A systematic review of informal supporters of intimate partner violence survivors: the intimate partner violence model of informal supporter readiness

Intervention and support from social networks

Survivors of IPV have two main streams of support that can help reduce the risks and harm associated with IPV—formal and informal supporters (Edwards & Dardis, 2016). Formal supporters are professionals such as police, domestic violence outreach services, health professionals, and counsellors. In contrast, informal supporters are members of the survivor’s social network, and include family members, friends, neighbours, and colleagues (Sylaska & Edwards, 2013). The two support streams can be utilised independently or in a complementary manner as needed by the survivor.

The types of support that can be offered to survivors which aim to reduce the risk of harm from IPV are typically conceptualised by public health models in three levels of intervention—primary, secondary, and tertiary (Coker et al., 2004; García-Moreno et al., 2015; Kirk et al., 2017). Primary interventions aim to prevent the onset of violence, secondary interventions aim to intervene and interrupt existing violence, and tertiary interventions aim to prevent the harm and risks associated with violence that has already occurred (García-Moreno et al., 2015). In the context of informal support, the majority of interventions occur as either secondary or tertiary responses and as such are the focus of this systematic review.

Secondary interventions relate to the actions taken when directly witnessing acts of IPV. Commonly conceptualised as ‘bystander behaviours’ and born from bystander theory as proposed by Darley & Latané (1968) these occur generally in three distinct streams of (1) physically or verbally intervening to protect the victim, (2) seeking additional assistance such as calling the police, or (3) ignoring the behaviour (Gracia et al., 2018). Given the private nature of IPV, secondary interventions are not commonly provided by formal supports who have limited opportunity to directly witness acts of IPV. Informal supporters, however, are generally more exposed to the occurrence of IPV behaviours and as such have a greater opportunity to provide secondary interventions (Taylor et al., 2016). However, bystander theory itself does not account for some of the contextual factors present in IPV, such as the influence of the bystander relationship with either the survivor or perpetrator.

Further, while there are numerous avenues for formal tertiary support post incidents of IPV (e.g., police, domestic violence outreach services, health professionals, counsellors), many survivors are reluctant to make a disclosure to professionals. There are many challenges survivors face when making the decision to disclose their abuse to a professional support, including the survivor’s perceptions of safety, concerns for confidentiality (Heron & Eisma, 2021), and fear of being negatively judged (Ansara & Hindin, 2010). Therefore, an estimated 75% of IPV survivors make initial disclosures to informal networks, such as family members, friends, colleagues, and neighbours (Ansara & Hindin, 2010).

Once an initial disclosure has been made, informal supporters are able to assist survivors with emotional support (e.g., listening to the survivor and validating their emotional experience), informational (e.g., providing useful advice and suggestions to cope), or instrumental support (e.g., providing tangible aid such as money or refuge) (Mahapatro, Prasad & Singh, 2021; Sylaska & Edwards, 2013). These support behaviours can subsequently reduce the barriers and risks associated with accessing formal supports (Davies, Rice & Rock, 2022; Evans & Feder, 2015). Unfortunately, responses from informal supporters to disclosures are not always helpful to the survivor. Negative responses to disclosure can include victim blaming, minimizing, and refusing to believe the survivor. When interviewing victims of IPV, Trotter & Allen (2009) found that it was not uncommon for informal supporters to respond with disbelief, shock, or to side with the perpetrator, which had negative consequences for the survivor. Further, it is noted that barriers such as substance use, childcare, and mental health can inhibit the ability of an informal supporter (Latta & Goodman, 2011).

Unplanned disclosures (i.e., those made after direct questioning) are also common among informal supporters and are comparatively rare within formal support settings (Fisher et al., 2020). Informal supporters have ongoing contact and familiarity with survivors that formal supporters do not and, therefore, may be more perceptive to indicators of abuse. The closeness of the relationship between the informal supporter and the survivor results in greater direct questioning about IPV and, in turn, unplanned disclosures (Sylaska & Edwards, 2013).

Benefits of informal support networks

The importance of social supports as a factor in reducing the risks associated with IPV have long been recognised (Carlson et al., 2002). Informal support networks have been shown to have positive implications for survivors even in the absence of formal support systems. First, strong social supports are a key protective factor in reducing the likelihood of a women experiencing violence in her relationship (Capaldi et al., 2012). Second, should a women experience an episode of violence, higher levels of social support are associated with reduced risk of future victimisation (Goodman et al., 2005). In a longitudinal study on re-abuse rates, Goodman et al. (2005) found women with higher levels of social support experienced a 20% risk of re-abuse in a 12-month period compared to a 60% risk of re-abuse for women with lower levels of social support. It has also been found that disclosure to formal supports was associated with greater risk of a survivor experiencing subsequent injury from violence compared to disclosing to informal supporters (Belknap et al., 2009). Additionally, women who have left an abusive relationship are significantly less likely to experience abuse in future intimate relationships if they have a strong social support network (Plazaola-Castano, Ruiz-Perez & Montero-Pinar, 2008).

Furthermore, informal supporters offer continued benefits to survivors who experience ongoing IPV. Broadly, IPV survivors who perceived having strong social supports reported increased quality of life (QoL) outcomes in areas such as physical health, vocational attainment and achievement, and sense of belonging, compared to women who reported weaker social networks (Beeble et al., 2009). QoL outcomes appear to be strengthened by support networks facilitating women to utilise appropriate coping strategies and skills. Positive coping strategies are also associated with better reported mental health outcomes (Coker et al., 2004). Additionally, through being supported, women have reported less self-blame and negative affect (Latta, 2009). For example, in a cross-sectional survey of 621 women experiencing IPV, higher levels of social support were associated with reduced risk of depression, anxiety, post-traumatic stress disorder, and suicidal ideation (Coker et al., 2004).

The wellbeing of informal supporters

Although a primary modality of support for an IPV survivor, being an informal supporter comes with challenges. The role of an informal supporter can be taxing given that the need to provide support is unpredictable. In a qualitative study of 23 participants in the UK, Gregory et al. (2017) identified a number of acute and chronic psychological and physical symptoms. These symptoms included increases in anxiety, anger, depression, sleep difficulties, and appetite loss. In a first of its kind study, Sigurvinsdottir, Riger & Ullman (2016) identified that emotional distress uniquely predicated increased symptoms of PTSD in informal supporters. Given the prevalence of IPV, and therefore the number of people who are providing informal support, further understanding of informal supporter self-care is warranted.

Objectives

As the field of IPV research has evolved, a deeper understanding of how survivor’s engage informal supporters to create safety and the benefits of strong social networks in reducing ongoing risks of IPV has been developed. However, research with a primary focus on perspectives of informal supporters is a relatively new area of research. Consequently, there is currently no conceptual model of the factors which influence an informal supporter’s decision to support IPV survivors. As such, this systematic review aimed to consider the gaps in understanding of informal supporters of IPV survivors, and consisted of the following objectives:

1. To identify factors associated with either an increase or decrease in the likelihood of an informal supporter helping a survivor of IPV

2. To identify informal supporter self-care strategies associated with greater psychological wellbeing

3. To identify the existing theories utilised to understand an individual’s likelihood of helping a survivor of IPV

Eligibility criteria

Studies that met the following criteria were included: (1) the study had first-hand consideration of social network members (e.g., friends, family members, colleagues) and not indirect reports from IPV survivors, (2) the study investigated the motivators and/or inhibitors of intention to help with either secondary interventions (i.e., bystander actions in response to directly witnessing an IPV act) or tertiary interventions (i.e., support following a disclosure of IPV), (3) both the informal supporter and the IPV survivor were adults (older than 16 years), (4) the IPV survivor identified as female, given the vast majority of this type of violence is perpetrated against women, (5) the study was published in English or an English translation was available. There were no exclusion criteria related to study type or geographic population. IPV was defined as physical, sexual, and/or psychological abuse (including coercive control) by a current or former partner (Jewkes, 2002).

Information sources

During November and December 2021, searches were conducted using four databases: PsychARTICLES, Scopus, ProQuest Social Services Abstracts, and EbscoHost, for articles published between 2005 and 2021. Only studies from 2005 onwards were included due to developments in the field at that time that included the perspective of the informal supporter in addition to that of the survivor. Identified articles were imported to Endnote and then saved to the Covidence systematic review software (Veritas Health Innovation, 2021). Table 1 presents a summary and overview of the included studies.

Search strategy

The search strategy was developed by the research team (RD, KR, AR) in consultation with a librarian, following a review of other systematic reviews of IPV. Search terms focused on identifying the occurrence of IPV, and also identifying the presence of an informal supporter. Search terms are presented in Table 2. Searches were conducted using the search terms across title and abstract.

Study selection

To determine if a study met the inclusion criteria, two reviewers (RD and a research assistant) independently evaluated eligibility using a two-step process. First, both reviewers individually screened each study by title and abstract in the Covidence systematic review software (Veritas Health Innovation, 2021). The Covidence systematic review software automatically notified the reviewers when a conflict occurred. In instances where a conflict occurred, a discussion was held between the reviewers to reach a consensus using the systematic review protocol as a guide. On each occasion a consensus was reached without the need for independent evaluation. Should a consensus not have been reached conflicts would have been resolved by the senior researcher (KR). The same review process was utilised in the subsequent full-text screening phase.

Data extraction

A standardised data collection form was developed by RD, adapted from the Cochrane data collection grid (Higgins et al., 2019). RD extracted all the data from the studies, which is presented in Table 1, and KR and AR reviewed the data.

Risk of bias

Assessments of the quality and risk of bias of each included study was independently carried out by two reviewers. As the studies included both quantitative (experimental and observational) and qualitative designs, the Mixed Methods Appraisal Tool (MMAT; Hong et al., 2018) was utilised. Each of the included 31 studies was found to have suitable quality and low risk of bias, as per the MMAT scoring system, and therefore were all included in the synthesis. A summary table of the MMAT is provided as a supplementary file.

Information about studies selected

The initial search retrieved 2,860 articles. Of these articles 1,037 were duplicates and a further 1,793 were assessed as irrelevant based on the screening eligibility criteria. Therefore, 120 articles were screened using the full text resulting in 31 articles being selected for inclusion in the systematic review. An overview of the screening stages is presented in Fig. 1.

Of the 31 studies included in this review, 29 were quantitative and two were qualitative. Of the quantitative studies, 17 were cross-sectional and 12 were experimental. All studies were published between 2005 and 2021. Nineteen studies were conducted in the United States, four in Italy, three in India, three in the United Kingdom, one in Uganda, and one in both the United States and India. The total sample size of all studies was 18,739. Of the total sample, 36.8% of participants were college students and 58.5% were female. Samples ranged between 18 and 6,010 participants. A total of 16 (52%) studies used measures of behavioural intention, 11 (35%) measured occurrences of actual behaviour, and four (13%) measured both behavioural intention and occurrences of actual behaviour. In total 81.5% of participants (n = 15,261) reported on behavioural action (i.e., actual helping behaviour as opposed to future intention).

Key findings from the systematic review

In relation to objective one, the review of identified factors positively or negatively associated with help-giving intention produced three overarching domains. The first domain, normative helping factors, related to an individual’s interpretation of social norms of help-giving in an IPV context. The second domain identified factors associated with individual beliefs about help-giving. The third domain included situation specific factors, such as an individual’s views and beliefs surrounding the survivor, the perpetrator, and the unique pattern of IPV. In relation to the second objective, there were no articles that considered self-care strategies employed by informal supporters. In relation to objective three, nine theories were applied across 22 of the articles. However, none of these theories adequately account for the unique and differing context specific social factors, identified in objective one, that are inherent to IPV, rather they focus on the broader idea of IPV.

Post-Hoc analysis of secondary and tertiary interventions

Following review of the included papers it was found that a majority of studies, 58% (n = 18), had used a single measure which explored both secondary and tertiary interventions together, thus, conflating these types of intervention. This was unexpected given the different barriers faced by informal supporters when providing secondary interventions, which have a greater risk to self, compared to tertiary interventions which occur post-assault when the situation is no longer an ‘emergency’.

Normative helping factors

The first factor discovered from the results was normative helping beliefs. Normative beliefs, also referred to as subjective norms, are an individual’s evaluation of the beliefs held by other people. Primarily, subjective norms relate to the interpretation of whether people who are important to you would support or condone a target behaviour (Ajzen, 2000). The role of subjective norms on influencing our behavioural intention has been widely studied (for an overview see Chung & Rimal, 2016). It is proposed that social norms are associated with behavioural intention through a desire to fit in with the group identity (Dempsey, McAlaney & Bewick, 2018). This finding is consistent with help-giving behaviour where a desire to conform to group identity benefits the individual through reciprocal altruism; that is, the notion that ‘if I have been helped, then I should help’, and so on (Manatschal & Freitag, 2014). This systematic review identified two social norms that are correlated with help-giving intention regarding IPV survivors (as identified in Baldry & Pagliaro, 2014; Edwards et al., 2014; Storer, McCleary & Hamby, 2021). These norms are categorised as injunctive, which are an individual’s beliefs about what those around them think appropriate behaviours are, and descriptive, which are an individual’s interpretation of the actual behaviours of those around them.

Storer, McCleary & Hamby (2021) found, in their study of low opportunity youth and young adults, that the injunctive norm of “mind you own business” was a substantial barrier to intervening in an incidence of IPV. This perception occurred in the context of high levels of community violence and racially motivated police violence in which intervening could be potentially dangerous. Edwards et al. (2014) measured the injunctive norm of collective efficacy (the perceived level of social cohesion among community members) in 16 rural counties and found that the greater an individual perceived the members of their community as being helpers the more likely they were to offer help.

In their study on descriptive norms, Baldry & Pagliaro (2014) presented a scenario of IPV to participants and then measured their willingness to help. Participants were split into two groups. Participants of group one were advised that most people who were of the same ethnic background as themselves indicated they had helped the survivor (helping condition). The second group were advised that most people of the same ethnic background indicated that although IPV was wrong they would not intervene as relationships are a private matter. Baldry & Pagliaro (2014) found that descriptive norms which suggest helping is morally right are positively correlated with the willingness of an individual to help during an incident of IPV.

The strength of subjective norms is influenced by an individual’s sense of belonging (Allen et al., 2021). An individual’s sense of connection or belonging to the ‘group’ is important in determining the strength of the association between subjective norms and helping intention (Dempsey, McAlaney & Bewick, 2018). In their norms-based study, Baldry & Pagliaro (2014) found that whilst a ‘helping norm’ was associated with intention to help, the level of helping intention was higher when the individual had a stronger sense of belonging to the normative group (i.e., being Italian). Banyard (2008) explored this correlation further and found that a greater perceived sense of connection to the local community was also associated with increased willingness to help and reduced feelings of ineffectiveness. Thus, while the interpretations of others’ thoughts on helping (injunctive norms) and beliefs about others’ actual helping behaviour (descriptive norms) are important, the sense of belonging of the individual appears to have an important association with behavioural intention.

Individual helping factors

The second factor to be derived from the results of this systematic review was the individual factor, which is related to an individual’s beliefs about help-giving. This factor consists of four distinct sub-factors which are described below.

Situational helping factors

The third and final factor to extracted from the data from this systematic review was situational helping factors, which relate to the individual’s interpretation of the unique elements of the IPV that is occurring. The situational sub-factors include an evaluation of the survivor and the perpetrator. Situational helping factors will vary depending on the context of the IPV occurring.

Self-care of informal supporters

The second objective of this systematic review was to consider how informal supporters utilise self-care strategies and the effectiveness of these strategies. As IPV is often an ongoing chronic pattern of behaviour, informal supporters are regularly subjected to the negative consequences of IPV over long periods of time. Gregory et al. (2017) found in their systematic review of the impacts of help-giving on informal supporters that it was common for informal supporters to experience a range of negative physical and psychological effects. However, this systematic review did not identify any articles that considered how informal supporters manage their self-care in the face of the difficulties experienced when supporting an IPV survivor.

Current theoretical conceptualisations

From the 31 articles selected for review, 22 had a theoretical basis for the hypotheses presented and nine articles presented no clear theoretical basis. Of these 22 theory-based articles, nine unique theories were tested. The most common theory presented was Bystander theory, which was applied in 12 articles. Bystander theory was first proposed by Darley & Latané (1968), in response to the (incorrectly) reported lack of bystander action taken by neighbours who could hear a woman being murdered (Kassin, 2017). The theory proposes five stages (i.e., notice the event, interpret as an emergency, assume responsibility, know how to help, and decide to implement help) that must be met for help to be given. Bystander theory has been widely supported in social psychology (Fisher et al., 2020); however, its utility in the context of IPV is limited. For example, bystander theory has largely been used to address responses to acts of violence occurring in public in which neither the perpetrator nor the victim is known to the individual. This is not the case for social network members of survivors who have a relationship with the survivor and often with the perpetrator as well. Bystander theory also does not account for the interpretation of responsibility, as informal supporters in an IPV context will make a determination of responsibility (e.g., the survivor’s actions, such as infidelity, might be attributed as being responsible for causing the violence).

The second most frequent theory was attribution theory, which was used in three articles. Attribution theory in the context of IPV was first explored by West & Wandrei (2002). Whilst primarily focused on attributions of responsibility, Edwards & Dardis (2016) created a model that included situation-specific, individual, relational, attributional, and emotional factors. However, while this model considered the unique context of the violence occurring within an intimate relationship, it did not account for the multiple individual factors that are associated with help-giving intention, such as individual efficacy, ability, and assuming responsibility to stop the violence. An overview of the reviewed theories is included in Table 3.

Proposed model

Following our synthesis of the literature, we propose the Intimate Partner Violence Model of Informal Supporter Readiness (IPV-MISR). This model hypothesises that behavioural intention to support a survivor of IPV is driven by normative helping intentions, individual helping intentions, and situational helping intentions. Each of these factors consists of a series of unique variables that have been found to be associated with help-giving readiness. Figure 2 presents a diagrammatic overview of the model and is followed by a description of these factors. This model will add support to the current understanding of help-giving intention to survivors of IPV; however, it is noted that decisions around support for IPV survivors should be centered on the individual survivor’s views and needs.

Normative helping readiness

1. Injunctive Norms guide individual behaviour by presenting perceptions of which behaviours are typically approved or disapproved. Therefore, injunctive norms assist in determining what is acceptable and unacceptable social behaviour. In the context of IPV, injunctive norms aid an individual to conceptualise whether intervening would be a positive step towards helping a survivor or would be a social misstep that would be interfering in a private matter.

2. Descriptive Norms are real world, observed behaviours of significant others in the target situation. How significant others respond to situations of IPV adds evidence to the development of our view of helping survivors of IPV as either beneficial or inappropriate.

3. Sense of Community and Belonging: the strength of injunctive and descriptive help-giving norms is correlated with the level of motivation and an individual has to comply with those norms. Therefore, an individual who has a stronger sense of belonging and connection to their community will have a greater tendency to conform to injunctive and descriptive norms.

Individual helping readiness

1. Self-efficacy is required to ensure that the informal supporter has the confidence that they can effectively help, whilst also having the capacity, skills, and knowledge to do so.

2. Acceptability of IPV can influence our view of the value of help-giving. Beliefs of traditional gender norms can foster beliefs that IPV is a private matter and, therefore, not to be interfered with. Both benevolent and hostile sexist attitudes contribute to the belief that survivors are to blame for the violence (even if partially) and, therefore, are not worthy of receiving help.

3. Social Responsibility: An individual’s belief that they have a responsibility to intervene in an IPV situation is associated with behavioural intention. This belief can be formed from a sense of justice, and this responsibility coupled with other factors (e.g., the relationship to the survivor) can be used to predict positive interventions.

4. Experience of violence can influence the level of emotional preparedness one has to respond to IPV. Additionally, prior experience can aid in developing practical skills on how to provide support and what support might be most appropriate.

Situational helping readiness

1. Relationship: Individuals are more willing to expend personal resources to aid those with whom they have a stronger relationship. A strong relationship to the survivor is particularly important in the context of chronic IPV, where an informal supporter may be required to provide ongoing (even if sporadic) support to a survivor for an extended period.

2. Abuse: An evaluation of the severity, frequency, and chronicity of the abuse helps to determine the overall impact of the abuse on the survivor and, therefore, the response needed. The greater the impact, the greater the need for intervention.

3. Responsibility: Greater help-giving intention occurs when an individual has a clear position that the perpetrator is responsible for the violence. If the informal supporter attributes responsibility to the survivor (e.g., apporting blame due to infidelity) they become less worthy of help.

4. Empathy: The sense of sympathetic wrongdoing to a survivor can motivate an informal supporter to act. An emotional connection to the survivor gives the informal supporter a sense of moral obligation to provide help.

5. Risk: Greater levels of perceived risk (to the survivor, the supporter, or others), will reduce the behavioural intention to help as the risk outcome might be more significant than the benefits of providing support.

6. Change Readiness: Informal supporters must decide if the cost of providing intervention will be well received and utilised by a survivor (i.e., the survivor is ready for change), therefore, making the informal supporter’s efforts useful.

7. Emotional Response: an individual’s emotional response can be linked to the perception that that their intervention will be useful. Emotions of hope are linked to long term goal success, which is important given the generally on-going nature of IPV before a survivor is safely able to remove themselves from a perpetrator (if this is ever possible).

Implications

The findings of this systematic review, and the subsequent development of the IPV-MISR, are a significant contribution to bridging the gap in current conceptualisations of help-giving in the context of IPV. With a focus on situational helping readiness, the IPV-MISR will contribute to extending research in this area by allowing for greater sensitivity to the nuanced social constructs inherent in IPV, which influence help-giving.

Specifically, these findings could be utilised in research and practice to refine bystander intervention programs. Currently, bystander programs are based on a bystander theory conceptualisation of help-giving and could benefit from greater consideration of the nuanced factors associated with IPV, as identified in this review. For instance, by incorporating additional exercises, such as self-reflection on the strength of relationships, bystander programs would be able to promote positive change across a greater number of helper readiness factors.

Being guided by the domains of readiness described above, consideration of how to improve interventions to promote tertiary informal supporter readiness could also consider how to promote ongoing positive bystander behaviours in the face of chronic IPV post-disclosure of abuse (which is the more common occurrence), as opposed to bystander behaviour in the context of witnessing an ‘urgent’ situation. Building the continuing capacity for informal supporters to safely engage with IPV survivors is important for the ongoing support needs of a survivor.

It is anticipated that the findings of this systematic review, and subsequent development of the proposed model of helping, will have real world implications in strengthening the social support systems of survivors. Through application of a network orientated approach (Ogbe et al., 2020), the current model can be utilised by both informal supporters and by IPV safety advocates (e.g., shelter workers, IPV outreach workers), to work collaboratively with survivors and their social network members to assess the readiness and willingness of informal supporters to provide help. This reflective process can be utilised to identify areas in which network members might require support themselves to increase their readiness to help survivors.

Finally, one of the purposes of this systematic review was to identify self-care strategies employed by informal supporters. However, this systematic review did not find any articles that evaluated informal supporter self-care strategies. This is noteworthy given the impact that IPV help-giving has on informal supporters (Gregory et al., 2017). In a systematic review on the topic of impacts of IPV help-giving, Gregory et al. (2017) found that help-giving is associated with physical and psychological health impacts, as well as having direct negative impacts from the perpetrator. However, to the best of our knowledge, there is no published study that considers how informal supporters can best maintain their physical and psychological safety.

Limitations of the review

The current review was limited to studies published in English, of which over half originated in the United States. While there were some studies that had been translated to English for publication, this might have influenced some of the conclusions drawn and limit generalisability to linguistically and culturally diverse groups. Therefore, it is possible that additional culturally specific factors would need to be considered if applying the IPV-MISR to cultural groups not considered in this review. Further, other key demographics such as education level, socio-economic status, and age were inconsistently reported. Therefore, it is unknown what role these demographics play on help-giving intention.

Additionally, the majority of articles in this review, 52% (n = 16) explored behavioural intention, as opposed to considering the actual behaviours of informal supporters. While there is evidence that suggests that behavioural intention is a predictor of actual behaviour (Webb & Sheeran, 2006), this has not been examined widely in the IPV informal support literature, with only four articles (13%) in this systematic review considering the relationship between help-giving intention and actual help-giving behaviour. As such, it is recommended that future research use the IPV-MISR in contexts of actual behaviours completed in order to provide validity to the utility of the constructs.

In a similar vein, the majority of articles in this systematic review (n = 18, 58%) used measures which included both secondary and tertiary interventions simultaneously. Given the different barriers and risks associated with these types of interventions, it is suggested that future research aims to understand the relationship between the constructs of the Informal Supporter Readiness Model and informal supporter intervention type.