Abstract
Intimate partner violence (IPV) has a destructive impact on the life of women all around the world. Several studies have reported reducing IPV after interventions. This study aimed to review interventional studies to reduce IPV in women. This review utilized the Cochrane collaboration method to search Magiran, Scientific Information Database, Iran Medex, PubMed, Science Direct, Web of Science, Scopus, and PsycINFO databases from the time to create each database to November 2019. All studies were assessed independently by two independent reviewers using the Cochrane collaboration risk-of-bias tool. A total of 24,685 records were recognized and reviewed. Finally, 20 studies met the inclusion criteria and entered into the study. Most of the studies had used the individual level of the socioecological model and the secondary prevention strategies. Seven studies had utilized models and theories. Out of 20 studies, 5 studies reported significant changes; 3 studies had no achievement in outcomes; and 2 studies reported a significant change in some consequences. The effectiveness of interventions for changing outcomes was varied. There is a gap in detecting items that reduce IPV in women. Further research is needed to recognize the role of other subjects in IPV interventions, determine the effectiveness of well-designed studies with low risk of bias, and detect strategic outcomes.
Introduction
Nowadays, intimate partner violence (IPV) against women is considered one of the crucial social problems that go beyond the cultural, social, and regional boundaries (Fulu and Miedema 2015). Violence against women means any act or threat of gender-based violence that causes physical, sexual, or psychological pain in women. It is painful for women and restricts their personal and social freedom (WHO 2017).
The most common type of violence against women is domestic violence, which is done by partners and close relatives (WHO 2013). Based on the World Health Organization report from 80 countries in 2013, about one-third of women have experienced at least some type of physical, sexual, or both physical and sexual domestic violence (WHO 2017).
Risk factors for violence against women are related to perpetrators, victims, or both of them. Violence risk factors against women are associated with antisocial personality disorders, perpetrators who had multiple sexual partners, low levels of education, witnessing family violence, alcohol abuse, attitudes toward violence, and gender inequality (Kirk et al. 2017).
IPV will influence women's health. Women who experience violence are at higher risk of physical, psychological, and social harm or even death (Bonomi et al. 2006). In many countries of the world, IPV is hidden due to social norms, religious beliefs, and cultural conditions (Moazami 2004). Regarding the harmful consequences of IPV against women, it is not only a major problem in women's health (WHO 2017) but it also involved a hidden epidemic of health problems (Roelens et al. 2006). Also, it will lead to the override of women's rights (WHO 2017). Since the phenomenon of violence against women is a complex and multidimensional issue (individual, relationship, community, and societal), it is important for combating IPV to pay attention to all aspects.
In recent decades, in many countries, primary and secondary prevention programs have been considered a priority for domestic violence against women. These programs include educational, supportive, and legal interventions for preventing and controlling this major health problem (Soleiman Ekhtiari and Ahmadi 2011).
In current years, several universal studies have combined evidence on effective, or at least hopeful, approaches to preventing and reacting to IPV (Heise 2011; WHO 2012; WHO/LSHTM 2010). Unfortunately, while individual-level programs are easy to consider, assessing comprehensive and multilevel interventions is more challenging. Although these approaches are surely the key to long-term prevention, they are slightly reviewed (Heise 2011).
To the best of our knowledge, the effectiveness of present interventions based on an ecological model and prevention levels has not been investigated, and also this gap exists in the previous literature review for IPV (Heise 2011; WHO 2012; WHO/LSHTM 2010). Therefore, the researchers decided to try to fill this gap and look at the issue from a new perspective and obtain useful information about the effectiveness of interventions, including dating violence prevention curriculum, media campaigns, couple counseling, substance abuse counseling, screening for IPV, community services for victims, police responses, court interventions, sentencing, batterer intervention programs (BIPs), coordinated community response (CCR), and a combination of these approaches at both prevention and social environment levels of the world and different cultures, it is necessary to do a systematic review. So, the present study aimed to review the interventions that were conducted for reducing IPV in women.
Materials and Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed for evaluating the studies and reporting systematic reviews (Moher et al. 2015).
Search strategy
This review followed the Cochrane collaboration method to search several databases. The electronic articles were searched in PubMed, Science Direct, Web of Science, Scopus, and PsycINFO, the Persian databases of Magiran, Scientific Information Database, and Iran Medex. Relevant studies that were published and peer-reviewed were entered in this systematic review. Besides, references of the selected articles were checked manually. Forward and backward citation searching was done from the time to create each database to November 2019. Randomized control trials (RCTs) or randomized clinical trials from all countries and all languages were entered in this study. An expert in systematic reviews wrote the search strategy using the studies by Hill et al. (2016) and Sawyer et al. (2016). Therefore, a wide range of terms was used to cover the following concepts of women, violence, and intervention. The search strategy has been shown in Appendix A1.
Study selection
One of the researchers searched the databases. Articles were extracted from databases and imported into EndNote software. Consequently, duplicate articles were removed. Then, titles and abstracts were separately screened by two reviewers (M.A. and S.K.). After initial screening, the full text of articles was screened and evaluated by two independent reviewers (M.A. and S.K.). The disagreement between reviewers was resolved by debating the subject or assessing by another reviewer (M.R.M.). So that if there was a difference during the initial screening, data extraction, and quality assessment, the third person would reexamine the issue and all three researchers would come to the same conclusion with sufficient explanation and argument.
Inclusion criteria
Included studies were published and peer-reviewed articles that had determined population, intervention, comparator, and outcome (Schardt et al. 2007).
Study population
We evaluated studies that had addressed IPV only in the females of all ages and women who had no disease. Also, girls, pregnant women, and addict women were excluded. We investigated eligible studies from all countries.
Types of studies
RCTs of IPV were included in this study. Descriptive studies, quantitative studies, reviews, systematic reviews, meta-analysis and, quasiexperimental (pretest/post-test interventions or controlled pretest/post-test interventions) studies that reduced IPV were excluded.
Types of intervention
In general, all interventions have been divided into 10 categories: dating violence prevention curriculum, media campaigns, couple counseling, substance abuse counseling, screening for IPV, community services for victims, police responses, court interventions, sentencing, BIPs and CCR. Besides, intervention strategies for IPV at both prevention and social environment levels were included (Whitaker et al. 2008).
Types of outcomes
The selected studies had used a subjective self-reporting measurement of IPV or an objective measurement of IPV by observing the subjects. Furthermore, we considered outcomes that highlighted only IPV. This review considers outcomes that reported an increase or decrease in percentage or proportion of positive or negative results at a significant level of <0.05.
Data extraction
Data extraction was done for 2 months by one of the three reviewers (M.R.M. or R.N. or Z.T.K.). Data were extracted to a form that included the first author, publication year, country, study design, participants, intervention, outcome(s), result(s), notes, and study quality (Table 1).
Effectiveness of Randomized Controlled Trials to Reduce Intimate Partner Violence
A-CASI, audio computer-assisted self-interviews; C, control group or comparison group; CBT, cognitive-behavioral therapy; CD, compact disc; EUC, enhanced usual care; HCP, health care providers; I, intervention group; IPV, intimate partner violence; TSS, telephone support services.
Risk of bias
All RCTs were assessed independently by two independent reviewers (M.A. and S.K.) using the Cochrane collaboration risk-of-bias tool (CCRBT). The CCRBT recommended six domains including selection bias, performance bias, detection bias, attrition bias, reporting bias, and other biases (Higgins and Green 2011). Two reviewers received parallel training for using the tool. The difference in the quality of studies was resolved by discussion. Also, inter-rater reliability was calculated by the percentage of agreement and the Cohen's Kappa coefficient. If inter-rater agreement is determined from 0.80 to 1.00, it will be considered very well (Schuck 2004).
Results
Results of the search and included studies
A total of 24,685 documents were recognized and reviewed: 24,490 articles from the databases and 195 articles from extra sources. After screening, 397 abstracts were selected for review, and after an in-depth check of selected abstracts, 49 articles were reviewed to determine if they match the inclusion criteria, and finally, 20 articles met the eligibility for this review (Fig. 1).
Flow diagram for the identification, screening, eligibility, and inclusion of studies.
Study time and settings
Twelve studies were published in 2010 or later (Cheung et al. 2019; Eden et al. 2015; Graham-Bermann and Miller-Graff 2015; Green et al. 2015; Gupta et al. 2013; Klevens et al. 2012a, 2012b, 2015; Koziol-McLain et al. 2010; Michalopoulou et al. 2015; Stevens et al. 2015; Tankard et al. 2019) and eight studies were published between 1994 and 2009 (Ahmad et al. 2009; Chronister and McWhirter 2006; Constantino et al. 2005; Kim et al. 2007; Margo 1999; McFarlane et al. 2002, 2006; Sullivan et al. 1994). Twelve studies were carried out in the United States (Chronister and McWhirter 2006; Constantino et al. 2005; Eden et al. 2015; Graham-Bermann and Miller-Graff 2015; Klevens et al. 2012a, 2012b, 2015; Margo 1999; McFarlane et al. 2002, 2006; Stevens et al. 2015; Sullivan et al. 1994).
The other eight studies were conducted outside the United States: one in Uganda (Green et al. 2015), one from Côte d'Ivoire (Gupta et al. 2013), and one from each of the following countries: Canada (Ahmad et al. 2009), New Zealand (Koziol-McLain et al. 2010), South Africa (Kim et al. 2007), Greece (Michalopoulou et al. 2015), Colombia (Tankard et al. 2019), and China (Cheung et al. 2019).
Participants and follow-up duration
Most articles had a large sample size of women. The number of participants in the three studies was <100 (Chronister and McWhirter 2006; Constantino et al. 2005; Michalopoulou et al. 2015). The follow-up duration for studies was often long term, 2 months or less in 3 studies (Chronister and McWhirter 2006; Klevens et al. 2012a; Michalopoulou et al. 2015), and >3 months in 16 studies (Cheung et al. 2019; Constantino et al. 2005; Eden et al. 2015; Graham-Bermann and Miller-Graff 2015; Green et al. 2015; Gupta et al. 2013; Kim et al. 2007; Klevens et al. 2012b, 2015; Koziol-McLain et al. 2010; Margo 1999; McFarlane et al. 2002, 2006; Stevens et al. 2015; Sullivan et al. 1994; Tankard et al. 2019). Follow-up in one study was unknown (Ahmad et al. 2009).
Theoretical framework usage
Of the included studies, only seven (35%) utilized the behavioral models and theories. Theories included social cognitive career theory (Chronister and McWhirter 2006), decisional conflict theory (Eden et al. 2015), stages of change constructs of the trans-theoretical model (Gupta et al. 2013), empowerment model (McFarlane et al. 2006), the Grameen bank model (Kim et al. 2007), and the cognitive-behavioral therapy (Graham-Bermann and Miller-Graff 2015). One study applied both the empowerment model and self-care models (Koziol-McLain et al. 2010). Of these studies, only in one study, components of theories/models were considered (Chronister and McWhirter 2006), and theories/models in the remaining studies were used only to guide the intervention development (Eden et al. 2015; Graham-Bermann and Miller-Graff 2015; Gupta et al. 2013; Kim et al. 2007; Koziol-McLain et al. 2010; McFarlane et al. 2006).
Strategies and levels used in the interventions
Six studies had used community-based services such as advocacy for victims in their interventions (Constantino et al. 2005; Margo 1999; McFarlane et al. 2006; Stevens et al. 2015; Sullivan et al. 1994; Tankard et al. 2019). Six studies had used BIPs in their interventions (Cheung et al. 2019; Chronister and McWhirter 2006; Eden et al. 2015; Graham-Bermann and Miller-Graff 2015; Kim et al. 2007; McFarlane et al. 2002). Five studies had used screening for IPV in their interventions (Ahmad et al. 2009; Klevens et al. 2012a, 2012b, 2015; Koziol-McLain et al. 2010).
Furthermore, 17 studies had used individual-level secondary prevention strategies (Ahmad et al. 2009; Cheung et al. 2019; Chronister and McWhirter 2006; Constantino et al. 2005; Eden et al. 2015; Graham-Bermann and Miller-Graff 2015; Kim et al. 2007; Klevens et al. 2012a, 2012b, 2015; Koziol-McLain et al. 2010; Margo, 1999; McFarlane et al. 2002, 2006; Michalopoulou et al. 2015; Stevens et al. 2015; Sullivan et al. 1994; Tankard et al. 2019). Moreover, two studies had used community-level secondary prevention strategies (Green et al. 2015; Gupta et al. 2013). Only one study had used counseling, relational level by the socioecological model, and secondary prevention strategies (Michalopoulou et al. 2015). We did not find any studies that exactly assessed other strategies and levels used in interventions for reducing IPV.
Types of outcome measures
Outcomes of the included studies were measured by self-reporting. Among these studies, one study targeted at decisional conflict (Eden et al. 2015), another study the quality of life of participants (Klevens et al. 2012b), four studies measured reduced stress or depressive symptoms of the participants (Cheung et al. 2019; Constantino et al. 2005; Graham-Bermann and Miller-Graff 2015; Michalopoulou et al. 2015), two studies tested safety behavior of the participants (McFarlane et al. 2002, 2006), and seven articles measured reduced IPV and its types including physical and/or sexual IPV, economic abuse, and psychological abuse (Ahmad et al. 2009; Gupta et al. 2013; Kim et al. 2007; Klevens et al. 2012a; Koziol-McLain et al. 2010; McFarlane et al. 2006; Sullivan et al. 1994).
In addition, five studies measured several consequences that were different, including quality of life, days lost from work or housework, feelings of chronic vulnerability to a perpetrator, stress/depressive symptoms, effect on monthly income, reductions for IPV and its types, and the participants (Green et al. 2015; Klevens et al. 2015; Margo 1999; Stevens et al. 2015; Tankard et al. 2019).
The impact of interventions in a different place, sample size, and study follow-up
Eight out of 12 studies in America had achieved the desired results (Chronister and McWhirter 2006; Constantino et al. 2005; Eden et al. 2015; Graham-Bermann and Miller-Graff 2015; Klevens et al. 2012b; Margo 1999; McFarlane et al. 2002, 2006), and 4 studies had not achieved all of their purposes (Klevens et al. 2012a, 2015; Stevens et al. 2015; Sullivan et al. 1994). However, all desirable results have been achieved in studies from Canada (Ahmad et al. 2009), Colombia (Tankard et al. 2019), and South Africa (Kim et al. 2007). Also, one study in New Zealand had not reported favorable results (Koziol-McLain et al. 2010). Other studies from Uganda, Côte d'Ivoire, Greece, and China were successful in achieving some of their purposes (Cheung et al. 2019; Green et al. 2015; Green et al. 2015; Michalopoulou et al. 2015, respectively).
Two out of three studies with <100 participants had reached their desired results (Chronister and McWhirter 2006; Constantino et al. 2005). Also, 8 out of 17 studies with >100 participants had reached their desired results (Eden et al. 2015; Graham-Bermann and Miller-Graff 2015; Kim et al. 2007; Klevens et al. 2012a; Margo 1999; McFarlane et al. 2002, 2006; Tankard et al. 2019). Five interventions had no success in outcomes (Klevens et al. 2012b, 2015; Koziol-McLain et al. 2010; Stevens et al. 2015; Sullivan et al. 1994), and four studies were successful in some of their purposes (Cheung et al. 2019; Green et al. 2015; Gupta et al. 2013; Michalopoulou et al. 2015).
From 16 studies with >3 months of follow-up, 8 studies reported significant changes in all of their results (Constantino et al. 2005; Eden et al. 2015; Graham-Bermann and Miller-Graff 2015; Kim et al. 2007; Margo 1999; McFarlane et al. 2002, 2006; Tankard et al. 2019), 3 studies had a positive change in some of their results (Cheung et al. 2019; Green et al. 2015; Gupta et al. 2013), and 5 studies had no significant change (Klevens et al. 2012b, 2015; Koziol-McLain et al. 2010; Stevens et al. 2015; Sullivan et al. 1994). One study with an unknown follow-up had a significant change in all of its outcomes (Ahmad et al. 2009).
Furthermore, two out of three studies with 2 months or less of follow-up reported a significant change in all of the outcomes (Chronister and McWhirter 2006; Klevens et al. 2012a) and one study reported a significant change in some of the outcomes (Michalopoulou et al. 2015).
Review of intervention effects based on theories and models
However, five studies that utilized models and theories had reached all their expected changes (Chronister and McWhirter 2006; Eden et al. 2015; Graham-Bermann and Miller-Graff 2015; Kim et al. 2007; McFarlane et al. 2006), but one study had significant changes in some of its outcomes (Gupta et al. 2013), and another study had no significant changes (Koziol-McLain et al. 2010).
Review of intervention effects based on strategies and levels
Community-based services for victims
From six studies with community-based services for victims that used individual-level secondary prevention strategies, four of them reported significant changes in all of their expected outcomes (Constantino et al. 2005; Margo 1999; McFarlane et al. 2006; Tankard et al. 2019), while two interventions did not report any significant change (Stevens et al. 2015; Sullivan et al. 1994). Of the six studies that applied community-based services for victims, two studies were evaluated as low quality (Margo 1999; Sullivan et al. 1994).
Batterer intervention programs
Six studies that used BIPs and individual-level secondary prevention strategies reported significant changes in their expected outcomes (Cheung et al. 2019; Chronister and McWhirter 2006; Eden et al. 2015; Graham-Bermann and Miller-Graff 2015; Kim et al. 2007; McFarlane et al. 2002). Of the six studies that applied for BIPs, one study was of low quality (Kim et al. 2007).
Screening for IPV
Two of the five studies with screening for IPV and individual-level secondary prevention strategies reported significant changes in their outcomes (Ahmad et al. 2009; Klevens et al. 2012a), and three interventions did not achieve all of their desired outcomes (Klevens et al. 2012b, 2015; Koziol-McLain et al. 2010). Of the five studies that applied screening for IPV, one study was considered low quality (Klevens et al. 2015).
Coordinated community response
However, two studies that used CCR and community-level secondary prevention strategies reported significant changes in some of the consequences (Green et al. 2015; Gupta et al. 2013).
Couple counseling
Counseling, relational-level by the socioecological model, and secondary prevention strategies reported that the used strategies had statistically significant changes in some of the outcomes (Michalopoulou et al. 2015). This study was not of low quality.
Review of overall quality of studies and inter-rater agreement
Most of the studies were at moderate risk of bias (Ahmad et al. 2009; Cheung et al. 2019; Chronister and McWhirter 2006; Constantino et al. 2005; Eden et al. 2015; Green et al. 2015; Gupta et al. 2013; Klevens et al. 2012a, 2012b; Koziol-McLain et al. 2010; McFarlane et al. 2002, 2006; Michalopoulou et al. 2015; Stevens et al. 2015; Tankard et al. 2019). Four studies were classified as high risk of bias (Kim et al. 2007; Klevens et al. 2015; Margo 1999; Sullivan et al. 1994), and only one study had a low risk of bias (Graham-Bermann and Miller-Graff 2015). An inter-rater agreement from 0.80 to 1.00 is considered a very good agreement. Therefore, it was very well for all domains of the CCRBT in this study (Table 2).
Inter-Rater Agreement for Component Ratings
SE, standard error.
Discussion
In this study, 20 studies were finally reviewed. The results of selected studies were assessed in the following three zones: (1) in terms of using strategies, (2) prevention level, and (3) using behavioral change theories or models.
Strategies used in the studied interventions to reduce IPV
This review showed that five out of 10 categories had been used to reduce IVP (Whitaker et al. 2008). These five categories included the following.
Community-based services for victims
Six studies used this strategy to reduce IPV (Constantino et al. 2005; Margo 1999; McFarlane et al. 2006; Stevens et al. 2015; Sullivan et al. 1994; Tankard et al. 2019). Four out of six studies that used community-based services for victims reported significant changes in all of their expected outcomes such as social empowerment and IPV victimization (Tankard et al. 2019), physical violence, psychological abuse, depression, quality of life, and social support (Margo 1999), psychological distress symptoms, perceived availability of social support, and health care utilization (Constantino et al. 2005), and threats of abuse, assaults, danger risks for homicide, and events of work harassment (McFarlane et al. 2006). Also, two studies did not report any significant change such as IPV victimization, feelings of chronic vulnerability to a perpetrator, depressive symptoms, and posttraumatic stress disorder symptoms (McFarlane et al. 2006), and depression, fear, anxiety, and emotional attachment to their assailants (Sullivan et al. 1994).
Advocacy as one of the community-based services for victims improved social support and quality of life in women. If advocacy is accompanied by providing shelter, it will have a greater effect on reducing IPV (Bybee and Sullivan 2002). The effect of social support and advocacy has been documented. For instance, a recent review showed that the effect of IPV interventions, focused on improving access to social support through the usage of advocates with powerful linkages to community-based structures and networks, on better mental health outcomes of victims has been proven (Ogbe et al. 2020).
According to the results of a review study to assess the effects of advocacy interventions within or outside health care settings in women who have experienced intimate partner abuse, staff delivering advocacy, setting (community, shelter, antenatal, health care), advocacy intensity (from 30 min to 80 h), and abuse severity can affect the effectiveness of interventions. For example, the setting was associated with intensity and duration of advocacy, or intensive advocacy (12 h) indicated reduced severe physical abuse in women leaving a shelter and promoted the short-term quality of life (Rivas et al. 2015).
Batterer intervention programs
Six studies used this strategy to reduce IPV (Cheung et al. 2019; Chronister and McWhirter 2006; Eden et al. 2015; Graham-Bermann and Miller-Graff 2015; Kim et al. 2007; McFarlane et al. 2002). BIPs include group counseling sessions, most of which are based on feminist theory or cognitive-behavioral theory, or both (Gregory and Erez 2002). In this review, five studies that used BIPs reported significant changes in their expected consequences such as decisional conflict about safety (Eden et al. 2015), positive parenting and depression (Graham-Bermann and Miller-Graff 2015), perceived stress and depressive symptoms (Cheung et al. 2019), career-search self-efficacy and critical consciousness (Chronister and McWhirter 2006), the safety behaviors, that is, hid the money, hid keys, hid extra clothing, social security number, insurance policy number, and asking neighbors to call the police (McFarlane et al. 2002), and reduce the risk of past-year physical or sexual violence (Kim et al. 2007).
The positive effect of BIPs has been confirmed in another study (Gregory and Erez 2002). So, the abovementioned factors are recommended for being incorporated into the design and implementation of future studies.
Screening for IPV
Five studies used screening for decreasing IPV (Ahmad et al. 2009; Klevens et al. 2012a, 2012b, 2015; Koziol-McLain et al. 2010). From these studies, two of them reported that they had significant changes in their outcomes including disclosure rates of IPV (Klevens et al. 2012b), and discussion opportunities about the risk for IPV and control and detection of women at risk based on the review of audiotaped medical visits (Ahmad et al. 2009). Also, three interventions did not achieve all of their desired outcomes such as hospitalizations, emergency department visits, and outpatient care visits (Klevens et al. 2015), violence exposure (Koziol-McLain et al. 2010), and quality of life (Klevens et al. 2012a).
Screening is typically executed by interviews, surveys, or computers in health care settings. For example, it is used in primary care or emergency departments (Gregory and Erez 2002). So, computer-based screening discloses greater rates of IPV than health care providers' screening (Klevens et al. 2012b). Also, other studies support the increased detection of IPV in computer-based interventions (Ondersma et al. 2007; Rhodes et al. 2002). It seems the computer-based screening provides a confidential opportunity for IVP self-reporting in battered women for detecting their problems. Most of the women may not be able to express IPV in a face-to-face communication and therefore hide their problems. Computer-based screening can reduce this barrier. In addition, health providers must educate women about using IVP computer-based assessment to avoid confusion for them.
Coordinated community response
In this review, two studies used CCR (Green et al. 2015; Gupta et al. 2013). These studies reported that significant changes were observed in some of the consequences such as quality of partner relationships, monthly income, and stress reduction. Typically, CCR confirmed better coordination between law enforcement, courts, and social services (Whitaker et al. 2008). The effectiveness of CCR has been supported in previous studies (Post et al. 2010; Robinson and Tregidga 2007).
Couple counseling
In the current review, one study used a couple counseling strategy (Michalopoulou et al. 2015). The study was provided with an 8-week stress management program (relaxation breathing and progressive muscle relaxation, twice a day counseling), mainly aimed to prevent women from IPV. Each woman consulted in a private room along with the researcher for a free-flowing chat session without structure. The results of the study indicated that in the intervention group, perceived stress was significantly decreased after 8 weeks of stress management program, but no significant results were shown for other outcomes such as sleeping hours, health locus of control, depression, and ways of coping (Michalopoulou et al. 2015). It sounds that it is better to use couple counseling when there is low-to-moderate violence, behavioral couple counseling for advocacy services for victims, and BIPs (Whitaker et al. 2008).
Prevention levels used in the studied interventions to reduce IPV
In this review, also the selected studies were categorized based on the socioecological level. Seventeen studies used individual-level secondary prevention strategies. Two studies used the community-level secondary prevention strategies (Green et al. 2015; Gupta et al. 2013), and only one study used counseling and relational-level secondary prevention strategies (Michalopoulou et al. 2015). Community-level interventions significantly decreased IPV and changed community attitudes to a tolerance of violence and inequality (Taft and Small 2014). Also, community-level interventions resulted in changing the norms in communities and reducing IPV especially the risk of physical violence (Abramsky et al. 2016). However, individual-level interventions create individual changes in attitude and behavior that can reinforce community actions on IPV reduction (Fulu et al. 2014).
In this review, most studies used the individual-level rather than the community-level and counseling and relational-level secondary prevention strategies. It seems that a possible reason for this could be the greater willingness of researchers to plan and implement interventions to reduce IPV at the individual level. Because the other levels such as the community levels have some challenges. For example, CCR has been widely implemented in practice (Edelson 1991), but few data show the effect. As well, the collection of suitable community-level outcomes is another difficult challenge (Whitaker et al. 2008).
Behavioral change theories or models used in the studied interventions to reduce IPV
Results of this review indicated that seven out of 20 studies utilized models and behavioral change theories (Chronister and McWhirter 2006; Eden et al. 2015; Graham-Bermann and Miller-Graff 2015; Gupta et al. 2013; Kim et al. 2007; Koziol-McLain et al. 2010; McFarlane et al. 2006). Various studies used intrapersonal, interpersonal, and social models/theories. Usually, behavioral change theories and models not only can predict important factors of IPV but also can show the methods and paths for a change.
One noteworthy point of this review was that although ICTs, such as the Internet, cell phones, and smartphones, are expanding worldwide, only one study used this capacity to carry out the intervention (Eden et al. 2015). The evidence indicates that ICT-based interventions were effective in screening, disclosure, and prevention of IPV (El Morr and Layal 2020). So, there is a clear need to develop the use of ICTs in IPV interventions in various contexts for women. This study had some limitations. First, it was unfeasible to do a meta-analysis since we included several types of outcomes. Second, we did not search the gray literature, and thus, a publication bias may exist in this study. Third, in this review, we did not consider treatment outcomes. Because we paid attention to the intervention strategies for IPV at both prevention levels including primary and secondary prevention.
Also, this study has its strengths. Studies were divided into categorized strategies, prevention level, and socioecological level.
Conclusion
This review showed that the effectiveness of interventions to change IPV outcomes was varied. Since the outcomes of current studies in the field do not lead to a consensus on reducing IPV in women, future studies can explore other issues in interventions and focus on the treatment outcomes. Further research is needed for detecting key outcomes and recognizing the role of other issues in IPV interventions especially BIPs that reported significant changes in their expected outcomes and the effectiveness of well-designed interventions with a low risk of bias.
Footnotes
Authors' Contributions
S.K., M.R-M., and M.A. are from Hamadan University of Medical Sciences (Hamadan, Iran); Z.T-K. is from Qom University of Health Sciences (Qom, Iran); and R.N. is from Kurdistan University of Medical Sciences (Sanandaj, Iran), all where education and research are the primary functions.
Author Disclosure Statement
No potential conflict of interest was reported by the authors.
Funding Information
The authors received no specific funding for this work.