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Program Profile: Empowerment Training for Abused Pregnant Chinese Women

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on May 26, 2011

Program Summary

An empowerment training program designed to raise self-esteem, improve health, and reduce intimate partner violence among pregnant Chinese women who have been abused. The program is rated Promising. The experimental group showed a larger decline in intimate partner violence for some measures such as psychological abuse and minor physical violence; improved health-related quality of life for some measures; and lower levels of postnatal depression compared to the control group.

This program’s rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Description

Program Goals/Target Population

The goal of this program is to help abused women in China cope with the negative impact of psychological and physical abuse by their partners. The program strives to help these women improve their self-esteem and make better choices so that they are able to overcome the negative experience of being abused. The main goals are to reduce intimate partner violence and improve health-related quality of life for these abused women.


The program is targeted at pregnant women in Hong Kong who have been emotionally or physically abused by their partner.


Program Theory

The theory behind this program is that intimate partner abuse is predominantly psychological, and women often do not report this type of abuse or seek help. Therefore, if women feel better about themselves, they will be more capable of making better decisions and avoiding abuse. When the woman feels empowered and confident, she will be less likely to fall victim to abuse and can live a happier, healthier life.


Program Components

The program provides a safe environment for abused pregnant women to talk about their experiences with abuse and receive support and advice, primarily through individual therapy. The therapy offers empathic understanding but also emphasizes the need for the woman to identify and accept her feelings in order to overcome the negative impact the abuse has had on her self-esteem. The women additionally receive advice in safety techniques, decision making, and problem solving. Such life skills training aim to empower the participants, enhance their independence and control, and help them make better life choices. The women receive a brochure at the end of their therapy session that reinforces the information covered.


Key Personnel

Senior research assistants with training in midwifery and counseling, along with trained therapists, are crucial for proper implementation of this program.


Evaluation Outcomes

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Study 1

Intimate Partner Violence

Tiwari and colleagues (2005) found that the experimental group showed a larger decline in levels of psychological abuse on the Conflict Tactics Scale (CTS) scale after the intervention, compared to the control group. The preintervention mean score for psychological abuse on the CTS scale was 3.1 for the experimental group; the mean score for this group decreased to 0.79 after the intervention. The preintervention mean score was 2.8 for the control group, which decreased to 1.6 after the intervention. These differences were found to be statistically significant.


The experimental group also showed a larger decline in levels of minor physical violence after the intervention, compared to the control group. The preintervention mean score for minor physical violence on the CTS scale was 1.3 for the experimental group, which decreased to 0.05 after the intervention. For the control group, the pre-intervention mean score was 0.7; this score decreased to 0.51 after the intervention. These differences were found to be statistically significant.


There were not significant differences between the two groups in severe physical violence or sexual abuse.


All women who participated in the study continued to stay with their partners during the entire study and follow-up period.


Health-Related Quality of Life

Following the intervention, the experimental group had the most significant changes compared to the control group in physical functioning, physical role limitation, and emotional role limitation. All of the changes were found to be statistically significant.


Prior to the intervention, the experimental group’s mean score on the physical functioning measure of the Short Form Health Survey (SF–36) was 80; the mean score for this group increased to 90 after the intervention. The control group had a mean score of 80 prior to the intervention; this score remained at 80 after the intervention.


On physical role limitation, prior to the intervention, the experimental group’s mean score on this measure was 43. The treatment group’s mean score increased to 73 after the intervention. The control group had a mean score of 35 on the physical role limitation measure, which increased to 45 after the intervention.


The experimental group’s mean score on the emotional role limitation measure of the SF–36 was 53 prior to the intervention; after the intervention, the mean score for this group increased to 77. Prior to the intervention, the control group had a mean score of 53 on the emotional role limitation measure. This score decreased to 47 after the intervention.


The only measure in which the experimental group’s SF–36 scores decreased after the intervention was the bodily pain measure. The pre-intervention mean score was 22, and the score decreased to 14 after the intervention. The control group saw a slight increase from a preintervention mean score of 22 to a postintervention mean score of 27.


The remaining measures (general health, vitality, social functioning, and mental health) did not vary significantly between preintervention and postintervention levels for the experimental or control group.


Postnatal Depression

As determined by the Edinburgh Postnatal Depression Scale, the experimental group showed a significantly lower level of postnatal depression compared to the control group. After the intervention, nine women from the experimental group showed signs of postnatal depression, compared to 25 in the control group.

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Evaluation Methodology

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Study 1

Tiwari and colleagues (2005) conducted a randomized controlled trial from May 2002 to July 2003 to evaluate the impact of the empowerment intervention. The women selected were over the age of 18 and were at less than 30 weeks’ gestation. They were informed of the study at their first antenatal appointment at a public hospital in Hong Kong.


The women were assessed using the Abuse Assessment Screen to determine the extent of their abuse. With this screening tool, women who answered “yes” to being emotionally or physically abused by their male partner were selected to be involved in the program. Tiwari and colleagues chose 110 women to participate in the study, who were randomly assigned to the experimental or control group, comprising 55 women each. The experimental group received the full range of services from the program. The control group received standard care for abused women, which involved distributing a wallet-sized card on community resources for abused women, such as hotlines for women’s shelters, and contact information for law enforcement, social services, and nongovernmental organizations. The entire study was conducted without the presence of the woman’s partner.


Follow-up was done 6 weeks after delivery of the woman’s baby, and was conducted via telephone. Four women were not available for the follow-up, so a total of 106 women completed the study. The main focus of the follow-up interview was how conflicts between the couple were handled since the administration of the program. The researchers examined the level of intimate partner violence as the primary outcome of the study; they examined health-related quality of life and levels of postnatal depression as secondary outcomes. The mean values for these measures were compared to their preintervention and postintervention measures for both groups.


The level of intimate partner violence was assessed through the Conflict Tactics Scale, a self-report scale listing 19 behaviors that may occur during conflicts. The questionnaire included questions about reasoning, psychological abuse, and physical violence. For this particular study, a question on sexual abuse was added, and physical violence was divided into two categories, distinguishing between minor and severe violence. The women were asked to report the frequency of these behaviors with their partner over the past year. A seven-point scale was used, where:


  • 0 = never
  • 1 = once
  • 2 = twice
  • 3 = 3–5 times
  • 4 = 6–10 times
  • 5 = 11–20 times
  • 6 = 20 or more times  

Health-related quality of life was assessed using the Short Form Health Survey, which had questions divided into eight categories: physical functioning, role limitation due to physical health problems, bodily pain, general health, vitality, social functioning, role limitation due to emotional health problems, and mental health. These scores were graded on a scale from 0 to 100, where higher scores indicated a higher health-related quality of life.


Postnatal depression was assessed using the Edinburgh Postnatal Depression Scale. A cutoff score of 9 out of 10 was recommended for screening depressive illness in a Chinese postnatal population.

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There is no cost information available for this program.
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Implementation Information

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Training in midwifery and counseling is necessary to assist the targeted population. This program was modeled after a program in the United States and was translated into Chinese for this study. Implementation materials should be adapted to meet the needs of individual cultures.

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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1

Tiwari, Agnes, Wing Cheong Leung, T.W. Leung, Janice Humphreys, B. Parker, Pak Chnng Ho. (2005). “A randomised controlled trial of empowerment training for Chinese abused pregnant women in Hong Kong.” BJOG: An International Journal of Obstetrics and Gynaecology 112(9):1249–56

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Related Practices

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Following are practices that are related to this program:

Advocacy Interventions for Women Who Experience Intimate Partner Violence
Advocacy interventions aim to empower women who have experienced intimate partner violence and link them to helpful services in the community. The practice is rated Effective for reducing domestic/intimate partner violence. Women who received services through advocacy interventions experienced significantly less physical abuse, compared with women in the control groups, at 12- to 24-month follow-up periods.

Evidence Ratings for Outcomes:
Effective - One Meta-Analysis Victimization - Domestic/intimate partner/family violence
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Program Snapshot

Age: 18+

Gender: Female

Race/Ethnicity: Asian/Pacific Islander

Geography: Urban

Setting (Delivery): Inpatient/Outpatient

Program Type: Conflict Resolution/Interpersonal Skills, Crisis Intervention/Response, Individual Therapy, Victim Programs, Violence Prevention

Targeted Population: Females, Victims of Crime

Current Program Status: Not Active

Agnes Tiwari
School of Nursing, The University of Hong Kong
4/F, 21, Sassoon Road, Pokfulam
Hong Kong
Phone: 852.2819.2629
Fax: 852.2872.607