimed to examine the role of primary healthcare physicians during the implementation of interventions programs which provide assistance and awareness on domestic violence. This with regards to a Violence against women (VAW) program which was implemented in a Primary Healthcare Center in Indonesia. A total of six primary healthcare physicians were recruited and their responses were obtained using as focus group discussion. The findings revealed that the role of primary healthcare physicians within domestic violence intervention programs were limited. The reasons for the same were: limited number of physician workforce, lack of infrastructure which support the involvement of physicians and the lack of adequate knowledge of domestic violence across physicians. These findings demonstrate useful implications in the form of supporting the importance of involving primary healthcare physicians in domestic violence intervention programs. This is because physicians are known to hold a sound therapeutic relationships with patients as well as demonstrate adequate knowledge on physiological outcomes and assessments which can shed light on the suspected risk and extent of violence experienced by victims. However, it is worthwhile to note that a limited sample size, as well as the risk of subjective responses like focus groups being prone to bias and social desirability are limitations which can affect the validity and reliability of this study. Additionally, restricting the sample size to Indonesia further restricts the applicability, transferability and generalizability of findings of this study (Purwaningtyas et al., 2019).
The cluster and repeat cross sectional, randomized trial by Clark et al., (2019) aimed to explore and compared the effect of a radio awareness program and a radio awareness program combined with a community engagement program on the 12 month prevalence of intimate partner violence in Nepal. The sample comprise of 36 rural communities across three village districts of Nepal and were randomly assigned to intervention and control groups. All participants received the control group intervention received behavior change and domestic violence awareness program via radio for a period of 40 weeks. Additionally, intervention group participants also received community engagement programs such as local discussing groups, street theatre and awareness messages from local leaders. The results indicate higher rates of intimate partner violence in control group areas as compared to those areas where groups received both radio as well as community engagement interventions. These findings are significant since they demonstrate useful implications in the form of demonstrating how a combination of both public media as well as community engagement campaigns can contribute to decreased prevalence of domestic violence respectively. While the use of randomized controlled measures and blinding improved the validity and reliability of findings, restricting the sample to only rural regions of a developing country further limit the generalizability of interventions used in this study across developed country population (Clark et al., 2019).
Scoping Review Process
The quasi-experimental design by Borsky et al., (2016) aimed to examine the impact of a bystander behavior program on the prevalence of dating or intimate partner violence across college students. Participants comprised of students from two colleges in Virginia, of which the intervention group (n = 329) were required to attend a 30 minute educational presentation on intimate partner violence and a social marketing campaign for a week which aimed at increasing awareness on the importance of bystanders to intervene for the de-escalation of abuse experienced by a suspected victim. As per the results, it was observed that the intervention group demonstrated a statistically significant increase in bystander behaviors (such as motivating a peer to obtain assistance from an abusive relationship) in comparison to control group (p > 0.05). Such findings thus demonstrate useful implications in the form of showing how bystander behavior programs can contribute to decreased prevalence of domestic abuse and violence respectively. However, the lack of any long term follow ups to understand the long term impact of such interventions on future student cohorts post intervention thus impact the reliability of these findings (Borsky et al., 2016).
The experimental and mixed method study by Bolhari et al., (2018) aimed to explore the impact of a spouse abuse prevention program across a sample of married women who were victims of domestic violence across a district in Tehran. This was in context to the spouse abuse program which was conducted across Tehran’s West Health Center and the intervention comprised of working with scientific committee and police services to offer screening, education and supportive services to the victims as well as the distribution of brochures and educational pamphlets. As per survey findings, the highest rate of satisfaction of 64% were observed in the program communication and encounter services while the lowest rate of satisfaction of 32% and 34% were reported for the quality of managerial support services and quality of presenting services respectively. Qualitative interviews revealed that staff and managers positively responded to the program and were willing to support the victims. However, interviews also revealed that absence of supportive laws, loneliness in victims, in adequate psychosocial and medical support and the absence of high level juridisction in courts for domestic violence along with absence of free of cost legal and social services were the key limitations. These findings thus reveal the need for the implementation of a comprehensive, governmentally assistance program comprising of a range of multidisciplinary professionals so as to assist victims of domestic violence for their multifaceted problems of health, financial, legal, emotional and social problems respectively. However, the usage of self-reported subjective data in the form of interviews or surveys as well as recruiting samples with very specific demographic characteristics (such as married women participating in the program) contribute to limitations of bias and limited validity and reliability of findings (Bolhari et al., 2018).
The qualitative study by Shoham et al., (2017) aimed to examine the perceptions held by prison staff regarding the importance and effectiveness of a rehabilitation counseling program for domestic violence victims respectively. This study was conducted as a part of the program titled ‘House of Hope’ where participating prisoners in Israeli prison services were found to demonstrate reduced rates of reoffending and domestic abuse behaviors. The qualitative part of this study comprised of conducting semi-structured interviews of prison staff as well as previous directors of this rehabilitation program. As per the findings, it was observed that staff felt that the success of this rehabilitation program lied in its ability to provide a less stressful and therapeutic prison environment to former perpetrators. Further, the combination of a range of evidence based rehabilitation interventions such as group therapy, individual therapy, psychodynamic therapy and cognitive behavioral therapy for a prolonged period of 1 year were the reasons contributing to long term reductions in reoffending and acts domestic violence by former prisoners. The findings of this study demonstrate useful implications in the form of showing how in addition to programs which support the victim, rehabilitation counseling programs are also important in order to reduce long term tendency of domestic abuse perpetrators to engage in such abusive behaviors. However, limiting the responses only to prison staff and not the prisoners as well as the risk of bias in subjective findings were key limitations which hinder the applicability, reliability and generalizability of findings across different contexts (Shoham et al., 2017).
Based on the scoping review, the findings can be tabulated into the following key themes:
- Theme 1: Multidisciplinary Community Programs: As per the findings from Bolhari et al., (2018), Clark et al., (2019) and Purwaningtyas et al., (2019), intervention programs which are multidisciplinary and involve a variety of inter-professional specialists from different fields, are likely to contribute positively in reducing the prevalence of domestic and intimate partner violence. These can include community campaigns, the involvement of police and medical services as well as the involvement of social welfare workers and physicians since such multiple expertise will assist victims to cater to their multifaceted legal, health, financial and social problems. It is thus recommended that governments work towards the implementation of the programs which incorporate a range of such specialist services so as to ensure comprehensive, long term reduction and promotion of wellbeing across victims of domestic abuse (Bolhari et al., 2018; Clark et al., 2019; Purwaningtyas et al., 2019).
- Theme 2: Bystander Behavior Programs: As per the findings by Borsky et al., (2016), it was observed that in addition to supportive or assistance programs, implementing bystander programs which can improve the knowledge of the public on the importance of intervening to assist a victim of violence was found to be beneficial in decreasing the prevalence of domestic abuse. It is thus important that the government and healthcare or social organizations collaborate to implement campaigns which can educate the public on the need to take action if they suspect their near or dear ones as being victimized by abuse (Borsky et al., 2016).
- Theme 3: Rehabilitation Counseling Programs: Lastly, as per the findings by Shoham et al., (2017), it was observed that the implementation of a rehabilitation counseling program was important to reduce the prevalence of domestic abuse since it directly aims to correct and assist perpetrators in identifying and regulating their offensive actions which can cause harm. However, in order to enhance its effectiveness, it is important that such rehabilitation counseling programs provide a relaxing, therapeutic environment to perpetrators and also a range of behavioral and psychotherapeutic techniques so as to assist them in understanding the causes, triggers and stimuli which can regulate their risk of offending and harming (Shoham et al., 2017).
Conclusion
A scoping review of 5 articles, comprising of qualitative, quasi-experimental, cross sectional, mixed methods and randomized controlled trials was conducted. Based on the themes so generated, it was found that the prevalence of domestic violence can reduce if victims as well as the public and perpetrators are able to access supportive strategies in the form of Multidisciplinary Community Programs, Bystander Behavior Programs and Rehabilitation Counseling Programs respectively.
Since this was a scoping review without any form of statistical analysis – there is a need to conduct further statistical procedures like a meta-analysis so as to establish where their exist any cause-effect relationship between these programs and the prevalence as well as wellbeing or quality of life of domestic abuse victims respectively. For this scoping review, only one randomized controlled trial was retrieved – which is a key limitation considering that other research designs qualitative, quasi-experimental, cross sectional and mixed methods do not incorporate blinding and may not be effective in hypothesizing and testing any causal relationships between key variables.
Conclusion
These findings demonstrate useful implications in the form of projecting how a range of intervention programs which cater to not just the victim but also the offenders and the general public, are important to decrease the prevalence of domestic violence. These findings also demonstrate future implications in the form of demonstrating how the inclusion of multidisciplinary professionals is a key strategy which can improve wellbeing in domestic violence victims. Lastly, to conclude, further robust research in the form of actually implementing these programs or obtain primary subjective data from domestic abuse victims or program directors must be implemented so as to evaluate the true effectiveness of these programs across more vulnerable populations like Indigenous Australians.
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