Enabling Workplace and Community Responses to Domestic Abuse: A Mixed Method Systematic Review of Training for Informal Supporters

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Introduction
Domestic abuse (DA) is a widespread and serious issue around the world.Estimates suggest that globally, a third of women have experienced physical or sexual violence from a current or former intimate partner [1].Domestic abuse refers to physical, sexual, economic, or psychological abuse and/or controlling, coercive, or threatening behaviour perpetrated by adults who are, or have been, personally connected to each other [2].Studies highlight that domestic abuse has signifcant social, public health, and economic consequences [3,4] and so warrants a robust, multisectoral response.Tis study focuses on the role of friends, relatives, colleagues, and community members (defned here as informal supporters) in responding to DA in workplace and community settings.
In the Global North, policy and practice responses to DA have included a diverse set of interventions, involving multiple agencies and actors [5].Alongside frontline services such as police, social workers, and healthcare professionals, community responses to domestic abuse have gained increasing prominence since the COVID-19 pandemic [6].During this period, informal supporters used creative ways to initiate and maintain support for victim-survivors [7].Tis is indicative of the wider signifcance of informal and social networks who have always been, and continue to be, uniquely placed to recognise domestic abuse, respond, and refer to wider services [8].In comparison to professionals, informal supporters often live or work in close proximity to the victim-survivor and so may be able to identify warning signs and help victim-survivors identify behaviours as abusive [7,9].Established, mutual relationships of trust and interactions that take place in private/home settings, often undeveloped in formal services, provide further opportunities to identify DA [7,10,11].
Studies highlight that mobilizing community members alongside formal services can improve outcomes for victimsurvivors and foster help-seeking [6].Helpful responses from informal networks are associated with improvements in mental and physical health and increased feelings of safety [12][13][14].Informal networks can also play an important role in linking victim-survivors with the police, legal services, and domestic abuse agencies and supporting decisions to make changes in their relationships, if and when desired [15][16][17].
Friends, family, or community members, however, may not know how to respond and feel overwhelmed or illequipped to ofer support [18][19][20].Seeking to overcome such barriers, a growing range of interventions are tailored towards informal networks and their skills, capacity, and/or motivation to provide positive support [21,22].Systematic reviews show that training and educational activities ofer promising impacts on informal supporters' knowledge and attitudes [23][24][25].Tese echo reviews of DA training in healthcare and policing, where there is growing understanding of the outcomes and characteristics of efective programmes [26][27][28][29][30][31].Such conclusions are primarily based on quantitative assessments.Yet, qualitative research can provide new, deeper insight into educational interventions from the perspective of the trainees [32].Utilising qualitative data, this systematic review aims to identify the features of DA training deemed important by informal supporters.By juxtaposing these characteristics with quantitative evidence of efectiveness, the review then aims to pinpoint features of successful training in workplace and community settings.
Te rationale for focusing specifcally on training tailored towards informal supporters, as distinct from professionals, is four-fold.First, education on DA may constitute a compulsory, discrete part of a wider training programme for professionals [26] although not for all professions, e.g., General Practice trainees [33].In comparison, training for informal supporters is often voluntary and provided in community settings, such as in faith organisations [34] and tends to be a stand-alone, brief intervention, such as workplace training [23].
Second, the content of training may difer.Healthcare professionals use structured tools to identify DA (such as clinical screening tools or risk assessments), and so, training focuses on the use of such tools [35,36].Informal networks, however, determine the existence or escalation of abuse through more improvisational methods based on their relationship with the victim-survivor and their prior knowledge of the situation [7,9].Further, professionals may be taught about clear and well-articulated protocols for intervening and referring victim-survivors of abuse [30].Yet, such prespecifed pathways are typically not appropriate for informal responders.Indeed, informal supporters can provide a broad range of support that may be invisible or discounted by formal services such as tailoring responses to the victim-survivor's identity or personal history [37].
Tird, individual and social factors shape the provision of informal support.Studies suggest that particular groups, such as women and ethnic minorities, are most likely to seek and provide informal support [7,14,38].Terefore, such factors may infuence the design and delivery of training in community contexts.
Fourth, with growing political attention on societal responses to DA (such as the "Enough" campaign in the UK https://enough.campaign.gov.uk/) and practitioner interest in informal support [37], there is a need to better understand the potential of educational interventions for enabling community responses to DA.

Research Questions
Te aim of the systematic review was to improve the understanding of DA training programmes tailored towards informal supporters and pinpoint the characteristics of successful educational interventions.To do so, the following research questions were addressed:

. Methods
A mixed method review [39] was undertaken with a sequential, staged approach to integrating qualitative and quantitative research [40].In the frst stage, a qualitative synthesis was conducted to identify themes based on informal supporters' views of training.Tese were then translated into recommendations.In the second stage, a matrix juxtaposed these recommendations alongside quantitative evidence of impact (based on outcome evaluations) to identify characteristics of efective training.Te PRISMA checklist was used to guide the reporting of the methods and fndings of the review [41].
Te review followed an EPPI-Centre approach [42], guided by the following underlying principles: (1) the review aimed to address policy/practice relevant questions and utilised diferent types of empirical evidence from both academic and grey literature sources.Te inclusion of credible grey literature (defned as reports written by respected colleagues or organisations working in DA) is valued by the DA sector [43] and so was deemed important for this review.(2) Te review was undertaken collaboratively, and stakeholder engagement was valued [25,44].Te review team was composed of university academics and researchers at a domestic abuse nongovernmental organisation.Te project engaged with wider stakeholder groups through an Advisory board composed of individuals with lived experience of abuse, frontline DA service providers,

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Health & Social Care in the Community and two DA specialists.Tree online meetings were held over the course of the project to inform the direction and methods of the review.[45]).Te sample needed to include informal supporters and reports were excluded if the study did not report data specifcally for this population (e.g., reporting data from a mixed sample of informal supporters and practitioners).Only English language reports were included.

Study Selection.
All references were imported into EPPI-Reviewer [46], specialist web-based systematic review software, to undertake the screening, data extraction, and quality appraisal stages of the review.Screening was initially undertaken on title and abstracts, followed by full text.For each of these screening phases, a sample of reports was screened independently by two members of the team until a high level of consistency was reached.Decisions on complex studies were discussed and resolved by the whole team.

Data Extraction.
A data extraction tool was developed to capture details about the study methods, sample, intervention, and fndings.Two reviewers extracted the data independently, and then a fnal version was agreed.Coding disagreements were resolved through discussion with a third reviewer.
3.5.Quality Appraisal.Te Mixed Method Appraisal Tool (MMAT) [47] was used to assess all included studies.In addition, the ACCODS checklist [48] was used to appraise grey literature.Two reviewers independently applied both tools and then reached agreement on the overall judgement for each study.A principle of "good enough" quality [49] was used to decide whether and how studies could contribute to the syntheses."Good enough" studies met at least 40% of the MMAT criteria for the appropriate study design and/or were deemed to ofer "signifcant" and "authoritative" contributions based on the ACCODS tool.

Synthesis.
A sequential design was used to integrate the fndings from diferent syntheses to answer the overarching research question [50].In the frst stage, thematic analysis was used to inductively code and generate descriptive themes from included studies with qualitative data.Tese descriptive themes were translated into analytical themes by tabulating the evidence to identify the extent, pertinence, and consistency of fndings across studies [51].Descriptive themes with data from two or more studies were used to generate analytic themes (those that "went beyond" the original fndings of the studies, [52]).Tese themes were translated into recommendations [50].In the second stage, these recommendations were juxtaposed with studies that reported quantitative fndings from quasiexperimental evaluations of the interventions (reported separately in [53]).Tis allowed for comparison of the recommendations from the qualitative studies with evidence of efectiveness [50].To assure the quality of the synthesis, characteristics of efective training were identifed where the quantitative evidence was judged to be moderate/high quality (40% or more on MMAT quantitative dimension) and consistent (two or more higher quality studies, supported by lower quality studies).

Results
Of the 9,345 records identifed, nine studies were deemed eligible for inclusion in the review (Figure 1).

Study Characteristics.
Te main characteristics of the included studies are presented in Table 1.Te majority were conducted in North America (n � 5) with further studies undertaken in the UK (n � 2), Vietnam (n � 1), and "globally" (n � 1).Sample sizes ranged from 13 to 1899 informal supporters.Te studies focused on specifc types of informal supporter: workplace supervisors or colleagues (n � 4), faith leaders (n � 3), community members (n � 3), and/or peers (n � 1).Two studies included more than one type of informal supporter [57,61].None of the studies examined interventions aimed at informal supporters who identifed as friends or relatives of victim-survivors.Sample demographics, where reported, were diverse in terms of gender and ethnicity.Tree studies included a majority female sample, two had a majority male sample, and one included an equal proportion of men and women.While most studies did not report population ethnicities (n = 5), two had majority Caucasian samples, one had Health & Social Care in the Community majority Korean American, and one African American sample.Two of the studies reported that informal supporters had prior experience of DA.

Study Design and Quality.
Included studies were diverse in study design with the majority (n � 6) using both qualitative and quantitative approaches.Two studies only used quantitative designs, including a randomised controlled trial and a quasiexperimental study.Only one study was purely qualitative.All studies were judged to be "good enough" to contribute to the synthesis.
Seven studies of variable methodological quality addressed research question 1. Tree studies had weak qualitative approaches, only fulflling 20% of the qualitative MMAT criteria, but were judged to ofer authority and signifcance to the feld based on the AACODS tool [57,59,62].Tree studies fulflled 40% of MMAT [55,58,60], and one study had a strong approach, fulflling 100% of MMAT [61].
Six studies included quantitative data to address RQ 2. Four of these were considered to ofer robust evidence as they fulflled 40% or more of the appropriate MMAT quantitative dimension [54,56,58,60].Lower quality evidence was provided by two further studies [57,62].

Intervention Characteristics.
DA training was delivered in the workplace (n = 4), community (n = 3), or faith-based settings (n = 2).Tese were typically one-of sessions, ranging between one and four hours, for workplace colleagues/supervisors and faith leaders.In comparison, training in the community, for peers or lay people, was longer in duration (up to 18 hours) and included multiple sessions.Across all interventions, the curricula provided information on DA, seeking to dispel myths and raise awareness while considering the impacts on, and needs of, victim-survivors.Te training also provided information on how to respond and/or how to refer victim-survivors to specialist services.4 Health & Social Care in the Community

Engaging Informal Supporters with the Issue of DA (1) Training Gives Everyone the Right and Responsibility to
Respond.In community and workplace settings, studies highlighted that training helped informal supporters to recognise that "everybody has a role to play" in responding to domestic violence and abuse.Training can support individual's recognition of their "right" to intervene [61] and was understood to give permission to individuals to respond to DA: "what were the benefts of the training?Gemma: I would say permission to do something about something that's happening in the workplace" [55].Training also highlights "the importance of taking action to address abuse, and that it is everyone's responsibility" [57].
(2) Engage All Informal Supporters in Training.Mandatory training for supervisors was deemed crucial in one study [59], and two further studies that highlighted the importance of ensuring senior management were involved [55,57].One of these studies also highlighted the importance of ensuring "that male employees are attending these training sessions cos that doesn't seem to be" [55].
(3) Domestic Abuse is Difcult to Talk about.Studies highlighted the difculties of engaging informal supporters on the topic of DA as it is a "difcult subject" [55] with "a great deal of stigma and aversion connected with DV that makes it hard to address in workplaces and society in general" [57].

Training Content and Materials
(1) Provide Information on How to Respond.In workplace settings, participants valued training that provided practical information on how to respond to disclosures of abuse.Tis included information on in-house resources, local community organisations, and formal services [55,[57][58][59].
Participants also recognised the value of training to improve knowledge of "how to respond in empathetic and nonjudgemental ways" [59].
(2) Raise Awareness and Understanding of DA.Studies reported that training stimulated greater awareness and understanding of DA, opening "people's eyes to the reality" [57].Tis awareness was associated with better understanding and a new perspective through which to view cases of abuse [55].
(4) Provide Information on the Impacts on Victim-Survivors.
Participants valued curricula that provided information about the impacts of abuse on victim-survivors [58,59].
(5) Training Needs to be Tailored to the Audience.Five studies identifed that training methods and content needed to be appropriate for the audience and tailored towards their needs.Tis ranged from tailoring training to pastors' "abilities and motivations" [56] to context-specifc resources such as "steps supervisors can take to support victims" [58].
Studies identifed the importance of developing strategies "to meet people where they are," building relationships and trust "especially those with diverse populations who may not inherently trust outsiders, and who often are more receptive to hearing the message from community leaders and in appropriate contexts" [57].Indeed, studies highlighted the importance of developing culturally appropriate material that, for example, focuses on cultural values that shape perceptions of DA and delivering training in suitable community locations [54,[56][57][58]60].
(6) Inclusive Materials that Avoid Stereotypes.Participants valued inclusive materials that represented diverse communities (in terms of gender, sexuality, and culture) [57,58,62].Tis included the need to "honour and acknowledge the trauma and experiences of male survivors of violence" [57] and recognise that abuse takes place in LGBTQ + communities.While participants liked "the diversity represented in the training," they also raised concerns that the materials may propagate unhelpful stereotypes such as "the inclusion of Latinos suggested inaccurately that domestic violence is a larger problem in the Latino community" [58].
(7) Use Visuals, Statistics, and Case Scenarios.Two studies reported that visuals, statistical content "that validate[s] the importance of the materials," [57] and "the use of a "case scenario" to walk participants through local resources were helpful [57].

Training Delivery
(1) Trainers with Professional Experience/Expertise in DA.
Tree studies recognised the value of trainers who had professional experience and/or expertise relevant to the feld of DA.Tis was seen to equip trainers with skills to address the challenges of the topic and provide relevant insights and models of expertise in this area [55,57,59]: "It brought home how important it was to get over our discomfort in dealing with domestic violence and that we needed some professional training to facilitate this" [57].
(2) Bringing Together Individuals with Diferent Perspectives, from Diferent Sectors.Studies identifed the importance of training that involved informal supporters with diferent perspectives and from across sectors.Tis was understood to foster information sharing and problem solving.Studies pointed to the value of "sharing actual experiences and anxieties" [55].

Features of Efective DA Training.
Included studies were used to assess whether each of the ten recommended features were supported by robust, quantitative evidence of efect.Tis was based on fndings of efectiveness reported separately (as reported in [53]).
Health & Social Care in the Community

Engaging informal supporters in the issue of domestic abuse
Training gives everyone right and responsibility to respond Five of the ten recommended features had sufcient evidence to suggest that they were characteristics of efective DA training (see Table 3).Tese included training content that covered (a) warning signs and nature of domestic abuse, (b) impacts of abuse, and (c) how to respond/local resources.Two further recommended features, with sufcient evidence, included tailored training and using nontext formats.Successful training was tailored to the type of informal supporter in terms of their cultural background [54,56] and their role as a community advocate [62] or workplace supervisor [58].Nontext formats included "charts, images, statistics, and videos" [54].
Te evidence for the remaining fve recommended features was less clear.Two of the features were not supported by the quantitative evidence: mandatory training, and delivery alongside the domestic abuse sector.Of the highquality evaluations, mandatory training was present in one intervention [56] and absent in two [54,60].Working alongside the DA sector was present in one training intervention but absent in three.Terefore, it is difcult to draw inferences about the role and signifcance of mandatory training or working alongside the DA sector for the efectiveness of the intervention.Tere was inconclusive evidence about whether training should include diverse attendees and group learning formats.Tis feature was both present and absent in interventions evaluated by studies of variable methodological quality.
Tere were insufcient details about the training interventions to determine the signifcance of the remaining two recommended features.None of the studies explicitly reported whether the intervention acknowledged the discomfort surrounding domestic abuse when recruiting trainees or delivering the training.Similarly, only one study reported whether teaching materials included diverse representations.

Discussion
Tis mixed method systematic review highlights the potential of DA training for enabling informal supporters to respond to disclosures of abuse.Te fndings provide insight into efective DA training in workplace and community settings, generating practical recommendations for organisations that are designing and delivering training in these contexts (see Table 4).
Te qualitative synthesis found that training is valued for bringing DA to the fore in workplace or community settings, despite being a difcult subject, and so sharing the responsibility to respond.Efective training curricula cover the warning signs and nature of DA, the impacts of abuse, and information on how to respond.Tese results echo the fndings of systematic reviews of DA training in the workplace [23] and professional healthcare settings [27,30].Such information is likely to be important because it addresses barriers to responding to victim-survivors, identifed by informal supporters, namely, not knowing what to do or feeling ill-equipped to ofer support [18][19][20].Tis suggests that training can help informal supporters to deal with difcult conversations and improve their response to disclosures of abuse [63].Such curricula align with the skills and knowledge that victim-survivors require from their informal networks: empathetic listening and ofers of practical support [14,64].
Te review found that informal supporters valued nontext based educational materials, such as visuals or statistics, and these constituted a feature of efective training.Tis fnding is also echoed in professional training contexts where interactive approaches, using role play, case studies, and videos are associated with improved knowledge in DA [27,65,66].
Te fndings highlight that informal supporters valued training programmes that were tailored to the audience and recognised the unique role or position of the informal supporter.Efective training for informal supporters needs to respond to their role and capacity as, for example, colleague, acquaintance, or pastor.Wider literature suggests that informal supporters defne their role in diferent ways, whether this is "being a listener" as a friend [9] or "walking alongside" individuals as pastoral counsellor [34].Training therefore needs to be tailored towards the defning features of the informal supporter role.While none of the studies included interventions that targeted friends or family, there is wider evidence to suggest that closer, more ingrained relationships between victim-survivor and informal supporter may be less receptive to educational intervention [67].Terefore, the quality and type of relationship between the informal supporter and the victim-survivor are important for shaping educational content and delivery.Indeed, the review identifed that successful curricula provided resources tailored to the context in which the training was delivered (e.g., workplace policies or community resources) and recognised the importance of cultural values in shaping responses to DA. Te qualitative synthesis specifcally highlighted the importance of inclusive materials that recognise diverse experiences of abuse, without stereotyping.Te importance of tailoring interventions to the needs of specifc groups of victim-survivors and informal supporters refects wider recognition that DA interventions need to address intersecting social and cultural factors [68,69].
Tere was insufcient evidence in the review to draw inferences about whether mandatory recruitment and the involvement of the DA sector are key ingredients for effective training programmes.Wider studies suggest that both features are useful for understanding DA training and associated impacts.First, efective training in professional contexts commonly involve DA educators or experts [30,70] and the DA sector plays a key role in advancing community education programmes [62].Terefore, it seems likely that DA specialists contribute to efective training, but more research is needed.Second, the review found that training was efective whether enrolment in the programme was voluntary or compulsory [56,59].Broader evidence suggests that giving employees the choice to participate in training is associated with more positive outcomes than compulsory attendance [71].However, voluntary training may also lead to unintended consequences such as the enrolment of groups who are already predisposed to providing support.Studies highlight that social reactions to disclosures of abuse Health & Social Care in the Community Health & Social Care in the Community are shaped by gender and race [72], with women more likely to identify and respond to abuse than men [7] and individuals from minoritized ethnic groups most likely to provide culturally sensitive support [73,74].Indeed, studies fnd that women are more likely than men to elect to undertake DA training in professional contexts [66].Terefore, voluntary training may further exacerbate the burden on specifc informal supporters, lead to small numbers participating in the training [75], or foster a diferentiated response across the setting [76].While compulsory training is not possible to administer in all settings, e.g., amongst neighbours or community members, mandatory training in informal contexts such as workplaces or faith organisations may potentially broaden community support for DA victimsurvivors, recognising that it is "everyone's responsibility" to respond [57].

Strengths and Limitations.
Overall, the review makes substantive contributions to knowledge by foregrounding the views of trained informal supporters and providing insight into the utility of training in workplace and community settings.By synthesising qualitative research, this mixed method review provides deeper understanding of the impacts of training, maximises the diverse evidence base, and generates inferences that ofer practical application (see Table 4).However, the evidence base included few studies and small sample sizes.Tis means that conclusions are tentative and research gaps remain.None of the studies evaluated educational activities aimed at friends or relatives of victimsurvivors, and qualitative data were relatively scarce.Terefore, more research is needed to explore informal supporters' views of training, especially those from family and close social networks.Moreover, scant details of the training intervention were provided in studies, such as the content of the curricula, and so improved reporting is necessary to share learning for future educational activities [27] (see Table 4).Yet, it is also important to note that the literature on training in community settings and workplaces has only recently emerged.Twenty years ago, for example, systematic reviews were lamenting the absence of studies on staf education/training programmes [77].Te small and developing evidence base is therefore an important step forward.Te conclusions of this study were underpinned by sound systematic review methods that adhered to EPPI-Centre standards [42].Te project was inherently collaborative, considered good practice in DA research, and engaged with key stakeholders [25].Te search strategy was comprehensive and included grey literature to refect the value attributed to such sources by the DA sector [43].Screening and data extraction processes adhered to methodological expectations and included consensus decisionmaking.Despite these strengths, more comprehensive handsearching methods would be useful to identify international grey literature (such as websites of international domestic abuse organisations and citation checking).Further, screening all the items by two independent reviewers, rather than a sample of all records, would improve the reliability of the review.

Conclusion
Tis review foregrounds the unique role played by informal supporters in responding to victim-survivors of DA in community settings.Training and educational initiatives

Practice
Develop training programmes that: (i) Provide information on the warning signs and nature of DA, the impacts of abuse on victim-survivors, guidance on how to respond (e.g., empathetic listening), and details about relevant resources (e.g., local specialist services) (ii) Incorporate nontext educational materials (use visuals, statistics, and case scenarios in the training) (iii) Tailor the training to the audience "meet people where they are" (e.g., providing information applicable to the workplace or community setting, building relationships of trust, and ensuring that materials are culturally appropriate) In delivering the training, consider (i) Involving educators or experts in domestic abuse Health & Social Care in the Community ofer opportunities for public health professionals and the wider DA sector to work with, and alongside, informal networks to optimise the society-wide response to DA [37].Tis review identifes key characteristics of educational interventions to maximise impacts and meet the needs of the trainees.In isolation, training for informal supporters is not sufcient for building links with victim-survivors or sustaining an adequate social and community response to DA.Additional interventions are required to provide care and assistance to informal networks, who identify adverse impacts associated with ofering support [45] while also improving opportunities for the disclosure of DA in formal settings.Moreover, the provision of positive support from informal networks is associated with further help-seeking [16], and so, investment in specialist DA services needs to remain a priority (see Table 4).

RQ 1 :
what are informal supporters' views of DA training?RQ 2: what are the characteristics of efective DA training tailored towards informal supporters?

Figure 1 :
Figure 1: Flow of records through the review.
Training content and materialsInformation on how to respond 4 Curricula content includes (a) warning signs and nature of domestic abuse, (b) impacts, and (c) how to respond and local resources Raise awareness and understanding of domestic abuse 3 Information on impacts of abuse on victim-materials but without stereotyping Visuals, statistics, and case scenarios useful 2 Use nontext formats in materials Training delivery Trainers with professional experience/expertise in DA training 3 Involve DA specialists in the delivery of training Bringing together individuals with diferent perspectives, from diferent sectors 2 Diverse attendees (experience, sector) and group learning formats 10 Health & Social Care in the Community (ii) Whether recruitment to training should be mandatory or voluntary Research (i) Undertake qualitative studies to develop understanding of informal supporters' experiences and views of education/training programmes and whether/how such interventions can meet their needs (ii) Ensure full and transparent reporting of educational interventions and research processes (iii) Evaluate the role of mandatory recruitment and working alongside DA sector in workplace and community training (iv) Support organisations that design and deliver training (e.g., employers/ nongovernmental organisations/voluntary sector) to develop and apply research methods to evaluate their programmes Policy (i) Invest in training or educational activities aimed at informal supporters (ii) Investment in specialist DA services is required alongside to respond to additional demand

Table 1 :
Characteristics of included studies.

Table 2 :
Summary of themes, extent of qualitative evidence, and recommended features.

Table 3 :
Summary of recommended features and extent of quantitative evidence, by quality of study.

Table 4 :
Recommendations for practice, research, and policy.