Development of an HIV/STI and partner violence health promotion intervention for abused US Virgin Islands women.

Women in the US Virgin Islands (USVI) experience intimate partner violence (IPV) and human immunodeficiency virus (HIV) at disproportionate rates compared to women on the US mainland. Women in violent relationships report experiencing controlling behaviours that decrease their ability to negotiate for sex using condoms or to prevent unwanted pregnancies. Though several evidence-based interventions exist to prevent either IPV or HIV, few address them through an integrated health promotion approach or attend to particular USVI cultural mores. This article describes the systematic development of a theory based, culturally tailored, integrated health promotion intervention that addresses IPV and HIV among USVI women experiencing abuse. The process included: (i) identifying and integrating evidence-based health promotion interventions, (ii) conducting formative research using focus groups, (iii) synthesizing focus group data to inform intervention development and (iv) developing a culturally and linguistically appropriate intervention specific to the needs and concerns of USVI women. The Empowered Sisters Project: Making Choices Reducing Risks (ESP) was developed through this research. ESP is a three-session health promotion curriculum focussed on enhancing sexual health and safety among women experiencing abuse. The ESP intervention components included promoting condom use, increasing IPV and HIV knowledge and developing a personalized safety plan. Health professionals facilitated individual intervention sessions using culturally tailored visual media and scripts. This program focussed on experiences of women living in the USVI and has implications for utility across the Caribbean diaspora.

Recognising and responding to intimate partner violence using telehealth: Practical guidance for nurses and midwives.

AIMS: To synthesise the current, global evidence-informed guidance that supports nurses and midwives to recognise and respond to intimate partner violence (IPV), and how these practices can be translated from face-to-face encounters to care that is delivered through telehealth. BACKGROUND: COVID-19-related social and physical distancing measures increase the risk for individuals who are socially isolated with partners who perpetuate violence. Providing support through telehealth is one strategy that can mitigate the pandemic of IPV, while helping patients and providers stay safe from COVID-19. DESIGN AND METHODS: In this discursive paper, we describe how practical guidance for safely recognising and responding to IPV in telehealth encounters was developed. The ADAPT-ITT (Assessment, Decisions, Administration, Production, Topical Experts, Integration, Testing, Training) framework was used to guide the novel identification and adaptation of evidence-informed guidance. We focused on the first six stages of the ADAPT-ITT framework. CONCLUSIONS: This paper fills a gap in available guidance, specifically for IPV recognition and response via telehealth. We present strategies for prioritising safety and promoting privacy while initiating, managing or terminating a telehealth encounter with patients who may be at risk for or experiencing IPV. Strategies for assessment, planning and intervention are also summarised. System-level responses, such as increasing equitable access to telecommunication technology, are also discussed. RELEVANCE TO CLINICAL PRACTICE: Integrating innovative IPV-focused practices into telehealth care is an important opportunity for nurses and midwives during the current global COVID-19 pandemic. There are also implications for future secondary outbreaks, natural disasters or other physically isolating events, for improving healthcare efficiency, and for addressing the needs of vulnerable populations with limited access to health care.

The Role of Religious Involvement in the Relationship Between Early Trauma and Health Outcomes Among Adult Survivors.

The purpose of this study was to determine the role of religious involvement and related indicators - religious coping, intrinsic religiosity, forgiveness and gratitude - in reducing the negative impact of early traumatic stress on the mental and physical health of adult survivors. Multiple linear regressions were used to analyze self-reported data of 10,283 Seventh-day Adventist men and women across North America. The study also included an original analysis on a subsample (n = 496) of the larger group, examining diabetes risk factors in conjunction with Adverse Childhood Events (ACE) data. Higher early trauma scores were associated with decreased mental health (B = -1.93 p < .0001) and physical health (B = -1.53, p < .0001). The negative effect of early trauma on mental health was reduced by intrinsic religiosity (B = .52, p = .011), positive religious coping (B = .61, p = .025), forgiveness (B = .32 p = .025), and gratitude (B = .87 p = .001). Adult survivors of early trauma experienced worse mental and physical health; however, forgiveness, gratitude, positive religious coping, and intrinsic religiosity were protective against poor mental health. The findings support a holistic perspective in the care of childhood trauma survivors.

Gender and Race Variations in the Intersection of Religious Involvement, Early Trauma, and Adult Health.

PURPOSE: This study aimed to determine gender and race variations in regards to the influence of religious involvement (RI) as a moderator of the effects of early traumatic stress (ETS) on health-related quality of life among adult survivors of child abuse. DESIGN: A cross-sectional predictive design was used to study Seventh-day Adventist adults in North America (N = 10,283). METHODS: A secondary analysis of data collected via questionnaires was done using multiple regression. RESULTS: Data revealed that women had a significantly higher prevalence of any or all ETS subtypes, except for physical abuse prevalence, which was the same for both genders. Blacks reported a significantly higher prevalence of at least one ETS subtype than did Whites, except for neglect, where Whites had a higher prevalence. Exposure to at least one ETS subtype was associated with worse negative effect on mental health (B = -2.08, p < .0001 vs. B = -1.54, p < .0001) and physical health (B = -2.01, p < .0001 vs. B = -1.11, p < .0001) for women compared to men. Among those exposed to all ETS subtypes (n = 447), Whites had significant worse physical health, with White women having almost two times the negative effect on physical health (B = -4.50, p < .0001) than White men (B = -2.87, p < .05). As for RI moderation, based on tests of three-way interactions of race-RI-ETS, there were no associated differences. However, tests of three-way interactions of gender-RI-ETS showed a significant buffering effect. Among those with high levels of negative religious coping (RC), women exposed to ETS had significantly worse physical health (B = -1.28) than men. CONCLUSIONS: Results give evidence of gender and racial differences on the magnitude of the ETS-health effect, as well as gender differences in ETS-health buffering by RC. CLINICAL RELEVANCE: Findings suggest gender and racial differences must be considered when devising holistic nursing interventions for improving health outcomes of early trauma survivors.

Immigrant and nonimmigrant women: factors that predict leaving an abusive relationship.

This research used logistic regression to test components of Choice and Lamke's (1997) two-part decision-making model and Hamby's (2008) holistic risk assessment as predictors of the decision to separate from an abusive partner, comparing significant predictors for immigrant (n = 497) and nonimmigrant (n = 808) women. Findings demonstrated that immigrant women reported higher levels of perceived risks/barriers to leaving, provided some support for the use of a holistic risk assessment in understanding women's decisions to leave, and demonstrated that immigrant and nonimmigrant women have both similarities and differences in the factors that predict leaving. Clinical and policy implications are addressed.

Factors related to posttraumatic stress symptoms in women experiencing police-involved intimate partner violence.

Relationships among intimate partner violence (IPV), Post Traumatic Stress Disorder (PTSD) symptoms, health, and danger, using M.A. Dutton's Empowerment framework, were examined among 423 ethnically diverse women in contact with police due to IPV. Significant predictors of PTSD symptoms in multivariate analysis included Danger Assessment score, poor overall health, abuse leading to pain, victim expectations of future injury victimization, feeling unsafe, and shame. Results provide further evidence supporting routine assessment for violent trauma and PTSD as well as the need for research testing holistic interventions for women traumatized by violence.

The mediation effect of posttraumatic stress disorder symptoms on the relationship of intimate partner violence and IFN-gamma levels.

BACKGROUND: Women who experience intimate partner violence (IPV) report greater stress and negative health consequences than nonabused women. Although an association between psychological stress and altered immune function has been shown, IPV studies have not investigated this relationship. OBJECTIVE: This study explored the association of IPV with mental health symptoms and an immune marker to determine if posttraumatic stress disorder (PTSD) symptoms mediate the effect of IPV on pro-inflammatory (IFN-gamma) cytokine levels. METHODS: A cross-sectional, comparative design was used to compare 62 women with IPV and 39 nonabused women. RESULTS: Mean IFN-gamma values were higher in abused women and in women with current PTSD symptoms. There were no significant relationships with potential confounding variables that could provide an alternative explanation for the increase in production of proinflammatory cytokines. CONCLUSIONS: PTSD symptoms mediate the association between IPV and IFN-gamma levels and may partially explain the association of mental health symptoms with physical health sequelae in IPV.