Background
Methods
Inclusion and exclusion criteria
Searching and screening strategy
Population | Health issue | Intervention | Evaluation | Location |
---|---|---|---|---|
femalea
womena
girla
wifeb
partnerb
childc
| sexual abusea
sexual violencea
intimate partner violenceb
abuseb
domestic violenceb
sexual assaultc
sexual coercionc
rapec
sexual harassmentc
| treatmenta
secondary preventiona
tertiary preventiona
responsec
best practicec
| efficacya
effectivenessa
outcomea
measurec
evaluationc
what worksc
impactc
| All countries listed as low or low-middle income by the World Banka
|
Data extraction, analysis and quality assessment
Key: 0 = low clarity and quality as assessed by the reviewer 1 = reasonable clarity and quality as assessed by the reviewer 2 = reflects a finding of high clarity and quality as assessed by the reviewer NC = not clear or not available from the paper | Bernath 2013 [24] | Bhate-Deosthali 2012 [44] | Doucet 2012 [43] | GHD Pty Ltd. 2015 [25] | Human Rights Watch 2015 [26] | Keesbury 2012 [27] | Kohli 2013 [46] | Manneschmidt 2009 [42] | Morel-Seytoux 2010 [28] | PHD Group 2012 [29] | Wessel 1997 [45] |
---|---|---|---|---|---|---|---|---|---|---|---|
1) Worth or relevance | |||||||||||
1.1) Was this piece of work worth doing at all? | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 |
1.2) Has it contributed usefully to knowledge? | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 |
2) Clarity of research question | |||||||||||
2.1) If not at the outset of the study, by the end of the research process, was the research question clear? | 2 | 1 | 2 | 2 | 1 | 2 | 2 | 2 | 2 | 2 | 1 |
3) Appropriateness of the design of the question | |||||||||||
3.1) Was an appropriate method used? | 1 | NC | 1 | 1 | 1 | 2 | 2 | 1 | 1 | 1 | 1 |
4) Context | |||||||||||
4.1) Is the context or setting adequately described so that the reader could relate the findings to other settings? | 2 | 2 | 2 | 1 | 2 | 2 | 2 | 2 | 2 | 2 | 2 |
5) Sampling | |||||||||||
5.1) Did the sample include the full range of possible causes or settings? | 0 | NC | 0 | NC | NC | 1 | 1 | NC | NC | NC | 1 |
5.2) If appropriate, were efforts made to obtain data that might contradict or modify the analysis extending or modifying the sample? | 1 | NC | 0 | NC | NC | NC | NC | NC | NC | NC | NC |
6) Data collection and analysis | |||||||||||
6.1) Were the data collection and analysis procedures systematic? | 1 | NC | 2 | NC | NC | 1 | 2 | 1 | 0 | 0 | 1 |
6.2) Was an ‘audit trail’ provided? | 1 | 0 | 2 | 1 | 0 | 1 | 1 | 1 | 1 | 0 | 0 |
6.3) How well did the analysis succeed in incorporating all the observations? | NC | NC | NC | NC | NC | NC | NC | 2 | 2 | NC | NC |
6.4) Did the analysis develop concepts and categories capable of explaining key processes? | 2 | 1 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | NC | 2 |
6.5) Was it possible to follow iteration between data and theory? | 2 | 0 | 2 | 1 | NC | 2 | 2 | 2 | 1 | 0 | 2 |
6.6) Did the researcher search for disconfirming cases? | 0 | NC | 0 | NC | NC | NC | NC | NC | NC | NC | NC |
7) Reflexivity of the account | |||||||||||
7.1) Did the researcher assess the likely impact of the methods used on the data obtained? | 0 | 0 | 2 | 0 | 0 | 0 | 0 | 0 | 2 | 0 | 0 |
7.2) Were sufficient data included in the reports to provide sufficient evidence for readers to assess whether analytical criteria were met? | 0 | 1 | 2 | 2 | 2 | 2 | 2 | 1 | 1 | 0 | 2 |
Results
Study | Country and setting | Study design and sample | Intervention | Outcomes | Global quality rating |
---|---|---|---|---|---|
Saggurti et al. 2014 [34] | Mumbai, IndiaLow-income community (slum) | Cluster-randomised controlled trial. Married women reporting IPV or that their husband engages in heavy drinking were enrolled in the intervention or control group based on their geographic cluster. Control group n = 102 Intervention group n = 118 | The Reducing HIV among Non-Infected Wives (RHANI) program included four individual sessions and two group sessions over 6–9 weeks. Sessions focused on problem solving and marital communication, as well as building social cohesion (group sessions). The control group received referrals to local services, and both groups viewed street plays about marital violence and alcohol use in their villages. | Intention-to-treat analysis of survey measures at baseline and follow-up. A reduction in self-reported marital conflict in the last 3 months was seen for the intervention group, but results were not statistically significant at a p-value of 0.05 (RR = 0.4; 90% CI 0.1–0.9; p = 0.064). Similarly no statistically significant effect was seen on marital IPV in the last 3 months (RR = 0.7; 90% CI 0.2–1.8; p = 0.548) or sexual coercion in the last 3 months (RR = 0.2; 90% CI 0.05–0.9; p = 0.082). | WEAK |
Satyanarayana et al. 2016 [39] | Bangalore, IndiaInpatient hospital psychiatric services | Randomised controlled trial. Male patients admitted to psychiatric services with Alcohol Dependency Syndrome (ADS), who were married with children, and admitted to perpetration of IPV were randomized: Control group n = 88Intervention group n = 89 | The Integrated Cognitive Behavioural Intervention (ICBI) consisted of eight sessions discussing links between alcohol and IPV, consequences and prevention of IPV, as well as teaching of cognitive behavioural techniques such as anger management. The control group received treatment as usual, consisting of pharmacotherapy and psychoeducation regarding treatment ADS. | Survey measures (from both husband and wife) at baseline, 1 month follow-up and 3 months follow-up. Though no statistically significant reduction in alcohol consumption was found among the intervention group relative to the control group at 3 months post-intervention (p = 0.44), significant reductions in the wives’ reports of violence (Effect size = 0.24; p = 0.005) and symptoms of depression (Effect size = 0.17; p = 0.04), anxiety (Effect size = 0.15; p = 0.006) and stress (Effect size = 0.07; p = 0.01) were seen, relative to the control group. | MODERATE |
Study | Country and setting | Study design and sample | Intervention | Outcomes | Global quality rating |
---|---|---|---|---|---|
Allon 2015 [30] | Democratic Republic of the Congo Treatment sites in the towns of Kakwende and Kasika | Controlled clinical trial. Female Congolese victims of sexual violence were enrolled in one of two therapies, based on provider’s opinion of most appropriate treatment. Individual therapy
n = 8 Group therapy
n = 28 | The individual therapy consisted of 2 sessions of eye movement desensitisation and reprocessing (EMDR) therapy. The group therapy consisted of 2 sessions of modified EMDR-Integrative Group Treatment Protocol (IGTP). Both therapies were delivered by a visiting Israeli doctor. | Subjective intensity of distress measured pre-and immediately post-treatment using SUD score. Mean SUD score decreased from 9.0 (±1.3) to 4.8 (±2.9) immediately post-treatment for EMDR-IGTP group (p < 0.0001), and from 9.3 (±0.9) to 1.9 (±2.2) for individual therapy group. NSD between pre-intervention SUD scores between individual and EMDR-IGTP group, but significant difference post-intervention (p < 0.01), with individual therapy more effective in lowering SUD scores. IES scores decreased from mean of 52 before group therapy to 33 afterwards (n = 6), p < 0.03. | MODERATE |
Bass et al. 2013 [31] | Democratic Republic of the Congo NGO offices in 14 villages in South Kivu and 2 villages in North Kivu provinces | Cohort study (two groups). 6 village clusters were randomized to receive one of two therapies and female survivors of sexual assault with clinically significant psychological problems were enrolled. Cognitive processing therapy group
n = 157 Individual support comparison group n = 248 | Cognitive processing therapy consisted of 1 individual 1-h session and 11 group sessions with 6–8 women each. Women in the individual support comparison group were invited to access individual psychosocial and case-management support as desired. | Depression and anxiety symptoms assessed by a questionnaire administered pre-treatment, immediately post and 6-months post treatment. Group therapy: probable PTSD reduced from 60% prevalence pre-treatment to 8% post-treatment and 9% 6 months later (p < 0.001). These measures were 83% to 54% to 42% for individual support (p < 0.001). Probable depression or anxiety reduced from 71% to 10%, then 9% at 6 months for group therapy (p < 0.001), and 83% to 54% to 42% for individual support (p < 0.001). Symptom improvements significantly greater for group therapy compared to individual support. | STRONG |
Deb, Mukherjee, and Mathews 2011 [37] | Kolkata, India Schools and shelters | Cross-sectional study. Sexually-abused girls, aged 13–18, were purposively selected from 4 randomly selected shelters for the intervention group. A comparison group of non-sexually abused girls of the same ages were randomly selected from 4 nearby schools. Comparison group
n = 120 Intervention group
n = 120 | Sexually-abused girls received a minimum of weekly individual and group counselling for at least 2 months. | Among sexually abused girls, 58.3% found counselling to be beneficial. A statistically significant difference in aggression was seen between sexually-abused girls who found counselling to be beneficial and sexually-abused girls who did not find counselling beneficial. Difference between mean aggression scores 14.00 95% CI 8.12, 21.68
p = 0.00 | WEAK |
Hall et al. 2014 [32] | As in Bass et al. 2013 | As in Bass et al. 2013 | As in Bass et al. 2013 | Social capital measured using a questionnaire administered pre and post intervention. Group therapy associated with increased group membership and participation (p < 0.05) at 6 month follow up. Emotional support seeking increased from pre to post- intervention (p < 0.05) but was not maintained at 6 months. NSD between group therapy and individual support for contact with non-kin social networks, instrumental support network size or financial network size. | STRONG |
Hogwood et al. 2014 [35] | Rwanda | Cohort study (one group). Rwandan women caring for their children born from rape were purposively selected to receive the intervention, mainly based on their geographic location and receipt of previous support from a local NGO.
n = 40 | Twelve fortnightly counselling groups of 10 members, led by female graduate-level trained Rwandan counsellors. The aims of the counselling groups were to encourage within-group social support, address emotional pain, assist in disclosure of rape to children, improve parenting skills and relationships. | Questionnaire administered pre-intervention, at halfway, post-intervention and 3 months post. Participants rated groups as helpful (mean 7/10 at mid-point, 9/10 at end). Life satisfaction increased between time one, two and three (p < 0.0005) but decreased at follow up (p < 0.005). 65% increase in social support over course of intervention (p < 0.0005). Acceptance of being a parent to the child, and reporting of “very good” relationship with child increased 47% and 33% respectively (p < 0.0005). | WEAK |
Hustache et al. 2009 [36] | Republic of the Congo MSF clinic in Brazzaville, during a period of conflict (2002–2003) | Cohort study (one group). Women over age 15, raped by unknown military personnel were enrolled.
n = 64 | Individual psychological counselling offered as part of post-rape care, specifically addressing - social and familial concerns - coping strategies - acceptance, future plans | Global functioning: Medium-extreme impairment in global functioning in 89.3% participants pre-intervention and 28.6% post-intervention, p = 0.04. Effect maintained 1–2 years post-treatment. However 31.3% participants report familial detachment, 3.1% met PTSD diagnostic criteria, 40.6% report re-experiencing symptoms 1–2 years after intervention. | WEAK |
Lekskes, van Hooren, and de Beus 2007 [33] | Liberia Rural villages | Controlled clinical trial. Liberian women who had experienced sexual violence during conflict were enrolled in one of two intervention groups, or the waiting list control group. Waiting list control group
n = 21 Trauma counselling group
n = 58 Support and skills training group
n = 54 | The trauma counselling group received a 3-month program, consisting of 8 individual sessions and group counselling. The support and skills training group received skill training to support income generation, and discussed gender issues and sexual abuse. The waiting list control group were pre-selected for either intervention. | Decrease in PTSD score (from 2.6 to 2.0) from pre-intervention to immediately post-intervention for the counselling group. Slight increase in PTSD score (1.5 to 1.7) for WHDP group. Increase in PTSD score for control group (2.0 to 2.5). (Significance not described) Reduction in PTSD scores for women in both interventions if initial PTSD score was high (statistics not described). | WEAK |
O’Callaghan et al. 2013 [38] | Democratic Republic of the Congo Secondary school in the town of Beni, North Kivu province | Randomised controlled trial. 12–17 year old female Congolese victims or witnesses of sexual abuse were randomized to the intervention or control groups: Control group
n = 28 Intervention group
n = 24 | Group based, culturally modified Cognitive Behaviour Therapy (CBT) was delivered to the intervention group for 2 h, 3 days/week for five weeks. The control group was waitlisted for the intervention. | PTSD, depression and anxiety symptoms assessed using validated measures, pre-intervention post-intervention and 3-months post. Greater improvements across all measures in intervention group compared to control (p < 0.001 for PTSD, Depression +Anxiety and conduct, p < 0–.024 for prosocial behaviour). Highly significant improvement in symptoms of PTSD with large effect size (P < 0.001, d = 2.04) anxiety and depression (p < 0.001, d = 2.45) conduct problems (p < 0.001, d = 0.95) and pro-social behaviour (p < 0.001, d = −1.57) between pre-intervention and 3 month follow up. | STRONG |
Parcesepe et al. 2016 [40] | Mombasa, Kenya HIV prevention drop-in centres | Randomised controlled trial. Women over 18 who engaged in transactional sex in the past 6 months, were moderate risk drinkers and visited a HIV prevention drop-in centre were randomised to the intervention or control groups: Control group
n = 408 Intervention group
n = 410 | WHO’s Brief Intervention for Hazardous and Harmful Drinking, adapted for the context of alcohol use and sex work, was delivered to the intervention group through 6 monthly individual sessions with trained nurse counsellors. The control group received 6 monthly individual sessions with trained nurse counsellors, focused on non-alcohol related nutrition information. | Questionnaire administered pre-intervention, immediately post-intervention and 6 months post. Compared to the control group, the intervention group experienced significant decreases in physical violence from paying sexual partners in the last 30 days, 6 months post-intervention (OR = 0.45, 95% CI 0.23–0.85, p = 0.01). The intervention group also experienced significant reductions in physical violence from non-paying partners in the last 30 days at 6 months post-intervention, compared to the control group (OR = 0.57, 95% CI 0.38–0.92, p = 0.02). | STRONG |
Study | Country and setting | Methods | Intervention | Findings |
---|---|---|---|---|
Bernath and Gahongayire 2013 [24] | Kigali, Rwanda One stop centre in Kacyiru Police Hospital | Mixed-methods evaluation included: - desk review of existing policies, laws, etc. - collection of existing statistical data - interviews with staff and stakeholders - interviews with clients | ISANGE One Stop Centre (IOSC) is a programme designed to provide psychosocial, medical, police and legal services to survivors of abuse. It is housed inside a public hospital and offers free 24/7 service. | The quality and availability of medical and forensic services are very high and strong links are present with police. However, weaknesses include: - Difficulty following-up with survivors - Inconsistent legal aid for survivors - Requirement for survivors to report abuse to police to obtain services - Limited data collection and monitoring - Staff training is not systematically planned or monitored |
Bhate-Deosthali, Sundari Ravindran, and Vindhya 2012 [44] | Mumbai, India Crisis centres at two public hospitals | Mixed-methods evaluation included: - Review of project documents - Interviews with program and hospital staff - Analysis of case records | The Dilaasa Crisis Centres offer counselling (informed by a feminist perspective) to women who have experienced violence and are referred from the hospital or other health facility. They also provide referrals to partner organizations that provide legal assistance and temporary or permanent shelter. | The centres’ locations in public hospitals make it possible to reach women from low-income or marginalized groups. Many survivors cited obtaining emotional support from the counselling and some reported improved psychological health. Survivors also stated that the centres helped them to register their complaints with the police. However, the centres faced an ongoing challenge while trying to change the attitudes of health professionals to recognize that domestic violence is an issue they should be concerned about, through ongoing training. |
Doucet and Denov 2012 [43] | Sierra Leone Rural area in south | 6 war-affected women and 4 social workers were purposively selected for open-ended interviews. | Social workers provided psychosocial support to women following the war. The social workers focused on giving advice, as well as principles of solidarity and spirituality in their psychosocial support, rather than clinical diagnostics and psychology. | War-affected women cited the social workers’ advice and support as playing an important role in their recovery. No women mentioned foreign professionals as making an impact on recovery, suggesting that local social work practices are valuable, despite being very different from those used in the Global North. |
Human Rights Watch 2015 [26] | Papua New Guinea | 46 interviews were conducted: 27 with survivors of family violence and the remainder with local officials, activists, NGO workers, and other stakeholders. | Interventions include: - Family and Sexual Violence Units (FSVU) in 17 police stations to make police more accessible to victims of gender-based violence - Family Support Centres in 15 hospitals to assist patients seeking care as a result of family violence - Hotline that provides counselling, information, guidance, and referrals for care at local services - Referral Pathway established by government officials in urban areas, designed to ensure that if a survivor accesses one service, they are linked to all other relevant ones | Many of these interventions are relatively new and are said to be effective at increasing support for survivors and access to services. However, barriers remain including: - Lack of awareness about available services - Limited access to services in rural areas - Shortage of safe houses - Service providers not putting the survivor’s best interests first (e.g., encouraging reconciliation) - Lack of psychosocial counselling and case management services - Weak law enforcement response. One expert stated that only 7 of the FSVU are functional. - Limited court capacity and legal assistance for survivors - Limited economic opportunities for survivors who leave their partners |
Keesbury et al. 2012 [27] | Kenya and Zambia One-stop centres (OSC) | A comparative case study was conducted with purposively selected OSCs: 2 in Kenya and 3 in Zambia, representing a range of approaches to the OSC model. Mixed-methods were used, including: - Facility inventory - Record reviews - Key informant interviews | One-stop centres (OSCs) provide integrated, multidisciplinary services for survivors of sexual and gender-based violence in a single physical location. Three major types of OSCs exist: - Health facility-based and hospital-owned OSC, where OSC functions are integrated into routine health centre activities - Health facility-based and NGO-owned OSC, where the NGO provides “wrap around” services at the health facility - Stand alone NGO-owned OSC, which provides legal and psychosocial support onsite but refers elsewhere for medical care | The health facility-based and hospital-owned OSC model was found to be better set up to achieve a broader range of legal and health outcomes for survivors, and survivors felt that they were meeting their health needs. Challenges still remain with the OSC model: - Poor integration of OSCs with the legal system - Strengthening of the range of services provided by OSCs and/or linkages to outside services is needed |
Kohli et al. 2013 [46] | Democratic Republic of Congo Two villages in Walungu Territory | In-depth interviews were conducted with 27 participants, including 13 survivors of sexual violence who were rejected by their families, 3 spouses of survivors, 1 community member, 5 mediators and 5 service providers | Family mediation is a process of resolving family conflict between family members who have rejected a survivor of sexual violence and the survivor. | Reintegrated survivors reported better relationships, improved opportunities for their children, and fewer mental health problems. However, challenges still exist, especially in cases where the survivor has a child from her rapist, or the survivor’s partner has remarried. Additional services such as economic support (e.g., children’s tuition, livelihood training, etc.) were cited as potential ways to improve reintegration. |
GHD Pty Ltd. 2015 [25] | Papua New Guinea | In-depth interviews and/or focus group were conducted with staff, survivors, police officers, referral partners and other stakeholders. Limited quantitative data was also aggregated and analysed. | The Family and Sexual Violence Units (FSVU) are police units that are tasked with responding to the needs of family and sexual violence survivors. They are present in 15 police stations and also provide referrals to other services for these survivors. | The FSVUs have begun to change police response to FSV in PNG, however limitations still remain, including: - Persistent culture of male dominance in police force - Further training needed on how to provide supportive, non-judgemental services for survivors - Improvements to procedures are needed, including timeliness of response, communicating their roles and processes to survivors and making arrest and prosecution protocols consistent across police stations |
Manneschmidt and Griese 2009 [42] | Afghanistan | 109 women who were survivors of war-related violence participated in group evaluations (maximum of 13 participants per group), giving feedback on the intervention | Basic Counselling Training (BCT) uses a group counselling process to provide women with psycho-education, relief from distressing symptoms, new social skills (e.g., problem-solving skills) and new support networks. | Over half of participants mentioned that their social life had improved after the intervention, including their interactions with family members and their stress levels. Many participants also cited being happier or an improvement to their health. |
Morel-Seytoux et al. 2010 [28] | Zambia | Mixed-methods evaluation included: - Desk review of 36 USAID and CDC monitoring and reporting documents - Key informant interviews with 240 beneficiaries, stakeholders, and ministry officials - 24 site visits/observations | Coordinated Response Centres (CRCs) in 7 districts provide care and support for survivors to meet their medical, psychological and legal needs. | The coordinated approach is an effective model and provides survivors with more comprehensive services. Coupling of these direct services with public awareness campaigns has improved the public’s knowledge of GBV and “broken the silence” |
The Population Health and Development (PHD) Group Pvt. Ltd. 2012 [29] | Nepal Mobile camps in conflict-affected areas | Mixed-methods evaluation included: - In-depth interviews and focus groups - Analysis of secondary data and reviews - Field visits | Mobile reproductive health camps were conducted for six days (plus four days follow-up) in 14 of the most conflict-affected areas of the country. Survivors of SGBV presenting to the camps were offered psychosocial counselling, legal and medical services, as well as shelter. | The use of reproductive health camps to identify survivors was successful at minimizing stigma for survivors of sexual violence. 86% of survey respondents said the camp services were good and reasons cited included free drugs and services, no wait time, good provider behaviour and good counselling. The camps successfully reached marginalised populations with over 66% of clients coming from disadvantaged communities. However, challenges arose, including: - Difficulty filing complaints with police because of politics, fear of family discord, etc. - Challenges tracking survivors because the camps were conducted 5 years after the end of conflict |
Wessel and Campbell 1997 [45] | Managua, Nicaragua Women’s centres in 3 poor neighbourhoods | Interviews with 21 survivors of domestic violence and 15 key informants involved in women’s centres or related projects. | The Inter-Collective is a group of three women’s centres, or casas de la mujer, running programs for survivors of domestic violence, including self defence classes, self-help groups, legal information workshops, health care for survivors, as well as professional services from lawyers, psychologists and nurses. | As a result of the intervention, survivors cited having new perceptions of women’s roles, increased emotional support and knowledge about their health and legal rights, decreased violence by their partners, and increased involvement in programs to help other survivors. |