الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Domestic Violence is a global human rights violation and a challenging public health problem, it affects one every three women around the world and have detrimental consequences on women, families and communities. Abused women were found to report poor physical and mental health problems, particularly anxiety, depression, post-traumatic stress disorder and low self-esteem. Children in families having violence between parents are commonly labeled as silent witnesses and are further subjected to mental problems and to being victims of abuse themselves.
Considering negative consequences of DV on victims and their great upheaval on their children and families, there is an arising need for an effective culturally tailored multi-component psychosocial intervention program.
The aim of the present study was to assess the efficacy of a culturally sensitive multi-component intervention program (psycho-education and brief CBT) for women exposed to DV attending NGOs in Alexandria. Specific objectives included: identifying women exposed to DV among women attending the mentioned setting; assessing depression and PTS symptoms among those women; assessing violence related knowledge, parenting tactics and child abuse practices among them; constructing and implementing a culturally sensitive multi-component intervention program on a group of abused women with depression and/or PTS symptoms; and finally evaluating the effect of the intervention program on the women’s violence related knowledge, depression and post traumatic stress symptoms as well as their parenting tactics and child abuse practices.
The present study targeted married women exposed to DV attending 6 NGOs in Alexandria, namely; Nady elseid (Middle district); Abees 8 (Middle district); Lewaa Al Eslam (West district); Al Hadara Qebly (West district); Al Motaqeen (Al Montaza district) and Hoda Al Eslam (Al Montaza district). The targeted sampled women were those having at least one child (2-17 years old), depressive and/ or PTS symptoms and not on current medication.
A cross-sectional design was used to recruit women eligible for the intervention then a quasi-experimental design (non-randomized controlled) was used in to assess the efficacy of the intervention program. 179 women were recruited using a structured interview to collect personal data, psychiatric history of women and the “Arabic Version of HITS” (Hurt, Insult, Threaten, Scream). Eligible women were further subjected to psychological tools; “Arabic version of Beck Depression Inventory” (BDI-II) and “Arabic version of Post-Traumatic Stress Disorder Checklist, Civilian Version” (PTSD-CV). Women who fulfilled study eligibility criteria totaled 143. Eligible women were contacted to be assigned to the intervention group according to order of taking the screening tools and appropriateness of the assigned day of the group to them. An equal number was set for control. Participants of the intervention phase (intervention and non-intervention groups) were subjected to another structured interview using a pre-designed questionnaire, “Arabic Version of Conflict Tactics Scales Parent-child” (CTS-PC) and “Conflict Tactics Scales” (CTS-2). By the end of the program full participants of this phase totaled 134 women (65 intervention and 69 control).
The multi-component psychosocial intervention program was composed of 8 sessions, 60-90 minutes each. Sessions were intended to; improve women’s DV knowledge; introduce and enhance effective parenting practices; explain CBT concept, challenge and replace maladaptive thoughts; build up women’s communication, problem solving and decision making skills; motivate the participants through learning self-esteem boosting strategies, rewarding activities and stress management using breathing exercises; as well as exposure training to PTSD symptoms.
Evaluation of the program was carried out twice (for intervention and control groups); immediately after the program completion and three months later.
The study revealed the following important results:
The mean age of the sampled intervention group was 36.18±7.69 years compared to 36.03±6.39 of the non-intervention group, most of the sampled women were married (93.80% of the intervention and 98.60% non-intervention group). Mean family size of the intervention group was 5.28 ± 1.193 compared to 5.07 ± 0.828 of the non-intervention group, 49.23% of the intervention sampled women were illiterates compared to 55.08% the non- intervention, while one third of the intervention group husbands were illiterates compared to18.84% of the non-intervention group.
Concerning occupation of the sampled women, 64.62% of the intervention group were housewives compared to 68.12% of the non- intervention group and 38.50% of the intervention women’ husbands were workers compared to 31.90% of the non-intervention.
A lot of sampled women of the intervention and non-intervention group reported that they did not have enough income (52.30% and 49.28% respectively). Similarly, 52.31% of the intervention compared to 49.30% of the non-intervention group received < 2 in the CI scores. The majority was of low socioeconomic (95.40% of the intervention group and the 94.20% of the non-intervention). No statistically significant difference was detected between the two groups regarding socio-demographic characteristics.
All of the intervention group and 95.65% of the non-intervention had psychological problems. While those who received a prescription more than one year prior to the study were only 13.30% and 37.50% respectively, with no statistically significant difference found between the two groups.
Regarding the total mean HITS score, the mean score of the intervention group was 17.12 ± 2.72 compared to 17.68 ± 2.20 of the non-intervention. There was no significant difference between the two groups.
Concerning the pattern of DV among sampled women according to the CTS-2; 90.77% versus 95.65% of the intervention and non-intervention group respectively had no emotional negotiation with their husbands; 78.46% versus 85.51% of the intervention and non-intervention group respectively lacked cognitive negotiation with their husbands; 76.92% versus 69.67% of the intervention and non-intervention group respectively were exposed to minor psychological aggression; severe psychological aggression was present in about half of the sampled women of both groups; 35.38% of the intervention group and 36.23% of the non- intervention were exposed to minor physical assault; severe physical assault was present in 3.08% and zero% of the intervention and non-intervention sampled women respectively; 56.92% versus 66.66% of the intervention and non-intervention respectively reported minor injury; severe injury was present in 9.23% of the intervention group and 11.59% in the non- intervention group; minor sexual assault in the intervention group was 24.62% while in the non- intervention group was18.84%; major sexual assault was reported in 13.85% versus 10.14% of the intervention group versus non- intervention group respectively. Yet no statistically significant difference was found between the two groups in all of the items.
The majority of sampled women (intervention and non-intervention group) were found to be suffering from severe depression symptoms (98.46% and 94.20%) according to Beck scale and all suffered from PTS symptoms with no significant difference detected between the two groups at base line assessment.
Regarding DV knowledge, the rate of unsatisfactory knowledge of the sampled intervention participants dropped from 29.23% at baseline to none at post-intervention-1 that was maintained at post-intervention-2. The results showed statistically significant increase in the DV related knowledge level in the intervention group compared to the non- intervention group.
There was a high percentage improvement for severe physical assault followed by psychological aggression, non- violent discipline, corporal punishment then very severe physical assault (92.10%, 88.50%, 84.61%, 71.00% and 62.90% respectively), while the least percentage improvement was for neglect (39.40%). At post intervention-2, further percentage improvement was recorded on all scales of the CTS-PC except for very severe physical assault and psychological aggression, yet not a statistically significant drop.
On measuring the parenting practices of the sampled women according to the CTS-PC, there was no statistically significant difference between the mean scores all scales of CTS-PC of the intervention group and non-intervention group at basal assessment. Assessment immediately after the completion of the intervention program and 3 months later, showed statistically significantly higher nonviolent discipline scores, less physical assault (corporal punishment, severe physical assault and very severe physical assault) as well as less psychological aggression in the intervention group versus the non-intervention group. There was a decline in neglect score, but it was not statistically significant until post-2. All the scales reported statistically significant improvement in favor of the intervention group compared to the non intervention across time except sexual abuse. (X2f= 80.33 P=0.00, X2f=23.41, P=0.00, X2f= 53.73, P=0.00, X2f= 25.40, P=0.00, X2f= 23.82, P=0.00 and X2f = 28.49 P=0.00 respectively).
Depression symptom of the intervention group showed statistically significant decline in the rates of depressive symptoms manifested by 44.62% at post intervention-1 and more than half at post intervention-2 being free from depression symptoms, although none were free at baseline. The DROP in severity of depressive symptoms was statistically significant among the intervention group across time (X2f=100.79, P=0.00). However, no statistically significant change was noticed in the entire non-intervention group.
Concerning PTS symptoms, a statistically significant decrease was reported at first and second follow up assessment in the intervention group compared to the non-intervention group. where the intervention group mean score decreased to 26.34±7.40 at first assessment, and 24.12±7.18 at second assessment compared to 66.91±7.316 at the base line with statistically significant DROP across time (X2f= 102.76, P=0.00).
There was evident significant improvement in the behaviors targeted to change by the intervention women and was manifested intervention group recorded significantly higher mean competence scores at post intervention-1 compared to baseline after completion of the intervention program. Targeted behaviors included controlling impulsive behaviors, anger and anxiety management, self expression and maintaining pleasurable activities.
Improvement in intervention outcomes were significantly predicted by; women education; income; pre-intervention DV knowledge; emotional and cognitive negotiation with the husband; psychological aggression and injury inflicted by the husband; depression and PTS symptoms.