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Program Profile: Empowerment Training for Abused Pregnant Women in China

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on May 26, 2011

Program Summary

This is an empowerment training program for pregnant women in China who have been abused. The program is rated Promising. For the experimental group, there were statistically significant declines in levels of psychological abuse, minor physical violence, physical functioning, physical and emotional role limitation, and postnatal depression. However, there were no statistically significant effects on severe physical violence, sexual abuse, and other health-related, quality-of-life measures.

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

Program Description

Program Goals
The goal of this empowerment training program is to help pregnant 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.

Target Population
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 (Tiwari et al. 2005).

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 life skills training in safety techniques, decision making, and problem solving. These skills are used 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
Overall, Tiwari and colleagues (2005) found mixed results with regard to the effects of the empowerment training. For pregnant women in the experimental group, there were statistically significant declines in levels of psychological abuse, minor physical violence, physical functioning, physical and emotional role limitation, and postnatal depression. However, there were no statistically significant effects on severe physical violence, sexual abuse, social functioning, and mental health. Overall, the preponderance of evidence suggests the program had the intended effects on participants.

Psychological Abuse
There were statistically significantly lower levels of psychological abuse as measured by the Conflict Tactics Scale (CTS) for the experimental group, compared with the control group.

Minor Physical Violence
There was a statistically significantly lower levels of minor physical violence as measured by the CTS for the experimental group, compared with the control group.

Severe Physical Violence
There were no statistically significant differences between the two groups in severe physical violence as measured by the CTS.

Sexual Abuse
There were no statistically significant differences between the two groups in sexual abuse as measured by the CTS.

Physical Functioning
There were statistically significant differences favoring the experimental group, compared with the control group, in physical functioning as measured by the Short Form Health Survey (SF-36). Higher scores indicated a higher health-related quality of life. The average score for the experimental group for physical functioning was 90, compared with the average score of 80 for the control group.

Physical Role Limitation
There were statistically significant differences favoring the experimental group, compared with the control group, in physical role limitation as measured by the SF-36. The average score for the experimental group for physical role limitation was 73, compared with the average score of 45 for the control group.

Emotional Role Limitation
There were statistically significant differences favoring the experimental group, compared with the control group, in emotional role limitation as measured by the SF-36. The average score for the experimental group was 77, compared with the average score of 47 for the control group.

Social Functioning
There were no statistically significant differences between the experimental and control groups in social functioning as measured by the SF-36.

Mental Health
There were no statistically significant differences between the experimental and control groups in mental health as measured by the SF-36.

Postnatal Depression
Statistically significantly fewer women in the experimental group had clinical levels of postnatal depression at follow-up, as measured by the Edinburgh Postnatal Depression Scale. After the intervention, nine women from the experimental group showed signs of postnatal depression, compared with 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 had an average age of 30 years. Of this group, 26 reported that the pregnancy was planned, 6 were smokers, 4 used alcohol, and 1 abused drugs. Twenty-four of the women were first-time mothers, and 48 were married, with the average length of marriage reported to be 4.3 years. Five women were single, and two were divorced. The control group had an average age of 31. Of this group, 28 reported that the pregnancy was planned, 6 were smokers, 2 used alcohol, and 2 abused drugs. Twenty-five of the women were first-time mothers, and 52 were married, on average for 5.4 years. Three women were single, and none were divorced. 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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Cost

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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 (Tiwari et al. 2005).
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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 Randomized 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 CrimeSolutions.gov-rated practices that are related to this program:

Advocacy Interventions for Women Who Experience Intimate Partner Violence
This practice uses advocacy interventions to empower women who have experienced intimate partner violence. The goals of advocacy interventions include helping abused women to access necessary services, reducing or preventing incidents of abuse, and improving women’s physical and psychological health. The practice is rated No Effects for reducing physical abuse. (This Practice was originally rated Promising. See “Other Information” in the practice profile for further discussion of that change).

Evidence Ratings for Outcomes:
No Effects - 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

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