Safety Planning With Marginalized Survivors of Intimate Partner Violence: Challenges of Conducting Safety Planning Intervention Research With Marginalized Women

Toxic Relationships Described by People With Breast Cancer on Reddit: Topic Modeling Study

BACKGROUND

Social support is essential to promoting optimal health outcomes for women with breast cancer. However, an estimated 12% of women with breast cancer simultaneously experience intimate partner violence (IPV; physical, psychological, or sexual abuse by an intimate partner). Women who experience IPV during breast cancer may lack traditional social support, and thus seek out alternative sources of support. Online community forums, such as Reddit, can provide accessible social connections within breast cancer-specific communities. However, it is largely unknown how women with breast cancer use Reddit to describe and seek support for experiences of IPV.

OBJECTIVE

This study aims to explore how patients with breast cancer describe toxic relationships with their partners and immediate family members on Reddit.

METHODS

This exploratory, cross-sectional, topic-modeling study analyzed textual data from 96 users in the r/breastcancer subreddit in February 2023. The meaning extraction method, inclusive of principal component analysis, was used to identify underlying components. Components were subjected to sentiment analysis and summative content analysis with emergent categorical development to articulate themes.

RESULTS

Seven themes emerged related to toxic relationships: (1) contextualizing storytelling with lymph nodes, (2) toxic behavior and venting emotions, (3) abandonment and abuse following diagnosis, (4) toxic relationships and social-related fears, (5) inner strength and navigating breast cancer over time, (6) assessing social relationships and interactions, and (7) community advice and support. Toxic relationships were commonly characterized by isolation, abandonment, and emotional abuse, which had profound emotional consequences for patients. Reddit facilitated anonymous venting about toxic relationships that helped patients cope with intense feelings and stress. Exchanging advice and support about navigating toxic relationships during breast cancer were core functions of the r/breastcancer community.

CONCLUSIONS

Findings emphasized the value of Reddit as a source of social support for patients with breast cancer experiencing toxic relationships. Clinicians who understand that many patients with breast cancer experience toxic relationships and considerable psychological sequelae are better prepared to support their patients' holistic well-being. Further investigation of Reddit as a possible resource for advice, information, and support has the potential to help inform clinical practice and subsequently, patient health outcomes.

Firearm-Related Risks and Consequences for Immigrant Women in Abusive Relationships: Barriers to Reporting Threats to Safety and Recommendations for Safety Planning

Firearms are the leading cause of intimate partner violence-related murders of women in the US. This study aimed to understand differing consequences of partners' firearm possession on abused women and barriers women face in reporting threats to safety due to the partners' possession of a firearm.. Additionally, the study explored participants' perceptions of effective approaches to risk assessments and safety planning with women who are at-risk for being harmed by their partners' possession of a firearm. Qualitative semi-structured interviews with seventeen service providers and 45 immigrant women survivors of intimate partner violence were conducted. Data were analyzed using content analysis procedure. Participants shared that the partners' possession of a firearm can increase risk for firearm-related injury or fatality in situations of escalation of violence. Abused women living with a partner with firearm possession live in constant fear or threat. The presence of a firearm can also be a trigger of unwanted memories of the past and can have legal and other consequences for survivors. Impediments to reporting threats to safety were barriers such as lack of knowledge of firearm-related risks and gender and social norms. The findings can be informative for safety planning with survivors of IPV whose partners own or have access to a firearm. Comprehensive assessment of risks and barriers can be used to develop individualized and tailored safety plans for survivors with a partner who possesses a firearm.

Impact of the Domestic Violence Housing First Model on Survivors' Safety and Housing Stability: Six Month Findings

Intimate partner violence (IPV) is a leading cause of homelessness, yet little evidence exists about effective strategies to assist IPV survivors as they work to avoid homelessness while freeing themselves from abuse. An ongoing demonstration evaluation is examining if and how one promising model assists IPV survivors in obtaining safe and stable housing over time. The Domestic Violence Housing First (DVHF) model involves providing IPV survivors with mobile advocacy and/or flexible funding, depending on individual needs, in order to attain these goals. We hypothesized that those receiving DVHF would experience greater housing stability and less re-abuse compared to survivors receiving services as usual. The current study evaluated the short-term efficacy of the DVHF model with a sample of 345 homeless or unstably housed survivors who sought services and who completed in-person interviews shortly after contacting the DV agency, as well as six months later. Those who received the DVHF model showed greater improvement in their housing stability compared to those receiving services as usual, as well as decreased economic abuse. Both groups experienced a sharp decline in all forms of abuse. The Domestic Violence Housing First model shows promise in helping unstably housed DV survivors achieve safe and stable housing. Study findings have implications for DV agencies as well as those funding such services. Understanding which interventions work best for which survivors is critical to ensuring that service providers are effectively working toward long-term housing stability and well-being for IPV survivors and their children.

Impact of the Domestic Violence Housing First Model on Survivors' Safety and Housing Stability: 12-Month Findings

Intimate partner violence (IPV) is a widespread and devastating phenomenon resulting in a myriad of long-term consequences for survivors and their children. IPV victimization not only has negative health and economic consequences, it has also been linked to homelessness and housing instability. In response, the Domestic Violence Housing First (DVHF) model is being used in some domestic violence (DV) agencies to help survivors attain safe and stable housing. The model includes using individualized advocacy and/or flexible funding to help survivors meet these goals. Using a longitudinal, quasi-experimental design, the current study involved conducting interviews with survivors and examining agency records to investigate the effectiveness of this model. We hypothesized that survivors who received DVHF would experience less re-abuse and greater housing stability over 12 months compared to those who received services as usual (SAU). The sample included 345 IPV survivors who had been homeless or unstably housed when they approached one of five DV programs for help. Interviews were spaced 6 months apart (when survivors first sought services as well as 6 months and 12 months later). Longitudinal analyses showed that survivors who received the DVHF model reported greater improvements in housing stability at both the 6-month and 12-month time points compared to those receiving SAU. At the 12-month time point, survivors who had received DVHF reported decreased physical, psychological, and economic abuse, as well as the use of their children against them as a form of abuse. This study adds to a growing body of evidence supporting this model's effectiveness and adds to our understanding of factors impacting the long-term housing stability and safety for IPV survivors.

Strengthening the service experiences of women impacted by gambling-related intimate partner violence

Background

While problem gambling does not directly cause intimate partner violence (IPV), it exacerbates that violence significantly. Women experiencing both gambling harm and IPV often find themselves in challenging situations; furthermore, stigma and shame frequently act as barriers to seeking help from health and social service agencies. Despite the links between problem gambling and IPV, little is known about women’s experiences of using support services for both IPV and gambling related issues. This paper explores positive experiences of help-seeking for gambling-related IPV in Australia by adopting a strengths-based research approach.

Methods

Qualitative, unstructured interviews were conducted for a larger study exploring the nature of the relationship between problem gambling and IPV. To gain new insights into the service experiences of women impacted by gambling related IPV, interviews with 48 women with lived experience of IPV relating to a male partner’s gambling, and 24 women with lived experience of IPV relating to their own gambling were reanalysed using thematic analysis.

Results

Three themes emerged from the data signifying or demonstrating strength-based responses: ‘Commitment to Integrated and Collaborative Responses’; ‘Therapeutic Support’; and ‘Instrumental Support’. The themes highlight the importance of recognising the intersectionality of gambling related IPV and supporting the person ‘at the centre of the service’. Tangible and instrumental supports, such as emergency accommodation and financial assistance, were also central to the recovery process.

Conclusion

Effective service responses are dependent on understanding how problem gambling and IPV intersect. Importantly, service providers must recognise and address the many facets of each woman’s situation and the shame associated with resolving interdependent and complex issues. Responding to the needs of women impacted by gambling related IPV requires both individual-level awareness and organisational support; recommendations to strengthen service provision are provided.

A technology-based intervention to improve safety, mental health and empowerment outcomes for immigrant women with intimate partner violence experiences: it's weWomen plus sequential multiple assignment randomized trial (SMART) protocol

BACKGROUND

Intimate partner violence (IPV) disproportionately affects immigrant women, an understudied and underserved population in need for evidence-based rigorously evaluated culturally competent interventions that can effectively address their health and safety needs.

METHODS

This study uses a sequential, multiple assignment, randomized trial (SMART) design to rigorously evaluate an adaptive, trauma-informed, culturally tailored technology-delivered intervention tailored to the needs of immigrant women who have experienced IPV. In the first stage randomization, participants are randomly assigned to an online safety decision and planning or a usual care control arm and safety, mental health and empowerment outcomes are assessed at 3-, 6- and 12-months post-baseline. For the second stage randomization, women who do not report significant improvements in safety (i.e., reduction in IPV) and empowerment from baseline to 3 months follow up (i.e., non-responders) are re- randomized to safety and empowerment strategies delivered via text only or a combination of text and phone calls with trained advocates. Data on outcomes (safety, mental health, and empowerment) for early non-responders is assessed at 6 and 12 months post re-randomization.

DISCUSSION

The study's SMART design provides an opportunity to implement and evaluate an individualized intervention protocol for immigrant women based on their response to type or intensity of intervention. The findings will be useful for identifying what works for whom and characteristics of participants needing a particular type or intensity level of intervention for improved outcomes. If found to be effective, the study will result in an evidence-based trauma-informed culturally tailored technology-based safety decision and planning intervention for immigrant survivors of IPV that can be implemented by practitioners serving immigrant women in diverse settings.

TRIAL REGISTRATION

This trial was registered with ClinicalTrials.gov as NCT04098276 on September 13, 2019.