Association between individual-level socioeconomic factors and intimate partner violence victimisation in women: a systematic review protocol

Abstract

Introduction

Intimate partner violence (IPV) is a global public health problem. Although both men and women experience IPV, the burden is more on women. To address IPV effectively, it is important to understand the factors that cause IPV including the socioeconomic factors. However, there is an inadequacy of knowledge on how socioeconomic factors at different levels affect IPV. Hence, the objective is to review the individual-level socioeconomic factors associated with IPV victimisation of women and girls.

Methods and analysis

The search strategy was developed to identify publications from January 2010 to 30 June 2024. The selected electronic databases of PubMed/MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, Scopus and Science Direct will be searched. The eligibility criteria for data collection are based on participants/population (women and girls), exposure (socioeconomic factors) and outcome (IPV). In primary search, the title and abstracts will be screened and reference lists of selected articles will be screened for additional studies. Two researchers will independently screen the articles, and in any disagreements, a third researcher will be consulted. The data will be tabulated to present the study and participant characteristics, comparison descriptors between victims and non-victims, inclusion and exclusion criteria, primary and secondary outcomes data, results, limitations and implications. A quality assessment will be performed on the selected studies to avoid bias. A narrative synthesis will summarise the findings.

Ethics and dissemination

Ethical approval was waived because only secondary data are used. The protocol will be published, and the findings will be disseminated via publication in a peer-reviewed journal.

PROSPERO registration number

CRD42022373535.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• This systematic review will use a comprehensive search strategy with predetermined criteria and keywords in multiple databases.

• This systematic review is not limited to studies from a specific region or context.

• The involvement of five researchers in the primary screening of the articles, data extraction and quality assessment will minimise bias.

• The exclusion of studies conducted in subgroups such as lesbian, gay, bisexual, transgender, queer and intersex communities is a limitation.

• Specifying and narrowing the broad concept of socioeconomic factors for this review and the inconsistency between studies in defining and measuring different types of violence are limitations.

Introduction

Rationale

Intimate partner violence (IPV) is a pervasive global health concern with significant implications for the well-being of individuals and communities.^{1 2} Women suffer mainly from violence in intimate relationships, which can have detrimental consequences.^2–4 Globally, 27% of ever-partnered women aged 15–49 years have experienced physical or sexual, or both types of IPV at least once in their lifetime, where the prevalence in the past year was 13%.¹ The lifetime prevalence of IPV experienced by women ranges between 15% and 71% with physical, sexual and psychological consequences, including stress and negative economic effects.^{5 6} Although IPV can adversely affect men, it is not a consistent factor in men’s poor health at the population level.⁷ Hence, more focus should be placed on women’s victimisation by IPV.

To address IPV effectively, it is important to understand the process through which factors cause IPV and to what degree they are associated. Many studies have examined the associations between various factors and elaborated on IPV as a complex issue with multiple factors.^8–11 Among the many related studies, numerous have explored income, education and occupation as some socioeconomic factors affecting IPV.¹¹ The American Psychological Association (APA) defines socioeconomic status (SES) as the social standing or class of an individual or group, which is often measured as a combination of education, income and occupation.¹² SES includes income, educational attainment, financial security, and subjective perceptions of social status and class. SES influences quality of life attributes and the opportunities and privileges afforded to people within society. Similarly, SES can influence the occurrence of IPV by increasing the risk of perpetration or victimisation.¹²

Poverty, economic hardship and related stress increase the risk of IPV.^{13 14} Socioeconomic disadvantage increases the risk of disagreements and conflicts in intimate relationships.¹⁴ Male control of income and low SES in terms of insufficient family income and living in rented houses are strong predictors of abuse.¹⁵ Both asking for money from one’s partner and receiving a large sum of money from one’s partner serve as risk factors for IPV.¹⁵

The employment and unemployment of women could be a protective or risk factor for IPV.¹⁵ Many studies have shown that women’s income is protective against IPV, but women who contribute more financially than their partners have greater IPV risk.¹⁶ A systematic review of studies in Arab countries showed that some employed women were significantly at risk of IPV, while other studies showed that women’s unemployment puts them at higher risk of IPV.¹⁵ Almiş et al (2018), cited in Mojahed et al, state that having no independent income and having a low opportunity to work due to a low educational level could cause women to accept violence and its continuity. However, Atkinson et al (2005), cited in Mojahed et al, have found that women’s employment is positively correlated with IPV if the husband has a traditional ideology.¹⁵ Studies conducted by Shiraz (2016) and Alsaleh (2015), cited in Mojahed et al, comparing IPV with diverse occupations, have shown that housewives suffer the highest level of violence. However, few studies have shown that unemployment of one’s male partner is a risk factor for IPV.^{15 17} Social security deprivation followed by acute stress can fuel conflict and lead to the potential development of aggressive behaviours by male partners.¹³

A higher education level could also be a protective factor or a risk factor for IPV.¹⁸ A low level of education is associated with poor life skills and low empowerment, increasing the risk of IPV.^{4 13 19} Secondary education is recognised as a protective factor for IPV.^{8 20} However, some studies have reported that women who have a higher education level are at risk of IPV, and these women may be well educated and more likely to challenge male authority.²¹ Higher education of one’s male partner is a protective factor against IPV with very few exceptions.^{15 18 22} Although education offers protection, acceptance of abuse at the community level can suppress the protective impact of higher education.²⁰

Several studies have shown that education operates more strongly than employment status.²³ It further indicates that income exhibits the strongest relationship to IPV compared with educational attainment.²³ Capaldi et al also reveal that unemployment and low income strongly affect IPV more than education level.¹¹

Considering the diverse types of IPV, higher rates of physical violence are found in low-income groups.²⁴ The same study reported that women who experienced coercive control were more economically disadvantaged.²⁴ Light physical violence, emotional violence, verbal abuse and sexual violence were significantly associated with low SES in a study conducted in Iran.²⁵

IPV prevails across different socioeconomic groups and the role of SES has been reported differently.^{4 10} A study conducted in the United States found high IPV victimisation reported by women with low income and low educational backgrounds.²⁶ A European study found more female victimisation of IPV among women with low education and low occupational status.¹⁷ A similar significant relationship between being more vulnerable to violence and lower socioeconomic backgrounds was revealed in a recent cross-sectional study conducted in Iran.²⁵ Another systematic review of domestic violence against women and associated factors in Ethiopia found a direct relationship between the occupation and educational status of the victim and the perpetrator.²⁷ A cross-sectional study cited in this review conducted in a refugee camp revealed that women who were working as farmers were 13 times more likely to have experienced IPV compared with housewives.²⁸

The ecological framework illustrates the causes of IPV at the individual, relational, community and societal levels, and they can increase the possibility of IPV victimisation and perpetration.²⁹ Although individual studies or reviews from diverse regions and populations have explored socioeconomic factors, a common understanding is required on how socioeconomic factors from different levels affect IPV.^{15 26} The studies are uneven in violence types and geography, but efforts are required to strengthen the evidence.³⁰ More information and better quality data are necessary to establish conclusive results on the role of SES.³¹ Hence, this study aims to systematically review how individual-level socioeconomic factors including income, education and occupation are associated with IPV victimisation of women and girls.

The hypothesis of the systematic review is ‘individual socioeconomic factors are associated with IPV victimisation of women and girls’ and the research question is ‘how does the individual’s (both victim and perpetrator) socioeconomic factors including income, education and occupation associate with IPV victimisation of women and girls?’.

Objectives

The objectives of this review are:

1. To describe the diverse individual-level socioeconomic factors associated with IPV victimisation of women and girls.

2. To review how the diverse individual-level socioeconomic factors are associated with IPV victimisation of women and girls.

Methods and analysis

This systematic review is designed to summarise the results of primary research studies on IPV and socioeconomic factors. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) guideline is used to write the protocol, which is presented according to the PRISMA-P checklist.³²

Key definitions

Intimate partner violence

The World Health Organization (WHO) provides an overall definition for IPV as ‘any behaviour within an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship’.³³ Further, the WHO comprehensively refers to IPV in terms of physical, sexual, emotional abuse and controlling behaviours. The glossary of definitions of rape, femicide and IPV was developed by the European Institute for Gender Equality (EIGE) to measure violence against women. The EIGE definition of IPV is ‘any act of physical, sexual, psychological or economic violence that occurs between former or current spouses or partners, whether or not the perpetrator shares or has shared the same residence with the victim’.³⁴ It defines physical violence as ‘any act which causes physical harm to the current or former partner as a result of unlawful physical force in the form of, among others, serious or minor assault, deprivation of liberty and manslaughter’.³⁴ Psychological violence is defined as ‘any act or behaviour which causes psychological harm to the partner or former partner in the form of, among others, coercion, defamation, a verbal insult or harassment’, and sexual violence is defined as ‘any sexual act performed on the victim without consent in the form of rape or sexual assault’.³⁴

Socioeconomic status

According to APA, ‘SES status is the position of an individual or group on the socioeconomic scale, which is determined by a combination of social and economic factors such as income, amount and kind of education, type and prestige of occupation, place of residence, and in some societies or parts of society, ethnic origin or religious background’.¹² It has been found that SES depicts inequities in access to resources, and issues related to privilege, power and control.¹²

For the purpose of this protocol, operational definitions are used for SES to be more explicit about the factors. The SES will be the self-reported or perceived levels reported by the individual studies considering the victim, or the perpetrator, or both. The variable of individual income or household-level income will be considered the monthly or annual income as reported. The variable of education will be considered as the highest level of education attainment by the individual/s (victim, or the perpetrator, or both). The variable of employment will be considered as employed and unemployed and based on the employment the subcategories may be recognised based on the nature of the employment. However, social class, caste, religion or race will not be considered.

Eligibility criteria

To determine search and identify the available studies that are most appropriate to review the association of socioeconomic factors on IPV victimisation of women and girls, we will use participants/population, exposure and outcome.³⁵

Participants/population

The inclusion criteria are as follows:

• Intimate relationship in the status of ever married, married, cohabiting, separated or divorced.

• Women and girls aged 15 years or above.

• Victimisation of any type of violence including physical, psychological/emotional, sexual or any other.

• Violence by a current or former partner (lifetime or past year prevalence).

The exclusion criteria are as follows:

• Studies on lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) communities because some aspects of IPV are unique to the LGBTQI experience and the variations in disclosure of sexual orientation or gender identity within the relationship.³⁶

• Victims of other forms of violence apart from IPV.

• Studies conducted only among widowed women.

Exposure

This systematic review focuses on studies that document IPV along with socioeconomic factors. Although SES is understood as defined by the APA, the exposure to socioeconomic factors will be mainly considered in terms of individual/household income, highest education attainment and employment for this study.

Outcome

To measure the outcome of violence, any tool such as the WHO Questionnaire, Conflict Tactic Scale (CTS), CTS–Revised, Abusive Behaviour Inventory, Measure of Wife Abuse, Index of Spouse Abuse, Demographic and Health Survey Questionnaire, and Abuse Assessment Screen can be used. However, when extracting data for the review, the given definitions in the study and standardised methods to measure IPV will be documented.

The other inclusion criteria for selection are as follows:

• Study design: observational studies such as cohort, case–control or cross-sectional studies, measuring risk factors for IPV.

• Publication: published in a peer-reviewed journal, conference proceedings, thesis or dissertations.

• Publication duration: from January 2010 to June 2024 because new studies could emerge on SES and IPV.

• Language: published in English or translated into English.

Information sources

The seven electronic databases including PubMed/MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, Scopus and Science Direct will be searched. The review will be conducted as an individual and dual process by researchers in screening eligibility and inclusion. Other methods, such as reference checking in existing reviews, will be searched for further articles. Furthermore, thesis and dissertations will be searched from other relevant databases and sources. Other electronic databases such as Google Scholar will also be screened for more literature.

Search strategy

The search strategy is developed to identify published literature. Studies on IPV have increased during the past four decades. However, considering the changes that occur in SES, studies published after 2010 will be collected.

Search strategy for some databases and websites is attached as online supplemental file 1.

The search strategy of the study is presented in table 1.

Table 1.

Search strategy of the study

Criteria	Search algorithm
Population	“marriage*”[tw] OR husband[tw] OR wife[tw] OR girlfriend[tw] OR boyfriend[tw] OR “dating couples”[tw] OR intimate[tw] OR partner[tw] OR couple[tw] OR relationship[tw] OR spous*[Mesh]
Exposure	“Socioeconomic Factors”[Mesh] OR “socioeconomic factors”[tw] OR income[Mesh] OR education[tw] OR occupation[tw] OR employment[tw] OR job [tw] OR SES [tw] OR socioecon*[tw] OR “socioeconomic status”[tw]
Outcome	“Intimate Partner Violence”[Mesh] OR “Spouse Abuse”[Mesh] OR “Domestic Violence”[Mesh] OR “partner violence”[tw] OR “partner abuse”[tw] OR “wife abuse”[tw] OR “dating violence”[tw] OR “dating abuse”[tw] OR “physical violence”[tw] OR “psychological violence”[tw] OR “emotional violence”[tw] OR “sexual violence”[tw] OR “Physical Abuse”[Mesh] OR “psychological abuse”[tw] OR “Emotional Abuse”[Mesh] OR “sexual abuse”[tw] OR victimisation[tw] OR perpetration[tw] OR “physical assault”[tw] OR “psychological assault”[tw] OR “emotional assault”[tw] OR “sexual assault”[tw] OR stalking[tw] OR assault[tw] OR coercion[tw] OR “battered women”[tw]
Publication	Published in peer-reviewed journals, conference proceedings, theses or dissertations
Duration	From January 2010 to 30 June 2024
Language	Published in English or translated into English

It is expected to rerun the search before the final analyses to identify whether any further studies have been added to the databases.

Selection process

Independently, two researchers will do an initial search in selected databases considering the eligibility, inclusion and exclusion criteria contained in the title and the abstract. They are categorised as relevant, irrelevant and uncertain. Articles that are inconsistent in decisions and uncertain are forwarded to a third researcher. A second search will be done using the reference lists of the selected articles and searching for additional studies. In the next step, the full text will be screened and data will be extracted.

It is expected that all studies may not include data on different types of violence such as physical, sexual and psychological violence, controlling behaviours and economic abuse. In such cases, only the types of IPV reported in the study will be considered for the review.

Study records

Data management

Data will be extracted into a summary table categorising: (1) details of the study: author(s), title, year, source; (2) study characteristics: study design, study setting, study population, sample size, response rate, study duration, data collection instrument; (3) participant characteristics: age, gender, SES (income/education/employment) and other relevant characteristics; (4) comparison of descriptors between victims and non-victims and comparison between different SES groups; (5) inclusion and exclusion criteria of the study; (6) primary and secondary outcomes data: effect sizes, outcome type, outcome measurement instrument; (7) study results: prevalence, time frame, that is, lifetime or during the past year; (8) limitations and implications.

Two researchers will extract the data and a third researcher will check the data. If there are any data extraction discrepancies or disagreements between the researchers’ individual judgements, they will be resolved after consultation with the third researcher. Any required missing data, unreported data or any additional details will be clarified by contacting the authors.

Data collection process

The planned time period for data extraction is from 1 February 2024 to 30 June 2024.

Data items

Prevalence data could be obtained related to IPV in terms of lifetime prevalence and past year prevalence.

Outcomes

Although IPV has been categorised into different types, for this review, physical, psychological/emotional and sexual violence will be the main outcomes of interest. However, in case of controlling behaviours and economic abuse, data will be recorded for analysis.

The main outcomes of interest are as follows:

• What is the association between income and the prevalence of IPV victimisation in women and girls?

• What is the association between education and the prevalence of IPV victimisation in women and girls?

• What is the association between occupation and the prevalence of IPV victimisation in women and girls?

Risk of bias in individual studies

Methods will be adopted to avoid bias when selecting individual studies for the systematic review. The ‘Quality Assessment Tool for Quantitative Studies’ will be used to assess the quality of the studies.³⁷ The assessment will be based on the following components: selection bias, study design, confounders, blinding, data collection methods and analysis. Studies will be classified on three levels: weak, moderate and strong. A third researcher will be consulted to solve any disagreements, eligibility or inclusion issues.

Data synthesis

A meta-analysis may not be possible because studies are not sufficiently homogeneous in methodological aspects and the individual studies would not have used the same methods.

The data will be used to review how the prevalence of IPV in terms of physical, sexual and psychological violence is associated with the selected socioeconomic factors. A narrative synthesis will be performed based on the words and text to summarise and explain the findings to understand how SES is associated with IPV. The extracted data will be synthesised by categorising findings based on similarities and differences. The findings will be stratified into meaningful categories such as type of violence and how it is associated with SES including victims’/perpetrators’ income, education and occupation in a comprehensive summary table with a qualitative description of the findings. Comparisons will be made relative to the differences in the type of IPV, its prevalence and its association with socioeconomic factors. Subgroups will also be categorised as abused or non-abused women. It is important to investigate these two subgroups separately to determine how SES operates differently.

Confidence in cumulative evidence

A summary of the primary studies and a presentation of sufficient details of the individual studies will be used in order to evaluate the quality of the completed synthesis.

Ethics and dissemination

Given that only secondary data collection will be performed, ethical approval will not be needed. The findings of the systematic review will be disseminated via publication in a peer-reviewed journal.

Patient and public involvement

None.

Ethics statements

Patient consent for publication

Not applicable.