A realist review of which advocacy interventions work for which abused women under what circumstances

Cochrane Realist Review (published June 2019). Using a realist approach, the reviewers tried to understand which advocacy interventions work to help abused women, under what circumstances and which women benefit, by exploring effects in different conditions. 


The reviewers assessed advocacy interventions for intimate partner abuse in women, in terms of which interventions work for whom, why and in what circumstances. 


98 studies: 88 core studies (37 focused on advocates, 7 on abused women and 44 experimental intervention studies); and 10 studies that did not fit the original criteria but provided useful information. 2 further studies are ongoing and 3 are awaiting classification. 

Advocacy interventions varied considerably in contact hours, profession delivering and setting. 

The reviewers constructed a conceptual model from six essential principles based on context-mechanism-outcome (CMO) patterns. 

They found evidence:

  • considering the importance of both women's vulnerabilities and intersectionalities and the trade-offs of abuse-related decisions in the contexts of individual women's lives (moderate and high confidence); 
  • regarding the significance of physical dependencies, being pregnant or having children (low confidence); 
  • on the links between setting (high confidence);
  • on the theoretical underpinning of interventions, type, duration and intensity of advocacy, advocate discipline and outcomes (moderate and low confidence);
  • of the importance of a good therapeutic alliance (high confidence); and 
  • on the significant challenges for advocates in inter-organisational working, vicarious traumatisation, and lack of clarity on how much support to give a woman (moderate and high confidence). 

The reviewers felt that the provisional model highlights the complex way that factors combine and interact for effective advocacy; however, they were unable to confirm the impact of complexity of the intervention (low confidence). 

The evidence is current to  January 2019. 


The reviewers confirmed the core ingredients of advocacy according to both women and advocates, supported by studies and theoretical considerations: education and information on abuse; rights and resources; active referral and liaising with other services; risk assessment and safety planning.  They advised that future research considers the different principles identified in the review and study outcomes in relation to the mechanisms and contexts elucidated. They suggested that more longitudinal evidence is needed, including work to determine the duration of longitudinal work and how to tailor advocacy interventions, as well as economic analyses to ascertain if advocacy interventions are cost-effective in healthcare and community settings.

Read the full review on The Cochrane Library