Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well‐being of women who experience intimate partner abuse

Carol Rivas; Jean Ramsay; Laura Sadowski; Leslie L Davidson; Danielle Dunne; Sandra Eldridge; Kelsey Hegarty; Angela Taft; Gene Feder

doi:10.1002/14651858.CD005043.pub3

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Figure 1

Risk of bias summary: review authors' judgements about each risk of bias item for each included study. Red circles with minus signs indicate high risk, green circles with plus signs indicate low risk, and yellow circles with question marks indicate unclear risk of bias.

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Figure 2

Review flow diagram.

IPV: intimate partner violence; RCT: randomised controlled trial.

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Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 4

Logic model summarising results for brief advocacy interventions.

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Figure 5

Logic model summarising results for intense advocacy interventions.

PTSD: Post Traumatic Stress Disorder.

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Analysis 1.1

Comparison 1 Physical abuse, Outcome 1 Brief advocacy.

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Analysis 1.2

Comparison 1 Physical abuse, Outcome 2 Brief advocacy (dichotomous outcome) (up to 12 months follow‐up).

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Analysis 1.3

Comparison 1 Physical abuse, Outcome 3 Brief advocacy (mean change).

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Analysis 1.4

Comparison 1 Physical abuse, Outcome 4 Intensive advocacy.

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Analysis 1.5

Comparison 1 Physical abuse, Outcome 5 Intensive advocacy (dichotomous outcome).

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Analysis 1.6

Comparison 1 Physical abuse, Outcome 6 Intensive advocacy: missing reassigned (dichotomous outcome) (up to 12 months follow‐up).

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Analysis 1.7

Comparison 1 Physical abuse, Outcome 7 Any advocacy.

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Analysis 1.8

Comparison 1 Physical abuse, Outcome 8 Any advocacy (dichotomous outcome) (up to 12 months follow‐up).

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Analysis 2.1

Comparison 2 Sexual abuse, Outcome 1 Brief advocacy (up to 12 months follow‐up).

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Analysis 2.2

Comparison 2 Sexual abuse, Outcome 2 Brief advocacy (mean change) (up to 12 months follow‐up).

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Analysis 2.3

Comparison 2 Sexual abuse, Outcome 3 Brief advocacy (dichotomous outcome) (up to 12 months follow‐up).

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Analysis 3.1

Comparison 3 Emotional abuse, Outcome 1 Brief advocacy.

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Analysis 3.2

Comparison 3 Emotional abuse, Outcome 2 Brief advocacy (mean change) (up to 12 months follow‐up).

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Analysis 3.3

Comparison 3 Emotional abuse, Outcome 3 Intensive advocacy.

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Analysis 3.4

Comparison 3 Emotional abuse, Outcome 4 Intensive advocacy (dichotomous outcome) (up to 12 months follow‐up).

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Analysis 3.5

Comparison 3 Emotional abuse, Outcome 5 Any advocacy.

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Analysis 4.1

Comparison 4 Risk of homicide, Outcome 1 Brief advocacy.

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Analysis 5.1

Comparison 5 Risk of work harassment, Outcome 1 Brief advocacy.

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Analysis 6.1

Comparison 6 Overall abuse, Outcome 1 Brief advocacy (up to 12 months follow‐up).

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Analysis 6.2

Comparison 6 Overall abuse, Outcome 2 Intensive advocacy (up to 12 months follow‐up).

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Analysis 6.3

Comparison 6 Overall abuse, Outcome 3 Intensive advocacy (dichotomous outcome) (up to 12 months follow‐up).

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Analysis 6.4

Comparison 6 Overall abuse, Outcome 4 Any advocacy (up to 12 months follow‐up).

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Analysis 7.1

Comparison 7 Quality of life, Outcome 1 Brief advocacy: 2 summary component subscales.

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Analysis 7.2

Comparison 7 Quality of life, Outcome 2 Brief advocacy: 8 subscales (mean change).

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Analysis 7.3

Comparison 7 Quality of life, Outcome 3 Intensive advocacy: 2 summary component subscales.

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Analysis 7.4

Comparison 7 Quality of life, Outcome 4 Intensive advocacy: overall.

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Analysis 7.5

Comparison 7 Quality of life, Outcome 5 Any advocacy: 2 summary component subscales.

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Analysis 8.1

Comparison 8 Depression, Outcome 1 Brief advocacy (up to 12 months follow‐up).

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Analysis 8.2

Comparison 8 Depression, Outcome 2 Brief advocacy (dichotomous outcome) (up to 12 months follow‐up).

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Analysis 8.3

Comparison 8 Depression, Outcome 3 Intensive advocacy.

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Analysis 8.4

Comparison 8 Depression, Outcome 4 Intensive advocacy (dichotomous outcome) (up to 12 months follow‐up).

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Analysis 8.5

Comparison 8 Depression, Outcome 5 Any advocacy (up to 12 months follow‐up).

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Analysis 8.6

Comparison 8 Depression, Outcome 6 Any advocacy (dichotomous outcome) (up to 12 months follow‐up).

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Analysis 9.1

Comparison 9 Anxiety, Outcome 1 Brief advocacy (up to 12 months follow‐up).

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Analysis 9.2

Comparison 9 Anxiety, Outcome 2 Intensive advocacy.

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Analysis 9.3

Comparison 9 Anxiety, Outcome 3 Intensive advocacy (mean change) (up to 12 months follow‐up).

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Analysis 9.4

Comparison 9 Anxiety, Outcome 4 Any advocacy (up to 12 months follow‐up).

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Analysis 10.1

Comparison 10 Chronic pain, Outcome 1 Brief advocacy (up to 12 months follow‐up).

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Analysis 11.1

Comparison 11 Chronic fatigue, Outcome 1 Brief advocacy (up to 12 months follow‐up).

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Analysis 12.1

Comparison 12 Low birth weight, Outcome 1 Brief advocacy (dichotomous outcome).

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Analysis 13.1

Comparison 13 Birth weight (grams), Outcome 1 Brief advocacy.

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Analysis 14.1

Comparison 14 Pre‐term birth, Outcome 1 Brief advocacy (dichotomous outcome).

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Analysis 15.1

Comparison 15 Gestational age (weeks) at delivery, Outcome 1 Brief advocacy.

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Analysis 16.1

Comparison 16 Post‐traumatic stress, Outcome 1 Brief advocacy (up to 12 months follow‐up).

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Analysis 17.1

Comparison 17 Perception of stress, Outcome 1 Brief advocacy (up to 12 months follow‐up).

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Analysis 18.1

Comparison 18 Self efficacy, Outcome 1 Intensive advocacy.

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Analysis 19.1

Comparison 19 Self esteem, Outcome 1 Intensive advocacy (up to 12 months follow‐up).

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Analysis 20.1

Comparison 20 Perceived social support, Outcome 1 Brief advocacy (up to 12 months follow‐up).

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Analysis 20.2

Comparison 20 Perceived social support, Outcome 2 Intensive advocacy.

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Analysis 20.3

Comparison 20 Perceived social support, Outcome 3 Intensive advocacy (mean change).

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Analysis 20.4

Comparison 20 Perceived social support, Outcome 4 Any advocacy (up to 12 months follow‐up).

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Analysis 21.1

Comparison 21 Independence from abuser, Outcome 1 Intensive advocacy (dichotomous outcome).

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Analysis 21.2

Comparison 21 Independence from abuser, Outcome 2 Intensive advocacy: missing reassigned (up to 12 months follow‐up) (dichotomous outcome).

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Analysis 22.1

Comparison 22 Emotional attachment to abuser, Outcome 1 Intensive advocacy.

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Analysis 23.1

Comparison 23 Use of safety behaviours, Outcome 1 Brief advocacy.

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Analysis 24.1

Comparison 24 Use of resources, Outcome 1 Brief advocacy.

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Analysis 25.1

Comparison 25 Difficulty obtaining resources, Outcome 1 Intensive advocacy.

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Summary of findings for the main comparison. Intensive advocacy interventions for women who experience intimate partner abuse versus usual care at up to 12‐month follow‐up

Intensive advocacy interventions for women who experience intimate partner abuse versus usual care at up to 12‐month follow‐up
Patient or population: women with intimate partner abuse Settings: within or outside of healthcare settings Intervention: intensive advocacy interventions
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	Intensive advocacy interventions
Physical abuse Conflict Tactics Scales (CTS; 80 items rated on a 7‐point scale) Follow‐up: 12 months	The mean physical abuse in the control groups was 1	The mean physical abuse in the intervention groups was 0.12 lower (0.39 lower to 0.15 higher)	—	265 (1 study)	⊕⊕⊝⊝ Low^a,b,c	Sullivan 1992
Physical abuse (dichotomous outcome) Follow‐up: 12 months	Study population		OR 0.61 (0.33 to 1.14)	182 (2 studies)	⊕⊝⊝⊝ Very low^b,d,e	Sullivan 1991; Sullivan 1992
	453 per 1000	336 per 1000 (215 to 486)
	Moderate effect
Emotional abuse (dichotomous outcome) Follow‐up: 12 months	Study population		OR 0.58 (0.30 to 1.13)	141 (1 study)	⊕⊕⊕⊝ Moderate^e,f	Sullivan 1992
	557 per 1000	422 per 1000 (274 to 587)
	Moderate effect
Emotional abuse Index of Psychological Abuse (IPA; 33 items rated on a 4‐point scale) Follow‐up: 12 months	The mean emotional abuse in the control groups was 1.4	The mean emotional abuse in the intervention groups was 0.02 lower (0.16 lower to 0.12 higher)	—	265 (1 study)	⊕⊝⊝⊝ Very low^c,g,h	Sullivan 1992
Overall abuse One study used a composite of two scales (12 items. Scale from 0 to 36) Other study used Composite Abuse Scale (CAS)ⁱ (30 items presented in a 6‐point format requiring respondents to answer 'never', 'only once', 'several times', 'monthly', 'weekly' or 'daily' in a 12‐month period) Follow‐up: immediately postintervention to 4 months	The mean overall abuse ranged across control groups from 0.58 to 27.10	The mean overall abuse in the intervention groups was 0.23 standard deviations lower (0.53 lower to 0.08 higher)	—	181 (2 studies)	⊕⊝⊝⊝ Very low^c,,j,k	Sullivan 2002; Taft 2011
Overall abuse (dichotomous outcome) Follow‐up: immediately postintervention	Study population		OR 0.72 (0.29 to 1.79)^l	103 (1 study)	⊕⊝⊝⊝ Very low^e,m,n	Taft 2011
	719 per 1000	648 per 1000 (426 to 821)
	Moderate effect
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: odds ratio; GRADE: Grades of Recommendations, Assessment, Development, and Evaluation
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
^aInsufficient information available concerning random sequence generation, blinding and protection against contamination, and attrition bias. ^bThere is a reduction in effect after 24 months, which is explained by the authors. ^cSample size less than 400. ^dOne study has incomplete information on blinding, but in the other we determined that there was no blinding; in addition, incomplete data on random sequence generation, protection against contamination and allocation concealment, and attrition bias. ^eTotal events less than 300. ^fResult consistent with continuous measure. ^gNo blinding and attrition bias; in addition, incomplete data on random sequence generation, protection against contamination and allocation concealment. ^hResult consistent with dichotomous measure. ⁱComposite of shortened Index of Psychological Abuse (IPA), Conflict Tactics Scale (CTS), and modified physical violence subscale (one study), and Composite Abuse Scale (CAS) (range 0 to 150) (other study). ^jOne study with very serious bias and one with many unclear biases and rated as having serious bias. ^kSmall sample size (less than 400), standard deviation (SD) greater than 0.5. ^lFigures supplied by Taft for subset of abused women only (paper does not separate abused women from women at risk of abuse in the analysis). ^mSample attrition greater than 20% and differential across groups, not intention‐to‐treat (ITT), and group allocation not concealed. ⁿWide confidence intervals around 1.

Summary of findings for the main comparison. Intensive advocacy interventions for women who experience intimate partner abuse versus usual care at up to 12‐month follow‐up

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Summary of findings 2. Brief advocacy interventions for women who experience intimate partner abuse versus usual care at up to 12‐month follow‐up

Brief advocacy interventions for women who experience intimate partner abuse versus usual care at up to 12‐month follow‐up
Patient or population: women with intimate partner abuse Settings: within or outside of healthcare settings Intervention: brief advocacy interventions
Outcomes	*Illustrative comparative risks (95% CI)**		No. of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	Brief advocacy interventions
Physical abuse Outcome was measured on different scales in different studies^a Follow‐up: immediately postintervention to 12 months	The mean physical abuse ranged across control groups from 0.45 to 12.6	The mean physical abuse in the intervention groups was 0 standard deviations higher (0.17 lower to 0.16 higher)	558 (3 studies)	⊕⊕⊕⊝ Moderate^b	Gillum 2009; McFarlane 2006; Tiwari 2010
Physical abuse by severity ‐ severe Conflict Tactics Scales (CTS) mean change from baseline Follow‐up: 16 to 34 weeks^c	The mean physical abuse by severity ‐ severe in the control groups was 0.17	The mean physical abuse by severity ‐ severe in the intervention groups was 0.08 higher (0.26 higher to 0.42 higher)	110 (1 study)	⊕⊕⊕⊝ Moderate^d	Tiwari 2005
Sexual abuse CTS and Partner Abuse Scale (PAS)^e Follow‐up: immediately postintervention to 12 months	The mean sexual abuse ranged across control groups from 0.10 to 0.14	The mean sexual abuse in the intervention groups was 0.12 standard deviations lower (0.37 lower to 0.14 higher)	239 (2 studies)	⊕⊕⊕⊝ Moderate^f,g	Gillum 2009; Tiwari 2010
Sexual abuse CTS sexual abuse single‐item mean change from baseline Follow‐up: 16 to 34 weeks^c	The mean sexual abuse in the control groups was − 0.06	The mean sexual abuse in the intervention groups was 0.07 lower (0.30 lower to 0.16 higher)	110 (1 study)	⊕⊕⊕⊝ Moderate^h,i	Tiwari 2005
Emotional abuse Outcome was measured on different scales in different studies^j Follow‐up: immediately postintervention to 12 months	The mean emotional abuse ranged across control groups from 12.11 to 24.80	The mean emotional abuse in the intervention groups was 0.05 standard deviations lower (0.22 lower to 0.11 higher)	558 (3 studies)	⊕⊕⊝⊝ Low^b,k	Gillum 2009; McFarlane 2006; Tiwari 2010
Emotional abuse CTS mean change from baseline Follow‐up: 16 to 34 weeks^c	The mean emotional abuse in the control groups was − 1.92	The mean emotional abuse in the intervention groups was 4.24 lower (6.42 lower to 2.06 lower)	110 (1 study)	⊕⊕⊕⊝ Moderateⁱ	Tiwari 2005
Overall abuse Index of Spouse Abuse (ISA) score. Scale from 0 to 30 Follow‐up: 3 to 4 months	The mean overall abuse in the control groups was 23.39	The mean overall abuse in the intervention groups was 7.74 standard deviations lower (20.33 lower to 4.85 higher)	53 (1 study)	⊕⊕⊝⊝ Low^l,m	Hyman 2001
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; GRADE: Grades of Recommendations, Assessment, Development, and Evaluation.
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
^aPartner Abuse Scale (PAS), physical subscale; 46‐item Severity of Violence Against Women Scale (SVAWS), physical violence subscale; Chinese version of the 39‐item Revised Conflicts Tactics Scale (CTS), psychological aggression subscale. ^bOne study has significant biases, one has moderate bias, and one no significant bias. ^c6 weeks post‐delivery, but representing 16 to 34 weeks postintervention. ^dDifference from severe abuse results are consistent with abuse severity effects; in this study, advocacy is less effective when the abuse is more severe. ^eConflict Tactics Scale, sexual coercion subscale; PAS, sexual abuse subscale. ^fThere is moderate overlap in CIs and moderate heterogeneity. ^gSample size less than 400. ^hThe low effect size is consistent across studies. ⁱTotal events greater than 300. ^jPartner Abuse Scale (PAS), non‐physical subscale, score range 0 to 25; 46‐item SVAWS, Chinese version of the 39‐item revised CTS, psychological aggression subscale. ^kThere is inconsistency between results, though this is partly explained by setting with one study in the community and two in healthcare settings. ^lAttrition and contamination bias, also insufficient information to determine whether there was allocation concealment. ^mSmall sample size (less than 400), standard deviation (SD) greater than 0.5

Summary of findings 2. Brief advocacy interventions for women who experience intimate partner abuse versus usual care at up to 12‐month follow‐up

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Table 1. Additional methods for use in future updates of this review

Issue	Method
Assessment of reporting bias	We planned to draw funnel plots to investigate possible relationships between effect size and study precision, closely related to sample size (Egger 1997). For meaningful funnel plots, a large number of trials with a spread of sample sizes are required (Glasziou 2001; Hayashino 2005). We planned to draw funnel plots if there were at least 7 trials with appropriate data.
Subgroup analyses and investigation of heterogeneity	We plan to perform subgroup analyses for the following. Single component interventions versus multi‐component interventions. Interventions set in health service settings versus non‐healthcare settings. Theoretical justification for subgroup analyses. Domestic violence activists and service providers argue that the effectiveness of advocacy is enhanced by integration of advocacy services into a co‐ordinated community response, including criminal justice agencies, refuges/shelters, welfare support, and health services (Feder 2006a). This strategy, based on the Duluth model, is a network of agreements, processes and applied principles created by the local shelter movement, criminal justice agencies, healthcare, and human service programmes (Clapp 2000). The proposed subgroup analysis will test whether the (potential) effectiveness of advocacy is enhanced (or diminished) by other interventions in the context of a co‐ordinated community response. It is theoretically plausible that even in the absence of a fully co‐ordinated community response, an additional intervention combined with advocacy will have a synergistic effect; therefore we will include studies that test a combined intervention, as long as the control group is also exposed to the additional intervention. If domestic violence advocacy is an effective intervention overall, policy makers and service commissioners need to know if this effect is moderated by the setting in which it is delivered. For example, if a healthcare setting enhanced the effect, then this would be an appropriate context for commissioning advocacy.
Sensitivity analyses	To assess the robustness of conclusions to quality of data and approaches to analysis, we will perform sensitivity analyses, including the following. The effects of risk of bias. Differential dropout. Intention‐to‐treat. Duration of follow‐up.

Table 1. Additional methods for use in future updates of this review

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Comparison 1. Physical abuse

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy Show forest plot	3		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

1.1 Up to 12 months follow‐up	3	558	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.00 [‐0.17, 0.16]
1.2 12 to 24 months follow‐up	1	319	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.02 [‐0.24, 0.19]
2 Brief advocacy (dichotomous outcome) (up to 12 months follow‐up) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

3 Brief advocacy (mean change) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

3.1 'Severe' up to 12 months follow‐up	1	110	Mean Difference (IV, Fixed, 95% CI)	0.08 [‐0.26, 0.42]
3.2 'Minor' up to 12 months follow‐up	1	110	Mean Difference (IV, Fixed, 95% CI)	‐1.0 [‐1.82, ‐0.18]
4 Intensive advocacy Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

4.1 Up to 12 months follow‐up	1	265	Mean Difference (IV, Fixed, 95% CI)	‐0.12 [‐0.39, 0.15]
4.2 12 to 24 months follow‐up	1	265	Mean Difference (IV, Fixed, 95% CI)	‐0.25 [‐0.50, ‐0.00]
4.3 24 + months follow‐up	1	124	Mean Difference (IV, Fixed, 95% CI)	0.18 [‐0.20, 0.56]
5 Intensive advocacy (dichotomous outcome) Show forest plot	2		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

5.1 Up to 12 months follow‐up	2	182	Odds Ratio (M‐H, Fixed, 95% CI)	0.61 [0.33, 1.14]
5.2 12 to 24 months follow‐up	1	265	Odds Ratio (M‐H, Fixed, 95% CI)	0.39 [0.20, 0.77]
5.3 24 + months follow‐up	1	124	Odds Ratio (M‐H, Fixed, 95% CI)	1.07 [0.52, 2.23]
6 Intensive advocacy: missing reassigned (dichotomous outcome) (up to 12 months follow‐up) Show forest plot	2		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

6.1 Missing intervention group not abused, control group abused	2	192	Odds Ratio (M‐H, Fixed, 95% CI)	0.54 [0.29, 1.01]
6.2 Missing intervention group and control group all not abused	2	192	Odds Ratio (M‐H, Fixed, 95% CI)	0.54 [0.29, 1.01]
6.3 Missing intervention group abused, control group not abused	2	192	Odds Ratio (M‐H, Fixed, 95% CI)	0.83 [0.46, 1.49]
6.4 Missing intervention group and control group all abused	2	192	Odds Ratio (M‐H, Fixed, 95% CI)	0.83 [0.46, 1.49]
7 Any advocacy Show forest plot	4		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

7.1 Up to 12 months follow‐up	4	823	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.04 [‐0.17, 0.10]
7.2 12 to 24 months follow‐up	2	584	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.12 [‐0.29, 0.04]
8 Any advocacy (dichotomous outcome) (up to 12 months follow‐up) Show forest plot	3	488	Odds Ratio (M‐H, Fixed, 95% CI)	0.50 [0.33, 0.76]

Comparison 1. Physical abuse

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Comparison 2. Sexual abuse

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy (up to 12 months follow‐up) Show forest plot	2	239	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.12 [‐0.37, 0.14]

2 Brief advocacy (mean change) (up to 12 months follow‐up) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

3 Brief advocacy (dichotomous outcome) (up to 12 months follow‐up) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 2. Sexual abuse

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Comparison 3. Emotional abuse

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy Show forest plot	3		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

1.1 Up to 12 months follow‐up	3	558	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.05 [‐0.22, 0.11]
1.2 12 to 24 months follow‐up	1	319	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.06 [‐0.28, 0.16]
2 Brief advocacy (mean change) (up to 12 months follow‐up) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

3 Intensive advocacy Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

3.1 Up to 12 months follow‐up	1	265	Mean Difference (IV, Fixed, 95% CI)	‐0.02 [‐0.16, 0.12]
3.2 12 to 24 months follow‐up	1	265	Mean Difference (IV, Fixed, 95% CI)	‐0.04 [‐0.19, 0.11]
4 Intensive advocacy (dichotomous outcome) (up to 12 months follow‐up) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

5 Any advocacy Show forest plot	4		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

5.1 Up to 12 months follow‐up	4	823	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.05 [‐0.18, 0.09]
5.2 12 to 24 months follow‐up	2	584	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.06 [‐0.22, 0.10]

Comparison 3. Emotional abuse

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Comparison 4. Risk of homicide

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

1.1 Up to 12 months follow‐up	2	358	Mean Difference (IV, Fixed, 95% CI)	0.13 [‐0.54, 0.80]
1.2 12 to 24 months follow‐up	1	319	Mean Difference (IV, Fixed, 95% CI)	‐0.30 [‐1.07, 0.47]

Comparison 4. Risk of homicide

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Comparison 5. Risk of work harassment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

1.1 Up to 12 months follow‐up	1	319	Mean Difference (IV, Fixed, 95% CI)	0.10 [‐0.36, 0.56]
1.2 12 to 24 months follow‐up	1	319	Mean Difference (IV, Fixed, 95% CI)	‐0.60 [‐0.97, ‐0.23]

Comparison 5. Risk of work harassment

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Comparison 6. Overall abuse

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy (up to 12 months follow‐up) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

2 Intensive advocacy (up to 12 months follow‐up) Show forest plot	2		Std. Mean Difference (IV, Fixed, 95% CI)	Totals not selected

3 Intensive advocacy (dichotomous outcome) (up to 12 months follow‐up) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

4 Any advocacy (up to 12 months follow‐up) Show forest plot	3	234	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.26 [‐0.52, 0.01]

Comparison 6. Overall abuse

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Comparison 7. Quality of life

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy: 2 summary component subscales Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

1.1 Physical component up to 12 months follow‐up	1	200	Mean Difference (IV, Fixed, 95% CI)	0.80 [‐1.27, 2.87]
1.2 Mental component up to 12 months follow‐up	1	200	Mean Difference (IV, Fixed, 95% CI)	0.37 [‐1.94, 2.68]
2 Brief advocacy: 8 subscales (mean change) Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

2.1 Physical functioning up to 12 months follow‐up	2	314	Mean Difference (IV, Fixed, 95% CI)	4.92 [‐0.32, 10.16]
2.2 Role physical up to 12 months follow‐up	2	314	Mean Difference (IV, Fixed, 95% CI)	7.42 [‐0.97, 15.80]
2.3 Bodily pain up to 12 months follow‐up	2	314	Mean Difference (IV, Fixed, 95% CI)	‐4.51 [‐10.42, 1.39]
2.4 General health up to 12 months follow‐up	2	314	Mean Difference (IV, Fixed, 95% CI)	‐0.85 [‐4.06, 2.37]
2.5 Vitality up to 12 months follow‐up	2	314	Mean Difference (IV, Fixed, 95% CI)	‐1.38 [‐5.56, 2.80]
2.6 Social functioning up to 12 months follow‐up	2	314	Mean Difference (IV, Fixed, 95% CI)	0.92 [‐5.00, 6.84]
2.7 Role emotional up to 12 months follow‐up	2	314	Mean Difference (IV, Fixed, 95% CI)	9.37 [‐0.31, 19.05]
2.8 Mental health up to 12 months follow‐up	2	314	Mean Difference (IV, Fixed, 95% CI)	‐1.72 [‐5.31, 1.87]
3 Intensive advocacy: 2 summary component subscales Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

3.1 Physical component up to 12 months follow‐up	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.2 Mental component up to 12 months follow‐up	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Intensive advocacy: overall Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

4.1 Up to 12 months follow‐up	2	343	Mean Difference (IV, Fixed, 95% CI)	0.23 [0.00, 0.46]
4.2 12 to 24 months follow‐up	1	265	Mean Difference (IV, Fixed, 95% CI)	0.25 [‐0.02, 0.52]
4.3 24 + months follow‐up	1	124	Mean Difference (IV, Fixed, 95% CI)	0.30 [‐0.07, 0.67]
5 Any advocacy: 2 summary component subscales Show forest plot	2		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

5.1 Physical component up to 12 months follow‐up	2	303	Std. Mean Difference (IV, Fixed, 95% CI)	0.21 [‐0.02, 0.44]
5.2 Mental component up to 12 months	2	303	Std. Mean Difference (IV, Fixed, 95% CI)	0.08 [‐0.15, 0.31]

Comparison 7. Quality of life

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Comparison 8. Depression

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy (up to 12 months follow‐up) Show forest plot	2	239	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.17 [‐0.43, 0.08]

2 Brief advocacy (dichotomous outcome) (up to 12 months follow‐up) Show forest plot	2	149	Odds Ratio (M‐H, Fixed, 95% CI)	0.31 [0.15, 0.65]

3 Intensive advocacy Show forest plot	3		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

3.1 Up to 12 months follow‐up	3	446	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.14 [‐0.33, 0.05]
3.2 12 to 24 months follow‐up	1	265	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.12 [‐0.36, 0.12]
4 Intensive advocacy (dichotomous outcome) (up to 12 months follow‐up) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

5 Any advocacy (up to 12 months follow‐up) Show forest plot	5	685	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.15 [‐0.30, 0.00]

6 Any advocacy (dichotomous outcome) (up to 12 months follow‐up) Show forest plot	3	252	Odds Ratio (M‐H, Fixed, 95% CI)	0.37 [0.21, 0.66]

Comparison 8. Depression

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Comparison 9. Anxiety

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy (up to 12 months follow‐up) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

2 Intensive advocacy Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

2.1 Up to 12 months follow‐up	1	265	Mean Difference (IV, Fixed, 95% CI)	‐0.13 [‐0.35, 0.09]
2.2 12 to 24 months follow‐up	1	265	Mean Difference (IV, Fixed, 95% CI)	‐0.01 [‐0.22, 0.20]
2.3 24 + months follow‐up	1	124	Mean Difference (IV, Fixed, 95% CI)	‐0.11 [‐0.40, 0.18]
3 Intensive advocacy (mean change) (up to 12 months follow‐up) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

4 Any advocacy (up to 12 months follow‐up) Show forest plot	2	318	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.22 [‐0.44, 0.01]

Comparison 9. Anxiety

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Comparison 10. Chronic pain

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy (up to 12 months follow‐up) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

Comparison 10. Chronic pain

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Comparison 11. Chronic fatigue

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy (up to 12 months follow‐up) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

Comparison 11. Chronic fatigue

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Comparison 12. Low birth weight

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy (dichotomous outcome) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

1.1 Low birth weight (< 2500 g)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Very low birth weight (< 1500 g)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 12. Low birth weight

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Comparison 13. Birth weight (grams)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

Comparison 13. Birth weight (grams)

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Comparison 14. Pre‐term birth

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy (dichotomous outcome) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

1.1 Pre‐term birth (37 weeks gestation)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Very pre‐term birth (< 33 weeks gestation)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 14. Pre‐term birth

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Comparison 15. Gestational age (weeks) at delivery

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

Comparison 15. Gestational age (weeks) at delivery

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Comparison 16. Post‐traumatic stress

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy (up to 12 months follow‐up) Show forest plot	2	92	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.21 [‐0.62, 0.21]

Comparison 16. Post‐traumatic stress

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Comparison 17. Perception of stress

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy (up to 12 months follow‐up) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

Comparison 17. Perception of stress

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Comparison 18. Self efficacy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Intensive advocacy Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

1.1 Up to 12 months follow‐up	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 12 to 24 months follow‐up	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 24 + months follow‐up	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 18. Self efficacy

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Comparison 19. Self esteem

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Intensive advocacy (up to 12 months follow‐up) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

Comparison 19. Self esteem

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Comparison 20. Perceived social support

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy (up to 12 months follow‐up) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

2 Intensive advocacy Show forest plot	3		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

2.1 Up to 12 months follow‐up	3	446	Std. Mean Difference (IV, Fixed, 95% CI)	0.00 [‐0.19, 0.19]
2.2 12 to 24 months follow‐up	1	265	Std. Mean Difference (IV, Fixed, 95% CI)	0.12 [‐0.12, 0.37]
2.3 24 + months follow‐up	1	124	Std. Mean Difference (IV, Fixed, 95% CI)	0.39 [0.03, 0.74]
3 Intensive advocacy (mean change) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

3.1 Overall support up to 12 months follow‐up	1	24	Mean Difference (IV, Fixed, 95% CI)	10.19 [5.67, 14.71]
3.2 Tangible support up to 12 months follow‐up	1	24	Mean Difference (IV, Fixed, 95% CI)	2.19 [0.93, 3.45]
3.3 Appraisal support up to 12 months follow‐up	1	24	Mean Difference (IV, Fixed, 95% CI)	0.67 [0.14, 1.20]
3.4 Self esteem support up to 12 months follow‐up	1	24	Mean Difference (IV, Fixed, 95% CI)	1.14 [0.43, 1.85]
3.5 Belonging support up to 12 months follow‐up	1	24	Mean Difference (IV, Fixed, 95% CI)	4.18 [1.18, 7.18]
4 Any advocacy (up to 12 months follow‐up) Show forest plot	4	646	Std. Mean Difference (IV, Fixed, 95% CI)	0.07 [‐0.08, 0.23]

Comparison 20. Perceived social support

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Comparison 21. Independence from abuser

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Intensive advocacy (dichotomous outcome) Show forest plot	2		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Up to 12 months follow‐up	2	301	Odds Ratio (M‐H, Fixed, 95% CI)	1.22 [0.74, 2.00]
1.2 12 to 24 months follow‐up	1	261	Odds Ratio (M‐H, Fixed, 95% CI)	1.27 [0.78, 2.08]
1.3 24 + months follow‐up	1	119	Odds Ratio (M‐H, Fixed, 95% CI)	0.97 [0.47, 1.98]
2 Intensive advocacy: missing reassigned (up to 12 months follow‐up) (dichotomous outcome) Show forest plot	2		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 Missing intervention group independent, control group not independent	2	330	Odds Ratio (M‐H, Fixed, 95% CI)	1.58 [0.98, 2.55]
2.2 Missing intervention group and control group all independent	2	330	Odds Ratio (M‐H, Fixed, 95% CI)	1.13 [0.71, 1.80]
2.3 Missing intervention group not independent, control group independent	2	330	Odds Ratio (M‐H, Fixed, 95% CI)	0.82 [0.52, 1.31]
2.4 Missing intervention group and control group all not independent	2	330	Odds Ratio (M‐H, Fixed, 95% CI)	1.13 [0.70, 1.82]

Comparison 21. Independence from abuser

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Comparison 22. Emotional attachment to abuser

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Intensive advocacy Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

1.1 Up to 12 months follow‐up	1	265	Mean Difference (IV, Fixed, 95% CI)	‐0.02 [‐0.08, 0.04]
1.2 12 to 24 months follow‐up	1	265	Mean Difference (IV, Fixed, 95% CI)	0.0 [‐0.05, 0.05]
1.3 24 + months follow‐up	1	124	Mean Difference (IV, Fixed, 95% CI)	‐0.07 [‐0.14, ‐0.00]

Comparison 22. Emotional attachment to abuser

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Comparison 23. Use of safety behaviours

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy Show forest plot	3		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

1.1 Up to 12 months follow‐up	3	558	Mean Difference (IV, Fixed, 95% CI)	1.39 [0.92, 1.87]
1.2 12 to 24 months follow‐up	1	319	Mean Difference (IV, Fixed, 95% CI)	0.10 [‐0.42, 0.62]

Comparison 23. Use of safety behaviours

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Comparison 24. Use of resources

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief advocacy Show forest plot	2		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

1.1 Up to 12 months follow‐up	2	358	Std. Mean Difference (IV, Fixed, 95% CI)	0.19 [‐0.02, 0.39]
1.2 12 to 24 months follow‐up	1	319	Std. Mean Difference (IV, Fixed, 95% CI)	0.15 [‐0.07, 0.37]

Comparison 24. Use of resources

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Comparison 25. Difficulty obtaining resources

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Intensive advocacy Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

Comparison 25. Difficulty obtaining resources

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