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https://doi.org/10.1177/08862605231207624
Journal of Interpersonal Violence
2024, Vol. 39(7-8) 1571 –1595
© The Author(s) 2023
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DOI: 10.1177/08862605231207624
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Original Research
Self-Compassion, Health,
and Empowerment:
A Pilot Randomized
Controlled Trial for
Chinese Immigrant
Women Experiencing
Intimate Partner
Violence
Yang Li1, Hyekyun Rhee1, Linda F. C. Bullock2,
Brigid McCaw3, and Tina Bloom4
Abstract
Chinese immigrant survivors of men’s violence experience both significant
mental health impacts from abuse and barriers to formal services.
Therefore, we examined the preliminary efficacy of an innovative mobile-
based empowerment-based intervention (self-compassion, health, and
empowerment; SHE) that specifically focuses on abused Chinese immigrant
women in the US. This pilot study used a two-arm randomized controlled
design with repeated measures. A convenience sample (N = 50) of Chinese
immigrant women who experienced past year intimate partner violence
(IPV) were recruited online and randomly assigned to the intervention or
control group (25 per group). We assessed IPV exposure, safety behaviors,
1School of Nursing, The University of Texas at Austin, USA
2Sinclair School of Nursing, University of Missouri, Columbia, USA
3Center to Advance Trauma-Informed Health Care, University of California, San Francisco, USA
4School of Nursing, Notre Dame of Maryland University, Baltimore, USA
Corresponding Author:
Yang Li, School of Nursing, The University of Texas at Austin, 1710 Red River Street, #3.446,
Austin, TX 78712, USA.
Email: yang.li@nursing.utexas.edu
1207624JIVXXX10.1177/08862605231207624Journal of Interpersonal ViolenceLi et al.
research-article2023
1572 Journal of Interpersonal Violence 39(7-8)
depressive symptoms, anxiety symptoms, post-traumatic stress disorder
(PTSD) symptoms, and self-compassion at baseline, post-intervention,
and 8-week follow-up. Of 95 eligible participants, 50 (52.6%) agreed to
participate and completed baseline data collection; intervention completion
rate was 64%. We found a significant group and time interaction for self-
judgment (a self-compassion component), with a significant reduction
seen in the intervention group compared to the control group. Despite
no other significant group differences observed over time, the intervention
group showed consistent trends toward improvements in most outcome
measures, including specific types of IPV (i.e., negotiation, psychological
aggression, and sexual coercion), depressive and PTSD symptoms, self-
compassion, and certain components of self-compassion (i.e., isolation and
over-identification) when compared to the control group. Our findings
suggest that the SHE intervention shows promise in improving the mental
health well-being of Chinese immigrant survivors. However, a fully powered
randomized controlled trial is warranted to determine its efficacy. Our
intervention has the potential to be translated in the Chinese immigrant
populations with the necessary organizational support.
Keywords
intimate partner violence, Chinese immigrant women, empowerment, self-
compassion, randomized controlled trial
Introduction
Intimate partner violence (IPV) is a serious social and public health issue, due
to its high prevalence, with a lifetime prevalence of 33% in the U.S. (Smith
et al., 2018), and its significant physical and mental health consequences
such as injury, chronic pain, and depression (Campbell, 2002; Miller &
McCaw, 2019). Since the late 1960s, Asian American women have begun to
advocate for their civil rights as a racial minority and as women. However,
progress has been slow, hindered by various social and cultural oppression
(Chow, 1992). Furthermore, the anti-domestic violence movement has pre-
dominately centered around White Americans, providing limited benefits to
Asian American women (Wang, 1996). Specifically, legal and social service
responses to IPV have primarily focused on the needs of White women, leav-
ing the needs of abused Asian American women unaddressed. Resources to
support abused Asian American women, especially those meeting their mul-
ticultural and multilingual needs, are scarce and concentrated in major urban
Li et al. 1573
areas. Moreover, given the diversity within the Asian Americans, including
many ethnic subgroups such as Chinese, Korean, Indian, and Vietnamese,
each with distinct languages and immigration experiences, their specific
needs for support remain largely unmet (Lee, 2014).
As the largest Asian ethnic subgroup, Chinese immigrant women have
been marginalized and underserved in IPV support services, despite a high
prevalence of over 20% within the past year (Li et al., 2020). They have very
limited access to support from formal services such as women’s shelters and
law enforcement due to various sociocultural barriers. For example, many
Chinese immigrant women have limited English proficiency, are often finan-
cially or legally dependent on their partners, and tend to stay at home, leading
to their isolation from mainstream American society. This isolation results in
low awareness of available resources and support. Furthermore, there is a
lack of culturally appropriate services, particularly in areas with a low
Chinese population density (Li et al., 2021). Therefore, it is crucial to develop
culturally appropriate interventions that incorporate innovative strategies to
overcome these barriers and enhance their acceptability and accessibility for
this underserved group of women.
Some existing IPV interventions are grounded in Dutton’s empowerment
theory (Dutton, 1992) which focuses on increasing IPV victims’ autonomy
and ability to decision making and problem solving by providing IPV infor-
mation, resources, safety planning, and support around the violence (Trabold
et al., 2020). The model’s components include (1) protection, a focus on
increasing the woman's safety; (2) enhanced choice making and problem
solving in decisions about the relationship; and (3) healing of post-traumatic
reactions. Guided by Dutton’s empowerment model, both the structured IPV
intervention developed by Parker et al. (1999), the Domestic Violence
Enhanced Home Visitation Program (DOVE) intervention (Sharps et al.,
2016), and the advocacy intervention in Hong Kong (Tiwari et al., 2010)
have been shown to significantly increase abused women’s safety behaviors
and reduce re-victimization.
Safety behaviors and IPV exposures are important outcomes for IPV inter-
ventions; however, these interventions mainly focused on empowering
abused women to ensure safety and make decisions about their relationship
with less attention to improving victims’ psychological and cognitive func-
tioning. This represents a significant gap for abused immigrant Chinese
women, given IPV’s substantial and well-documented effects on their mental
health, for example, depression, anxiety, and post-traumatic stress disorder
(PTSD; Chan et al., 2010; Xu et al., 2020). An understudied but potentially
related and important component of mental health among IPV survivors is
self-compassion, that is, acknowledging suffering, failure, and inadequacies
1574 Journal of Interpersonal Violence 39(7-8)
as part of the common human experience and offering oneself warmth, kind-
ness, and empathy instead of being self-critical and judgmental toward one-
self (Neff, 2003). Evidence consistently suggests that depression, anxiety,
and PTSD are associated with decreased self-compassion (MacBeth &
Gumley, 2012; Winders et al., 2020). However, due to the deep influence of
the Chinese cultural values of criticism and self-criticism, Chinese immigrant
women often blame themselves for the violence that happens to them, which
can lead to feelings of failure and inadequacies (Li et al., 2022).
Building self-compassion has been recognized as a promising psychologi-
cal approach for alleviating guilt, shame, and self-blame and enhancing men-
tal health well-being. The Mindful Self-Compassion (MSC) program
developed by Neff and Germer (2013) provides participants with a variety of
tools and teach them loving-kindness skills. The MSC program has been
shown to significantly increase participants’ self-compassion and decrease
depression and anxiety (Neff & Germer, 2013). The MCS program has also
been shown to improve psychological well-being specifically among Chinese
participants in China (Finlay-Jones et al., 2018).
Similarly, interventions based on relaxation techniques such as deep
breathing, progressive muscle relaxation, and visualization have been shown
effective in mitigating depression, anxiety, and PTSD (Klainin-Yobas et al.,
2015; Niles et al., 2018). Furthermore, it is simpler, easier to implement, and
more socially acceptable than psychotherapy. Taken together, incorporating
self-compassion and relaxation techniques into IPV interventions appears
promising in reducing the significant impact of IPV on survivors’ mental
health, an important consideration for Chinese immigrant survivors.
Finally, addressing the challenges posed by the wide geographical disper-
sal of the Chinese population in the U.S., as well as potential language and
cultural barriers, requires innovative approaches to ensure accessibility and
acceptability of culturally appropriate interventions. The use of telephone-
based and mobile app-based delivery methods can facilitate access to this
hard-to-reach population. Mobile health is a promising, ideal approach to
deliver targeted care and support to the hard-to-reach population and to
overcome barriers (e.g., stigma, shame, privacy concern) in seeking help
(Silva et al., 2015) and has been safely and widely used with IPV survivors
(Emezue et al., 2022).
Therefore, our intervention, Self-Compassion, Health, and Empowerment
(SHE), adapted the structured IPV intervention from the DOVE study and
additionally incorporated self-compassion and relaxation techniques for
Chinese immigrant women experiencing IPV. The study aimed to test the
preliminary efficacy of our SHE intervention in reducing IPV and improving
the mental health well-being of Chinese immigrant women in the U.S. who
Li et al. 1575
have experienced IPV. We hypothesized that participants in the intervention
group would report less frequent IPV and demonstrate improved mental
health outcomes compared to the control group.
Methods
Study Design
This pilot study used a two-arm randomized controlled design with repeated
measures, and it was conducted from March 2022 to March 2023. Outcome
measures were assessed at baseline, post-intervention, and 8-week follow-up.
The study was registered in ClinicalTrials.gov (ID: NCT05011552).
Sample and Recruitment
To be eligible for this study, participants had to be female, aged 18 or older,
self-identify as Chinese currently residing in the U.S., in an intimate relation-
ship at the time of enrollment, and with current experience of IPV (i.e., within
the past year). Exclusion criteria were self-reported substance use, suicidal-
ity, or ongoing treatment for severe mental illness. Based on prior research
that used an empowerment-based intervention for abused Chinese women in
Hong Kong (Tiwari et al., 2010), the estimated effect size (Cohen’s d) for
between-group differences in depressive symptoms at 9 months post-inter-
vention was about 0.2. Following the stepped rules of thumb for pilot trial
sample size per treatment arm (Whitehead et al., 2016), 20 participants per
arm would provide a power of 80% to detect an effect size of 0.1–0.3 with a
two-tailed Type I error of .05. Considering an anticipated dropout rate of up
to 20%, we recruited and randomized 25 participants per arm.
A convenience sample of participants were recruited online from March
2022 to October 2022 through platforms such as WeChat, Prolific, and the
Collaborative Approach for Asian Americans & Pacific Islanders Research &
Education (CARE) registry. WeChat is the most widely used social media
application among the Chinese population, while Prolific is a platform pro-
viding a large pool of potential participants. The CARE registry is a research
registry specifically established to enhance the participation and representa-
tion of Asian American and Pacific Islander individuals in research studies.
The majority of participants were recruited through WeChat Advertisements.
This study followed established safety procedures for recruitment and
retention of community-based IPV survivors, to reduce the risk of breach of
confidentiality and an abuser discovering they were participating in the study,
which might result in further abuse (Sabri et al., 2023; Sullivan & Cain,
1576 Journal of Interpersonal Violence 39(7-8)
2004). For safety reasons, the study flyer was carefully designed to avoid
implying that the study was recruiting Chinese women experiencing IPV. It
described the study as a “Chinese immigrant women’s health care study” and
provided a link or QR code leading to a survey for eligibility screening.
Randomization and Blinding
Potential participants completed a brief online survey to confirm their eligi-
bility. Eligible participants were then directed to a page that provided brief
study information and asked to provide their preferred safe contact informa-
tion, preferred time for contact, and any special instructions for the research
team to follow when contacting them if interested in participation.
Alternatively, potential participants could opt to contact the research team
directly via email or phone instead of entering their contact information on
the page, offering additional options for safety. Potential participants were
contacted and scheduled for a telephone call at a safe and convenient time
chosen by the participant.
Participants were randomized in a 1:1 ratio to either the intervention or
control group using blocked randomization. This was achieved by generating
a list of random permutations using the website Randomization.com (https://
www.randomization.com; Kim & Shin, 2014). During the initial phone call,
separate informed consent forms were read for participants in the two groups,
and verbal consent (employing a waiver of documentation of informed con-
sent process) was obtained to ensure participant safety and confidentiality. In
this study, only participants were blinded to the group allocation. After the
collection of follow-up data, a debriefing session was conducted over the
phone with the participants to disclose their group allocation and provide
them with an opportunity to withdraw their data if desired. None of the par-
ticipants opted to withdraw their data after being informed of their group
allocation. The study was approved by the Institutional Review Board of the
University of Texas at Austin (ID: STUDY00001645).
Measures
IPV screen. The Abuse Assessment Screen (AAS) was used to screen for IPV
(Soeken et al., 1998). Participants who reported emotional, physical, and/or sex-
ual abuse by an intimate partner within the past year were considered to have
screened positive for IPV. The Chinese version of the AAS, which has been vali-
dated among Chinese women in Hong Kong, demonstrated satisfactory measure-
ment accuracy, with a specificity of at least 89% for emotional, physical, and
sexual abuse and a sensitivity ranging from 36% to 66% (Tiwari et al., 2007).
Li et al. 1577
The frequency of IPV. The Revised Conflict Tactics Scales (CTS2) were used
to measure the frequency of violent behaviors used by the partner (Straus
et al., 1996). It consists of 27 items and 5 subscales, including negotiation,
psychological aggression, physical assault, injury, and sexual coercion. The
Chinese version of CTS2 has been found to have good reliability (Cronbach’s
α: 0.84) and validity in China (Zhang et al., 2014).
Depressive symptoms. The Patient Health Questionnaire-9 (PHQ-9) was used
to assess depressive symptoms (Kroenke et al., 2001). The PHQ-9 includes
nine items that inquire about the frequency of depressed mood in the past
2 weeks. The four responses are “not at all,” “several days,” “more than half
the days,” and “nearly every day.” The total score was computed by summing
up individual item scores, ranging 0–27. Higher total scores indicate more
severe depressive symptoms. In the study, a PHQ-9 score of 10 or higher was
considered as indicative of the presence of depression. The Chinese version
has shown good reliability (Cronbach’s α: 0.85; Test-retest coefficient: 0.87)
and validity among college students in China (Zhang et al., 2013).
Anxiety symptoms. The Generalized Anxiety Disorder-7 (GAD-7) was used to
measure anxiety symptoms experienced in the past 2 weeks (Spitzer et al.,
2006). Respondents rated the frequency of experiencing each of the seven
anxiety symptoms on a 4-point Likert-type scale (0=not at all, 1=several
days, 2=more than half the days, 3=nearly every day). The total score was
computed by summing up individual item scores, ranging 0–21. Higher total
scores suggest more severe anxiety symptoms. A score of 10 or greater on the
GAD-7 was used in this study to indicate the presence of anxiety. The Chi-
nese version of GAD-7 has been shown to have good reliability (Cronbach’s
α: 0.87; Test-retest coefficient: 0.82) and validity (Li et al., 2014).
PTSD symptoms. The PTSD Checklist for DSM-5 (PCL-5) was used to assess
PTSD symptoms in response to a stressful experience during the past month
(Weathers et al., 2013). It comprises of 20 items that correspond to the DSM-5
symptom criteria for PTSD. Responses are rated on a 5-point Likert-type
scale, ranging from 0 (not at all) to 4 (extremely). The total symptom severity
scores range 0—80, with higher scores indicating more severe PTSD symp-
toms. A cutoff score of 31 was used in the study to indicate probable PTSD.
The Chinese version of PCL-5 has shown good reliability (Cronbach’s α:
0.91) and convergent and discriminant validity (Cheng et al., 2020).
Safety behaviors. Safety behaviors were measured using 27 items adapted
from the IPV Strategies Index (Goodman et al., 2003). Respondents were
1578 Journal of Interpersonal Violence 39(7-8)
asked whether they had engaged in a list of behaviors to protect their safety
(e.g., seeking help from formal or informal network, legal assistance, safety
planning). As not all 27 items were applicable to each participant, the
adjusted total number of safety behaviors were computed in the study. Spe-
cifically, it was obtained by dividing the number of behaviors performed by
the number of applicable behaviors and then multiplying by 27. The range
of scores was 0–27, with higher values suggesting more safety behaviors
taken by respondents.
Self-compassion. The Self-Compassion Scale-Short Form (SCS-SF) com-
prises 12 items and 6 subscales, including self-kindness, common humanity,
mindfulness, self-judgment, isolation, and over-identification. Items are
rated on a 5-point response scale ranging from 1 (almost never) to 5 (almost
always). To calculate each subscale score, the negative subscale items were
first reverse-scored, and then the subscale items were averaged. Higher sub-
scale scores indicate higher levels of self-kindness, common humanity, and
mindfulness, while suggesting lower levels of self-judgment, isolation, and
over-identification. The SCS-SF showed adequate reliability (Cronbach’s α:
0.87) and a near-perfect correlation with the original SCS (Raes et al., 2011).
Similarly, the Chinese version of the scale also demonstrated acceptable
reliability (Cronbach’s α: 0.84; Test-retest coefficient: 0.89) and validity
(Chen et al., 2011).
Sociodemographic characteristics. Participants were asked to self-report age,
education, employment, annual personal income, marital status, number of
children, religion, nativity, and immigration status.
Data Collection Methods
Sociodemographic information was collected at baseline. Outcome variables
(the frequency of IPV, depressive symptoms, anxiety symptoms, PTSD
symptoms, safety behaviors, and self-compassion) were measured at base-
line, immediately after the 7-week intervention, and 8 weeks post-interven-
tion. Baseline data was collected from the participants after obtaining their
consent. Survey questionnaires are available in either English or Chinese.
Qualtrics, a secure online data collection service, was used as the survey
platform. Women were sent survey links via safe email addresses or text mes-
sages. Participants were compensated with a $25 electronic gift card for each
of the three completed assessments, totaling $75 over approximately four
months. This compensation aligns with recommendations for payment in
clinical research studies (Grady, 2005). The 8-week follow-up period was
Li et al. 1579
determined based on existing research on mindfulness-based interventions
for victims of interpersonal violence. In these similar studies, follow-up peri-
ods have varied widely, ranging from 4-, 8-, to 24 weeks post-intervention
(Gallegos et al., 2015; Kimbrough, et al., 2010). Notably, a study involving a
sample of victims of childhood sexual abuse administered an 8-week mind-
fulness-based stress reduction intervention. This study reported significant
reductions in depression, anxiety, and PTSD symptoms at 4-, 8-, and 24-weeks
post-intervention compared to baseline (Kimbrough, et al., 2010). Given the
earlier report, we determined that an 8-week follow-up period would be a
pragmatic choice to allow for capturing the potential sustained effects of our
intervention while operating within our resource limitations.
Study Treatments
The SHE intervention. Guided by Dutton’s empowerment model, the SHE
intervention consisted of seven weekly sessions. The first session was
delivered over the phone with the woman, using a brochure adapted from
the DOVE study (Sharps et al., 2016). The brochure describes four major
areas: a) IPV information, b) Danger Assessment, c) Safety Planning, and
d) Resources. The brochure was discussed with the woman in an interactive
manner so that the participant was encouraged to share her experiences and
choose her options as she proceeded. At the end of the first session, the
interventionist provided an overview of the following sessions to ensure
that the woman had a clear understanding of what to expect. The first ses-
sion lasted 30–40 minutes. Sessions 2–7 focused on providing mental health
self-care resources, including deep breathing, progressive muscle relax-
ation, visualization, self-compassion, mindfulness, and loving-kindness.
These six sessions were delivered through a WeChat mini-program specifi-
cally designed for this intervention. WeChat mini-program is a lightweight
micro-app hosted on WeChat. Each session included a video introduction
on one of the six topics, along with audio instructions on exercises. The
video durations ranged from 5 to 20 minutes, and the audio durations varied
between 4 and 20 minutes.
At the beginning of each session, the woman was asked to review the
video and then practice the exercises presented in that session at their pre-
ferred time and location every day for one week. Safe reminder messages,
referring to the study as the “Chinese Immigrant Women’s Health Care
Study,” were sent one day prior to the start of each session. In the reminder
messages, we also asked about how many times they practiced that previous
week’s exercises. Practicing the exercises at least four times a week was con-
sidered the completion of one session. This criterion aligns with a previous
1580 Journal of Interpersonal Violence 39(7-8)
mobile-based mindfulness intervention that similarly defined the completion
of one session as a minimum of four days of practice per week (Zhang et al.,
2023). The intervention was provided based on the participant's preference,
either in English or Chinese.
The control group. Women in the control group were provided with the same
brochure as the intervention group, as well as mental health care resources
and information. These resources were delivered to them on a weekly basis,
either in English or Chinese, via a secure email address they had provided. It
is important to note that unlike the intervention group, the control group did
not participate in a phone call to discuss the brochure or have access to the
WeChat mini-program.
Data Analysis
Descriptive statistics (i.e., means and standard deviations, percentages)
were computed for all variables. Mixed analysis of variance (ANOVA)
was conducted to test group differences in outcome measures over time
from baseline to immediately after the intervention and 8 weeks post-
intervention. Cohen’s d was calculated as a measure of effect size. We
used the intention-to-treat analysis with the last observation carried for-
ward method. The sensitivity analysis was also conducted, which included
only participants who completed all the assessments. All statistical analy-
ses were performed using SPSS Version 26. Statistical significance was
considered at p < .05, two-tailed.
Results
Participant Flow
A total of 965 Chinese immigrant women were approached and screened for
eligibility. Out of the 95 eligible women who were invited to participate, 51
agreed to participate in the study. However, one woman did not start the base-
line assessment, resulting in a final sample of 50 participants (52.6% response
rate), with 25 in each group (SHE and control). In the SHE intervention
group, a total of 19 participants completed the assessment immediately after
the intervention, while 18 completed the assessment at 8 weeks after the
intervention. In the control group, 20 participants completed the assessment
both immediately and at 8 weeks after the intervention. The overall retention
rate was 76% at 8 weeks post-intervention. The participant flow chart is
shown in Figure 1.
Li et al. 1581
Sample Characteristics
Baseline sociodemographic characteristics of the participants are displayed
in Table 1. Among the 50 participants, the average age was 36 years. Sixty-
four percent of the participants had a bachelor’s degree or above and were
employed, while over one-third had no personal income. The majority of
participants were married or currently partnered, 84% had at least one child,
and 72% had no religious beliefs. About 70% were either U.S. citizens or
permanent residents. No significant group differences were found in sociode-
mographic factors and outcome measures at baseline between the SHE and
Figure 1. Participant Flow Diagram.
1582 Journal of Interpersonal Violence 39(7-8)
Table 1. Baseline Sample Characteristics.
Variables
Total sample
(N = 50)
SHE group
(n = 25)
Control group
(n = 25)
Sociodemographic characteristics
Age, M (SD) 36.16 (9.89) 35.24 (10.42) 37.13 (9.44)
Education, n (%)
Less than a bachelor’s degree 18 (36.0) 10 (40.0) 8 (32.0)
Bachelor’s degree or above 32 (64.0) 15 (60.0) 17 (68.0)
Employment, n (%)
Unemployed 18 (36.0) 11 (44.0) 7 (28.0)
Employed 32 (64.0) 14 (56.0) 18 (72.0)
Annual personal income, n (%)
None 17 (34.7) 10 (40.0) 7 (29.2)
≤$40,000 15 (30.6) 8 (32.0) 7 (29.2)
>$40,000 17 (34.7) 7 (28.0) 10 (41.7)
Marital status, n (%)
Married 45 (90.0) 23 (92.0) 22 (88.0)
Not married, but having an
intimate partner
3 (6.0) 1 (4.0) 2 (8.0)
Divorced 2 (4.0) 1 (4.0) 1 (4.0)
Number of children, n (%)
0 8 (16.0) 4 (16.0) 4 (16.0)
≥1 42 (84.0) 21 (84.0) 21 (84.0)
Religion, n (%)
No 36 (72.0) 18 (72.0) 18 (72.0)
Yes 14 (28.0) 7 (28.0) 7 (28.0)
Foreign born, n (%)
No 1 (2.0) 1 (4.0) 0 (0)
Yes 49 (98.0) 24 (96.0) 25 (100)
Immigration status, n (%)
U.S. citizenship or permanent
residency
34 (69.4) 15 (62.5) 19 (76.0)
Non-immigration visa 15 (30.6) 9 (37.5) 6 (24.0)
Outcome variables
IPV, M (SD)
Negotiation 42.76 (38.21) 46.12 (42.75) 39.25 (33.40)
Psychological aggression 23.31 (33.28) 26.36 (37.06) 20.00 (29.08)
Physical assault 3.46 (8.38) 4.91 (11.05) 2.00 (4.13)
Injury 1.10 (4.27) 0.92 (3.34) 1.29 (5.10)
Sexual coercion 1.68 (3.69) 1.48 (3.53) 1.91 (3.94)
Depressive symptoms, M (SD) 8.46 (6.22) 9.12 (6.06) 7.80 (6.44)
Depression, n (%)
Yes 18 (36.0) 11 (44.0) 7 (28.0)
No 32 (64.0) 14 (56.0) 18 (72.0)
(continued)
Li et al. 1583
Variables
Total sample
(N = 50)
SHE group
(n = 25)
Control group
(n = 25)
Anxiety symptoms, M (SD) 6.82 (5.50) 6.52 (4.98) 7.12 (6.07)
Anxiety, n (%)
Yes 11 (22.0) 6 (24.0) 5 (20.0)
No 39 (78.0) 19 (76.0) 20 (80.0)
PTSD symptoms, M (SD) 20.68 (17.56) 20.72 (17.13) 20.64 (18.34)
PTSD, n (%)
Yes 11 (22.0) 6 (24.0) 5 (20.0)
No 39 (78.0) 19 (76.0) 20 (80.0)
Number of safety behaviors, M (SD) 6.21 (7.84) 6.46 (9.05) 5.97 (6.59)
Self-compassion, M (SD) 3.26 (0.63) 3.27 (0.65) 3.24 (0.63)
Self-kindness 3.44 (0.90) 3.40 (0.97) 3.48 (0.84)
Common humanity 3.52 (1.11) 3.56 (1.00) 3.48 (1.22)
Mindfulness 3.42 (1.11) 3.52 (0.98) 3.32 (1.23)
Self-judgment 3.48 (0.84) 3.52 (0.78) 3.44 (0.91)
Isolation 2.89 (1.13) 2.90 (1.01) 2.88 (1.25)
Over-identification 2.78 (1.04) 2.74 (0.95) 2.82 (1.14)
Note. SHE = self-compassion, health, and empowerment; IPV = intimate partner violence; PTSD = post-traumatic
stress disorder.
Table 1. (continued)
control groups (p < .05). Two participants in the intervention group and one
participant in the control group completed the study in the English
language.
Among the entire sample, at baseline more than 1 in 3 (36%) reported
clinically significant depressive symptoms (i.e., a PHQ-9 score ≥10); more
than 1 in 5 (22%) reported clinically significant symptoms of anxiety (GAD-7
score ≥10) and 22% reported clinically significant PTSD symptoms (PCL-5
score ≥31).
Group Differences in Primary and Secondary Outcomes Across
Time
As seen in Table 2, the mixed ANOVA results showed that there were no
significant group effects for any of the outcome variables (p > .05). However,
the main effect of time was significant for psychological aggression (F(2, 92)
= 3.50, p = .043), depressive symptoms (F(2, 96) = 5.16, p = .010), anxiety
symptoms (F(2, 96) = 3.77, p = .027), PTSD symptoms (F(2, 96) = 8.29, p
< .001), and self-compassion (F(2, 96) = 3.36, p = .048) at different time
points. Notably, a significant group and time interaction was observed for
1584
Table 2. Group Differences across Time on Outcome Measures.
Outcome Variables
Mean Difference
(95% CI) pCohen’s d
Group Effect Time Effect
Group × Time
Effect
F p F P F p
IPV
Negotiation 1.05 .311 1.59 .209 0.35 .704
T1 6.87 [−15.24, 28.98] 0.535 N/A
T2 11.60 [−8.93, 32.13] .262 0.32 [−0.24, 0.88]
T3 14.64 [−10.34, 39.62] .244 0.33 [−0.22, 0.89]
Psychological aggression 0 .987 3.50 .043* 1.70 .194
T1 6.36 [−13.11, 25.83] 0.514 N/A
T2 0.44 [−16.30, 17.18] .958 0.015 [−0.54, 0.57]
T3 −4.96 [−19.28, 9.36] .489 −0.20 [−0.75, 0.36]
Physical assault 0.65 .426 0.66 .520 0.91 .407
T1 2.91 [−2.05, 7.87] .243 N/A
T2 −0.31 [−6.03, 5.41] .914 −0.031 [−0.59, 0.52]
T3 0.41 [−5.69, 6.52] .892 0.039 [−0.52, 0.59]
Injury 0.05 .824 1.10 .326 0.21 .761
T1 −0.38 [−2.88, 2.13] .765 N/A
T2 0.62 [−1.98, 3.22] .635 0.14 [−0.42, 0.69]
T3 0.21 [−0.21, 0.63] .313 0.29 [−0.27, 0.84]
Sexual coercion 0.38 .543 0.68 .509 0.24 .789
T1 −0.43 [−2.62, 1.76] .695 N/A
T2 −0.35 [−4.12, 3.43] .855 −0.053 [−0.61, 0.50]
T3 −1.24 [−5.08, 2.60] .519 −0.18 [−0.74, 0.37]
Depressive symptoms 0.05 .827 5.16 .010* 1.61 .209
T1 1.32 [−2.23, 4.87] .459 N/A
(continued)
1585
Outcome Variables
Mean Difference
(95% CI) pCohen’s d
Group Effect Time Effect
Group × Time
Effect
F p F P F p
T2 0.04 [−3.29, 3.37] .981 0.0068 [−0.55, 0.56]
T3 −0.32 [−3.51, 2.87] .841 −0.057 [−0.61, 0.50]
Anxiety symptoms 0.04 .853 3.77 .027* 0.31 .735
T1 −0.60 [−3.76, 2.56] .704 N/A
T2 −0.28 [−3.24, 2.68] .850 −0.054 [−0.61, 0.50]
T3 0.08 [−2.94, 3.10] .958 0.015 [−0.54, 0.57]
PTSD symptoms 0.20 .655 8.29 <.001*** 0.92 .401
T1 0.08 [−10.01, 10.17] .987 N/A
T2 −3.12 [−12.65, 6.41] .514 −0.19 [−0.74, 0.37]
T3 −3.12 [−12.63, 6.39] .512 −0.19 [−0.74, 0.37]
Number of safety behaviors 0.08 .784 0.58 .506 0.66 .473
T1 0.48 [−4.02, 4.99] .830 N/A
T2 −1.86 [−5.29, 1.58] .283 −0.31 [−0.87, 0.25]
T3 −0.48 [−4.96, 4.01] .832 −0.061 [−0.62, 0.49]
Self-compassion 0.91 .344 3.36 .048* 1.94 .157
T1 0.04 [−0.33, 0.40] .840 N/A
T2 0.29 [−0.08, 0.65] .119 0.45 [−0.11, 1.01]
T3 0.13 [−0.20, 0.46] .422 0.24 [−0.32, 0.80]
Self-kindness 0.30 .587 0.64 .497 0.05 .917
T1 −0.08 [−0.59, 0.43] .756 N/A
T2 −0.12 [−0.64, 0.40] .645 −0.13 [−0.69, 0.42]
T3 −0.16 [−0.71, 0.39] .559 −0.17 [−0.72, 0.39]
Table 2. (continued)
(continued)
1586
Outcome Variables
Mean Difference
(95% CI) pCohen’s d
Group Effect Time Effect
Group × Time
Effect
F p F P F p
Common humanity 0.19 .667 2.16 .121 0.14 .871
T1 0.80 [−0.56, 0.72] .801 N/A
T2 0.06 [−0.58, 0.70] .851 0.054 [−0.50, 0.61]
T3 0.20 [−0.40, 0.80] .504 0.19 [−0.37, 0.75]
Mindfulness 0.27 .606 1.14 .325 0.30 .743
T1 0.20 [−0.43, 0.83] .529 N/A
T2 0.20 [−0.41, 0.81] .516 0.19 [−0.37, 0.74]
T3 0.04 [−0.61, 0.69] .902 0.035 [−0.52, 0.59]
Self-judgment 2.97 .092 0.50 .609 3.84 .025*
T1 0.08 [−0.40, 0.56] .740 N/A
T2 0.72 [0.21, 1.23] .006** 0.81 [0.24, 1.39]
T3 0.30 [−0.23, 0.83] .264 0.32 [−0.24, 0.88]
Isolation 1.05 .311 2.01 .140 2.27 .109
T1 0.02 [−0.63, 0.67] .951 N/A
T2 0.52 [−0.08, 1.12] .088 0.49 [−0.069, 1.06]
T3 0.30 [−.30, 0.90] .316 0.29 [−0.27, 0.84]
Over-identification 0.60 .649 0.38 .685 1.38 .255
T1 −0.08 [−0.68, 0.52] .788 N/A
T2 0.34 [−0.30, 0.98] .290 0.30 [−0.25, 0.86]
T3 0.12 [−0.53, 0.77] .712 0.11 [−0.45, 0.66]
Note. SHE = self-compassion, health, and empowerment; IPV = intimate partner violence; PTSD = post-traumatic stress disorder; T1 = baseline; T2 = immediately after the
intervention; T3 = 8 weeks after the intervention.
Table 2. (continued)
Li et al. 1587
self-judgment (F(2, 96) = 3.84, p = .025). Specifically, self-judgment was
significantly improved in the SHE intervention group compared to the con-
trol group immediately following the intervention (Mean Difference = 0.72,
95% CI (0.21, 1.23), p = .006), followed by no significant group difference
at the 8-week follow-up, as shown in Figure 2.
Although failing to reach statistical significance, the SHE intervention
group showed consistent trends toward improvements in most of the outcome
measures, including negotiation, psychological aggression, sexual coercion,
depressive symptoms, PTSD symptoms, self-compassion, isolation, and
over-identification when compared to the control group. Importantly, our
sensitivity analysis, which only included cases with complete data, yielded
similar results to the intention-to-treat analysis, thus not reported here.
Intervention Adherence
Of the 25 participants in the SHE intervention group, five were lost to follow-
up during the intervention delivery stage. Among the remaining 20 partici-
pants, one withdrew from the study after the first session, while one completed
Figure 2. Changes in self-judgment over time in the SHE and control groups.
SHE = Self-Compassion, Health, and Empowerment; T1 = Baseline; T2 = Immediately after
the intervention; T3 = 8 Weeks after the intervention.
1588 Journal of Interpersonal Violence 39(7-8)
the first session only. A further one participant completed the first five ses-
sions. The remaining 16 participants completed the entire intervention,
resulting in an intervention completion rate of 64%.
Discussion
This is a pilot intervention study conducted in the U.S. that specifically
focuses on Chinese immigrant women who have experienced IPV. Using a
randomized controlled group design, the study examined the preliminary
efficacy of our SHE intervention in reducing IPV and improving mental
health well-being among Chinese immigrant women who have experienced
IPV. The majority of participants adhered to the intervention protocol, and
the study also provides preliminary evidence supporting the efficacy of our
SHE intervention, laying a foundation for future research.
Our study reported a response rate of eligible survivors who chose to
enroll close to that of the DOVE study (60.5%), which involved a sample of
pregnant women experiencing IPV (Sharps et al., 2016). The satisfactory
response rate and intervention completion rate suggest that our intervention
using an mHealth delivery approach is feasible and acceptable to Chinese
immigrant IPV survivors. It offers a promising way for this underserved and
isolated group of women to access necessary support. A fully powered RCT
is needed to demonstrate the effectiveness of our intervention before consid-
ering its broader implementation in Chinese immigrant women with various
social and immigration status.
We found a significant decrease in self-judgment, which is one of the com-
ponents of self-compassion, in our SHE intervention group as compared to
the control group. This finding is consistent with a previous study supporting
the benefit of self-compassion training for improving self-compassion,
depression, and anxiety in a Chinese community sample (Finlay-Jones et al.,
2018). This may be a particularly salient finding in the specific context of
Chinese culture, where criticism and self-criticism are highly encouraged and
valued, and individuals are more likely to use self-criticism as a way of striv-
ing for being a good self (Chen et al., 2018). As influenced by this cultural
value of criticism and self-criticism, Chinese immigrant women may criticize
or judge themselves for the violence that happened to them. Consequently,
the self-compassion component of our intervention proved particularly ben-
eficial for Chinese immigrant women with a tendency of self-criticism in
dealing with an experience of IPV.
Participants in both the intervention and control groups demonstrated sig-
nificant reductions in psychological aggression and depressive, anxiety, and
PTSD symptoms, along with improved self-compassion levels. This suggests
Li et al. 1589
that simply offering written materials with information about IPV and mental
health resources would be beneficial to those who suffer from IPV. In addi-
tion, notable trends toward improvement were observed in our SHE interven-
tion group in comparison to the control group across most outcome measures,
including specific types of IPV (i.e., negotiation, psychological aggression,
and sexual coercion), depressive symptoms, PTSD symptoms, self-compas-
sion, and certain components of self-compassion (i.e., isolation and over-
identification). These findings provide encouraging indications of the
potential efficacy of our SHE intervention in addressing IPV and improving
the mental health well-being of Chinese immigrant IPV survivors. However,
a future RCT with an adequate sample size is warranted to assess whether
these trends toward improvement are statistically significant.
There were several limitations in this study. First, as this was a pilot
study with a small sample size, the study may have lacked sufficient statis-
tical power to detect significant effects. Although we observed trends
toward improvement in certain outcome measures in our SHE intervention
group compared to the control group, the statistical significance of these
trends remains to be confirmed. It is possible that these group differences
would have reached significance in a larger sample of women. Second, our
participants were recruited online, mostly via WeChat, which may have
introduced potential selection bias by inadvertently excluding older women
or women with low digital literacy who might be less inclined to use social
media. Consequently, our sample may not be representative of the broader
population of Chinese immigrant women residing in the US. However,
using the online recruitment approach, we were able to reach Chinese
immigrant women across different regions of the U.S. efficiently and
achieve the target sample size within six months. More importantly, we
successfully enrolled a significant proportion of participants who had no
income (34.7%) and were unemployed (36%) by advertising on WeChat.
Overall, the online recruitment method has proved to be a feasible and
effective way to reach Chinese immigrant women in the U.S. Third, we did
not collect data on participants’ sexuality, number of marriages, place of
residence (rural or urban areas), and their experiences of seeking family or
institutional support. Particularly, participants’ utilization of family or insti-
tutional support may have confounded the effects of our intervention.
Lastly, it is important to note that participants self-reported their daily com-
pletion of the intervention, which may have resulted in inaccurate measure-
ment of adherence to the intervention protocol. Future research may
consider using alternative intervention delivery approach that incorporates
backend recording of daily practice duration to improve the measurement
accuracy of intervention adherence.
1590 Journal of Interpersonal Violence 39(7-8)
Despite these limitations, this study provides important preliminary evi-
dence on the potential efficacy of an empowerment-based intervention for
Chinese immigrant women experiencing IPV. If demonstrated effective in a
future RCT with a more robust sample size, our intervention has the potential
to be disseminated in the Chinese populations with various immigration sta-
tus in the U.S. Collaborating with the Chinese organizations and seeking the
support of influential community leaders could promote the dissemination of
our intervention. For example, outreach events could be conducted in part-
nership with Chinese organizations or community leaders, including work-
shops, information sessions, or community events. Chinese social media
platforms such as WeChat could also be utilized to disseminate information
about the intervention by creating engaging content in Chinese such as arti-
cles, videos, and infographics. In addition, our intervention could be adapted
and translated for other immigrant groups of women to help them better cope
with IPV and mitigate its mental health impacts.
In conclusion, our SHE intervention, comprising a brochure-based phone
conversation providing IPV information, resources, and safety planning, along
with six weekly relaxation and mindfulness self-compassion exercises, dem-
onstrates promising potential in reducing IPV and improving the mental health
well-being of Chinese immigrant survivors. These findings lay a strong foun-
dation for a future large-scale RCT to further validate its efficacy.
Acknowledgments
The authors would like to thank all of the women who participated in the study. We
would also like to thank our research assistants for their contributions in the develop-
ment of the intervention and implementation of the study.
Data Availability Statement
The data that support the findings of this study are available from the corresponding
author upon reasonable request.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interests with respect to the authorship
and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research and/
or authorship of this article: This research is funded by the Pilot Research Grant of the
St. David’s Center for Health Promotion & Disease Prevention Research in
Underserved Populations (St. David’s CHPR).
Li et al. 1591
Ethical Standards Statement
This study was performed in line with the principles of the Declaration of Helsinki.
Approval was granted by the Institutional Review Board of the University of Texas at
Austin (No. STUDY00001645).
Patient Consent Statement
Informed consent was obtained from all individual participants included in the study.
Clinical Trial Registration
The study was registered in ClinicalTrials.gov (ID: NCT05011552).
ORCID iD
Yang Li https://orcid.org/0000-0001-8901-3454
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Author Biographies
Yang Li, PhD, RN, is an Assistant Professor in the School of Nursing, the University
of Texas at Austin. Her research focuses on the effects of lifetime trauma, including
adverse childhood experiences and intimate partner violence, on women’s health,
with a particular focus on mental health and childbearing outcomes.
Li et al. 1595
Hyekyun Rhee, PhD, RN, FAAN, is a Professor in the School of Nursing, the
University of Texas at Austin. She has established a robust research program focused
specifically on asthma in adolescents based on several large clinical trials supported
by the NIH. Specifically, her focus has been on developing and evaluating innovative
asthma self-management interventions that capitalize on unique developmental
opportunities presented by adolescents and cutting-edge technologies that can amelio-
rate the burdens of the disease.
Linda F. C. Bullock, PhD, RN, FAAN, is a Professor Emerita in the Sinclair School
of Nursing at the University of Missouri. Her research has focused on domestic vio-
lence in a population of pregnant women and has included collaborating with nurses
nationally and internationally and with members of other disciplines on the MU cam-
pus. Specifically, she has investigated the prevalence of intimate partner violence, its
consequences to mother and fetus, and intervention strategies to improve health out-
comes in both the woman and child.
Brigid McCaw, MD, MPH, MS, FACP, is a Senior Clinical Advisor at the Center to
Advance Trauma-Informed Health Care of University of California. She led the
implementation of a comprehensive, coordinated approach for improving screening,
identification, and services for family violence. She guides the national Kaiser
Permanente efforts in this area, impacting 10 million members. Her leadership,
research, and publications focus on developing a health systems response to family
violence, adverse childhood experiences, and trauma-informed care.
Tina Bloom, PhD, MPH, RN, is an Associate Professor in the School of Nursing at the
Notre Dame of Maryland University. Her research focused on developing and testing
effective violence interventions that decrease exposure to intimate partner violence as
well as decrease the negative impact that violence exposure has on their health.
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