Study 1
Palm and colleagues (2020) conducted a randomized parallel controlled design to assess the effectiveness of routine inquiry about violence victimization and follow-up support on self-reported physical, sexual, and emotional violence in young women in health centers in the county of Västernorrland, Sweden, at the 12-month follow-up.
All youths ages 15 to 22 coming for their first visit to one of the four youth health centers during the period of Jan. 1, 2012, to Dec. 31, 2012, were asked to participate. In one of the youth health centers, participants were included until June 10, 2013, because of a lack of staff at the beginning of the study period. Possible participants were privately informed about the study orally and in writing by a midwife or social worker, and oral informed consent was obtained. In Sweden, consent from parents or guardians is not needed for a youth older than 15 to participate in a study, as long as the youth is considered able to fully comprehend the information. Exclusion criteria included severe mental disease, intellectual mental impairment, and inability to understand written Swedish. The eligible youths who agreed to participate were randomized into the intervention group or the control group through a random allocation sequence procedure. A total of 1,051 young women consented and were enrolled; of these, 565 young women answered the 12-month follow-up questionnaire (n = 280 in the intervention group, n = 285 in the control group) and were the focus of the analysis. A very small number of young men participated in this study (n = 86); therefore, only the young women’s results were reported on.
The participants assigned to the intervention group were asked structured questions about violence victimization by the midwife or social worker during their regular visits. For the participants in the intervention group who had been violence victimized, the midwife or social worker employed empowerment strategies. The participants in the control group had a regular visit with a midwife or social worker who attended to the specific reason for the visit. Violence victimization was not generally addressed, but these participants answered the same questions about violence victimization in a questionnaire after the visit. A questionnaire including the questions on violence victimization was then administered to the participants in both the intervention and control groups by mail, email, or cellphone text message, at 3 months and 12 months after the baseline.
To assess lifetime violence victimization, five structured questions were used in the health dialogue interview for the intervention group and in the questionnaire for the control group. Four questions were modeled on the NorVold Abuse Questionnaire: 1) “Have you ever experienced being repressed, humiliated, or threatened?” 2) “Have you ever experienced physical abuse (e.g., been slapped in the face, hit with fists or kicked, or had a weapon used against you)?” 3) “Have you ever experienced being touched against your will on your body or genitals, or been forced to touch someone else’s body or genitals, or has anybody used your body to satisfy himself or herself?” and 4) “Have you ever experienced someone, against your will, putting or trying to put his penis, or something else, into your (vagina), mouth, or rectum?” A fifth question was added about witnessing family violence: “Have you ever seen or heard an adult in your family hurting someone in your family?” with three options on the individual: a) “parent,” b) “stepparent or mother’s or father’s partner,” and c) “another adult in the family.” After each question, the participant, if victimized, was asked to mark on a Visual Analogue Scale of 0 to 10 to what extent they were still adversely affected by the violence (0 = not at all, to 10 = very much). In the 3-month and 12-month follow-ups, a question about the person who perpetrated the crime was added for each of the five questions on violence, worded as “By whom, mark all answers that apply to you” with the options: a) “parent, sibling, or other relative”; b) “stepparent or mother’s or father’s partner”; c) “partner or ex-partner”; d) “friend, schoolmate, or acquaintance”; and e) “unknown.”
The full sample of young women who completed the 12-month follow-up questionnaires were on average 18.2 years of age. Of the young women in the intervention group, 53 percent reported any lifetime violence victimization at baseline (“violence-victimized”), versus 60 percent in the control group. This difference was not statistically significant. Forty-five percent of the violence-victimized intervention group reported two or more types of violence victimization (emotional, physical, sexual-touch or sexual-penetration violence), compared with 55 percent of the control group. The most commonly reported type of violence was emotional violence (78 percent of the violence-victimized intervention group, and 82 percent of the violence-victimized control group) perpetrated by a friend or acquaintance (60 percent of the violence-victimized intervention group, and 65 percent of the violence-victimized control group). There were no statistically significant differences between the violence-victimized intervention and control groups at baseline on any of the outcomes of interest.
To determine differences in the outcomes of physical violence, sexual violence—touch, sexual violence—penetration, and emotional violence victimization over the 12-month follow-up period between the intervention group and the control group, generalized estimating equations were performed. Subgroup analyses were conducted with the 147 young women in the intervention group and the 171 in the control group who reported experiences of violence victimization at baseline.
