Background
Methods
Search strategy
Data abstraction
Methodological quality of included studies
Bias
Data analysis and synthesis
Theme | Kohli, A. et al., 2012. | Tanabe, M. et al., 2013. | Barron, I. G. & Topping, K. J. 2013. | Merkin, L. & Smith, M. J. 1995. | Rossman, L. & Dunnuck, C. 1999. | Zraly, M., Rubin-Smith, J. & Betancourt, T. 2011. | Itzhaky, H. & York, A. S. 2001. |
---|---|---|---|---|---|---|---|
Acceptability of CHW services | Patients reported satisfaction with services provided; Few adolescents attended to, interviews with some revealed discomfort being seen in the same clinic with older women as being identified as SV survivor may diminish marriage opportunities | Community members reported that CHWs are trusted members of society that survivors can seek care from | Survivors reported liking the programme & the programme being understandable | Rising invitations to give lectures & workshops to the community | Rise in the use of volunteer advocates by 75%; feedback from victims of non-judgemental compassionate support provided | Women found the services useful and particularly when hospital services were inadequate for their needs | Feeling of trust for community workers developed; Large number of community members becoming involved in the prevention efforts |
Feasibility of CHW services | Overall, the mobile clinic utilised limited human resources, equipment & medication | CHWs demonstrated comfort with the subject of sexual assault and good understanding of medical treatment; CHWs also demonstrated full understanding of confidentiality and data collection; Safety was not an issue of concern to CHWs | Cost of delivery was minimal particularly because the facilitators were volunteers. Training & experience contributed to facilitators spending very little time on preparation, one hour | No assessment of feasibility documented | No assessment of feasibility documented | Study identifies the potential opportunity to incorporate the current informal support networks for survivors with the national CHW programme being implemented | No assessment of feasibility documented |
Results
Characteristics of included studies
Author, Year | Country | Study design | Number of survivors | Age of survivors | Socio-demographics characteristics of survivors | Type of services received by survivors | Community health workers (CHWs) service model | Number of community health workers |
---|---|---|---|---|---|---|---|---|
Kohli, 2012 [49] | Democratic Republic of Congo (DRC) | Observational: Longitudinal follow-up for one month | 657 survivors received medical treatment | 0.9% below 20 years, 59.6% above 40 years | Females, 3.7% single, 61.9% married, 19.8% separated & 14.6% widowed | Treatment for sexually transmitted infections (STIs) and other diseases, HIV testing, psychosocial support | General CHWs attached to a mobile clinic | Not reported |
Tanabe, 2013 [52] | Burma | Qualitative: Focus group discussions with CHWs, traditional birth attendants & community members | No survivor presented | No survivor presented | No survivor presented | Medical treatment of STIs, pregnancy prevention, wound care, psychosocial support & referral | Specialised CHWs providing mobile maternal health care at the community level & trained to provide sexual violence care | Not reported |
Barron, 2013 [47] | Scotland | Mixed methods: Experimental pre- & post-test design; Qualitative in-depth interviews | 20 included in the study | 6–13 years | Intervention group: 4 males, 6 females; comparison group 10 females | Small group training- 4 lessons of 50 min duration on child sexual abuse prevention |
aVolunteer workers trained in delivering the programme | 3 females |
Merkin, 1995 [50] | United States of America |
b Qualitative: Observations, informal conversations | 225 cases | 4–76 years: (205 adults & 20 children) | 204 females & 21 males; 197 deaf & 28 deaf-blind | Crisis intervention, medico-legal & social support |
aVolunteer workers trained in gender-based violence & in supporting survivors | 18 females & 2 males |
Rossman, 1999 [51] | United States of America |
b Qualitative: Observations, informal conversations | Not reported | Not reported | Not reported | Psychosocial support |
aVolunteer workers attached to a community treatment centre | Not reported |
Zraly, 2011 [53] | Rwanda | Qualitative semi-structured interviews | 44 interviewees | Not reported | Females | Individual & group counselling |
aPeer survivor trained in counselling | One female |
Itzhaky, 2001 [48] | Israel | Qualitative in-depth interviews & observations | 15 child sexual abuse cases identified | Children, age not reported | Children | Counselling |
aVolunteer community workers | Not reported |
Methodological quality of quantitative studies
Study | Rating domain (EPHPP for evaluation studies) | |||||||
Selection bias | Study design | Confounders | Blinding | Data collection methods | Withdrawals and dropouts | Intervention integrity | Analyses | |
Barron, 2013 [47] | Moderate | Moderate | Weak | Not applicable | Moderate | Strong | Moderate | Moderate |
Rating domain (QUATSO for) | ||||||||
External validity | Reporting | Confounding | Bias (Privacy) | |||||
Kohli, 2012 [49] | 0 | Response rate | Outcome measure | Not applicable | 1 | |||
Not applicable | 1 |
Methodological quality of qualitative studies
Rating section | Barron, 2013 [47] | Itzhaky, 2001 [48] | Merkin, 1995 [50] | Rossman, 1999 [51] | Tanabe, 2013 [52] | Zraly, 2011 [53] |
---|---|---|---|---|---|---|
1.1 Is a qualitative approach appropriate? | Appropriate | Appropriate | Appropriate | Appropriate | Appropriate | Appropriate |
1.2 Is the study clear in what it seeks to do? | Clear | Mixed | Mixed | Unclear | Clear | Mixed |
2.1 How defensible/rigorous is the research design/methodology? | Defensible | Defensible | Not defensible | Not defensible | Defensible | Defensible |
3.1 How well was the data collection carried out? | Appropriate | Appropriate | Inadequately reported | Inadequately reported | Appropriate | Appropriate |
4.1 Is the context clearly described? | Clear | Clear | Unclear | Unclear | Clear | Clear |
4.2 Were the methods reliable? | Reliable | Reliable | Unreliable | Unreliable | Unreliable | Unreliable |
5.1 Are the data ‘rich’? | Rich | Not sure/not reported | Not reported | Not reported | Rich | Rich |
5.2 Is the analysis reliable? | Reliable | Not reported | Not reported | Not reported | Unreliable | Reliable |
5.3 Are the findings convincing? | Convincing | Not convincing | Not convincing | Convincing | Convincing | Convincing |
5.4 Are the conclusions adequate? | Adequate | Adequate | Adequate | Adequate | Adequate | Adequate |
6.1 Was the study approved by an ethics committee? | Yes | Not reported | Not reported | Not reported | Yes | Yes |
6.2 Is the role of the researcher clearly described? | Clear | Not clear | Not clear | Not reported | Clear | Clear |
As far as can be ascertained from the paper, how well was the study conducted? | ++ | + | – | – | ++ | ++ |
Components of CHW models for sexual violence services
Socio-demographic characteristics of CHWs | Selection of CHWs | Training of CHWs | Roles CHWs | Mode of service delivery | Population served | |
---|---|---|---|---|---|---|
Kohli, 2012 [49] Democratic Republic of Congo | Not documented | Respected community members known for supporting neighbours to deal with loss of family, rejection and stigma due to sexual violence. | Training in the provision of ethical, compassionate and competent care for GBV survivors. | Identify & build relationships with survivors & educate them on available services; assist providers in prioritising services; spread the word throughout the village about the mobile clinic visit schedule & encourage women and others to attend | General CHWs attached to a mobile clinic | All survivors of sexual violence |
Tanabe, 2013 [52] Burma | Not documented | Highest cadre of CHWs- previously trained to provide reproductive health services | 5 days training on care of SV survivors, 3 day refresher training every 6 months | Conducting medical examination, treatment or preventive treatment for STIs, emergency contraception, care of wounds, supportive counselling & referral | Specialised CHWs providing mobile maternal health care at the community level | No survivors presented during the study period |
Barron, 2013 [47] Scotland | 3 Female; 20–30 years; working class; adult survivors of child sexual abuse | Not documented | Trained & experienced in delivering the programme- training details not given | Facilitate small group training sessions | Volunteer workers delivering group training | Children |
Merkin, 1995 [50] United States of America | 18 female & 2 male | Rigorous screening including an interview to determine suitability | 50-h training on gender-based violence & programme delivery; continuous monthly meetings & trainings | Receive calls on the crisis line, educating victims, accompany victims to hospital & police | Volunteer workers attached to a crisis centre | All survivors both male and female who are deaf & deaf-blind |
Rossman, 1999 [51] United States of America | Not documented | Not documented | Not documented | Setting up counselling appointments; provide emotional support to the victims | Volunteer advocates attached to a community treatment centre | Not documented |
Zraly, 2011 [53] Rwanda | Female | Not documented | 12 weeks theory & 250 h of supervised practice on trauma counselling | Providing individual & group counselling; assisting with setting up peer support associations | Members of survivor support associations trained to provide counselling | Adult female |
Itzhaky, 2001 [48] Israel | Not documented | Not documented | Workshop-type training on child abuse & incest | Identified cases of abused children, conducted community awareness and group trainings | Community workers/activists not affiliated to the health system | Children |
Socio-demographic characteristics of CHWs used
Selection of CHWs
Training of CHWs
Roles of the CHWs and mode of service delivery
Populations served
Acceptability and feasibility of CHWs services in sexual violence care
Acceptability | Feasibility | |
---|---|---|
Kohli, 2012 [49] | Not documented- assessment of whole programme rather than CHWs | Not documented- assessment of whole programme rather than CHWs |
Tanabe, 2013 [52] | Community members interviewed reported that CHWs are trusted members of society that survivors can seek care from | CHWs demonstrated comfort with the subject of sexual assault and good understanding of medical treatment; CHWs demonstrated full understanding of confidentiality and data collection; Safety was not an issue of excess concern to CHWs |
Barron, 2013 [47] | Survivors reported liking the programme & the programme being understandable | Cost of delivery was minimal particularly because the facilitators were volunteers. Training & experience contributed to facilitators spending very little time on preparation |
Merkin, 1995 [50] | Not documented- assessment of programme rather than CHWs | No assessment of feasibility documented |
Rossman, 1999 [51] | Rise in the use of volunteer advocates by 75%; feedback from victims of non-judgemental compassionate support provided | No assessment of feasibility documented |
Zraly, 2011 [53] | Interviewed women found the services useful and particularly when hospital services were inadequate for their needs | No assessment of feasibility documented |
Itzhaky, 2001 [48] | Feeling of trust for community workers developed; Large number of community members becoming involved in the prevention efforts | No assessment of feasibility documented |
Challenges and benefits of CHWs providing services for sexual violence
Benefits | Challenges | |
---|---|---|
Kohli, 2012 [49] | Authors report that local CHWs assisted healthcare providers in targeting education sessions to community concerns; CHWs provided feedback to healthcare providers e.g. reported increased patient satisfaction | Authors report “travel distance & other commitments sometimes prevented CHWs from reminding patients about appointments and thus, follow-up rates were not as high as expected.” |
Tanabe, 2013 [52] | Community reported that CHWs are trusted persons that survivors can approach for help | CHWs reported lacking confidence in history-taking and psychosocial care; ‘Lower cadres’ of CHWs were unhappy with some aspects of medical care & referrals, complained they already had too many responsibilities, had issues with maintaining confidentiality & had some safety concerns |
Barron, 2013 [47] | Increased knowledge & skill; Occurrence of disclosures in the intervention group compared to no disclosures in the comparison group; satisfaction with programme; minimal cost of delivery | Not documented |
Merkin, 1995 [50] | Increased number of victims taking action on violence in their lives & increase in number of cases of abuse going to trial | Not documented |
Rossman, 1999 [51] | Feedback from victims report non-judgemental compassionate support by volunteers | Time taken to contact the volunteer & get them to the centre to offer support was long delaying care for survivors; Failure of recognition & acceptance by both the victim & professional healthcare workers |
Zraly, 2011 [53] | Available care in crisis & source of support | Not documented |
Itzhaky, 2001 [48] | Increased community awareness with change of attitude towards child sexual abuse; Reduction in stigma & therefore increased acceptance & support for survivors; Reduced incidence of cases | Child abuse reportedly normative thus community workers not motivated to act initially |