A protocol for the safe recruitment of Indigenous and Black women experiencing intimate partner violence during the COVID-19 pandemic into a large mixed methods study: The Sisters by Choice Study

ABSTRACT

Intimate partner violence (IPV) is a complex and pervasive public health problem disproportionately affecting Indigenous and Black women. During the COVID-19 pandemic, IPV became more complicated for advocates because social distancing, quarantine, and isolation measures further endangered women experiencing IPV. This manuscript is based on an ongoing community-engaged study in an upper Midwestern state. Our primary goal for this study is to generate urgently needed knowledge on the impact of the COVID-19 pandemic on Indigenous and Black women’s help-seeking behaviours following IPV by systematically documenting barriers women faced during the pandemic. Engaging women in a large study that seeks to garner information about their experiences of violence is complex and challenging and requires significant planning, especially for ensuring participants’ safety. In this write-up, we detail the safety planning protocol developed for the purposes of recruiting and engaging women in rural and urban areas in an upper Midwestern state in the United States. Our goal is to provide scholars conducting research in the area of violence with practical considerations for safely conducting a study of this nature.

KEYWORDS:

• Intimate partner violence
• COVID-19
• help-seeking
• barriers

Background

Intimate partner violence (IPV) is a complex and pervasive public health crisis experienced by women globally. Violent behaviour perpetrated against women has long-lasting negative physical and mental health consequences for victims, their children, and their families. IPV is associated with adverse physical, psychological, and emotional consequences, including post-traumatic stress disorder, depression, anxiety, substance abuse, decreased productivity, sleep disturbances, and suicidal thoughts (Campbell, 2002; Dillon et al., 2013; Gone & Trimble, 2012).

Indigenous and Black women experience disproportionate rates of IPV while simultaneously experiencing systemic barriers to help-seeking. These barriers are related to and often rooted in institutional racism and racialized poverty, leading to poorer health outcomes, including homicide (Ruiz et al., 2022). We define help-seeking as women’s capacity and willingness to access healthcare providers through hospitals and other community health facilities, advocates, social workers, and law enforcement officers to obtain the necessary assistance for their experiences of violence. Advocates included in this definition are those working at community-based domestic violence or sexual assault programmes who support women following an experience of IPV.

IPV in the lives of indigenous and black women

Indigenous women

The U.S. National Intimate Partner and Sexual Violence Survey (NISVS) revealed that among Indigenous women who were surveyed, 55.5% reported physical violence by an intimate partner, and 66.4% reported being psychologically or emotionally abused by an intimate partner (Rosay, 2016). Indigenous women in the U.S. also have some of the highest rates of homicide perpetrated against them compared to other racially defined groups; homicide is the third-leading cause of death among Indigenous girls ages 1–19 and the sixth-leading cause of death for Indigenous women ages 20–44 (Heron, 2018).

Indigenous women experience barriers to help-seeking following an experience of violence, and these are uniquely based on tribal affiliation and whether they live in a rural or urban area. IPV support services, which can include shelter, food, group therapy, legal assistance, and advocacy, can be inaccessible to Indigenous women due to potential geographic distance if living in rural or reservation-based areas (Hawkins et al, 2017; Klevens et al., 2008). Supports and services may also be inaccessible to off-reservation or urban-dwelling women because culturally specific services are not available, and women may not feel comfortable accessing mainstream services. Many of the barriers that Indigenous women face are also related to the mistrust between women and healthcare providers, who often represent a colonial establishment that has historically caused harm to Indigenous people. A lack of cultural awareness among mainstream healthcare providers does little to lay a foundation for trusting relationships and further hinders women’s access to care (Luebke et al., 2022).

Black women

The NISVS shows that 41% of Black women have experienced physical IPV in their lifetime, with homicide being one of the leading causes of death for Black women aged 44 and younger (Smith et al., 2017). In a study conducted by Mugoya et al. (2020) with a community-based sample of nearly 500 African-American women caring for adolescents living in extreme poverty, it was found that approximately three-quarters of the women had experienced some form of IPV. In 2021, a quarter of the women killed by intimate partners in Wisconsin were identified as Black within a state where the Black population is only six percent of the total (End Domestic Abuse Wisconsin, 2022).

Black women also experience unique barriers when it comes to IPV (Spencer, 2021). According to Ullman and Lorenz (2020), Black women reported issues with the lack of racial representation of service providers. They noted that they were met with incomplete care, inadequate follow-up, and a poor relationship between them and their providers. These factors can negatively impact future help-seeking for Black women who experience violence (Ullman & Lorenz, 2020).

Limited social support networks available to Black and Indigenous women in both urban and rural environments can have important implications for help-seeking (Roschelle, 2017). Both Black and Indigenous women do not ordinarily seek help after IPV despite the potential for severe negative impacts such as injury or even loss of life (Satyen et al., 2019). Understanding the unique reasons why Black and Indigenous women do not seek help and the barriers they experience when seeking support after IPV is critical and central to this study.

IPV, the COVID-19 pandemic, and help-seeking behaviours

Preliminary findings from our ongoing study confirm the reality voiced by women that during the COVID-19 pandemic, there was no pause from violence experienced in the home compared to during non-quarantine times (Luthern, 2020). Before the pandemic began, there could be some reprieve or escape when one was dropping children off at school, or the abuser was out of the house at work.

Our advocate colleagues¹ Note that fewer women reached out, with the majority of those seeking services being women² who had sought help in the past. Those who did reach out reported that the severity of the violence was escalating, with the risk of homicide higher for all callers. Physical violence was more extreme, weapons were more frequently used, and strangulation was also reported, more so than in the past. In a study by Voth Schrag et al. (2022), service providers spoke of survivors experiencing violence that was more severe and frequent during the pandemic. Service providers in that study spoke of an increase in strangulation, which is also a preliminary finding in our study. More women started reaching out in person with the end of quarantine/isolation regulations. Women newly seeking help from one of our partner agencies increased from 1,029 in 2020 to 1,468 in 2022.

Studies focused on IPV during the pandemic have centered on the work of advocates and other workforce members in this area, particularly those working in shelters (Wood et al., 2020). This research is especially important because it provides us with an understanding of how safety planning³ approaches shift during pandemics, such as COVID-19, and the need to account for how survivors are engaged and how safety planning is done using various other technologies and platforms.

In relation to survivors’ experiences, Wood et al. (2020) and also Voth Schrag et al. (2022) pointed out how the COVID-19 pandemic created new avenues and mechanisms for partners engaged in violence to exert power, control, and coercion. Additionally, service providers had not been adequately trained in the use of new technologies, such as virtual platforms, as tools for keeping survivors safe or meeting their needs. Advocates thus needed to urgently and creatively learn how to keep survivors safe during a pandemic and how to protect survivors and themselves from a lethal virus that had proven to be a global threat (Nnawulezi & Hacskaylo, 2021). Our study may help to fill a gap in the literature on how new technologies and strategies may have helped or not helped, and in the case of this current manuscript, how to safely recruit women into a study focused on violence in their lives during the COVID-19 pandemic.

COVID-19's impact on IPV community resources

Within the context of a pandemic, resources in the community may be limited, and women are continually home with the person causing them harm, which can accentuate lethality. Nnawulezi and Hacskaylo (2021) specifically and critically noted that the capacity of shelters was limited, with some agencies serving survivors losing valuable resources, and that this contributed to the severity of IPV experiences. This was especially the case in a pandemic that required the enforcement of policies and mandates to effectively mitigate the spread of disease.

Chiaramonte et al. (2022) noted that the financial stressors and isolation that came about as a result of the pandemic created a situation where it was more difficult for survivors to leave an abusive relationship. These realities need to be accounted for in the provision of services during a pandemic. Chiaramonte et al. (2022) as well as Voth Schrag et al. (2022) additionally found that the COVID-19 pandemic had a temporary disruptive effect on the positive gains of survivors in relation to safety, housing stability, and mental health. These studies are all of great value in preparing for a response to future pandemics or other public health emergencies.

The gap created by the limitations of previous studies in terms of ethnic minority representation will be somewhat addressed by our study, which is focused on Indigenous and Black women, populations that disproportionately experience the highest rates of violence as well as homicide. Our study is important because it provides us with a deep understanding of women's actual experiences of violence during the pandemic as the basis for the development of future interventions and policies. Globally, there have been anecdotal reports of violence increasing in women's lives, but no large-scale analysis of which we are aware. To our knowledge, there are no systematic studies of this nature that have been done with Indigenous and Black women who have experienced IPV during a pandemic, disaster, or extraordinary circumstances. Our study is transferable and generalisable to not only Indigenous and Black women but also to all women globally to examine the unique presentation of IPV and how women navigate barriers to help-seeking during a pandemic, disaster, or under extraordinary circumstances. This new body of knowledge will be invaluable to healthcare providers, social service agencies, and policymakers in minimising barriers and enhancing protections for women in the future.

Community-engagement in IPV research

Our write-up here also expands on the current literature on how to engage meaningfully with community partners in a study focused on IPV. The literature on how to develop safety protocols when engaging with women in IPV research is limited, and any expansion of this literature is a welcome development, considering that safety issues when it comes to women experiencing IPV are multifaceted and complex (Anderson et al., 2017). This manuscript adds to this limited body of knowledge while specifically focusing on Indigenous and Black women, who are even more underrepresented in this literature. While we mostly focus on how we safely engaged with women in our study, we also narrate in detail our engagement throughout the research process with community partners through a community advisory board (CAB). The ultimate goal of a study that engages community partners in advancing research in the area of IPV is to ensure that study findings are meaningful and accessible and to ensure that the process leading up to those findings does not result in undue harm to members of the community (Goodman et al., 2018). It is important to note here that our study is based on relationships and collaborations with community partners and agencies that were established before the pandemic began. These collaborations were central to other work in which we were engaged together (Department of Justice 2020-SI-AX-0001) and formed an important basis for the current study when the pandemic started. Our community partners expressed deep concern about the heightened risk for people experiencing IPV. Community partners were involved in the planning and writing of the current grant and rendered the necessary support to ensure its success.

Additional literature pertinent to this work focuses on safety planning, more broadly, with diverse populations of survivors. This literature includes the recommendations by Sabri et al. (2018) for safety planning interventions for immigrant and refugee women identifying as African, Asian, and Latina. These recommendations were especially useful in developing a culturally relevant safety planning protocol for research with women who identify as Indigenous and Black. Some of the items noted by Sabri et al. (2018) that were similar to the cultural considerations we have for our protocol include engaging with team members who share a similar cultural background and accounting for how survivors engage in storytelling and not rushing them through the data collection process. For Indigenous and Black women, the desire to share their stories also informed how we recruited them, as we have found that women were more apt to be willing to participate if they felt that their story could help other women or could be useful in improving services that would benefit other women. Storytelling is an important cultural element in both Indigenous and Black cultures.

Theoretical framework

The study is informed by Indigenous feminist and Black feminist thought in its design and execution. These feminisms are consistent with the philosophical leanings of the agencies that are partnered in this study to ensure the safe recruitment and engagement of Indigenous and Black women. Both Indigenous and Black feminist thought are intersectional in nature, focusing on the various interrelated oppressions that women face that are not only gendered but also racialized, thus impacting women’s access to resources when it comes to help-seeking following experiences of IPV. Indigenous and Black feminist thought also implores us to identify women's health needs while acknowledging their strength and resilience even in the midst of oppression that has been experienced across lifetimes and across several generations (Darroch et al., 2022). In employing these feminisms, the research team sought to engage with community partners in an equitable and collaborative relationship to design and execute this study, with the understanding that the research process and products are shared with the ultimate goal of contributing to the improvement of women’s lives.

Guidelines from the World Health Organization and knowledge developed by scholars who engage women in violence research emphasise the added importance of weighing the costs and benefits of the study with the goal of minimising risk and harm to participants (Contreras-Urbina et al., 2019). We considered these guidelines in the design of our study. At the same time, based on the feminist framework guiding our study, we attempted to avoid a paternalistic approach in recruiting women and engaging them in the study. van der Heijden et al. (2019) emphasised the need to reconsider paternalistic approaches to the recruitment of populations that experience vulnerability into studies focused on violence, taking into account the right to participate in research that has a bearing on future safety and protection from violence for the most affected populations. Scholars in this field argue that this kind of research should not be restricted but should rather be approached sensitively and expertly while ensuring appropriate safeguards and taking into account the unique context of participants (Bender, 2017; Love et al., 2021; van der Heijden et al., 2019; Yick, 2007). Bender (2017) also noted that to improve outcomes for survivors of IPV, we need to expand our knowledge base through research.

From a feminist perspective, engaging Indigenous and Black women whose sovereignty has been stripped away, challenged, and dishonored requires that we re-center women’s personhood, which includes their self-sovereignty and their self-determination (Casselman, 2016; Deer, 2015; U.S. Government Accountability Office, 2010). Our recruitment and engagement efforts bear in mind that women experiencing IPV are often protecting themselves and their children from the harm of their intimate partners and, in the case of Indigenous and Black women, with minimal help from the systems that are supposed to be providing them with support (Ruiz et al., 2022). We engaged women, trusting that they were most knowledgeable about their circumstances and realities and that they would not contact us to participate in a study if they did not believe it was safe to do so (Yick, 2007). Our role is one of support and information-sharing as opposed to hindering women from participation or coercing them to participate.

Methods

This study is a large, mixed methods study funded by the National Institute on Minority Health and Health Disparities that is ongoing, to be conducted over a period of four years, beginning in September 2021 and ending in 2025. Approval for the protection of human subjects was obtained from the Institutional Review Board at the University of Wisconsin Milwaukee. We are currently meeting with tribal leaders to obtain tribal council approval for the study so we can engage with women currently residing on tribal territory.

Over the life of the study, we will recruit different samples of Indigenous and Black women and collect data through surveys, focus groups, and individual interviews. For the survey, we are working to recruit 600 women across two waves over the life of the study. This approach enables us to understand the impact of the pandemic on women's individual experiences and on help-seeking behaviours over time. For the qualitative portion, we are engaging with 300 women over the life of the study, in focus group or individual interviews, based on their preference. Participants for the study include (1) women who access care from different agencies that provide services and support to women experiencing IPV in rural and urban areas of an upper Midwestern state and (2) women who have not accessed services following IPV, recruited through flyers at various sites including grocery stores, clinics, and other spaces where our partner agencies ordinarily advertise services. We hypothesise that structural factors such as racism, racial segregation, and gender inequality interact in complex ways to make IPV help-seeking more difficult for Indigenous and Black women. We also hypothesise that Indigenous and Black women navigate help-seeking in different and unique ways based on rural versus urban residence and cultural identity. Recruiting from different sites based on who the women are and where the women live, while also recruiting women who have not accessed services, will enable us to gain an understanding of women's various help-seeking behaviours and the unique presentation of barriers across various sites and geographic areas. The goal of our write-up here is not to report on our findings, as our analyses are currently in process and data collection efforts are continuing, but rather to share the safety planning protocol that we developed to guide our study.

Eligibility criteria

Women participating in the study must meet the following inclusion criteria: (1) participants must be at least 18 years of age; (2) must identify as Indigenous or Black; (3) must self-report to have been in an intimate relationship (irrespective of cohabitation) for at least three months (as self-identified by the participant), in which there had been an episode of IPV since March 2020, when the COVID-19 pandemic began; and (4) must have the mental capacity to provide informed consent. Women are excluded from the study if they are living with severe mental illness in the form of psychosis, suicidality, or intoxication and/or if there are validity concerns related to inconsistent reporting.

Safety planning protocol

Several strategies have been implemented in this study to ensure women’s safety and well-being, including consultation with CAB, the use of evidence-based methods for recruitment, the experience of the research team members, and consideration for the safety of the study team (See Appendix 1).

Community advisory board

In keeping with community-engaged and feminist methodologies that call for research to be transformative, we formed a CAB of diverse stakeholders responsible for providing guidance on our research methods as well as the implementation of the study. As mentioned earlier, the current study was developed in partnership and collaboration with community partners with whom the academic team that submitted the funding application had been working prior to the start of the pandemic. This previous work was focused on enhancing the provision of culturally relevant, advocacy-driven medical forensic care to Indigenous survivors of sexual assault in the same communities in which the current study is focused.

The CAB is constituted of advocates who identify as tribal members and descendants.⁴, advocates who identify as Black, as well as advocates who identify as White, working with Indigenous and Black women survivors of violence. The advocates represent domestic violence and sexual assault agencies that are mainstream and also those that are culturally specific to Indigenous and Black survivors, including agencies on tribal lands.

Members of the CAB provided important insight and guidance on how to effectively and safely recruit Indigenous and Black women into the study and how to design the recruitment flyer so that it was culturally relevant to Indigenous and Black women. They also helped to select the tools for survey data collection and helped structure the questions on the interview guide so that they were culturally appropriate and did not inadvertently cause harm to women.

Cultural considerations based on guidance from the CAB. CAB members provided valuable suggestions and feedback about conducting interviews in person, such as creating a safe space to conduct interviews, use of aromatherapy, providing beverages and snacks, having childcare available, and providing transportation assistance. We have frequently interviewed Indigenous women at trusted Indigenous-led organisations where we are allowed to use traditional medicines gathered from the earth, such as sweetgrass, tobacco, sage, and cedar. The Indigenous-specific agencies usually smudge the rooms where we hold the interviews. Smudging is an Indigenous cultural practice that is used to purify or cleanse the negative thoughts or energy of a person or place. It consists of placing the medicine (typically sage, cedar, or sweetgrass) in a container such as an abalone or turtle shell and then lighting it with a match. The flames are then gently blown out, and the smoke is wafted over the person, using an eagle feather or by hand, to aid in mental, physical, and spiritual healing. The person being smudged pulls the smoke to cover their face and body. The smudging causes negative thoughts, feelings, or energy to be absorbed by the ashes, and the ash is then returned to the earth. The participants are offered to be smudged after the interview by the Indigenous interviewer or staff at the agency. The agencies also make small smudge kits available for the participants to take home with them.

Another example of how our team engages with Indigenous and Black women in a specific way is through anti-racist praxis. We have learned about anti-racist praxis from Embrace, our partner and advocacy agency that serves survivors experiencing domestic and sexual violence in multiple counties in Northern Wisconsin. Embrace experienced a sudden loss of funding and a decline in local support from its tight-knit community, resulting from the agency placing a ‘Black Lives Matter’ sign in its yard during the racial reckoning of 2020. The loss of support for Embrace and subsequent vitriol from the conservative community in which they are located–stoked by local law enforcement–towards the most harmed and underserved survivors pushed Embrace advocates to deepen their learning in Black Feminist Liberation theories. These learnings have also informed how we engage with women in this study. Additional cultural considerations for the implementation of our study are centered around the notion that healing is not just about the woman as an individual, but it is also about the community for both Indigenous (McKinley et al., 2023) and Black women. Sabri et al. (2018) noted the importance of building on the positive aspects of the cultural values of women who have ordinarily experienced marginalisation.

Academic-community engagement

Jumarali et al. (2021) coined the notion of showing up for community partners. Throughout our research process, academic partners have attempted to maintain a presence outside of the research study, particularly with the culturally specific agencies serving Indigenous and Black women. For example, academic partners have been involved in cultural activities like pow-wows facilitated by community partners. Academic partners have also been involved in fundraising activities, town hall meetings, and health fairs in the community facilitated by community partners. This has helped to enhance a trusting relationship between academic and community partners that helps advance our common goal of ultimately ensuring the safety and well-being of survivors of IPV. We also use these community events to share information about the study with women so that they can volunteer to participate if interested.

Meetings of the CAB. As data are being collected, key findings are communicated to CAB members, who then consider how these findings could be translated into the various organisations that they represent in an effort to improve programming for the women they serve. Because our engagement with CAB members, as well as other community agencies, is ongoing as we recruit, meetings are held regularly to facilitate recruitment and to include ongoing feedback as to the findings of our study, especially those findings that have important and urgent implications for Indigenous and Black women’s access to services.

In keeping with tenets of community engagement, CAB members are compensated for the time they spend attending meetings and doing the work of the board. CAB members were initially scheduled to meet monthly at the beginning of the study, but because we began during the COVID-19 pandemic, it was not possible to regularly gather CAB members together. All CAB members are women, many of whom are survivors and also advocates working for various agencies across the state. Given the nature of their everyday work and the crisis, the endangerment and entrapment that many women survivors of IPV experienced during the pandemic, CAB members were inundated with their work, which involved keeping women safe. This also affected the ability of the CAB to meet regularly. As the pandemic waned, CAB members, along with academic partners, rotated meeting spaces to meet at the offices of the various agencies represented on the CAB. This practice has continued to date with plans to meet on Tribal land in Northern Wisconsin in the near future. Meeting together at the various agencies enhanced relationship building not only between academic partners and community partners but also among the community partners themselves. It also allowed for knowledge exchange about the various services that agencies provide and an opportunity to share resources and services as appropriate. For example, one of the agencies represented on the CAB provides services specifically to women who are survivors of sexual assault. Advocates from the agency were able to connect with the advocates and healthcare providers from the tribal clinic also represented on the CAB to ensure that the Indigenous women they serve could access health care. They had the opportunity to visit the tribal clinic when one of the CAB meetings was held there and to share about the clinic with the women they serve who identify as Indigenous.

At the meetings of the CAB and at other community events, we have ensured that we have food that is culturally relevant. For example, we have had catered events where we procured food that was locally supplied, like soul food. This has enhanced our relationships as our community partners see us investing in the community and valuing them in meaningful ways.

Providing Guidance and Solutions. The CAB members are responsible for providing guidance on how to implement solutions in the targeted communities where the study is taking place in an effort to enhance the health, well-being, and safety of Indigenous and Black women. Community partners through the CAB offer important guidance on not only recommendations but also on how recommendations can be practically carried out in their agencies as well as in the community. We also spend time speaking with women who are leaders in anti-violence work within their respective tribal nations and communities. Gathering the input and guidance of Indigenous women within tribal communities and Black women in urban and rural communities ensures that we are honoring the priorities of tribal nations and communities, respectively.

Having this CAB has been instrumental in enabling us to communicate findings with our community partners and other agencies in the targeted communities as we analyze our data in a timely manner. We regularly communicate and connect with various CAB members and the agencies they represent to report developing findings on the barriers women face in reaching out to agencies. Our agency partners can then adapt their approach to advertising their services to maximise outreach to help-seeking, specifically for Indigenous and Black women. Our findings thus go beyond yielding academic knowledge to contributing to a more immediate impact and social transformation to better serve their clients. The involvement of the CAB ultimately enables us, as academics, through these ongoing collaborative relationships with community-based organisations working with Indigenous and Black women, to produce relevant and legitimate research grounded in the experiences of survivors, advocates, and community leaders.

Training of the Team Members. Prior to team recruitment, all team members met with an advocate at one of the major partner agencies to undergo training. This training lasted several hours and was conducted by an advocate who had worked in the field of violence against women for at least three decades. The training included information about IPV from the perspective of an advocate, how to safely engage with women who have experienced violence, how to make referrals, and other information that was of relevance.

Development of the Study Tools. CAB members were closely involved in identifying the various tools that were preferable for Indigenous and Black women for the study. During the pandemic, this work was done mostly via e-mail but, at times, in person by meeting with various CAB members individually to obtain their input. We identified a number of different tools from which CAB members could select those they felt were most appropriate. The CAB recommended the use of the following tools for data collection: Everyday Discrimination Scale (EDS) (Williams et al., 1997); Household Food Security Survey Module (HFSSM) (Government of Canada, 2012); Lethality assessment (Campbell, 2005); COVID sense of safety questions, and help-seeking behaviours and barriers survey (See Appendix 2, which includes instruments the CAB considered but did not recommend for the survey tool).

CAB members preferred tools that were brief and did not tax women who would likely already be stressed and perhaps burdened with having to recollect their experiences of IPV. Identification of the survey instruments took several months, and the CAB members were apprehensive about many of the tools that were initially identified. This struggle is understandable, considering that many of the tools used to measure women's experiences of violence and other related experiences were mostly validated among White, English-speaking, and heterosexual women who were more likely to live in urban environments. Some instruments also contained questions that were deemed triggering to women already experiencing violence in their lives. It was important that we were intentional with this process to ensure the instruments chosen would not cause additional harm to the women. Prompts were provided when a potential triggering question would be asked so women had the opportunity to decline. Such prompts were added to the surveys with recommendations from the CAB.

CAB members preferred qualitative inquiry, which they felt allowed women control over what they could say, whereas they saw the quantitative survey instruments as being prescriptive and limiting. We had planned to conduct the surveys first and then engage women in qualitative inquiry; however, we adjusted our study to start with qualitative interviews, considering the CAB quickly approved the qualitative interview guide but were still recommending revisions to the quantitative survey.

One of the other challenges experienced with the survey in identifying appropriate tools was that this was the first systematic study of its kind with Indigenous and Black women in this region of the United States. We wanted our investigation to augment the work of the State’s recently created Missing and Murdered Indigenous Women’s Taskforce. For example, we considered adding a collection of data that would address urgent problems in communities state-wide. CAB members, however, insisted that we remain true to the original goals of the study and that we minimise collecting any data outside of its scope, considering the emotional energy that women would need to expend in providing data. As such, we targeted the shortest tools that provided us with data that were central to the goals and the specific aims of our study.

Finally, CAB members provided guidance on how much women should be compensated for their participation in the study, pointing out the need to adequately compensate them for a study of this nature. Women are given a $50 gift card for participating in the survey and an additional $50 for participating in the interview.

Recruitment

Recruitment for the study has primarily been done in collaboration with the various agencies across the state and involves advocates connecting us with women who are interested in participating. This form of recruitment has the added benefit of ensuring safety because women are already in close communication with an advocate about their situation; sometimes, they are already in a shelter. Advocates share information about the study with women already accessing their services and are able to determine whether it is safe for the women to participate in the study. Advocates also provide support on how to guide women in participating so that their safety is not compromised.

Participants are also recruited through flyers posted at various sites, including churches, mosques, corner grocery stores, hair and nail salons, libraries, restaurants, strip malls, health clinics (including free community clinics) and mental health and substance abuse treatment locations, WIC clinics, area doctor's offices, women's prisons, and parole locations. These sites were chosen because they are the same sites where our community partners post information about their services.

Women whom we are tasked with paying the most attention to when it comes to safety are those who have not accessed services at all, especially women who contact us because they have seen our flyer in the community. For women who have not received any services and are calling because they saw our flyer, it is imperative that we first determine whether they feel safe to talk to us, what to do if the situation becomes unsafe while they are on the call with us, and how and where to connect with them in order to ensure their safe participation in the study. For any woman calling our line, we have a script that team members use while they receive the call (See Appendix 3). This script guides the team member on what to say, how to say it and ensures that team members are able to engage with women safely. One of the first items on the script is to develop a code word with women on the call to ensure that if the situation becomes unsafe, she can easily communicate this to the team member on the call or hang up if needed. The script also includes information that enables the team member to screen for eligibility to participate in the study. Additionally, the script includes information about how confidentiality and privacy will be protected to the best of our ability so that women feel safe engaging with us and participating. Our approach helps to ensure that women are safe in the case that the partner causing them harm is within the vicinity or is present when we engage with them. The lethality assessment (Campbell et al., 2003), which is one of the tools the CAB selected for inclusion as a data collection instrument, allows for an assessment of safety and risk. We developed a resource list for women at any risk for lethality as well as a protocol to follow for those participants who were determined to be at high risk for lethality (See Appendix 4). The protocol is for the researcher to stay on the line with the participant as an advocate, and/or an IPV hotline was accessed to ensure a warm handoff for the participant.

Flyers broadly indicate our interest in speaking with women who have experienced violence in their lives, but the phone number tab that can be cut off and taken home does not mention anything regarding violence. This lack of identification on the phone number tab was done purposefully to minimise any harm women might encounter if the person perpetrating violence were to learn of their interest in participating in a study of this nature. The phone number provided on the flyer connects to our secured Teams site, where all communications for the study occur. Consistent with the recommendations of other researchers (Clough et al., 2010), the research team does not use their personal phone numbers to interact with women interested in study participation. Team members work in shifts to take calls from women. If a team member is unavailable to take the call, for example, over the weekend or on holidays, women can leave a voicemail. When women call our Teams line to express interest in participating in our study, for the purposes of safety, we do not call women back unless they expressly state when they leave a message that we can do so.

It is made clear to women recruited that participating or not participating in our study has no bearing on the services they receive from the respective agencies where they may have seen the information about the study. It should be noted that the flyer was revised based on feedback from Indigenous and Black advocates and also based on the knowledge that we gained through our interviews with women. Advocates on the CAB pointed out that the flyer needed to be more colourful and culturally appealing to Indigenous and Black women (See Appendix 5 for the flyer approved by Indigenous and Black advocates on the CAB).

Women who have been calling us because they saw our study flyer and have not sought any services for their experiences of IPV noted that they are uncomfortable seeking services, sometimes because of past experiences of racism while engaging with various systems and other times because they have a history with the carceral system. For women in these situations, we noted that they called mostly because they wanted to have their stories heard and also because they wanted to help other women. This finding is consistent with other studies focused on violence that engages women (Love et al., 2021). To facilitate our recruitment efforts in this regard, we changed the flyer to ensure that we shared a similar goal in engaging women in our study – to listen to their stories, validate their experiences, and ensure that their experiences had a meaningful impact on charting a course that would ensure the protection and support of women in the future.

The revised flyers have been posted on social media, including on partner agencies’ private Facebook and Instagram pages, community pages, and private groups already established on social media. A number of our partners have Facebook pages that help people in need of domestic violence services become aware of how to access them. On these pages, they often advertise upcoming events and announcements. We have also included a QR code. The QR code was added to potentially reach a younger audience of women and other women who may be difficult to reach. The QR code connects participants to our website, where they can learn more about the study. This website landing page has an escape option for women to quickly exit the page if they do not feel safe. Since the recruitment line that we currently staff as a team has limited hours, the website enables participants to access information about the study more conveniently and also communicate with the team about their interest in participating (See Appendix 6).

Participation Options. Women are assured that the research team can accommodate any children that they need to bring with them to the site if they choose to participate in person. Finally, the script reminds the team members to find and identify a location close to or convenient for the participant. Advocates providing guidance on the study insisted on the need to provide detailed instructions to women about where they would be interviewed and what to expect when they got there. This included what the building looked like in addition to its location, where they could find parking, and which door to use to enter the site. Information is also provided about how much time women are expected to spend with us for the interview and that they would be compensated for their time participating in the study. Transportation vouchers are available to enable them to easily get to the site if needed. This information is also shared on the call. Detailed information is important for women who have experienced IPV to ensure that they feel in control of their experiences, considering that in an abusive relationship, their power and control are taken from them.

Another option offered is to have a team member collect data in the participant's home, virtually, or over the phone. This is especially important for women who are uncomfortable or concerned about engaging with systems that have historically contributed to their marginalisation. The team member on the call asks questions to determine the safety of the home location for data collection. Earning the trust of participating women is a priority, and we believe that women are self-aware and capable of ensuring their own safety. We thus rely on women to communicate with us the best time and place for data collection while ensuring their safety. For example, women often know the time when the person causing them harm would be at work or otherwise out of the home.

Other studies that involve home visits with women who have experienced violence are noted in the literature and point out that research team members need to be cognizant of safety in the home both before arriving, during data collection, and while leaving (Love et al., 2021). For most of the participants who invite us into their homes for data collection, their partners are either not living with them in the home or they are no longer with the partner. Before scheduling the study appointment, the team member asks women to confirm the availability of a private space in their home where they feel safe. This is re-confirmed upon contact with the woman at the time when the actual data collection is to take place. If it is deemed that the home is no longer a safe and private space, the researcher either reschedule or does not proceed with data collection.

The academic institution primarily involved in this study is one where faculty from various units on campus are frequently in the community for purposes other than data collection. As such, it is not surprising for people to see faculty in their community engaging with women and coming into their homes. The research team also includes Black, Indigenous, and other women of colour, who are involved in data collection, making it easy for team members to navigate and engage with women in the community and to do data collection in the home.

Safety of the study team

We were cognizant of the fact that the study is emotionally taxing not only for the women engaged in our study but also for our research team members. We have developed a protocol for how team members engage with one another during the research process to ensure that they are mentally healthy both during the recruitment process and while collecting data and thereafter.

Team members engage with one another across various forums, including through Teams, e-mail, and Signal. Signal was recommended by our Information Technology security experts as a secure platform for communication. Team members remain in close contact and work in collaboration after a study participant has been identified and then in determining where data collection should take place. Data collection usually involves two team members, one serving as a support person while the other collects the data. This ensures the provision of not only support for the study but also emotional support in case the member collecting data needs to process what they have learned from the participant. An additional member of the research team is also present at the site during data collection in case there is a need for childcare if a woman needs to bring along a child or children to the site. We decided it was important to have childcare available to ensure that women were not limited in their ability to participate by having young children who need care.

Collecting data at agencies is supportive as team members know that women are afforded the necessary help even during the interview, should they need emotional or mental health support. The camaraderie and relationship-building that has occurred over the life of the study also enable the research team to build bonds with agency advocates. Additionally, having an advocate to engage with after interaction offers emotional support to the team. The research team also checks in via Signal with the entire team after an interview is complete so that everyone is assured of the team member's mental well-being. Engaging in this kind of reflection is done not only after the interview but also throughout the research process among all the team members as a way of enhancing team-building.

Discussion

Recruitment of women for this study has been challenging for various reasons, some of which we have alluded to in this current write-up. Women have been hesitant to participate in the study even when approached by advocates from the agencies where they are accessing services. At the writing of this manuscript, though, recruitment has picked up as women share information about the study with one another in the community and through the agencies where they access services. Our strategies for recruitment have also improved over time as we have learned what works in helping Indigenous and Black women feel safe participating in our study. Some important and notable recruitment strategies that have been particularly effective include a greater presence of the academic team in the community through various community activities and, working closely with community advocates, ensuring that flyers are culturally appealing to Indigenous and Black women, and developing genuine relationships with community agencies and members of the community. Recruitment has also been enhanced by research staff having a regular presence at domestic violence shelters and/or drop-in centers. Research staff being present has allowed women to participate in a more spontaneous manner at their convenience.

Moradi and Grzanka (2017) argue that intersectional problems involving complex factors such as racism, poverty, and sexism in the IPV experience require a response that involves cross-disciplinary coalitions to be effective. The diversity of the CAB members in their racial and ethnic identities and their representation of various disciplines and agencies has been invaluable not only to recruitment but also to ensure that we uphold ethical standards in the conduct and implementation of the study. This has also enabled us as a team to be attentive to the unique cultural needs of Indigenous and Black women in our engagement with them throughout the entire research process. To date, we have recruited a total of 156 Indigenous and Black women to our study. We are no longer recruiting urban Black women to the qualitative portion of the study as we have reached the data saturation necessary for the completion of qualitative analyses for this population.

One of the most important lessons we have learned in the execution of this study is one that other researchers in this field have noted – the need for nimbleness and willingness to adjust protocols to accommodate new knowledge as it arises and to address new challenges that come about (Contreras-Urbina et al., 2019; Krishnan et al., 2012). Contreras-Urbina et al. (2019) pointed out the need for ongoing risk assessment in a study focused on violence. As shown in other studies, working closely with advocates, the CAB, and agencies already serving women has been instrumental in ensuring women's safety in recruitment and data collection efforts (Bender, 2017). Minimising vicarious trauma among the research team members is also critical (Contreras-Urbina et al., 2019).

Team-building is an important aspect of research that has been noted by scholars engaged in any large study if the team is to successfully accomplish its goals (Strnadová et al., 2014). For a study of this nature, team-building becomes even more imperative as team members may respond to the vicarious trauma they experience in many ways, including those that are not conducive to individual well-being, team cohesiveness, and the advancement of study goals. Processing any vicarious trauma is, therefore, urgent, and the need for ongoing team-building activities to enhance the cohesiveness of the team is a priority. Team-building activities are incorporated into the study team and CAB meetings. The long-term relationships that we have developed with the CAB and other community partners involved in the study have been invaluable in not only ensuring the safety of women but in enabling us to remain culturally rooted in how we engage women and develop meaningful knowledge that will advance health outcomes. Such longer-term relationships also contribute meaningfully to the community in terms of developing knowledge that is impactful and sustainable and thus serves as a form of important investment in the community (McKinley et al., 2023).

Study limitations

There are possible challenges or limitations to consider. Firstly, there have been some changes to our study team and the CAB as the study has progressed. In these circumstances, it was crucial to train new research team members on our safety protocol in order to protect their safety and privacy in addition to our survivor participants. Additionally, changes to CAB members added new perspectives and consideration for different approaches, which, at times, were challenging to implement when their suggestions required changes to our IRB-approved protocol. As previously noted, rapid changes in the adjustment of protocols were necessary but added a further complication regarding ethical review and human subjects’ protection approvals. It is thus important to consider the time it may take for review and changes when adjusting protocols and communicating early with ethical review offices to discuss possible changes. Another possible limitation to our research is that our study enquires about experiences of violence during COVID-19 and thus may not be generalisable to barriers pre- or post-pandemic or comparable to future pandemics.

The need for studies that engage women who experience the deepest vulnerabilities and are at greatest risk for IPV cannot be overemphasised. Research in the area of violence in the lives of women must be not only ethical and considerate of women’s safety needs, but it must also be inclusive (van der Heijden et al., 2019), particularly in those populations that are most impacted as well as most underserved.

Conclusion

While the societal impact of COVID-19 seems to have waned since the start of the pandemic, future pandemics are expected to occur, along with natural and unnatural disasters that disproportionately affect Indigenous and Black women and other populations experiencing the deepest vulnerabilities (Ruiz et al., 2022). Developing knowledge on how women seek help following IPV in the context of extenuating circumstances is critical for determining how to ensure that women receive the help that they need. The voices of women who experience the greatest barriers to care following IPV are urgently needed if we are to develop meaningful interventions and policies that are grounded in women's reality.

Acknowledgments

This study was funded by the National Institute on Minority Health and Health Disparities. (R01 MD016388). The official study is entitled Impact of the COVID-19 Pandemic on Help-seeking of Indigenous and Black women experiencing intimate partner violence. The title of the study, as coined by an Indigenous woman elder in one of the tribal nations that share geography with Wisconsin, is Sisters by Choice: United by Voice. Special thanks to Ms. Katie Klein and Ms. Cindy Figgins-Hunter, who helped lay the foundation for the safe conduct of this study through their coordination efforts, hard work, and guidance. We are also grateful to all of our women elders, both Indigenous and Black women, who have supported this study in an advisory role, along with the community advisory board members. We are especially grateful to the women whom we continue to engage in our study, who share painful realities that they lived and how these realities were exacerbated by an ongoing global pandemic. We are hopeful that the knowledge we have generated through their engagement with us will help us be better prepared in supporting and protecting women in a future pandemic, disaster or extraordinary circumstance.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by National Institutes of Health [grant number: ].

Notes

1 Advocate colleagues are considered members of our research team. Some of them are involved in our CAB and provided guidance on the selection of data collection tools and will be involved in data analysis. They are also co-authors of the current manuscript as well as any future manuscripts. Others are not necessarily involved in the CAB but work for various domestic violence and sexual assault agencies in the communities in which we are engaging women and have assisted us with recruitment efforts. The advocate colleagues are mostly tribal members, descendants, and Black women who work with and support AI and Black women experiencing violence in their lives. Some of our advocate colleagues are themselves survivors.

2 People who identify as all genders were served by advocate partners. The term women was used for consistency and clarity in this write-up.

3 Safety planning in this manuscript refers to the strategies implemented to ensure the well-being of women during their participation in a study focused on intimate partner violence (IPV), as distinct from the safety planning conducted by an advocate to mitigate potential harm stemming from a present or past intimate partner relationship.

4 The Bureau of Indian Affairs (BIA) defines American Indian (or Native American or Indigenous) as an individual who is a 'member' of an Indian tribe, band, or community 'recognized' by the federal government; who lives on 'or near' a reservation; who is of 1/4 or more Indian ancestry. This includes American Indians, Alaskan Natives, and Pacific Islanders. Those who are descendants of enrolled tribal members that do not meet the blood quantum requirement of a particular tribal nation are referred to as descendants.