Objective: To test the effectiveness of an advocacy, case-management nursing intervention to a.) Increase safety-seeking behaviors, b.) Decrease experienced violence, c.) Increase physical and emotional functioning, and d.) Increase employment productivity of abused women
Design: Two-group, Clinical Randomized Trial.
Population, Sample, Setting, and Years: Following a power analysis based on pilot effect size data and allowing 30% attrition, a sample of 150 women was required. Criteria for the sampled population were physical and/or sexual abuse by an intimate partner within the past three months, female, 18 years or older, and English or Spanish speaking. Consecutive population sampling was completed at a large justice service agency for abused women. The agency serves an urban population of 3 million citizens. The agency typically serves over 3,000 people, mainly women, each year. All women meeting study criteria were approached and invited into the study. Four women refused to participate. 75 abused women were randomized to the control group and 75 women to the intervention group. The study began in January 2001 and will end in August 2002.
Intervention & Outcome Variables: The advocacy, case-management nursing intervention is based on American Nurses Association (ANA) criteria and adapted to meet abused women’s needs. The intervention was delivered over an eight-week period. Specific elements of the intervention protocol will be presented. Outcome variables, measured at 3-, 6-, 12-, and 18-months after the intervention, include type and number of practiced safety behaviors; frequency, type, and severity of reported violence; physical and emotional functioning; and employment productivity. Standardized, norm referenced instruments are used to measure the outcome variables. Each measurement instrument will be presented along with psychometrics.
Methods: Following signed, informed consent, abused women were randomized into treatment and control groups. Women in the treatment group received an initial 15-minute intervention session followed by six 15-minute supportive telephone calls made over an eight-week period. This intervention included education on safety planning and the cycle of violence, crisis management, supportive care, and guided referrals. Safety seeking behaviors were measured before each intervention session as well as at the standard measurement periods of 3-, 6-, 12-, and 18 months. Analysis consists of Chi Square and a mixed-model repeated measures MANCOVA. The between factor is group (control or intervention) and the within factor is time (intake, 3-, 6-, 12-, and 18 months follow-up interviews). At 12 months into the study all 150 women remain in the study, 100% retention. The subject retention methodology and specific protocol will be presented.
Findings: The 150 women consisted of 40% Latino/Hispanic, 32% African American, 26% Anglo, and 2% bi-racial. Mean age was 32 years; 79% of the women were employed and the median years of formal education was 12 years. Safety seeking behaviors were quickly adopted during the eight week intervention session for women in the treatment group and continued to be practiced at the 3- and 6-month follow-up sessions. When compared to women in the control group, women in the intervention group reported practicing significantly (p<.01) more safety-seeking behaviors. Outcome differences at 3-, 6-, 12-, and 18- months between intervention and control groups for measures of violence, physical and emotional health, and work productivity will be presented at the conference.
Conclusions: Violence against women is a global health issue that impacts women’s physical and mental functioning. This study demonstrates that safety information coupled with advocacy and nurse case management can quickly and significantly increase women’s safety seeking behaviors and thereby promote health and well-being. More specific conclusions will be presented with the final repeated measures analysis at 12- and 18 months and available at the conference.
Implications: The role of professional nursing toward promoting the health and safety of abused women is presently being defined. Universal assessment of women for abuse has been recommended by all major professional organization. However effective, tested interventions to be used once a woman disclosed abuse is not known. This research is one of the first randomized clinical trials to define and describe the outcome of a nursing intervention toward treating abused women.
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