Jennifer C. D. MacGregor

Priorities for research in child maltreatment, intimate partner violence and resilience to violence exposures: results of an international Delphi consensus development process

BackgroundIntimate partner violence (IPV) and child maltreatment (CM) are major global public health problems. The Preventing Violence Across the Lifespan (PreVAiL) Research Network, an international group of over 60 researchers and national and international knowledge-user partners in CM and IPV, sought to identify evidence-based research priorities in IPV and CM, with a focus on resilience, using a modified Delphi consensus development process.MethodsReview of existing empirical evidence, PreVAiL documents and team discussion identified a starting list of 20 priorities in the following categories: resilience to violence exposure (RES), CM, and IPV, as well as priorities that cross-cut the content areas (CC), and others specific to research methodologies (RM) in violence research. PreVAiL members (N = 47) completed two online survey rounds, and one round of discussions via three teleconference calls to rate, rank and refine research priorities.ResultsResearch priorities were: to examine key elements of promising or successful programmes in RES/CM/IPV to build intervention pilot work; CC: to integrate violence questions into national and international surveys, and RM: to investigate methods for collecting and collating datasets to link data and to conduct pooled, meta and sub-group analyses to identify promising interventions for particular groups.ConclusionsThese evidence-based research priorities, developed by an international team of violence, gender and mental health researchers and knowledge-user partners, are of relevance for prevention and resilience-oriented research in the areas of IPV and CM.

Exploring the uptake and framing of research evidence on universal screening for intimate partner violence against women: a knowledge translation case study

BackgroundSignificant emphasis is currently placed on the need to enhance health care decision-making with research-derived evidence. While much has been written on specific strategies to enable these “knowledge-to-action” processes, there is less empirical evidence regarding what happens when knowledge translation (KT) processes do not proceed as planned. The present paper provides a KT case study using the area of health care screening for intimate partner violence (IPV).MethodsA modified citation analysis method was used, beginning with a comprehensive search (August 2009 to October 2012) to capture scholarly and grey literature, and news reports citing a specific randomized controlled trial published in a major medical journal on the effectiveness of screening women, in health care settings, for exposure to IPV. Results of the searches were extracted, coded and analysed using a multi-step mixed qualitative and quantitative content analysis process.ResultsThe trial was cited in 147 citations from 112 different sources in journal articles, commentaries, books, and government and news reports. The trial also formed part of the evidence base for several national-level practice guidelines and policy statements. The most common interpretations of the trial were “no benefit of screening”, “no harms of screening”, or both. Variation existed in how these findings were represented, ranging from summaries of the findings, to privileging one outcome over others, and to critical qualifications, especially with regard to methodological rigour of the trial. Of note, interpretations were not always internally consistent, with the same evidence used in sometimes contradictory ways within the same source.ConclusionsOur findings provide empirical data on the malleability of “evidence” in knowledge translation processes, and its potential for multiple, often unanticipated, uses. They have implications for understanding how research evidence is used and interpreted in policy and practice, particularly in contested knowledge areas.

Strategies to promote uptake and use of intimate partner violence and child maltreatment knowledge: An integrative review

BackgroundIntimate partner violence (IPV) and child maltreatment (CM) are major social and public health problems. Knowledge translation (KT) of best available research evidence has been suggested as a strategy to improve the care of those exposed to violence, however research on how best to promote the uptake and use of IPV and CM evidence for policy and practice is limited. Our research asked: 1) What is the extent of IPV/CM-specific KT research? 2) What KT strategies effectively translate IPV/CM knowledge? and 3) What are the barriers and facilitators relevant to translating IPV/CM-specific knowledge?MethodsWe conducted an integrative review to summarize and synthesize the available evidence regarding IPV/CM-specific KT research. We employed multiple search methods, including database searches of Embase, CINAHL, ERIC, PsycInfo, Sociological Abstracts, and Medline (through April, 2013). Eligibility and quality assessments for each article were conducted by at least two team members. Included articles were analyzed quantitatively using descriptive statistics and qualitatively using descriptive content analysis.ResultsOf 1230 identified articles, 62 were included in the review, including 5 review articles. KT strategies were generally successful at improving various knowledge/attitude and behavioural/behavioural intention outcomes, but the heterogeneity among KT strategies, recipients, study designs and measured outcomes made it difficult to draw specific conclusions. Four key themes were identified: existing measurement tools and promising/effective KT strategies are underused, KT efforts are rarely linked to health-related outcomes for those exposed to violence, there is a lack of evidence regarding the long-term effectiveness of KT interventions, and authors’ inferences about barriers, facilitators, and effective/ineffective KT strategies are often not supported by data. The emotional and sometimes contested nature of the knowledge appears to be an important barrier unique to IPV/CM KT.ConclusionsTo direct future KT in this area, we present a guiding framework that highlights the need for implementers to use/adapt promising KT strategies that carefully consider contextual factors, including the fact that content in IPV/CM may be more difficult to engage with than other health topics. The framework also provides guidance regarding use of measurement tools and designs to more effectively evaluate and report on KT efforts.

‘My health is not a job’: a qualitative exploration of personal health management and imperatives of the ‘new public health’

BackgroundThere is an increasing push in Western healthcare for people to ‘manage’ their health, a key aspect of what has been called the ‘new public health’. It has been argued that this ‘personal health management’ – informal work done to monitor, inform, or influence one’s health – may be a burden, with potential to contribute to poor health outcomes. However, there is little research actually examining perceptions of personal health management and the ‘burden’ of these activities, particularly for generally healthy individuals.MethodsWe conducted exploratory qualitative interviews with 30 generally healthy men and women about their perceptions and experiences of personal health management. Questions focused on health behaviours (e.g., information seeking), as well as feelings about these behaviours and perceptions of the time dedicated to health. Audio-recorded interviews were transcribed and analyzed qualitatively using NVivo 10. Where appropriate, quantitative codes were applied and descriptive statistics are reported alongside qualitative findings.ResultsParticipants were generally satisfied with the amount of time spent on their health and few perceived personal health management as a burden. Many participants took issue with the concept of ‘work’ being associated with health and stressed the importance of taking personal responsibility for health.ConclusionsOur findings suggest that generally healthy people have internalised the notion of the ‘new public health’ and accepted the imperative of personal health responsibility. On the one hand, this bodes well for healthy individuals; their positive attitude may lead to better health outcomes, and the manageable amount of time spent suggests personal health management is unlikely to cause negative health consequences associated with stress. On the other hand, our findings may indicate that other factors, such as social determinants of health, are ignored in health promotion efforts and that those who cannot manage their own health may fall further behind. Future research should continue to explore the time people spend ‘working’ for their health, and how they perceive and respond to ‘new public health’ imperatives.

Into the gray: a modified approach to citation analysis to better understand research impact.

Academic authors and funders often want to know the “impact” of their publications, and this impact is generally judged by how and where the paper is cited in other academic works. This limited appraisal has been expanded in recent years as many are beginning to argue that nonacademic publishing venues should be included in assessing the impact of academic publications. This is an issue of particular concern with the growing emphasis on “knowledge translation” from the scientific literature to policy and practice applications 1–3 and to sources other than the traditional peer-reviewed and indexed venues, in other words, translation into the “gray literature” 4. In this comment and opinion piece, the authors describe the process of developing and applying a “modified citation analysis” that builds on existing methods of examining a research papers impact in two key ways: (1) by deliberately including gray literature in the citation analysis search process, and (2) by including quantitative and qualitative methods of analysis to gain a better understanding of how a research paper was used. By broadening the search and deepening the level of analysis, we suggest this new approach can better assess the impact of a given research paper—both within and outside of traditional peer-reviewed venues. We begin with a review of gray literature and then describe current methods for analyzing the impact of a research paper. Finally, we use a specific example to describe our new approach, highlight its potential for evolving the field of citation and impact analysis, and discuss future refinements and evaluation.

Relationships Among Intimate Partner Violence, Work, and Health

Intimate partner violence (IPV) is a major public health problem, and recent attention has focused on its impact on workers and workplaces. We provide findings from a pan-Canadian online survey on the relationships among IPV, work, and health. In total, 8,429 people completed the survey, 95.5% of them in English and 78.4% female. Reflecting the recruitment strategy, most (95.4%) were currently working, and unionized (81.4%). People with any lifetime IPV experience reported significantly poorer general health, mental health, and quality of life; those with both recent IPV and IPV experience over 12 months ago had the poorest health. Among those who had experienced IPV, about half reported that violence occurred at or near the workplace, and these people generally had poorer health outcomes. Employment status moderated the relationship between IPV exposure and health status, with those who were currently working and had experienced IPV having similar health status to those without IPV experience who were not employed. While there were gender differences in IPV experience, in the impacts of IPV at work, and in health status, gender did not moderate any associations. In this very large data set, we found robust relationships among different kinds of IPV exposure (current, recent, and lifetime), health and quality of life, and employment status, including the potentially protective effect of current employment on health for both women and men. Our findings may have implications for strategies to address IPV in workplaces, and should reinforce emerging evidence that IPV is also an occupational health issue.

Mandated reporters’ experiences with reporting child maltreatment: a meta-synthesis of qualitative studies

Objective To systematically search for research about the effectiveness of mandatory reporting of child maltreatment and to synthesise qualitative research that explores mandated reporters’ (MRs) experiences with reporting. Design As no studies assessing the effectiveness of mandatory reporting were retrieved from our systematic search, we conducted a meta-synthesis of retrieved qualitative research. Searches in Medline (Ovid), Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, Education Resources Information Center, Criminal Justice Abstracts and Cochrane Library yielded over 6000 citations, which were deduplicated and then screened by two independent reviewers. English-language, primary qualitative studies that investigated MRs’ experiences with reporting of child maltreatment were included. Critical appraisal involved a modified checklist from the Critical Appraisal Skills Programme and qualitative meta-synthesis was used to combine results from the primary studies. Setting All healthcare and social-service settings implicated by mandatory reporting laws were included. Included studies crossed nine high-income countries (USA, Australia, Sweden, Taiwan, Canada, Norway, Finland, Israel and Cyprus) and three middle-income countries (South Africa, Brazil and El Salvador). Participants: The studies represent the views of 1088 MRs. Outcomes Factors that influence MRs’ decision to report and MRs’ views towards and experiences with mandatory reporting of child maltreatment. Results Forty-four articles reporting 42 studies were included. Findings indicate that MRs struggle to identify and respond to less overt forms of child maltreatment. While some articles (14%) described positive experiences MRs had with the reporting process, negative experiences were reported in 73% of articles and included accounts of harm to therapeutic relationships and child death following removal from their family of origin. Conclusions The findings of this meta-synthesis suggest that there are many potentially harmful experiences associated with mandatory reporting and that research on the effectiveness of this process is urgently needed.

“Blaming the Flowers for Wilting” Idealized Aging in a Health Charity Video

Amid growing concern about the graying population, an emerging theme in public health discourse is that of “successful aging.” In this article, we use a governmentality lens to analyze a Canadian health promotion video, titled “Make Health Last: What Will Your Last 10 Years Look Like?” and viewers’ responses to its message. The video presents starkly different scenarios of the last decade of life, conveying a neo-liberal rationality in which health in old age is positioned as a matter of individual choice. Our analysis suggests that while viewers generally support the video’s message of personal responsibility for health, some are uneasy about implied claims that age-related illness can be prevented by choosing to be healthy. We argue that the video’s simplistic messaging about health in later life raises disturbing questions about health promotion campaigns that deny the “normal” aging body and blame the elderly for “deciding” not to remain youthful and healthy.

Linking Research to Action for Youth Violence Prevention: Community Capacity to Acquire, Assess, Adapt and Apply Research Evidence

ObjectivesCommunity-based organizations (CBOs) are important stakeholders in the health system, providing many valuable community-based programs and services. However, limited efforts have been made to encourage CBOs to incorporate research evidence into service provision, and their capacity to do so is not well understood. Therefore, the primary goal of this research was to examine CBOs’ perceptions of: 1) the frequency of using research and other forms of evidence related to youth violence prevention, and 2) their capacity to acquire, assess, adapt and apply research evidence.MethodsCBOs involved in youth violence prevention completed a survey (n=35) and/or attended a focus group (n=16). Survey questions were adapted from the Canadian Health Services Research Foundation’s “Is Research Working for You?” tool.ResultsCBOs’ reported use of and capacity to acquire research evidence was high. CBOs reported possessing the structures, processes, and organizational culture needed to apply research evidence in decision-making. Assessing research evidence was a challenge for CBO staff, although many have external experts who can effectively do so. Generally, CBOs reported adequate capacity to adapt (i.e., synthesize, contextualize, and present) research evidence. Adapting research evidence for use in particular populations or geographical areas presented a considerable challenge.ConclusionAlthough many barriers and socio-political complexities make linking research to action challenging, we found that CBOs generally feel competent and well equipped. Our findings support the viability of extending the push for evidence-based health care to community contexts so that the most effective programs and services for Canadians can be offered.RésuméObjectifsLes organismes communautaires sont d’importants acteurs du système de santé et offrent de nombreux programmes et services communautaires très utiles. Cependant, on fait peu d’efforts pour inciter ces organismes à intégrer les données probantes issues de la recherche dans la prestation de services, et leur capacité de le faire est mal comprise. C’est pourquoi notre objectif principal était d’examiner les perceptions des organismes communautaires à l’égard de: 1) la fréquence de l’utilisation de la recherche et d’autres formes de données probantes liées à la prévention de la violence chez les jeunes et 2) la capacité de ces organismes d’acquérir, d’évaluer, d’adapter et d’appliquer les données probantes issues de la recherche.MéthodeDes organismes communautaires faisant de la prévention de la violence chez les jeunes ont répondu à un sondage (n=35) et/ou assisté à un groupe de discussion (n=16). Les questions du sondage étaient adaptées de l’outil «La recherche vous réussit-elle?» de la Fondation canadienne de la recherche sur les services de santé.RésultatsL’utilisation déclarée des données probantes issues de la recherche par les organismes communautaires et leur capacité d’acquérir ces données étaient élevées. Ces organismes ont déclaré posséder les structures, les processus et la culture organisationnelle nécessaires pour appliquer les données probantes issues de la recherche à la prise de décisions. L’évaluation de ces données de recherche était difficile pour le personnel des organismes communautaires, bien que beaucoup fassent appel à des experts indépendants pour faire ce travail efficacement. Dans l’ensemble, les organismes communautaires ont dit avoir une capacité suffisante pour adapter (résumer, mettre en contexte et présenter) des données de recherche. L’adaptation des données de recherche pour les utiliser auprès de populations ou dans des zones géographiques particulières présentait cependant des difficultés considérables.ConclusionDe nombreux obstacles et complications sociopolitiques font qu’il est difficile de lier la recherche à l’action, mais nous constatons que les organismes communautaires se sentent généralement compétents et bien équipés. Nos constatations confirment qu’il est viable de militer pour que l’on étende la prestation de soins de santé fondés sur les preuves au milieu communautaire, afin que les programmes et services les plus efficaces puissent être offerts à la population canadienne.

Trajectories for women who disclose intimate partner violence in health care settings: the key role of abuse severity

ObjectivesTo examine the role of abuse severity in predicting women’s trajectories in mental and physical health and psychological quality of life during the 18 months following abuse identification in a health care setting.MethodsThe present analysis used growth curve modeling in a sample of 411 women positive for abuse on the Composite Abuse Scale.ResultsA high proportion of women experienced severe combined abuse (SCA; 55 % at baseline and 29 % at 18 months). On average, there was an improvement in depressive symptoms and psychological quality of life over time. Controlling for sociodemographic characteristics, women scoring positive versus negative for SCA experienced increased depressive symptoms and decreased quality of life; however, exposure to severe abuse did not affect the rate of change over time in these outcomes. Severe abuse was not associated with physical health.ConclusionsThere is an important association between abuse severity and women’s health and well-being over time. Understanding the role of different abuse experiences, risk and protective factors, and trajectories can assist in more accurate identification and appropriate care provision for women exposed to IPV.