Sections have been reproduced or adapted from published manuscripts.1–11 These are Open Access articles distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) licence, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: https://creativecommons.org/licenses/by/4.0/. The text below includes minor additions and formatting changes to the original text.
Background
Intimate partner violence (IPV) perpetration involves any behaviour by a current or former intimate partner [(ex)-partner] causing physical, sexual or psychological harm, including aggression, sexual coercion, psychological abuse, financial abuse and controlling behaviours.12 IPV is most commonly directed towards women by men.12 No single factor explains why some people perpetrate IPV,13 but substance use is a strong risk factor.14–16 We found around 6 in 10 men in substance use treatment had ever perpetrated IPV, and 4 in 10 had done so in the past year,17,18 rates up to 4 times higher than for men in general, veteran or military populations.19–22 Men with alcohol and drug use disorders had seven- to eightfold increased risks for being arrested for IPV compared with general population controls.23 The lack of referral pathways and access to perpetrator programmes in the UK has been highlighted,24–28 with < 1% of perpetrators receiving specialist behaviour change interventions.26 Men who misuse substances infrequently meet threshold for community Domestic Abuse Perpetrator Programmes. Evidence on what perpetrator interventions work for men who misuse substances is sparse.7 There remains a need to understand the role of substance misuse in IPV perpetration and develop and test perpetrator interventions for men who misuse substances.29
Overview
This research programme aimed to (1) undertake intervention development research, (2) develop an evidence-informed integrated intervention to address both substance misuse and IPV perpetration for men in substance misuse treatment, (3) assess the feasibility and acceptability of conducting a definitive trial of the intervention and (4) determine its efficacy and cost-effectiveness (suspended due to COVID-19). Four mixed-methods interconnected work packages (WPs) and a cross-cutting WP addressed these aims (Figure 1). Learning Alliances of key stakeholders and people with lived or living experience (PWLE) supported the research.
FIGURE 1 Research pathway. RCT, randomised controlled trial. (Figure not reproduced here; see the original article.)
Patient and public involvement and engagement
Aims and methods of patient and public involvement and engagement
To inform the research phases and intervention development, the views and experiences of key stakeholders, practitioners and PWLE were sought via Learning Alliances (stakeholders) and practitioner and PWLE consultation groups.
Planned patient and public involvement and engagement activities
Separate advisory panels were intended for perpetrators and survivors, alongside a Learning Alliance, and dedicated patient and public involvement and engagement (PPIE) intervention development groups. It was not always possible to involve the same PPIE throughout the duration of the research as some PWLE were no longer engaged with services. However, we did gain PPIE feedback on all research and intervention development phases, including the Plain language summary.
Patient and public involvement and engagement activities and impact
One PPIE member served on the Programme Steering Committee, and one served on the Data Monitoring and Ethics Committee (DMEC) throughout the programme. On average, 10 stakeholders from both substance use and domestic abuse sectors attended 20 Learning Alliances to guide the research, by sharing experiences and informing best practice in IPV and substance misuse and supporting knowledge translation (see Cross-cutting work package).
In WP1(ii), WP4(i) and WP4(ii), WP(5), PPIE members reviewed written materials, for example, patient information sheets, consent forms, topic guides, questionnaires and participant summary reports for language and length. In WP4(i), the PPIE members requested consent was sought to discuss men’s histories with their keyworker, which was implemented.
In WP3(i), six female survivors, two male perpetrator programme completers and six substance use service users informed intervention content and structure, engagement and retention strategies. The following changes were introduced:
- end-of-session emotional checkouts and weekly follow-up calls from keyworkers between website sessions
- participation in the intervention even if their female (ex)-partner declined support
- travel reimbursement and food at sessions to encourage attendance
- men should not be excluded for non-attendance. Keyworkers should determine why session was not attended and update participants on missed content
- potentially triggering substance use imagery should be avoided in videos.
Work package 3(ii) involved in-depth formative consultation with men and women from substance use services and women from domestic abuse services to adapt ADVANCE for digital delivery (ADVANCE-D). The following suggestions were included:
- provision of technology, data and IT support to enhance participation
- website sessions should include audio of written content
- contingency management linked to pro-social activities (e.g. cinema, gym membership).
Feedback from six men on the ADVANCE-D website sessions paper prototypes was implemented:
- provision of tablets, not smartphones
- introductory session about using the technology
- sending reminders to log on
- avatar (digital coach) should resemble a real-life professional, and with a clear voice, regardless of accent
- website sessions should include recaps, avoid quizzes or tests, take < 30 minutes to complete and recognise completion (we used stars rather than ‘rewards’)
- telephone support following each website session
- maximum of 10 men for video groups
- notebook provision.
Four female survivors consulted about website appropriateness found the safety messages acceptable and welcomed the opportunity for website access, noting that other perpetrator programmes do not share content with survivors.
Think-aloud video interviews to review the digital prototypes were conducted with eight men. They suggested changes to the website for ease-of-use, clarity and visual impact, including a progress bar [see Work package 3(ii)].
Discussion
Patient and public involvement and engagement ensured ADVANCE was developed and adapted (ADVANCE-D) based on best practice and lived experience. While the benefits to research and dissemination of PPIE engagement were demonstrated in this research programme, the impact for those engaged in PPIE was not explored. Future research should evaluate the experiences of PPIE engagement in IPV research.