Women’s experience of meaningful change following domestic abuse: a qualitative study nested in a trial of a specialist psychological advocacy intervention (the ‘PATH’ trial)

The problem

Advocacy has little impact on mental health outcomes of survivors of domestic violence and abuse (DVA) and there is uncertainty about the effectiveness of psychological interventions for this population. Despite increasing identification in primary care of women experiencing DVA, GPs are limited in their referral options. Evidence suggests that approaches such as counselling that do not directly address the violence may be ineffective or even harmful. There is a need for a targeted intervention aimed at improving the mental health and psychological functioning of women experiencing DVA.

The approach

This qualitative study was nested within the PATH trial (Psychological Advocacy Towards Healing), a randomised controlled trial of a specialist psychological advocacy intervention. It aimed to investigate participants’ experiences of the content and delivery of the PATH intervention; to explore outcomes attributed to the intervention that were meaningful for participants; any difficulties encountered; to identify facilitators and barriers to participant adherence. We recruited a purposive sample of thirty-one women seeking support from two specialist DVA agencies in two UK cities who were participating in the PATH trial. Semi-structured interviews were carried out shortly after the start of the intervention or usual care, three months and one year later. Thematic data analysis with a narrative interpretivist perspective compared accounts of women with full and partial adherence to the intervention and usual care.

Findings

All women in the intervention group valued the educational and psychological-emotional elements of the intervention, and the opportunity to learn new skills and self-help techniques, which many had integrated into their lives one year later. The close confiding relationship with a DVA advocate enabled them to talk about abuse, often for the first time, to re-frame their experiences, let go of self-blame and build a more positive sense of identity. Improvements in mental health were seen as contingent on these other changes. Adherence was affected by women’s psychological ‘readiness’, the competing demands of practical issues and lack of continuity with the advocate. Women receiving usual care reported un-met need for psychological-emotional support, lengthy waiting-lists and limited effectiveness of counselling without a specific focus on DVA.

Consequences

The qualitative study revealed the impact of different elements of the intervention, distinguishing which were perceived as most beneficial and meaningful for women dealing with the emotional and psychological sequelae of DVA. The findings highlight the importance of embedding the intervention within a specialist DVA agency, and the need for individual assessment to tailor the timing and content to individual need. In combination with the trial results, these findings will help in the future development and implementation of the intervention.

Credits

• Maggie Evans, Domestic Violence Training, London, UK
• Roxane Agnew-Davies
• Gene Feder, Domestic Violence Training, London, UK