女性在经历家庭暴力后接受专门心理倡导干预的随机对照试验：一项嵌套定性研究。

Women's experiences of a randomised controlled trial of a specialist psychological advocacy intervention following domestic violence: A nested qualitative study.

机构信息

Centre for Academic Primary Health Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom.

Domestic Violence Training Ltd., London, United Kingdom.

出版信息

PLoS One. 2018 Nov 27;13(11):e0193077. doi: 10.1371/journal.pone.0193077. eCollection 2018.

DOI:10.1371/journal.pone.0193077

PMID:30481185

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6258524/

Abstract

BACKGROUND

Women's experience of domestic violence and abuse (DVA) is associated with mental illness which may not be addressed by domestic violence advocacy. The study aimed to compare the experiences of women receiving a psychological intervention with women receiving usual advocacy in a randomized controlled trial (PATH: Psychological Advocacy Towards Healing), to illuminate the trial results by exploring women's experiences of benefits and difficulties.

METHODS

A qualitative study nested within the PATH trial, based in two DVA agencies in the UK. A purposive sample of thirty-one intervention and usual care participants were interviewed up to three interviews over a year. Thematic analysis was carried out, incorporating concepts from the Trans-Theoretical Model of change.

FINDINGS

The PATH trial reports a clinically relevant improvement in mental health outcomes for women receiving the intervention compared to usual advocacy. The qualitative study reveals which elements of the intervention were beneficial or problematic, which outcomes were most meaningful and relevant to participants and highlights reasons for variations in adherence. Women valued the educational, psychological and emotional elements of the intervention, they felt safe to explore repressed emotions for the first time and experienced a reduction in self-blame, improved sense of identity and greater self-esteem. They also incorporated new skills and self-help techniques to enable sustainable change. Women receiving usual advocacy reported un-met needs for psychological and emotional support. Adherence was affected by women's 'psychological 'readiness' to engage, the competing demands of practical issues such as housing insecurity, legal proceedings or the availability of child care, and breaks in the continuity of professional care.

CONCLUSIONS

Continuity and regularity of sessions with a trained specialist worker was key to women's recovery. Individual assessment of 'readiness' would optimise the timing of delivery to maximise adherence and benefit.

摘要

背景

女性遭受家庭暴力和虐待（DVA）的经历与精神疾病有关，而这些问题可能无法通过家庭暴力倡导得到解决。本研究旨在通过比较接受心理干预的女性与接受常规倡导的女性的经历，以阐明试验结果，探索女性在受益和困难方面的经历。

方法

这是一项在英国两个家庭暴力机构进行的 PATH 试验中的嵌套定性研究。采用目的抽样法，对 31 名干预组和常规护理组参与者进行了访谈，为期一年，最多进行了三次访谈。采用主题分析法进行分析，结合了改变的跨理论模型的概念。

结果

与接受常规倡导相比，PATH 试验报告称接受干预的女性心理健康结果有临床相关的改善。定性研究揭示了干预的哪些要素是有益的或有问题的，哪些结果对参与者最有意义和相关，并强调了坚持的差异原因。女性重视干预的教育、心理和情感元素，她们感到安全，可以第一次探索被压抑的情绪，并体验到自责感的减少、身份认同感的提高和自尊心的增强。她们还采用了新的技能和自助技巧，以实现可持续的改变。接受常规倡导的女性报告说，他们对心理和情感支持的需求没有得到满足。坚持受到女性“心理”准备程度的影响，以及住房不安全、法律程序或儿童保育可用性等实际问题的竞争需求，以及专业护理连续性的中断。