Article type
Year
Abstract
Background:
Worldwide, 30% of adult women have experienced intimate partner abuse (‘domestic violence’). One way these women can be supported is through advocacy. The problem with reviews on the effectiveness of advocacy is that it is a multifaceted and personalised approach - a particularly heterogeneous complex intervention. Advocacy may include helping abused women to access services and resources, guiding them through safety planning, educating them in relationships, and supporting them to improve their physical or psychological health through practical support. It may be delivered in various settings by people in a multitude of roles and it may be offered stand-alone or as part of a multi-component (and possibly multi-agency) intervention. This individualized and multi-access approach is likely to result in more effective advocacy but it makes effectiveness hard to evaluate, complicating evidence syntheses. This is an increasingly common issue because of the drive to provide the most efficient and cost-effective healthcare in times of austerity, which often means multi-component complex interventions.
Objectives:
To explore whether realist reviews are an effective way to increase understandings of the strength of the evidence for complex interventions.
Methods:
We undertook a realist review of the literature to consider, for advocacy interventions for abused women, not just what works, but where, in what circumstances, for whom and how, thus with more attention paid to the interaction and adjunctive nature of different components of advocacy interventions and the contexts in which they are played out out.
Results:
Our findings, which we describe, help explain successes, failures and partial successes and small effect sizes in published empirical studies of advocacy interventions delivered in different settings, and in particular explain mechanisms of effect in heterogeneous complex advocacy interventions. This has enabled us to make clear decisions on which studies to aggregate or synthesise in our 'what works' review.
Conclusions:
Realist review can offer important insights regarding complex interventions that can feed into more useful evidence syntheses.
Patient or healthcare consumer involvement:
Parallel work with service users on core outcome sets for domestic violence research will be integrated.
Worldwide, 30% of adult women have experienced intimate partner abuse (‘domestic violence’). One way these women can be supported is through advocacy. The problem with reviews on the effectiveness of advocacy is that it is a multifaceted and personalised approach - a particularly heterogeneous complex intervention. Advocacy may include helping abused women to access services and resources, guiding them through safety planning, educating them in relationships, and supporting them to improve their physical or psychological health through practical support. It may be delivered in various settings by people in a multitude of roles and it may be offered stand-alone or as part of a multi-component (and possibly multi-agency) intervention. This individualized and multi-access approach is likely to result in more effective advocacy but it makes effectiveness hard to evaluate, complicating evidence syntheses. This is an increasingly common issue because of the drive to provide the most efficient and cost-effective healthcare in times of austerity, which often means multi-component complex interventions.
Objectives:
To explore whether realist reviews are an effective way to increase understandings of the strength of the evidence for complex interventions.
Methods:
We undertook a realist review of the literature to consider, for advocacy interventions for abused women, not just what works, but where, in what circumstances, for whom and how, thus with more attention paid to the interaction and adjunctive nature of different components of advocacy interventions and the contexts in which they are played out out.
Results:
Our findings, which we describe, help explain successes, failures and partial successes and small effect sizes in published empirical studies of advocacy interventions delivered in different settings, and in particular explain mechanisms of effect in heterogeneous complex advocacy interventions. This has enabled us to make clear decisions on which studies to aggregate or synthesise in our 'what works' review.
Conclusions:
Realist review can offer important insights regarding complex interventions that can feed into more useful evidence syntheses.
Patient or healthcare consumer involvement:
Parallel work with service users on core outcome sets for domestic violence research will be integrated.