In keeping with the central aim of this paper to report on IPV-focused group programs for IL in the academic literature, we selected the following inclusion criteria for articles: (a) exclusively IL samples, (b) group models, (c) mention of IPV intervention or prevention, and (d) published within the past 25 years. Given population increases among immigrant Latino families in the U.S. and the unique circumstances of IL compared to U.S.-born Latinas (i.e., limited English proficiency, legal status, reduced natural supports; Bhuyan and Velagapudi 2013; Gonzalez-Guarda et al. 2013), we chose to focus on models developed uniquely for IL. We included a variety of group models, such as therapy groups, support groups, psycho-education groups, and workshops. We included articles that employed quantitative, qualitative, program evaluation, and mixed methodologies. In addition, we considered studies that were published within the past 25 years. We were interested in recent investigations of intervention or prevention programs for IL living in the U.S. because of the increase of the Latino population within a 25-year time period.
We excluded those articles which included non-IL populations in the sample, that were not group-format interventions, that lacked mention of IPV intervention or prevention in the program, and those which were published outside of the 25-year timeframe. We chose to limit the present review to examining programs tailored to address the needs of IL as opposed to Latinas in general, given the unique vulnerabilities implicated by immigrant status when experiencing IPV. We excluded non-IL samples to highlight those programs which respond to the complexities surrounding immigrant status and IPV, including legal status, social isolation, language, and culture.
We identified articles via scholarly databases, including PsycINFO, SocINDEX, Social Work Abstracts, EBSCOhost, and Academic Search Premier. We selected these databases because they often are consulted by mental health and other professionals engaging in community-based practice with vulnerable populations. We chose to utilize scholarly databases exclusively for this review to ascertain the state of the academic literature regarding IPV interventions for IL, in keeping with our research aim. Keywords were selected based on the aim of the research question and topic (e.g., IPV), type of prevention or intervention program, and group population. Search terms including domestic violence OR intimate partner violence AND immigrant Latinas AND prevention OR intervention generated a total of 1211 articles after removing duplicates (Fig. 1). Both authors were involved at all levels of the selection process, including collaboration regarding inclusion criteria analysis of full-text articles and systems employed for determining selection at all levels of the selection process.
Given the relatively small number of studies that directly targeted IPV intervention and prevention with IL, the IPV inclusion criterion was broadened during the article collection process to include those articles that mention the search terms domestic violence or intimate partner violence to some degree (e.g. IPV as one of several constructs being targeted by interventions, acknowledgement of IPV as an environmental factor for group participants). Of the total 1211 initial articles, we reviewed article titles and abstracts and excluded 1166 that did not clearly meet inclusion criteria. The remaining 45 full-text articles were reviewed and 35 were excluded because they did not meet full inclusion criteria. Ten articles met full inclusion criteria and were included in the present review.
Analysis of Intervention Studies
We analyzed and coded the 10 included articles by hand (i.e., we did not use a computer software) to generate descriptive themes (i.e., program characteristics), which involved re-reading articles and creating qualitative coding systems to monitor frequency and consistency of characteristics to support the objectives of this systematic review. Tables and color-coding tools were used to collect and organize the codes used for analysis. Descriptive themes were selected as most appropriate to respond to our research question to describe recent IPV intervention and prevention programs for IL as reported in the academic literature. In keeping with this research question, we coded articles for characteristics including type of group method used, foci of group work, degree of IPV focus, degree of cultural responsiveness, use of theoretical frameworks, and use of curricula. For each article, we analyzed the intervention program first for these and other categories of intervention characteristics that addressed our research question. We then narrowed analysis of these characteristics into themes present or absent among the 10 articles to shed light on the current state of the literature regarding IPV prevention programs for IL in group settings (Fig. 1).
To reduce bias in the study, we implemented journaling, memoing, peer debriefing, and feedback from peers who were knowledgeable about group-format programs (Monette et al. 2014). Both authors consulted with one another throughout the qualitative analysis of the included articles, which was done independently. Collaboratively, the authors discussed and reviewed each other’s process and what they were finding to support validity and reliability of the analysis. In addition, to ensure validity and reliability of codes, we obtained rich data by re-reading the articles several times, which generated patterns and themes (Monette et al. 2014). We then re-reviewed generated themes to ensure the codes were consistent with what we observed.
This review generated 10 articles that describe group-format programs designed for IL. All programs selected for inclusion describe interventions in group settings that serve IL with experiences related to IPV. Intervention programs varied in study methodology, type of group, group setting, primary program aims, and reported outcome efficacy (Table 1).
In our qualitative analysis of the articles, several themes emerged: (a) Type of Group, (b) Focus of Group, (c) Intervention Setting, (d) Tailoring Group to Participant Needs, and (e) Use of Curricula and Theoretical Frameworks (Table 2). We also reviewed reported intervention effectiveness and generalizability among the sample articles.
Type of Group
In the articles reviewed, practitioners utilized support, therapy, psycho-education, and workshop types of groups as intervention measures for IL experiencing IPV. Eight interventions were framed around one type of group work only. Those that utilized support groups tended to focus on sharing of personal stories as a method of providing aid among group peers with similar experiences (Breton 2000; Molina et al. 2009; Morales-Campos et al. 2009). Psycho-education groups focused on providing education and information on specific topics related to IPV and self-esteem among group peers (Marrs Fuchsel et al. 2016; Rayle et al. 2006). Workshop interventions focused on training and empowering groups of IL health promotoras to address health concerns in their communities (Bonilla et al. 2012; Serrata et al. 2016). Those that utilized therapy groups tended to focus on helping participants manage symptoms of mental health disorders (Kaltman et al. 2016). The remaining two interventions blended support group elements with therapy (Nicolaidis et al. 2013) and psycho-education (Perilla et al. 2012). Of note, support and psycho-education were the most common types of groups employed among the 10 articles reviewed.
Focus of Group
The foci of the group interventions in the 10 reviewed articles varied and overlapped greatly. Identified foci were self-esteem/empowerment, social support, general wellness, and mental health. Three articles presented group interventions with a single topical focus: self-esteem/empowerment (Marrs Fuchsel et al. 2016; Serrata et al. 2016) or social support (Breton 2000). The majority presented interventions combining two or more of the four identified foci. Across all reviewed articles, self-esteem/empowerment and social support were the intervention foci used most often, with at least one used in all 10 interventions. General wellness and mental health were less common among the reviewed articles, occurring in only four interventions (Bonilla et al. 2012; Kaltman et al. 2016; Nicolaidis et al. 2013; Rayle et al. 2006).
The setting of the group interventions was quite similar among the 10 reviewed articles. As previously noted, IL encounter barriers in seeking and receiving social services and programs in formal settings, however, in this study, successful implementation of these 10 intervention programs were in community-based agencies and clinics. Based on authors’ descriptions, we reasonably inferred that all interventions were facilitated to some degree in a community-based agency or setting, and many groups were held on-site at community-based agencies or clinics serving immigrant Latino families. There was notable diversity regarding the geographic location among the intervention studies reviewed. Most geographic regions in the U.S. were represented, including Southeastern, Southwestern, Northwestern, and Midwestern locations. Implications of geographic diversity as reported in the studies are discussed in a later section.
Tailoring Group to Participant Needs
All reviewed articles responded to the particular needs of IL survivors of IPV, including language, social, and cultural considerations. Each group intervention was facilitated in Spanish by trained, bilingual facilitators, and all interventions were developed by mental health professionals or academic leaders in the healthcare or social service field, with several utilizing support from peer supporters and advocates in the social service field. Many groups focused on social support, such as sharing of personal stories with group peers and encouraging the exchange of contact information among group members, to mitigate the social isolation accompanying immigrant status and IPV (Breton 2000; Molina et al. 2009). Several groups incorporated cultural considerations into the intervention, such as familism, machismo, immigration issues, religiosity, and group discussions on the impact that these and other cultural concepts had on intimate relationships (Marrs Fuchsel et al. 2016; Nicolaidis et al. 2013; Perilla et al. 2012; Rayle et al. 2006). Responding to legal issues around immigration and IPV, many interventions provided information about legal resources, such as filing orders of protection and restraining orders, applying for immigration benefits and changing status, and legal support to navigate court processes (Marrs Fuchsel et al. 2016; Molina et al. 2009; Perilla et al. 2012).
Use of Curricula and Theoretical Frameworks
The majority of the reviewed articles utilized curricula and theoretical frameworks to support intervention design and execution. Most often, groups were guided by topics set for each meeting, some programs planning cumulative topics (e.g. Marrs Fuchsel et al. 2016; Nicolaidis et al. 2013) and others planning disparate topics (e.g. Bonilla et al. 2012). Examples of topics included reproductive rights, cycle of violence, self-esteem, and self-care. Curricula utilized in the reviewed articles ranged from fluid sessions and topics co-created with participants (Breton 2000; Molina et al. 2009; Morales-Campos et al. 2009; Perilla et al. 2012) to pre-set, facilitator-driven plans and structured sessions (Bonilla et al. 2012; Kaltman et al. 2016; Marrs Fuchsel et al. 2016; Nicolaidis et al. 2013; Perilla et al. 2012; Rayle et al. 2006; Serrata et al. 2016). The articles presenting support group interventions did not follow a pre-set curriculum but rather were topically oriented around IPV and open to participant direction (Breton 2000; Molina et al. 2009; Morales-Campos et al. 2009).
Multiple theoretical approaches were mentioned among most of the 10 reviewed articles (see Table 2). There was variance among the reviewed articles in employment of one or a combination of theoretical frameworks to underpin group interventions. Among the most commonly cited theoretical approaches to group interventions with IL were empowerment theory, feminist theory, ecological theory, and cognitive-behavioral theory. Empowerment theory (cited in: Marrs Fuchsel et al. 2016; Nicolaidis et al. 2013; Serrata et al. 2016), asserts that increased awareness of personal factors related to one’s ability to make change leads to mastery over issues of concern to them (Zimmerman 1995). Feminist theory (cited in: Nicolaidis et al. 2013; Perilla et al. 2012) perceives individual-level power discrepancies between males and females as directly connected to oppressive patriarchal forces at the political level (Millett 1970). Ecological theory (cited in: Bonilla et al. 2012; Perilla et al. 2012), considers individual-level phenomena as nested interactionally within community- and societal-level systems (Bronfenbrenner 1977; Carlson 1984). Cognitive-behavioral theory (cited in: Kaltman et al. 2016; Nicolaidis et al. 2013; Rayle et al. 2006) posits that altering phenomena on cognitive and behavioral domains leads to emotional relief from a wide range of mental health disorders (Beck 1979, 2011).
Other less commonly used approaches among the articles reviewed included intersectionality, existential theory, mutual aid, and structural theory. Intersectionality (cited in: Marrs Fuchsel et al. 2016) highlights the juncture of multiple systems of oppression or discrimination (Crenshaw 1989). Existential theory (cited in: Rayle et al. 2006) is present-focused and highlights the individual’s sense of purpose, personal power, and choice (May 1994). The mutual aid approach to group work (cited in: Molina et al. 2009) helps participants focus on one another’s strengths and engage in receiving and offering support to work through problems (Steinberg 2004). The structural approach to social work practice (cited in: Breton, 2000) understands personal problems as resulting from unequally distributed opportunities and resources in society (Wood and Middleman 1992).
Reported Intervention Effectiveness
All interventions discussed in the 10 reviewed articles reported generally positive outcomes for participants (see Table 1). Some articles reported anecdotal observations of program effectiveness (Breton 2000, Bonilla et al. 2012; Perilla et al. 2012). For example, Perilla et al. (2012) asserted that the two-tiered program is considered effective given ongoing feedback from participants and direct observation of participant growth in skillfulness, socialization, and critical awareness of themselves and IPV. Several studies reviewed used quantitative methods to measure effectiveness (e.g., pre-/post-tests) and found statistically significant outcomes for participants for constructs including depression, self-esteem, self-perceived leadership, and knowledge of wellness (Kaltman et al. 2016; Marrs Fuchsel et al. 2016; Nicolaidis et al. 2013; Rayle et al. 2006; Serrata et al. 2016). Studies using qualitative methods reported similar thematic findings, including increased knowledge of IPV and self-esteem, social support, education, tools to communicate with children, and coping skills (Kaltman et al. 2016; Marrs Fuchsel et al. 2016; Molina et al. 2009; Morales-Campos et al. 2009; Nicolaidis et al. 2013; Rayle et al. 2006; Serrata et al. 2016).
Reported Intervention Generalizability
All of the reviewed intervention studies encouraged further implementation of the programs in community-based agencies serving IL. In addition, many authors noted the need for further research to determine generalizability of programs in other settings, geographic locations, and diverse groups of IL (Kaltman et al. 2016; Morales-Campos et al. 2009; Nicolaidis et al. 2013; Rayle et al. 2006; Serrata et al. 2016). Some authors specifically discussed the need to determine generalizability with IL living in other geographic locations of the U.S. (Morales-Campos et al. 2009; Nicolaidis et al. 2013). Finally, half of the articles discussed the possible moderating effect of language, culture, or gender concordance between the group facilitator and participants on intervention outcomes (Breton 2000; Marrs Fuchsel et al. 2016; Molina et al. 2009; Morales-Campos et al. 2009; Rayle et al. 2006). These authors recommend consideration of these factors when implementing intervention programs for further research and practice.