From campus to communities: evaluation of the first UK-based bystander programme for the prevention of domestic violence and abuse in general communities

Abstract

Background:
Violence against women and girls is a public health epidemic. Campus-based research has found bystander programmes show promise as effective primary prevention of sexual violence. However, evidence regarding domestic violence and abuse bystander prevention specifically, and in community settings generally, is still in development. Further, research has predominantly emanated from the US. Examining proof of concept in differing cultural contexts is required. This study evaluates the feasibility and potential for effectiveness of a domestic violence and abuse bystander intervention within UK general communities-Active Bystander Communities.

Methods:
Participants recruited opportunistically attended a three-session programme facilitated by experts in the field. Programme feasibility was measured using participant attendance and feedback across nine learning objectives. Myth acceptance, bystander efficacy, behavioural intent and bystander behaviours were assessed using validated scales at baseline, post-intervention, and four-month follow-up. Results were examined for potential backlash. Analyses used a paired sample t-test and effect size was quantified with Cohen's d.

Results:
58/70 participants attended all programme sessions. Participant feedback consistently rated the programme highly and significant change (p ≤ 0·001) was observed in the desired direction across behavioural intent, bystander efficacy, and myth acceptance scores at post and follow-up. Effect size was generally large and, with the exception of Perception of Peer Myth Acceptance, improved at follow-up. Backlash was minimal.

Conclusions:
To our knowledge this is the first UK-based study to examine the potential of bystander intervention as a community-level intervention for domestic violence and abuse. Findings are promising and indicate the translatability of the bystander approach to domestic violence and abuse prevention as well as community contexts. This is likely to be of great interest to policymakers and may help shape future community-based interventions. Further research is now needed using experimental designs engaging diverse community audiences.

Full text

R E S E A R C H A R T I C L E Open Access
From campus to communities: evaluation
of the first UK-based bystander programme
for the prevention of domestic violence
and abuse in general communities
Alexa N. Gainsbury
1*
, Rachel A. Fenton
1
and Cassandra A. Jones
2
Abstract
Background: Violence against women and girls is a public health epidemic. Campus-based research has found
bystander programmes show promise as effective primary prevention of sexual violence. However, evidence
regarding domestic violence and abuse bystander prevention specifically, and in community settings generally, is
still in development. Further, research has predominantly emanated from the US. Examining proof of concept in
differing cultural contexts is required. This study evaluates the feasibility and potential for effectiveness of a
domestic violence and abuse bystander intervention within UK general communities—Active Bystander
Communities.
Methods: Participants recruited opportunistically attended a three-session programme facilitated by experts in the
field. Programme feasibility was measured using participant attendance and feedback across nine learning
objectives. Myth acceptance, bystander efficacy, behavioural intent and bystander behaviours were assessed using
validated scales at baseline, post-intervention, and four-month follow-up. Results were examined for potential
backlash. Analyses used a paired sample t-test and effect size was quantified with Cohen’sd.
Results: 58/70 participants attended all programme sessions. Participant feedback consistently rated the
programme highly and significant change (p≤0·001) was observed in the desired direction across behavioural
intent, bystander efficacy, and myth acceptance scores at post and follow-up. Effect size was generally large and,
with the exception of Perception of Peer Myth Acceptance, improved at follow-up. Backlash was minimal.
Conclusions: To our knowledge this is the first UK-based study to examine the potential of bystander intervention
as a community-level intervention for domestic violence and abuse. Findings are promising and indicate the
translatability of the bystander approach to domestic violence and abuse prevention as well as community
contexts. This is likely to be of great interest to policymakers and may help shape future community-based
interventions. Further research is now needed using experimental designs engaging diverse community audiences.
Keywords: Bystander, Community, Domestic violence and abuse, Interpersonal violence, Prevention, Violence
against women and girls
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* Correspondence: a.gainsbury@exeter.ac.uk
1
University of Exeter, Exeter EX4 4PY, UK
Full list of author information is available at the end of the article
Gainsbury et al. BMC Public Health (2020) 20:674
https://doi.org/10.1186/s12889-020-08519-6
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Background
Violence against women and girls (VAWG) is a public
health crisis of ‘epidemic proportions’[1] (p3) which im-
pacts severely upon individuals and communities. The
burden that VAWG places on health, social care and just-
ice resources [2]issogreat“that even marginally effective
interventions are cost effective”[3]. Whilst legislative re-
sponses to VAWG have been historically piecemeal, one
positive UK advancement is the Consultation Response
and Domestic Abuse Draft Bill 2019 [4]. In addition to en-
hancing justice and survivor processes, the Consultation
highlights the need for raising awareness and changing so-
cial attitudes which are supportive of violence. However,
juxtaposed with this policy development, is a popular cul-
ture in which UK media narratives recently attempted to
silence and de-legitimise neighbours for alerting police in
the case of suspected abuse in the home of the now British
Prime Minister [5,6].
One way of moving social attitudes might be through
bystander programmes, which show promise as effective
primary prevention of VAWG [7–10]. Bystander ap-
proaches are complex models which seek to engage
those outside the victim - perpetrator relationship to
play an active role in preventing and responding to
VAWG by shifting gender inequitable attitudes, beliefs
and cultural norms which support abuse, and ultimately
increasing pro-social bystander behaviour to prevent it.
As interventions are made, over time social attitudes re-
garding the acceptability of both VAWG within society
and bystander actions will shift [11].
The organising framework for bystander programmes
is underpinned by Latané’s Five Step Model of Helping
[12]. The model is based on progressing participants
through the processes of change; from noticing the be-
haviour, seeing it as a problem, assuming responsibility
for helping and possessing the skills for effective and safe
intervention, through to the final stage of taking action.
Further, bystander programmes also aim to deliver
changes in attitudes and beliefs, and social and cultural
norms which are associated with enhanced bystander
likelihood and reduced perpetration, such as sexism,
empathy and rape myth acceptance [7]. The incorpor-
ation of social norms theory is thought to be maximally
effective because peer norms are variables for bystander
intervention [7]: perceptions of others’willingness to
intervene is related to bystander behaviour [13]. Peer
norms are also related to perpetration where they are
supportive of abuse [14–16]. Consequently, correcting
misperceptions about others’intentions to intervene and
support for abusive behaviours may ameliorate barriers
to intervention [7,14,15], although studies have rarely
reported on peer norm perceptions [7].
As a reduction in incidence of violence is problematic
to measure, most studies use proxy outcome measures
which correlate with the aims and determinants of by-
stander programme effectiveness [7]. Thus, studies, in-
cluding experimental, have found significant change in
the desired direction in victimisation and perpetration at
a community level, bystander attitudes, efficacy and in-
tent, rape myth rejection, knowledge and empathy, and
actual bystander behaviours. The evidence is available
elsewhere [7–10,17]. Law plays a symbolic role in com-
municating the acceptability of behaviours to the public
and is central to combatting VAWG at a structural level
[18]. Many bystander programmes intend to increase
knowledge on substantive law but this is rarely reported
on [7].
There are a number of widely accepted criteria for ef-
fective prevention programming for behavioural change
[7,19,20]. Bystander programmes should be under-
pinned by theory and evaluated accordingly. Measure-
ment should include potential backlash effects, as some
prevention efforts may have the opposite outcome to
that intended [7], such as an entrenchment of the
attitudes programming is attempting to shift [21].
Further, as permanency of outcomes is uncertain [10]
and programme effects may diminish over time [8],
follow-up is important. Other criteria relate to effective
pedagogy, design and implementation [20,22]. Longer
programmes which are cumulative, sequential and deliv-
ered over time by well-trained facilitators are more ef-
fective [10,20,23]. A wide range of teaching pedagogies
including emphasis on role-play for skills acquisition
and use of socio-culturally relevant materials are indi-
cated [10,20]. Mixed- sex groups are also appropriate
for bystander programmes [10,24].
The research base for bystander programmes as pri-
mary prevention of domestic and sexual violence and
abuse (DSVA) emanates predominantly from the US
with a focus on campus sexual violence prevention. Al-
though there is some evidence as to the translatability to
other non-college audiences in the US [10]. To date, lit-
tle is known about domestic violence and abuse (DVA)
bystander programmes and general communities. How-
ever, we do know that VAWG is pervasive [1] and that
third parties may both witness warning signs, incidents
of abuse [25,26] and be in a position to help, and that
abusers misperceive norms about others’use of DVA
[27]. Thus, understanding the applicability, utility and
limitations of bystander programmes in UK non-student
contexts and as a DVA prevention tool is an important
next step. Compared to university populations, general
communities represent a challenge in terms of imple-
mentation. Universities have a strategic interest in
prevention, a captive audience with a potential shared
identity as a student of that institution, and in situ envir-
onmental space for delivery and the making of
supported interventions. These factors are absent for
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general communities, resulting in complexities in deter-
mining commonalities of potential audience both in
terms of physically bringing people together to receive
an intervention and in terms of fostering communities
for making supported interventions [28,29]. Capturing
the acceptability of programme content, implementation
and delivery approaches within the community context
is thus important.
This paper reports on the quantitative phase of a
mixed methods feasibility study [30] intended to deter-
mine the acceptability and potential utility of the first
UK DVA bystander intervention within general commu-
nities: Active Bystander Communities (ABC). The study
involved a pre-post and follow-up survey design, re-
ported on in this paper. We also undertook 17 semi-
structured interviews with participants, approximately 1
month after the intervention, which examined the pro-
cesses that lead to change and how they map onto the
theoretical underpinnings of the programme. These are
reported on elsewhere [31]. In this paper we contribute
to the developing evidence base regarding the translata-
bility of bystander interventions to DVA prevention and
make a significant contribution to exploring the proof of
concept for the first time within broader societal
contexts.
Methods
Study population
The study was conducted across three local authority
areas in the South West of England. Participants over 16
who identified as a community member or undertook a
community-facing role (professional or volunteer) were
recruited opportunistically using snowballing over the 2
month period prior to intervention delivery in February
2019; information promoting the pilot and the oppor-
tunity to attend ABC was disseminated to community-
facing organisations and groups via community and pro-
fessional networks (emails and face-to-face). A booking
link was also featured on an online hub for local com-
munity organisations and paper fliers distributed to
community organisations (for example churches and
charity hubs) within one area of Exeter. An email ac-
companying project information encouraged participants
to pass information onto interested parties and indicated
we were particularly interested in engaging men. We
also reached out directly to two large predominantly
male community groups in the local area to encourage
their participation. Because of the nature of snowballing
we were unable to track either the reach or response
rate our recruitment method elicited. Participants were
arranged into five pilot groups according to geography
and session time preference (morning, afternoon or
evening), with a maximum of 20 participants per group,
thought to be optimal based on author and facilitator ex-
perience (Additional file 1).
The intervention
ABC was co-created by researchers and DVA and public
health practitioners [28]. The theoretical design, content
and pedagogy was adapted from The Intervention Initia-
tive [32]. Structurally and theoretically ABC follows The
Intervention Initiative design [7,19,22,28,29] and pro-
gresses participants through Latané’s five step theoretical
model [12] over three sessions. Sessions one and two
correspond with the first three stages for intervention
(noticing to responsibility) and session three corre-
sponds with the skills training in stage four [19,28,29].
In accordance with the criteria for effective prevention
[20], varied pedagogy was utilised, including presenta-
tion, media, active learning exercises, group work and
role-play vignettes. Content and the process of co-
creation is described in detail by Fenton et al. 2019 [28].
In brief, content was adapted to use information on
DVA prevalence, impacts and myths, and the law relat-
ing to DVA. All examples in the presentation and group
exercises were changed to be proximal and salient to
DVA in adult general populations (for example refer-
ences to campus resources were changed to community
resources; scenarios were changed to encompass family
situations including children, rather than student bar-
based or classroom contexts). New DVA role-plays were
designed and scripted by a DVA specialist agency and
included appropriate responses to perpetrators and vic-
tims [28] as well as community sources of support re-
lated to DVA agencies. Participants received handouts
containing a summary of the information delivered
within the intervention and slides. In accordance with
best practice [20], ABC was delivered to four groups of
between nine and 20 participants over 3 two-hour ses-
sions 1 week apart by two expert co-facilitators, one
male and one female, one of whom was a specialist from
a DVA service provider. In order to compare feasibility,
one further group of 16 was arranged to receive the
same intervention over the course of a day. Participant
wellbeing was addressed at the start of each session and
community sources of DVA specialist support reiterated.
If a participant needed support during or after a session
this was provided by the DVA specialist facilitator.
Procedure
Facilitators collected attendance data. Participants com-
pleted paper-based questionnaires before session one
began and after session three finished, and an online
survey at four-months post-intervention. The question-
naire administered at programme end contained course
evaluation feedback questions. Written informed con-
sent was given and participants could still attend the
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intervention if they did not consent to participate in the
research. Only participants who attended the full
programme were included in the post and 4 month
follow-up analysis.
One pilot group of participants (n= 9) who received
the intervention approximately 1 year in advance of the
substantive study were not asked to complete the four-
month follow-up for practical reasons.
Participants received a £5 e-voucher after completing
the post-intervention survey. Ethical approval was given
by the College of Social Sciences and International Stud-
ies Ethics Committee at the University of Exeter.
Measures
Attendance
Facilitators registered attendance at each session.
Participant demographics
Participants were asked to describe their age, gender,
sexual orientation, ethnicity and whether English was
their first language at baseline. Participants were also
asked to write down (open text) their motivations for at-
tending, whether they knew someone who had been af-
fected by domestic abuse (yes, no, not sure), if they had
attended a programme about domestic abuse (in the last
5 years or ever) and if they had taken part in a campaign
that raises awareness about domestic abuse (in the last 5
years or ever).
Programme feedback
Participants were asked to rank the programme on a
five-point rating scale with one being “definitely no”to
five being “definitely yes”, against nine learning objec-
tives (Table 1).
Instruments
Part of the purpose of this feasibility study was to assess
the utility of instruments. The instruments adopted cor-
respond to the theoretical processes of change for by-
stander action commonly reported on in the extant
literature relating to bystander intent, efficacy and be-
haviour. Whilst these measures originate in US college-
based sexual violence research we theorised that they
would be equally applicable because the processes for
change are likely to remain the same, and because they
are likely translatable to other forms of violence [10].
Thus, we adapted the content of these measures from
sexual violence to DVA, and in accordance with previ-
ous work, altered the language to UK-English and UK
concepts [19,22,29]. We provide examples of these
adaptions below. Most bystander evaluations have used
rape myth acceptance [7], and, accordingly, we changed
our attitudinal measure to domestic abuse myth accept-
ance. Regarding peer norms, we changed the comparator
group from “people in your peer group (other students
of the same sex as you at this university)”,to“friends,
family and neighbours of the same gender”to corres-
pond with community participants. A participant mean
score was calculated for each instrument based on their
responses to items within that scale.
DVA myth acceptance
We used the Domestic Violence Myth Acceptance Scale
[33] (DVMAS) to measures attitudes and beliefs about
DVA which includes items about prevalence (“Domestic
abuse does not affect many people”) as well as attitudes
towards victimhood and perpetration (“If a woman con-
tinues living with a man who beats her then it’s her own
fault if she gets beaten again”). We asked participants to
indicate their level of agreement with 16 described state-
ments on a scale of one (strong disagreement, i.e. myth
rejection) to seven (strong agreement, i.e. myth
endorsement).
Bystander efficacy
We used a shortened adapted version of Banyard et al’s
(2005) Confidence Scale [34]. Examples of amendments
and items include “Call for help (I.e. call 999) if I hear
someone in my neighbourhood yelling ‘help’” and “Ex-
pressing my discomfort if someone says that domestic
abuse victims are to blame for being abused”(adapted
from “Call for help (I.e. call 911) if I hear someone in
my dorm yelling ‘help’” and “Expressing my discomfort
if someone says that rape victims are to blame for being
raped”. We asked participants to score their degree of
confidence in enacting 11 described behaviours from 0%
(no confidence) to 100% (full confidence).
Bystander intent
We used items from the Bystander Attitude-Scale Re-
vised and Bystander Behavior Scale Revised [35] along-
side Intent to Help Scales [36] to measure participants’
attitudes and likelihood of helping others. Example items
include “Speak up to someone who is calling his/her
partner names or swearing at them”and “Approach
someone I know if I thought they were in an abusive re-
lationship and let them know I’m here to help”. Partici-
pants indicated their likelihood of taking 17 described
actions on a scale of one (not at all likely) to five (ex-
tremely likely).
Bystander behaviours
We used the Bystander Behavior Scale –Revised (BBS-
R) (as modified by McMahon et al. 2011 [37]) to meas-
ure behaviours participants had recently engaged in. Par-
ticipants were asked to think about the previous 2
months for the pre-intervention survey and “since at-
tending”the intervention for the post-intervention and
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follow-up surveys. They reported “Yes”, they engaged in
that behaviour (1); “No”, they did not engage when in
the situation (−1); or they were “Not in the situation”
(0) for 19 described scenarios. Items included “Went
with a friend, relative, or neighbour to the police to be
of support as they filed a complaint related to domestic
abuse, e.g. restraining order”and “Visited a website to
learn more about domestic abuse”(adapted from “Go
with a female friend to the police department if she says
she was raped”and “Visit a website to learn more about
sexual violence”. Composite scores were calculated by
summing the score on each item. We also report on the
mean number of times participants recognised them-
selves as being in the situation described as identified by
either a score or 1 (“Yes”)or−1(“No”).
Perception of peer DVA myth acceptance
We used a subset of DVMAS items included in our
DVA Myth Acceptance scale. Participants indicated what
proportion (0–100%) of their friends, family and neigh-
bours of the same gender they thought would agree with
four described statements.
Perception of peer behavioural intent
We used a subset of items included in our Behavioural
Intent scale and asked participants to indicate how likely
they thought that friends, family and neighbours of the
same gender would enact six stated behaviours on a
scale of one (not at all likely) to five (extremely likely).
Perception of law knowledge
We asked participants to rate their overall knowledge
about law relating to DVA on a scale of one (very poor)
to five (very good).
Backlash
We followed Moynihan (2011) [38] and calculated the
difference between participants’pre and post mean
scores for the scales Behavioural Intent and Myth Ac-
ceptance. An attitudinal change in the undesired direc-
tion ≥1 standard deviation (SD) from the study
population was taken to indicate a substantial negative
shift that could be attributable to backlash.
Statistical analysis
StataSE 15 [39] was used to undertake data analysis. We
generated descriptive statistics for attendance, partici-
pant demographics and programme feedback. We calcu-
lated paired sample t-tests and 95% confidence intervals
for scale aggregate means at pre, post-intervention and
follow-up for the scales examining DVA Myth Accept-
ance (self and perception of peers), Bystander Efficacy,
Behavioural Intent (self and perception of peers), By-
stander Behaviours and Perceived Law Knowledge.We
examined paired data at each stage so as not to
present artificially high difference between pre and
post-intervention measures. Effect size was quantified
using Cohen’sd(d> 0.8 is indicative of a large effect
whilst d> 0.5 is viewed as the minimum threshold for
meaningful change [40].
Fig. 1 Participant flow
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Results
Our recruitment method resulted in 83 people register-
ing to attend ABC of which 70 (84%) attended and 68
(82%) participated in the study. 67/70 (96%) attended
two sessions and 58/70 (83%) attended all three sessions.
Figure 1describes participant flow through the study.
Attrition from registration to attendance was greatest
amongst those booked onto the full day session: 10/16
(63%) of registrants did not attend the full day session
compared to 3/67 (4%) booked onto a three-session
programme. Attrition within programme was greatest
amongst participants attending an evening programme;
17/25 (68%) of evening (6-8 pm or 7-9 pm) participants
attended all three sessions compared to 35/39 (90%) of
those attending a day programme (10 am-12 pm or 2
pm–4 pm). Overall 58/70 (89%) participants received the
full intervention dose and completed pre and post ques-
tionnaires, and 36/52 (69%) of eligible participants re-
ceived the full intervention dose and completed four-
month follow-up.
Participant demographics (Additional file 2)
Eighteen (26%) of participants identified as male and 1
(1%) as a transgender man (included in analysis as
male). Nearly all (93%) identified as heterosexual and
white British (96%) with English as their first language
(97%). Participant age ranged from 16 to 73 years. 49/
68 (72%) identified as being in a relationship. 48/60
(47% of men and 80% of women) knew someone who
had been affected by domestic abuse. Most had not
previously attended domestic abuse training nor been
involved in a campaign raising awareness of domestic
abuse although women were more likely to have done
so than men. As motivations for attending were col-
lected qualitatively, no descriptive data was generated.
However, the most common theme was supporting
participants’occupations (paid or voluntary) with ap-
proximately half identifying this as a reason for
attending.
Programme feedback
The programme was very well-received and participants’
(n= 58) self-reported learning measures consistently
scored > 4 out of a possible five (Table 1). There was
some difference in feedback between genders, however,
due to small sample size this was rarely significant.
Utility of instruments
Scale reliability (Cronbach’sα) was good or acceptable at
each stage (Table 2), except for Perception of Peer Myth
Acceptance at four-month follow-up. A small number of
participants fedback (either verbally during completion
or by annotating their surveys) difficulty in assigning a
single score to family, friends and neighbours due to
perceived differences between these groups.
Effectiveness
We observed a statistically significant change (p< 0.01)
in the desired direction across Myth Acceptance (self
and perception of peers), Bystander Efficacy,Behavioural
Intent (self and perception of peers) and Perceived Law
Knowledge at post. Significance was maintained at four-
months with the exception of Perception of Peer Myth
Acceptance (p= 0.22) (Table 2). We observed a change
in the desired direction for Bystander Behaviours at 4
months follow-up and at post, however this was not sta-
tistically significant. Where significant change was ob-
served, effect size was generally large and, with the
exception of Perception of Peer Myth Acceptance, im-
proved at four-month follow-up.
Male participants had higher Myth Acceptance and
lower Bystander Efficacy, Behavioural Intent and By-
stander Behaviours scores at baseline and experienced
greater change across these measures at post and four-
months after the intervention. However, whilst the dif-
ference in observed change between genders at baseline
was significant, due to wide confidence intervals, the dif-
ference in change from baseline was not.
Table 1 Mean participant feedback score against learning objective (out of a possible 5)
The programme met its objectives in assisting me to: Mean Score (95% CI) Male (95% CI) Female (95% CI)
Improve my knowledge about domestic abuse 4.6 (4.4–4.8) 4.9 (4.7–5.0) 4.4 (4.2–4.7)
Understand that domestic abuse is a serious problem in society 4.7 (4.6–4.9 4.7 (4.5–5.0) 4.7 (4.5–5.0)
Understand that coercive control is a criminal offence 4.5 (4.3–4.8) 4.6 (4.3–4.9) 4.5 (4.2–4.8)
Know where to go for help and or support in cases of domestic abuse 4.3 (4.0–4.5) 4.1 (3.8–4.5) 4.3 (4.0–4.6)
Understand the stages of bystander interventions from noticing to acting 4.7 (4.5–4.8) 4.4 (4.0–4.8) 4.8 (4.6–4.9)
Understand that individuals can often be mistaken about others’beliefs and values 4.4 (4.2–4.6) 4.5 (4.1–4.9 4.4 (4.1–4.7)
Be familiar with intervention strategie 4.5 (4.4–4.7) 4.3 (4.1–4.6) 4.6 (4.4–4.8)
Be confident to use intervention strategies in your everyday life 4.2 (4.1–4.4) 4.0 (3.7–4.3) 4.3 (4.1–4.5)
Increase the likelihood you will use intervention strategies in your everyday life 4.4 (4.2–4.6) 4.0 (3.7–4.3) 4.6 (4.4–4.8)
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Table 2 Paired two-tailed t-test, effect size (Cohen’sd) and scale reliability (Cronbach’sα) post-intervention and follow-up
Measure Unpaired Pre-test
(n= 68)
Paired Pre-test
(n= 58)
Post-test (n= 58) Four-month follow-up (n= 36)
a
Mean (CI) [α] Mean (CI) Mean (CI) Change
from pre (CI)
PdMean (CI) Change
from pre (CI)
Pd
DVA Myth Acceptance (1 = strongly
disagree, 7 = strongly agree)
2.09 (1.95–2.23) [0.56] 1.97
(1.81–2.13) [0.67]
1.50
(1.38–1.61) [0.71]
−0.48
(−0.28–0.67)
< 0.0001 0.83 1.45
(1.28–1.63) [0.78]
0.52
(0.29–0.75)
0.0001 1.02
Bystander Efficacy (0–100%) 79.88
(76.51–83.26) [0.83]
81.07
(77.59–84.55) [0.87]
91.37
(89.14–93.59) [0.85]
10.30
(6.21–14.38) [0.86]
< 0.0001 0.93 93.65
(91.29–96.00) [0.77]
12.01
(7.17–17.02)
< 0.0001 1.15
Behavioural Intent (1 = not at all likely,
5 = very likely)
3.97
(3.84–4.11) [0.71]
4.03
(3.89–4.17) [0.86]
4.42
(4.32–4.52) [0.81]
0.40
(0.23–0.57)
< 0.0001 0.86 4.44
(4.35–4.52) [0.58]
0.44
(0.26–0.62)
< 0.0001 1.16
Perception of Peers’DVA Myth Acceptance
(% who would agree with statement)
35.39
b
(31.20–39.57) [0.61]
34.54
c
(30.11–38.97) [0.66]
23.65
(19.13–28.16) [0.75]
- 10.89
(4.63–17.16)
0.0008 0.65 28.30
(26.52–35.47) [0.30]
−5.55
(−14.47–3.37)
0.22 0.30
Perception of Peers’Behavioural Intent
(1 = not at all likely, 5 = very likely)
3.68
(3.52–3.84) [0.78]
3.66
(3.49–3.83) [0.80]
4.02
(3.86–4.18) [0.87]
0.36
(0.13–0.60)
0.0023 0.58 4.19
(3.96–4.42) [0.89]
0.54
(0.31–0.75)
0.0012 0.79
Bystander Behaviours (1 took action,
0 not in situation, −1 didn’t take action)
0.74
(−0.39–1.87) [0.74]
0.88
d
(−0.35–22) [0.69]
1.41
d
(0.23–2.80) [0.79]
0.53
(−1.31–2.37)
0.57 0.11 2.16
e
(0.57–3.76) [0.71]
1.17
(−0.84–3.17)
0.25 0.27
Number of listed bystander scenarios
experienced (i.e. scored either 1 or −1)
8.24
(7.04–9.43)
7.92
d
(6.56–9.28)
7.94
d
(6.76–8.82)
0.02
(−1.76–1.80)
0.98 8.89
e
(6.14–8.94)
1.35
(−0.62–3.31)
0.18
Perceived Law Knowledge (1 = very
poor, 5 = very good)
2.75
(2.50–3.00)
2.79
(2.52–3.06)
3.67
(3.48–3.87)
0.89
(0.66–1.11)
< 0.0001 0.99 3.92
(3.70–4.14)
1.01
(0.65–1.45)
< 0.0001 1.24
a
Paired data only
b
n= 65 due to blank responses at baseline
c
n= 55 due to blank responses at baseline
d
n= 51 due to six participants excluded from post analysis (received intervention within a day) and one blank response at post
e
n= 35 due to one blank response at follow up
Gainsbury et al. BMC Public Health (2020) 20:674 Page 7 of 11
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Backlash
We observed backlash in 3% of the study population for
Myth Acceptance and 2% of the study population for Be-
havioural Intent. This, however, is vastly outweighed by
the proportion of participants whose scores improved by
≥1 standard deviation for each of the attitudinal mea-
sures at post and follow-up (Fig. 2).
Discussion
This study was as an explorative descriptive study using
a cohort of participants who were the first to undertake
a newly developed bystander programme for UK general
communities. To our knowledge, it is the first UK-based
study to examine the potential of bystander intervention
as a community-level intervention for DVA. Findings are
very promising and consistent with extant studies, sug-
gesting translatability of the bystander approach to
broader societal contexts, including outside North
America, and the feasibility and potential for effective-
ness of the ABC programme as community-level pri-
mary prevention. Further positives are that high effect
size was observed even with a self-selecting group with
desirable baseline scores, and that improvement was not
only maintained but improved upon at follow-up across
most measures.
The sustained high attendance over time and positive
programme feedback endorses both the pedagogical con-
tent and mode of delivery of ABC. Interestingly, 10/16
registered participants for the one-day programme did
not attend, compared to 3/67 for the three-session deliv-
ery (Additional file 1/Appendix A). Further exploration
is required but this observation is counter to assump-
tions that delivering interventions over multiple sessions
risks programme feasibility. Attrition across the
programme was low overall, but highest amongst even-
ing attendees when it is reasonable to assume partici-
pants were more likely to be attending in their own
time. These findings of feasibility warrant further investi-
gation with a larger sample as they are central to future
implementation of community-level bystander interven-
tions and sustainability of programmes such as ABC.
Significant change in the desired direction was
achieved for participant DVA Myth Acceptance (self),
Bystander Efficacy and Behavioural Intent (self and per-
ception of peers) and Perceived Law Knowledge at post
and follow-up. These findings map positively onto the
theoretical model design underpinning ABC which in-
tends to progress participants through the stages of the
Model of Helping [12], including changes to participant
attitudes and beliefs, perceptions of peer norms and per-
ceived knowledge of law. Given that changes in Percep-
tion of Peers’DVA Myth Acceptance were still improved
at follow-up, the loss of significance is not suggestive of
anything more complex at play and is more likely a re-
sult of low power. Whilst numerous campus-based stud-
ies [15] have found positive effects decline over time,
Fig. 2 Changes in attitudinal scores ≥1 SD from pre-test to post-test and pre-test to four-month follow-up
Gainsbury et al. BMC Public Health (2020) 20:674 Page 8 of 11
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this study found changes were not only maintained but,
with the exception of Perception of Peers’DVA Myth Ac-
ceptance, improved upon at four-months, indicating a
sustained shift in the variables associated with positive
helping behaviours. Further research should explore
whether our findings are an effect of participant bias or
can be replicated in experimental studies and, if so,
examine the features of a community-based intervention
that better lends itself to sustained impact than has been
previously observed in campus-based studies.
Change in the desired direction was observed for By-
stander Behaviours at post, and even more so at follow-
up. Although these changes were not statistically signifi-
cant, it is nonetheless promising to witness more by-
stander behaviours at follow-up when participants had
had more time and opportunity to enact interventions
[29]. However, it is noteworthy that, even at follow-up,
participants had experienced fewer than half the situa-
tions described in the scale, limiting opportunity to de-
tect programme effect. Thus, whilst we concur with
Jouriles et al. (2018); that small effects observed at indi-
vidual level can accumulate resulting in real-life impact
at societal level [8], we also note that our method of
measuring Bystander Behaviours may have led to an un-
derrepresentation of enacted behaviours. Rather than
asking participants to indicate action against a limited
list of pre-defined situations, we suggest the inductive
approach of qualitative methods may be best suited to
capturing and understanding the breadth and scope of
actual bystander behaviours. These insights may subse-
quently be helpful for the development of tools specific
to DVA community intervention to capture behaviours
in future studies. Our findings on backlash compare well
with other studies [29] and backlash appears minimal.
With the exception of Bystander Behaviours, measures
adapted for DVA appeared appropriate to the study de-
sign, mapping onto previous findings [22]. However, we
note the difficulty of establishing a peer group compara-
tor for individuals who come together randomly as op-
posed to in a defined peer setting such as a university
cohort. Although the findings suggest acceptable scale
reliability, with the exception of Peers’DVA Myth Ac-
ceptance, the use of the “friends, family and neighbours”
needs to be examined further.
Limitations
These findings should be read within the context of sev-
eral limitations. Resource and practicalities precluded
both an experimental design and identifying a matched
control group of sufficient size to enable meaningful
comparison. Whilst attrition was low and completeness
of questionnaires generally good, we cannot rule out the
potential bias arising from missing data and study de-
sign, including a convenience sample, cannot preclude
the potential for participant bias. Thus, promising find-
ings should not overshadow the potential for false sig-
nificant results. Sub-group analysis, including difference
in the potential effectiveness of a day programme com-
pared to a three-session programme, was prevented by the
small sample size and the predominance of white hetero-
sexual women participants. Despite our recruitment strat-
egy focusing on encouraging male attendance, we
achieved only 26% men. Considering the gendered nature
of VAWG, and indications that bystander interventions
may be particularly effective in engaging men [7,41–43],
this is disappointing but speaks to the broader challenge
of engaging men in DVA prevention [44,45].
Our recruitment method resulted in a self-selecting co-
hort; whilst most had not previously attended domestic
abuse training, nor been involved in domestic abuse
awareness campaigns, baseline scores were desirable and
around half identified occupational (voluntary and paid)
reasons for attending, suggesting a highly engaged sample
who may have been more receptive to the intervention. It
is still promising to observe positive findings amongst a
‘warm’cohort as they may be well placed to enact inter-
ventions within personal and professional spheres. How-
ever, it is important to note that the intervention remains
untested amongst broader populations. Recruiting diverse
samples (in terms of demographics and pre-existing level
of engagement) is a challenge, particularly at pilot stage
where resource is small and programme feasibility and po-
tential for effectiveness is still unknown. In this context
communities are different to the college campuses previ-
ous studies have recruited from. Universities, for example,
can encourage attendance by positioning bystander pro-
grammes as mandatory learning modules whereas com-
munity focused programmes need alternative ways of
engaging diverse audiences for both evaluation and imple-
mentation. This itself needs further study but should in-
clude consulting with communities to identify routes in,
as well as developing approaches identified by existing lit-
erature such as utilising existing social networks [45]. Ex-
ploring the workplace as an intervention setting or the
feasibility of integrating interventions within existing com-
munity infrastructure may also be beneficial.
Finally, the decision to collect four-month data elec-
tronically was a practical one and, whilst consistency
was observed, electronic administration may have af-
fected responses. The inclusion of follow-up data is a
strength of the study as there is a paucity of evidence
regarding the positive lasting impact of interventions,
vital in the context of real-world application. However,
the timeframe is still limited, not sufficient to advance
our understanding of the potential longer lasting im-
pacts of bystander interventions and may have limited
the opportunity to collect bystander behaviours enacted
over time.
Gainsbury et al. BMC Public Health (2020) 20:674 Page 9 of 11
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Conclusions
This feasibility study makes a significant and timely con-
tribution to the emergent evidence base on bystander in-
terventions in the UK context. It indicates the
transferability of the bystander approach to violence pre-
vention from student populations to general communi-
ties, and from sexual violence to DVA. Our study is the
first UK community-based study to show feasibility and
significant effects on variables associated with positive
helping behaviours and supports the hypothesis that by-
stander interventions can be a potentially effective stra-
tegic component of community-level primary prevention
of DVA. Bystander programmes such as ABC may there-
fore be an important vehicle for the awareness-raising
and changing of social attitudes and norms, foreseen as
necessary by the Home Office Domestic Abuse Consult-
ation Response [4], but not actually provided for in prac-
tice [4].
More research is now required using experimental de-
signs and diverse community audiences. To further
understand feasibility, acceptability and effectiveness, as
well as any implications as to health inequalities, it is
vital to understand if and how we can engage diverse
populations and the impact that audience has on out-
comes. Future studies should focus on the under-studied
issue of recruiting harder-to-reach populations and those
with no prior understanding or engagement with DVA
prevention.
More research is also needed as to how best to de-
scribe peers within the community context as well as
capture bystander behaviours and, considering the limi-
tations of quantitative methods in relation to unknown
outcomes, the potential use of qualitative methodologies.
Further examination of the interaction between per-
ceived knowledge of law and the processes and variables
leading to change is required to understand the role of
law, if any, within bystander interventions.
Supplementary information
Supplementary information accompanies this paper at https://doi.org/10.
1186/s12889-020-08519-6.
Additional file 1. “Group Composition by number of sessions attended
(and gender)”. The table provides details of participant attendance by
group gender and session.
Additional file 2. “Participant demographics and prior experience of
domestic abuse provided at baseline”. The table provides details of
participants’demographics and self-reported experience of attending
previous domestic abuse training or participating in domestic abuse
campaigns.
Abbreviations
ABC: Active Bystander Communities; DVA: Domestic Violence and Abuse;
DVMAS: Domestic Violence Myth Acceptance Scale; US: United States;
VAWG: Violence Against Women and Girls
Acknowledgements
Nick Gazzard, Nicola Gregg, Emma Provins and Sara Williams, who delivered
the intervention. Erik Sörensen, who developed the online survey and
supported the collection of follow-up data.
Authors’contributions
AG led recruitment, data collection, statistical analysis (with input from CJ),
and the writing of the manuscript. RF was the supervising author and led on
intervention development and the identification and adaptation of measures
(with input from CJ) and was a major contributor to the manuscript. CJ
contributed to intervention development, measures, statistical analysis and
manuscript revision. All authors have read and approved the manuscript.
Funding
This project was supported by:
Bristol City Council. Bristol City Council funded intervention development
and the public health team co-created the intervention alongside re-
searchers. They were not subsequently involved in study design, data collec-
tion, analysis or interpretation.
Devon County Council funded intervention facilitation but were not involved
in study design or data collection, analysis or interpretation.
Public Health England South West and the University of Exeter provided
evaluation funding in kind and undertook study design, data collection,
analysis and interpretation.
Availability of data and materials
The datasets used during the current study are available from the
corresponding author under reasonable request.
Ethics approval and consent to participate
Ethical approval was given by the College of Social Sciences and
International Studies Ethics Committee at the University of Exeter. Written
consent was received from all participants prior to data collection.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Author details
1
University of Exeter, Exeter EX4 4PY, UK.
2
University of Strathclyde, G1 IXQ
Glasgow, Scotland.
Received: 8 November 2019 Accepted: 12 March 2020
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