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Article: Methodological Challenges in Group-based Randomised Controlled Trials for Intimate Partner Violence Perpetrators: A Meta-summary.

Turner, William / Morgan, Karen / Hester, Marianne / Feder, Gene / Cramer, Helen

Psychosocial intervention = Intervencion psicosocial

2023 Volume 32, Issue 2, Page(s) 123–136

Abstract: Evidence for treatment effects of group-based Intimate Partner Violence (IPV) perpetrators programmes remains, at best, inconclusive. In the present review, systematic/meta-analytic reviews were used to identify randomised controlled trials and a meta- ... ...

Abstract	Evidence for treatment effects of group-based Intimate Partner Violence (IPV) perpetrators programmes remains, at best, inconclusive. In the present review, systematic/meta-analytic reviews were used to identify randomised controlled trials and a meta-summary approach was employed to identify methodological challenges in the design and conduct of these trials. Of the fifteen studies identified, seven were comparative effectiveness trials. A range of methodological challenges were also identified by the trialists; source of outcome data, treatment modality, attrition and sample characteristics were the most frequently mentioned. Although there are only a few randomised controlled trials compared to non randomised studies, the findings of both highlight the need to invest in the development of innovative and/or combined IPV treatment programmes to address co-occurring issues such as substance use and trauma. The summary of methodological challenges will provide the first step in the development of methods guidance for researchers working in this area.
Language	English
Publishing date	2023-05-26
Publishing country	Spain
Document type	Journal Article
ZDB-ID	2439942-5
ISSN	2173-4712
ISSN	2173-4712
DOI	10.5093/pi2023a9
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Article ; Online: Researching Men's Violence Against Women as Feminist Women Researchers: The Tensions We Face.

Dheensa, Sandi / Morgan, Karen / Love, Beverly / Cramer, Helen

Violence against women

2022 Volume 30, Issue 2, Page(s) 347–371

Abstract: Qualitative and feminist researchers aim to build rapport, show empathy, be non-judgemental, and equalise power imbalances. A crucial challenge researchers face is how to navigate and balance competing aims and values when interacting with and ... ...

Abstract	Qualitative and feminist researchers aim to build rapport, show empathy, be non-judgemental, and equalise power imbalances. A crucial challenge researchers face is how to navigate and balance competing aims and values when interacting with and interviewing participants who have perpetrated intimate partner violence and abuse towards women. In this article, four female researchers evaluating perpetrator programmes for abusive men use reflexive analysis to identify the tensions encountered in such research. We outline how these tensions affected us and the data produced, and end with recommendations, which we hope will help prepare researchers, particularly women, for conducting interviews with violent/abusive men.
MeSH term(s)	Male ; Humans ; Female ; Men ; Intimate Partner Violence ; Feminism ; Aggression ; Interpersonal Relations
Language	English
Publishing date	2022-11-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2031375-5
ISSN	1552-8448 ; 1077-8012
ISSN (online)	1552-8448
ISSN	1077-8012
DOI	10.1177/10778012221134823
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Article ; Online: Shared decision making in consultations for hypertension: Qualitative study in general practice.

Johnson, Rachel / Turner, Katrina / Feder, Gene / Cramer, Helen

Health expectations : an international journal of public participation in health care and health policy

2021 Volume 24, Issue 3, Page(s) 917–929

Abstract: Background: Hypertension is mainly managed in primary care. Shared decision making is widely recommended as an approach to treatment decision making. However, no studies have investigated; in detail, what happens during primary care consultations for ... ...

Abstract	Background: Hypertension is mainly managed in primary care. Shared decision making is widely recommended as an approach to treatment decision making. However, no studies have investigated; in detail, what happens during primary care consultations for hypertension. Aim: To understand patients' and clinicians' experience of shared decision making for hypertension in primary care, in order to propose how it might be better supported. Design: Longitudinal qualitative study. Setting: Five general practices in south-west England. Method: Interviews with a purposive sample of patients with hypertension, and with the health-care practitioners they consulted, along with observations of clinical consultations, for up to 6 appointments. Interviews and consultations were audio-recorded and observational field notes taken. Data were analysed thematically. Results: Forty-six interviews and 18 consultations were observed, with 11 patients and nine health-care practitioners (five GPs, one pharmacist and three nurses). Little shared decision making was described by participants or observed. Often patients' understanding of their hypertension was limited, and they were not aware there were treatment choices. Consultations provided few opportunities for patients and clinicians to reach a shared understanding of their treatment choices. Opportunities for patients to engage in choices were limited by structured consultations and the distribution of decisions across consultations. Conclusion: For shared decision making to be better supported, consultations need to provide opportunities for patients to learn about their condition, to understand that there are treatment choices, and to discuss these choices with clinicians. Patient or public contribution: A patient group contributed to the design of this study.
MeSH term(s)	Decision Making ; Decision Making, Shared ; General Practice ; Humans ; Hypertension/therapy ; Qualitative Research ; Referral and Consultation
Language	English
Publishing date	2021-04-05
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2119434-8
ISSN	1369-7625 ; 1369-6513
ISSN (online)	1369-7625
ISSN	1369-6513
DOI	10.1111/hex.13234
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Article ; Online: Improving access to general practice for and with people with severe and multiple disadvantage: a qualitative study.

Potter, Lucy C / Stone, Tracey / Swede, Julie / Connell, Florrie / Cramer, Helen / McGeown, Helen / Carvalho, Maria / Horwood, Jeremy / Feder, Gene / Farr, Michelle / Gaps, Bridging

The British journal of general practice : the journal of the Royal College of General Practitioners

2024 Volume 74, Issue 742, Page(s) e330–e338

Abstract: Background: People with severe and multiple disadvantage (SMD) who experience combinations of homelessness, substance misuse, violence, abuse, and poor mental health have high health needs and poor access to primary care.: Aim: To improve access to ... ...

Abstract	Background: People with severe and multiple disadvantage (SMD) who experience combinations of homelessness, substance misuse, violence, abuse, and poor mental health have high health needs and poor access to primary care. Aim: To improve access to general practice for people with SMD by facilitating collaborative service improvement meetings between healthcare staff, people with lived experience of SMD, and those who support them; participants were then interviewed about this work. Design and setting: The Bridging Gaps group is a collaboration between healthcare staff, researchers, women with lived experience of SMD, and a charity that supports them in a UK city. A project was co-produced by the Bridging Gaps group to improve access to general practice for people with SMD, which was further developed with three inner-city general practices. Method: Nine service improvement meetings were facilitated at three general practices, and six of these were formally observed. Nine practice staff and four women with lived experience of SMD were interviewed. Three women with lived experience of SMD and one staff member who supports them participated in a focus group. Data were analysed inductively and deductively using thematic analysis. Results: By providing time and funding opportunities to motivated general practice staff and involving participants with lived experience of SMD, service changes were made in an effort to improve access for people with SMD. These included prioritising patients on an inclusion patient list with more flexible access, providing continuity for patients via a care coordinator and micro-team of clinicians, and developing an information-sharing document. The process and outcomes improved connections within and between general practices, support organisations, and people with SMD. Conclusion: The co-designed strategies described in this study could be adapted locally and evaluated in other areas. Investing in this focused way of working may improve accessibility to health care, health equity, and staff wellbeing.
MeSH term(s)	Humans ; Health Services Accessibility ; General Practice/organization & administration ; Qualitative Research ; Female ; Ill-Housed Persons ; United Kingdom ; Focus Groups ; Vulnerable Populations ; Quality Improvement ; Substance-Related Disorders/therapy ; Male ; Adult ; Primary Health Care/organization & administration
Language	English
Publishing date	2024-04-25
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1043148-2
ISSN	1478-5242 ; 0035-8797 ; 0960-1643
ISSN (online)	1478-5242
ISSN	0035-8797 ; 0960-1643
DOI	10.3399/BJGP.2023.0244
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Article ; Online: Randomised pilot and feasibility trial of a group intervention for men who perpetrate intimate partner violence against women.

Cramer, Helen / Gaunt, Daisy M / Shallcross, Rebekah / Bates, Lis / Kandiyali, Rebecca / Sardinha, LynnMarie / Rice, Caoimhe T / Man, Mei-See / Feder, Gene / Peters, Tim J / Morgan, Karen

BMC public health

2024 Volume 24, Issue 1, Page(s) 1183

Abstract: Background: There is a need for robust evidence on the effectiveness and cost-effectiveness of domestic abuse perpetrator programmes in reducing abusive behaviour and improving wellbeing for victim/survivors. While any randomised controlled trial can ... ...

Abstract	Background: There is a need for robust evidence on the effectiveness and cost-effectiveness of domestic abuse perpetrator programmes in reducing abusive behaviour and improving wellbeing for victim/survivors. While any randomised controlled trial can present difficulties in terms of recruitment and retention, conducting such a trial with domestic abuse perpetrators is particularly challenging. This paper reports the pilot and feasibility trial of a voluntary domestic abuse perpetrator group programme in the United Kingdom. Methods: This was a pragmatic individually randomised pilot and feasibility trial with an integrated qualitative study in one site (covering three local-authority areas) in England. Male perpetrators were randomised to either the intervention or usual care. The intervention was a 23-week group programme for male perpetrators in heterosexual relationships, with an average of three one-to-one sessions, and one-to-one support for female current- or ex-partners delivered by third sector organisations. There was no active control treatment for men, and partners of control men were signposted towards domestic abuse support services. Data were collected at three-monthly intervals for nine months from male and female participants. The main objectives assessed were recruitment, randomisation, retention, data completeness, fidelity to the intervention model, and acceptability of the trial design. Results: This study recruited 36 men (22 randomly allocated to attend the intervention group programme, 14 to usual care), and 15 current- or ex-partners (39% of eligible partners). Retention and completeness of data were high: 67% of male (24/36), and 80% (12/15) of female participants completed the self-reported questionnaire at nine months. A framework for assessing fidelity to the intervention was developed. In interviews, men who completed all or most of the intervention gave positive feedback and reported changes in their own behaviour. Partners were also largely supportive of the trial and were positive about the intervention. Participants who were not allocated to the intervention group reported feeling disappointed but understood the rationale for the trial. Conclusions: It was feasible to recruit, randomise and retain male perpetrators and female victim/survivors of abuse and collect self-reported outcome data. Participants were engaged in the intervention and reported positive benefits. The trial design was seen as acceptable. Trial registration: ISRCTN71797549, submitted 03/08/2017, retrospectively registered 27/05/2022.
MeSH term(s)	Humans ; Male ; Pilot Projects ; Feasibility Studies ; Female ; Intimate Partner Violence/prevention & control ; Adult ; Middle Aged ; England ; Young Adult ; United Kingdom
Language	English
Publishing date	2024-04-27
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Randomized Controlled Trial
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-024-18640-5
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Article ; Online: Domestic violence and injuries: prevalence and patterns-a pilot database study to identify suspected cases in a UK major trauma centre.

Garbett, Hollie / Carter, Ben / Gregory, Alison / Cramer, Helen / Lewis, Natalia V / Morgan, Karen / Thompson, Julian / Feder, Gene / Braude, Philip

Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention

2022

Abstract: Background: Victim-survivors of domestic violence and abuse (DVA) present to secondary care with isolated injuries to the head, limb or face. In the UK, there are no published studies looking at the relationship of significant traumatic injuries in ... ...

Abstract	Background: Victim-survivors of domestic violence and abuse (DVA) present to secondary care with isolated injuries to the head, limb or face. In the UK, there are no published studies looking at the relationship of significant traumatic injuries in adults and the relationship to DVA.The primary objective was to assess the feasibility of using a tailored search method to identify cases of suspected DVA in the national audit database for trauma. The secondary objective was to assess the association of DVA with clinical characteristics. Methods: We undertook a single-centre retrospective observational cohort pilot study. Data were analysed from the local Trauma and Audit Research Network (TARN) database. The 'Scene Description' field in the database was searched using a tailored search strategy. Feasibility was evaluated with notes review and assessed by the PPV and prevalence. Secondary objectives used a logistic regression in Excel. Results: This method of identifying suspected cases of DVA from the TARN database is feasible. The PPV was 100%, and the prevalence of suspected DVA in the study period was 3.6 per 1000 trauma discharges. Of those who had experienced DVA, 52.7% were male, median age 43 (IQR: 33-52) and mortality 5.5%. Subgroup analysis of older people demonstrated longer hospital stay (p=0.17) and greater likelihood of admission to intensive care (OR 2.60, 95% CI 0.48 to 14.24). Conclusion: We have created a feasible methodology to identify suspected DVA-related injuries within the TARN database. Future work is needed to further understand this relationship on a national level.
Language	English
Publishing date	2022-05-25
Publishing country	England
Document type	Journal Article
ZDB-ID	1433667-4
ISSN	1475-5785 ; 1353-8047
ISSN (online)	1475-5785
ISSN	1353-8047
DOI	10.1136/injuryprev-2021-044481
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Article ; Online: Experiences of Ambulatory Care for Frail, Older People and Their Carers During Acute Illness: A Qualitative, Ethnographic Study.

Glogowska, Margaret / Cramer, Helen / Pendlebury, Sarah / Purdy, Sarah / Lasserson, Daniel

Journal of the American Medical Directors Association

2019 Volume 20, Issue 10, Page(s) 1344–1347

MeSH term(s)	Aged ; Aged, 80 and over ; Ambulatory Care ; Female ; Frail Elderly ; Humans ; Interviews as Topic ; Male ; Patient Satisfaction ; Qualitative Research
Language	English
Publishing date	2019-05-10
Publishing country	United States
Document type	Letter ; Research Support, Non-U.S. Gov't
ZDB-ID	2171030-2
ISSN	1538-9375 ; 1525-8610
ISSN (online)	1538-9375
ISSN	1525-8610
DOI	10.1016/j.jamda.2019.03.022
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Article ; Online: The effectiveness and cost-effectiveness of a group domestic abuse perpetrator programme: protocol for a randomised controlled trial.

Morgan, Karen / Man, Mei-See / Bloomer, Rachael / Cochrane, Madeleine / Cole, Melissa / Dheensa, Sandi / Eisenstadt, Nathan / Feder, Gene / Gaunt, Daisy M / Leach, Rwth / Kandiyali, Rebecca / Noble, Sian / Peters, Tim J / Shirkey, Beverly A / Cramer, Helen

Trials

2023 Volume 24, Issue 1, Page(s) 617

Abstract: Background: In contrast to evidence for interventions supporting victim/survivors of domestic violence and abuse (DVA), the effectiveness of perpetrator programmes for reduction of abuse is uncertain. This study aims to estimate the effectiveness and ... ...

Abstract	Background: In contrast to evidence for interventions supporting victim/survivors of domestic violence and abuse (DVA), the effectiveness of perpetrator programmes for reduction of abuse is uncertain. This study aims to estimate the effectiveness and cost-effectiveness of a perpetrator programme for men. Methods: Pragmatic two-group individually randomised controlled trial (RCT) with embedded process and economic evaluation. Five centres in southwest England and South Wales aim to recruit 316 (reduced from original target of 366) male domestic abuse perpetrators. These will be randomised 2:1 to a community-based domestic abuse perpetrator programme (DAPP) or usual care comparator with 12-month follow-up. Female partners/ex-partners will be invited to join the study. The intervention for men comprises 23 weekly sessions of a group programme delivered in voluntary sector domestic abuse services. The intervention for female partners/ex-partners is one-to-one support from a safety worker. Men allocated to usual care receive no intervention; however, they are free to access other services. Their partners/ex-partners will be signposted to support services. Data is collected at baseline, and 4, 8 and 12 months' follow-up. The primary outcome is men's self-reported abusive behaviour measured by the Abusive Behaviour Inventory (ABI-29) at 12 months. Secondary measures include physical and mental health status and resource use alongside the abuse measure ABI (ABI-R) for partners/ex-partners and criminal justice contact for men. A mixed methods process evaluation and qualitative study will explore mechanisms of effectiveness, judge fidelity to the intervention model using interviews and group observations. The economic evaluation, over a 1-year time horizon from three perspectives (health and social care, public sector and society), will employ a cost-consequences framework reporting costs alongside economic outcomes (Quality-Adjusted Life Years derived from EQ-5D-5L, SF-12 and CHU-9D, and ICECAP-A) as well as the primary and other secondary outcomes. Discussion: This trial will provide evidence of the (cost)effectiveness of a DAPP. The embedded process evaluation will further insights in the experiences and contexts of participants and their journey through a perpetrator programme, and the study will seek to address the omission in other studies of economic evaluations. Trial registration: ISRCTN15804282, April 1, 2019.
MeSH term(s)	Female ; Male ; Humans ; Cost-Benefit Analysis ; Quality of Life ; England ; Domestic Violence/prevention & control ; Qualitative Research ; Randomized Controlled Trials as Topic
Language	English
Publishing date	2023-09-28
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article
ZDB-ID	2040523-6
ISSN	1745-6215 ; 1468-6694 ; 1745-6215
ISSN (online)	1745-6215
ISSN	1468-6694 ; 1745-6215
DOI	10.1186/s13063-023-07612-6
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Article ; Online: Trauma-informed co-production: Collaborating and combining expertise to improve access to primary care with women with complex needs.

McGeown, Helen / Potter, Lucy / Stone, Tracey / Swede, Julie / Cramer, Helen / Horwood, Jeremy / Carvalho, Maria / Connell, Florrie / Feder, Gene / Farr, Michelle

Health expectations : an international journal of public participation in health care and health policy

2023 Volume 26, Issue 5, Page(s) 1895–1914

Abstract: Introduction: Health, social care, charitable and justice sectors are increasingly recognising the need for trauma-informed services that seek to recognise signs of trauma, provide appropriate paths to recovery and ensure that services enable people ... ...

Abstract	Introduction: Health, social care, charitable and justice sectors are increasingly recognising the need for trauma-informed services that seek to recognise signs of trauma, provide appropriate paths to recovery and ensure that services enable people rather than retraumatise. Foundational to the development of trauma-informed services is collaboration with people with lived experience of trauma. Co-production principles may provide a useful framework for this collaboration, due to their emphasis on lived experience, and intent to address power imbalances and promote equity. This article aims to examine trauma-informed and co-production principles to consider the extent to which they overlap and explore how to tailor co-production approaches to support people who have experienced trauma. Methods: Bridging Gaps is a collaboration between women who have experienced complex trauma, a charity that supports them, primary care clinicians and health researchers to improve access to trauma-informed primary care. Using co-production principles, we aimed to ensure that women who have experienced trauma were key decision-makers throughout the project. Through reflective notes (n = 19), observations of meetings (n = 3), interviews with people involved in the project (n = 9) and reflective group discussions on our experiences, we share learning, successes and failures. Data analysis followed a framework approach, using trauma-informed principles. Results: Co-production processes can require adaptation when working with people who have experienced trauma. We emphasise the need for close partnership working, flexibility and transparency around power dynamics, paying particular attention to aspects of power that are less readily visible. Sharing experiences can retrigger trauma. People conducting co-production work need to understand trauma and how this may impact upon an individual's sense of psychological safety. Long-term funding is vital to enable projects to have enough time for the establishment of trust and delivery of tangible results. Conclusions: Co-production principles are highly suitable when developing trauma-informed services. Greater consideration needs to be given as to whether and how people share lived experiences, the need for safe spaces, honesty and humility, difficult dynamics between empowerment and safety and whether and when blurring boundaries may be helpful. Our findings have applicability to policy-making, funding and service provision to enable co-production processes to become more trauma-informed. Public contribution: Bridging Gaps was started by a group of women who have experienced complex trauma, including addiction, homelessness, mental health problems, sexual exploitation, domestic and sexual violence and poverty, with a general practitioner (GP) who provides healthcare to this population, alongside a support worker from the charity One25, a charity that supports some of the most marginalised women in Bristol to heal and thrive. More GPs and healthcare researchers joined the group and they have been meeting fortnightly for a period of 4 years with the aim of improving access to trauma-informed primary care. The group uses co-production principles to work together, and we aim to ensure that women who have experienced trauma are key decision-makers throughout our work together. This article is a summary of our learning, informed by discussion, observations and interviews with members of the group.
MeSH term(s)	Humans ; Female ; Access to Primary Care ; Delivery of Health Care ; Palliative Care ; Social Support
Language	English
Publishing date	2023-07-10
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2119434-8
ISSN	1369-7625 ; 1369-6513
ISSN (online)	1369-7625
ISSN	1369-6513
DOI	10.1111/hex.13795
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Article ; Online: Left behind and left out: The impact of the school environment on young people with continence problems.

Whale, Katie / Cramer, Helen / Joinson, Carol

British journal of health psychology

2017 Volume 23, Issue 2, Page(s) 253–277

Abstract: Objectives: To explore the impact of the secondary school environment on young people with continence problems.: Design: In-depth qualitative semi-structured interviews.: Methods: We interviewed 20 young people aged 11-19 years (11 female and nine ...

Abstract	Objectives: To explore the impact of the secondary school environment on young people with continence problems. Design: In-depth qualitative semi-structured interviews. Methods: We interviewed 20 young people aged 11-19 years (11 female and nine male) with continence problems (daytime wetting, bedwetting, and/or soiling). Interviews were conducted by Skype (n = 11) and telephone (n = 9). Transcripts were analysed using inductive thematic analysis. Results: We generated five main themes: (1) Boundaries of disclosure: friends and teachers; (2) Social consequences of avoidance and deceit; (3) Strict and oblivious gatekeepers; (4) Intimate actions in public spaces; and (5) Interrupted learning. Conclusion: Disclosure of continence problems at school to both friends and teachers was rare, due to the perceived stigma and fears of bullying and social isolation. The lack of disclosure to teachers and other school staff, such as pastoral care staff, creates challenges in how best to support these young people. Young people with continence problems require unrestricted access to private and adequate toilet facilities during the school day. There is a need for inclusive toilet access policies and improved toilet standards in schools. Addressing the challenges faced by young people with continence problems at school could help to remove the barriers to successful self-management of their symptoms. It is particularly concerning that young people with continence problems are at higher risk of academic underachievement. Increased support at school is needed to enable young people with continence problems to achieve their academic potential. Statement of Contribution What is already known on this subject? Continence problems are among the most common paediatric health problems Self-management of continence problems requires a structured schedule of fluid intake and bladder emptying Inadequate toilet facilities and restricted access make it difficult for young people to manage their incontinence What does this study add? Improvement is needed in teacher understanding of the needs of young people with continence problems Young people are reluctant to disclose continence problems due to perceived stigma and fear of social isolation Young people with continence problems may be at increased risk of academic underachievement.
MeSH term(s)	Adolescent ; Adult ; Child ; England ; Environment Design ; Female ; Humans ; Interpersonal Relations ; Interviews as Topic ; Male ; Schools ; Scotland ; Social Environment ; Social Stigma ; Urinary Incontinence/psychology ; Young Adult
Language	English
Publishing date	2017-12-11
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2026500-1
ISSN	2044-8287 ; 1359-107X
ISSN (online)	2044-8287
ISSN	1359-107X
DOI	10.1111/bjhp.12284
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