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. 2026 Jul 7;43(5):1383–1393. doi: 10.1111/phn.70149

The Process of Change for Victims of Intimate Partner Violence: Effect of a Public Health Nurse‐Led Training and Counseling Program in Türkiye

Nilufer Yildirim 1,2,✉, Aynur Uysal Toraman 3
PMCID: PMC13535892  PMID: 42411137

ABSTRACT

Objective

The study examined the effects of a transtheoretical model based training and counseling program on the stages of change, the decisions to avoid partner violence, and the self‐efficacy of the victims of intimate partner violence.

Methods

The study was planned as a single group pre‐test post‐test quasi‐experimental design. Data were collected from 40 women from the Investigation Bureau of Violence Against Women in a courthouse in Turkey between September 2018 and June 2019. Personal questionnaire form, a tool to determine the type of intimate violence, Abused Women's Change Process Scales, telephone interview form, and semi‐structured interview forms were used.

Results

Informative training and a counseling program were offered to the women, who were then followed up for 6 months; the difference between the identified stages of change of the abused women before and after the intervention was found to be statistically significant (p < 0.05). The differences between the mean scores on the pros and cons scales and the Temptations and Confidence Scales before and after the training and counseling program for the victims of intimate partner violence were found to be significant (p < 0.01).

Conclusion

Nurses can use sample training and counseling models in institutions where victims of violence apply.

Keywords: counseling, intimate partner violence, nursing, training, transtheoretical model

1. Introduction

Intimate partner violence (IPV) is a widespread public health problem that is seen in all societies and all periods. The World Health Organization has reported that overall, one woman in three has been exposed to physical and sexual violence by her husband or partner (WHO 2024). In Turkey, national data state that 28.2% of women experience psychological violence, 18.3% economic violence and 12.8% physical violence at least once in their lifetime (TURKSTAT 2024). According to a statistical study conducted in Turkey with women applying to a non‐governmental organization operating a women's shelter, the Purple Roof Foundation, in 2023, 89% of women had been exposed to psychological abuse, 62% to physical violence, 35% to economic abuse, and 19% to sexual violence (Purple Roof Activity Report 2024).

It is known that IPV hurts many aspects of women's physical and psychological health and social life, and health workers are thought to have many responsibilities in this regard (WHO 2002; Ekizceleroglu and Zeyrekli 2007; Sallan Gul 2011; Alvarez et al. 2017; Bradley et al. 2020; Ergönen et al. 2020; Unal and Gulseren 2020; Thomas 2021; Kostu and Uysal Toraman; 2022). However, the healthcare system has only recently become recognized as an essential resource for IPV programs, and even now, most existing programs emphasize screening and identification rather than intervention (Haggerty and Goodman 2003; McCloskey et al. 2016). Indeed, nurses in the health care system have essential roles in the prevention of IPV in the family, in the early detection of women, and in interventions for support and care (ICN 2001; Tel 2002; Ozvarıs et al., Özvarış et al. 2008; Olive et al., 2007; Jack et al. 2012; Tiwari et al. 2012; Reinsenhofer and Taft 2013; Koci et al. 2014; Koziol‐McLain et al. 2015; Alhalal 2020; Thomas 2021).

It was stated in the literature that interventionist studies on creating change and providing support to women victims of IPV are limited (Taft et al. 2015; Gupta et al. 2017). There is a need for conceptually based intervention strategies that provide help for victims once they are identified (Haggerty and Goodman 2003). In the research on interventions against IPV, different models such as the health belief model, ecological model, psychosocial readiness model, grounded theory, push model, and culture‐stress model have been used to target the victim (Chung 2006; Gustafsson et al. 2012; Balabukha et al. 2016). Also, The Transtheoretical Model (TM) can be used to help women who are victims of IPV change their violent relationships. Model reinforces the notion of behavior change as a gradual occurrence over time through intentional decision making by an individual, instead of an immediate result. The TM was created by psychologists James O. Prochaska and Carlo C. DiClemente and involves the notion of an individual's journey through precontemplation, contemplation, preparation, action and maintenance, while some studies include relapse as a stage as well. Yet it's not just the stages that the model champions, for it also relies upon its constructs of cognitive and behavioral processes that inspire change and the determinants of decisional balance and self‐efficacy. Moreover, the importance of the TM as a theory of behavior change is that it's applicable to all people at various locations of change which implies that they don't need an intermediary stage‐of‐change facilitative approach but instead, something else, relative to their level of involvement, currently. Thus, the early stages focus on intention and awareness, the middle stages focus on intention and preparedness and the later techniques focus on application and maintenance of sustainable behavior. However, as a collaborative approach, motivational interviewing is stage specific to better align with the client in the moment as it champions concepts that facilitate stage progression, reduce ambivalence and increase internalized motivation and confidence. Therefore, with a universally applicable approach that is relativistically appropriate to each client's needs, the TM is an effective theoretical model for change and maintenance of compliance when such an relationship exists. (Prochaska and DiClemente 1983; DiClemente and Prochaska 1985; Prochaska and Velicer 1997). The model helps suggest interventions that are consistent with the ways victims perceive their situations and how they take actions to end IPV in their lives (Burke et al. 2004; Catallo et al. 2012; Schrager et al. 2013; Cicek et al. 2019). The model facilitates the determination of the stage of change that a woman is in. Accordingly, the woman can seek appropriate interventions for each stage. When the model is used for women who are victims of IPV, motivational interviews are conducted. Awareness is created by discussing the positive and negative effects that making changes will wield on the woman's life (herself, her partner, her children, and her social circle), thus developing and reinforcing the woman's self‐efficacy (Weisz 2003; Devine 2003; Kelley 2003; Shroeder 2004; Burke et al. 2004; Yaman 2009; Shrager et al., 2013; Zapor et al. 2018).

Therefore, the model's biopsychosocial, person‐oriented, situationally adaptive interventions imply that it can be used in cultures where IPV is recognized as such and operated under the guise of social patriarchy and socioednic constraints. For example, in Turkey, where patriarchal systems still dictate how women respond to IPV (Ozmen Yilmaz 2024), the staging and gradual levels and susceptibility of the TM may be a culturally effective precursor to such a nursing‐led interventions aimed at enhancing awareness, readiness for change, and self‐efficacy, rather than structural transformation (Yaman 2009). But where legally, IPV falls under the umbrella of domestic violence, purely legislative solutions do not measure up to cultural considerations and there are shortcomings in delay and implementation. Where IPV falls under the category of domestic violence and, therefore, regulated by formal law in the Republic of Turkey, one must acknowledge the shortcomings in delay and implementation for protective measures/preventive solutions. The most extensive, systematic approach to such legal progress was the establishment of inquiry bureaus for acts of violence against women through the judicial system (Turkey Ministry of Justice 2023).

The Investigation Bureau of Crimes of Violence Against Women was established in 2015 and continues its activities by Law No. 62841 on the Protection of the Family and the Prevention of Violence Against Women (Turkey Ministry of Justice 2023). The SONIMs (Violence Prevention and Monitoring Centers), which were created in 2012 by Law No. 6284, are government, multidisciplinary centers in the Turkish Ministry of Family and Social Services that connect legal intervention, psycho‐social assistance and monitoring of legal (court ordered) intervention and protective measures for intimate partner violence (Algan and Alev 2024).

Despite the positive developments regarding IPV in Turkiye in recent years, Turkish nurse researchers have mainly conducted cross‐sectional studies on the reasons for IPV, on affecting factors, the results of IPV, and the attitudes toward IPV (Aslan et al. 2005; Tunçel et al., 2007; Sahin et al. 2012; Kanbay et al. 2012; Sabancıogulları et al. 2016). It is also worthy of note to see that nurses have recently conducted a limited number of interventional studies on IPV (Celik et al. 2015; Kaplan and Komurcu 2017; Varcoe et al. 2017; Cicek et al. 2019).

In the current study, the TM was assessed using the Process of Change in Abused Women Scales (PROCAWS). The women's stage of change was assessed by using the Problems in Relationships subscale. The representation of the TM construct decisional balance was assessed by the Pros and Cons of Relationships subscale, which is relevant at the contemplation stage of change. The self‐efficacy constructs were operationalized by the Tempting Situations in Relationships and Confidence in Tempting Situations subscales, which are relevant from the preparation to action and maintenance stages of change. Thus, hypotheses of the study were formulated to assess TM variables that are subject to change. This study aimed to begin to fill this gap by investigating the effect of a TM based training and counseling program on women's stages of relationship change, their decisional balance, and their self‐efficacy.

1.1. Research Hypotheses

H1: There is a statistically significant difference over time in the mean scores of women exposed to IPV on the Problems in Relationships subscale of the Processes of Change in Abused Women Scales.

H2: There is a statistically significant difference over time in the scores of the Pros and Cons of Relationships subscale of the Processes of Change in Abused Women Scales.

H3: There is a statistically significant difference over time in the scores of the Tempting Situations in Relationships subscale of the Processes of Change in Abused Women Scales.

H4: There is a statistically significant difference over time in the scores of the Confidence in Tempting Situations in Relationships subscale of the Processes of Change in Abused Women Scales.

2. Materials and Methods

2.1. Type of Research

This research was conducted using a single‐group, pretest‐posttest quasi‐experimental design.

2.2. Place and Time of Research

The research was conducted between September 2018 and June 2019 at the Bureau of Investigation for Family Protection and Crimes of Violence Against Women of the Izmir Court of Justice in the west of Turkey. The Investigation Bureau of Crimes of Violence Against Women, affiliated with the Izmir Chief Public Prosecutor's Office, was established in 2015 and continues its activities by Law No. 6284 on the Protection of the Family and the Prevention of Violence Against Women. Investigations of all crimes within the scope of domestic violence and violence against women are carried out in this office (Turkey Ministry of Justice 2023). This office was the only official unit established to provide legal support for cases of violence against women during the years when the research was conducted.

2.3. Research Sampling

The research universe consisted of 600 women victims of IPV who applied to this office between March 1 and September 1, 2018. Victims of IPV who matched the inclusion and exclusion criteria of the research, who could be contacted by telephone, n:40, who agreed to participate in the study were included in the study group of women who were victims of IPV. The study's observed 1‐β and effect size were calculated using the G‐power program. The effect size was calculated using the PROCAWS pretest and posttest score averages used in the study (effect size: 0.7237262), α: 0.05, and 1‐β were taken as 0.95. As a result, it was determined that 27 people were sufficient for the study. The study was completed with 34 women. Effect sizes from pretest to posttest were calculated using Cohen's dz, appropriate for the paired‐sample design. Effect sizes for each dependent variable were moderate to large (Pros in Relationships: dz = 0.68; Cons in Relationships: dz = 0.58; Tempting Situations in Relationships: dz = 0.64; Confidence in Tempting Situations: dz = 0.97), indicating this construct significantly changed over time for participants who underwent the intervention twice (Lakens 2013).

The criteria for inclusion in the research were as follows:

  • Being 18 or over

  • Being literate

  • Having been exposed to violence from husband, former husband, or partner

  • No danger of life (the Bureau of Court selects no life danger files)

  • Agreeing voluntarily to participate in the research.

The exclusion criteria were as follows:

  • Being pregnant (because it is a 6‐month program)

  • Having an intellectual disability

  • Having previously taken part in any training and counseling program regarding IPV.

2.4. Data Collection Instruments

A Personal Inquiry Form, the Domestic Violence Questionnaire, the Process of Change in Abused Women Scales, and a Telephone Interview Form were used to collect research data.

2.5. Personal Inquiry Form

This was a form used to determine the sociodemographic characteristics of the women. The researcher prepared it to use similar studies (Sahin et al. 2012; Knox 2018). Six questions were asked on the form, querying the women's age, training, income, and marital and employment status. Five of the questions were multiple choice; one was open‐ended.

2.6. Domestic Violence Questionnaire (DVQ)

The Domestic Violence Questionnaire (DVQ) used by Kelleci et al. (2009) is a researcher‐created, standardized tool that assesses women's victimization by partner violence in the areas of physical, emotional/verbal, economic, and sexual. Questions are rated on a 1–5 frequency response scale of “never” to “very often.” There is not an overarching score that rates cumulative level of severity, but instead, the results indicate how often and what type of incidents occurred. In this study, having experienced intimate partner violence was defined as responding to one item on the scale (within the last year) by acknowledging victim status. The DVQ intended to determine the acts experienced but not necessarily act to determine victim vs. non‐victim. The violence is determined based on at least one “yes” answer out of multiple possible responses at each change stage (Kelleci et al. 2009).

2.7. The Process of Change in Abused Women Scales (PROCAWS)

The scale was developed by Brown (1998) in line with the basic concepts of the TM to make an integrated measurement of the stages of change abused women go through, their decisional balance, and their perception of self‐efficacy. Many studies have used the scale as a data collection instrument (Weisz 2003; Burkitt et al., 2008; Alexander et al. 2010; Zapor et al. 2018). The original scale consists of 51 items and four scales titled Problems in Relationships (25 items), Pros and Cons (12 items), Tempting Situations (7 items), and Confidence in Tempting Situations (7 items). A five‐way Likert‐type scale determines each statement's degree of agreement (Brown 1998). The PROCAWS consists of four scales based on the Transtheoretical Model of Change. The *Problems in Relationships* scale contains 25 items. There are five subscales (one for each stage of change), with five items each. The maximum score on each subscale is 25. The dominant stage of change was assigned using T‐scores and using cluster‐based classification, which determined the stage of change with the greatest score. The *Pros and Cons of Relationships* scale contains 12 items and has two subscales (pros and cons). Each subscale has a maximum score of 30. T‐scores were calculated for the subscales, with a higher score for pros indicating increased readiness to leave a violent relationship, and a higher score for cons indicating ambivalence. The *Tempting Situations in Relationships* scale and the *Confidence in Tempting Situations in Relationships* scale each contain seven items and have maximum scores of 35. A higher score on the first scale indicates increased vulnerability to returning to an abusive relationship, and a higher score on the second scale indicates increased self‐efficacy to remain out of the relationship. Raw scores for the scales were converted to T‐scores (mean = 50; SD = 10) prior to analysis. This was performed to allow for interpretation of the score on the subscales to be standardized. Yildirim and Uysal Toraman tested the validity and reliability of the Turkish scale. The Cronbach alpha coefficients of the four parts of the Turkish scale were calculated as follows: Problems in Relationships, 0.73; Pros and Cons of Relationships, 0.77; Tempting Situations in Relationships, 0.96; and Confidence in Tempting Situations in Relationships, 0.97 (Yildirim and Uysal Toraman 2023).

2.7.1. Telephone Interview Form

The Telephone Interview Form is the author's structured interview guide for the motivational interview during months 3 and 4 post‐training completion. This tool was developed to give all subjects a standardized, stage‐matched motivational interview stemming from the Transtheoretical Model. The form contains a short informational preamble that is read to each subject, along with researcher‐reported interview date and time, and open‐ended questions for data collection related to partner violence experience. Thus, there is no scoring of this form or corresponding variables from it, for it is not a scale.

2.8. Data Collection Method and Intervention

Before starting the training and counseling program, a preliminary interview was conducted with the women included in the study. An introductory meeting was held with the women, and information on the research and the program was provided. The Izmir Court of Justice provided a judicial interview room to offer a private and secure environment for the training program. The interview room was arranged to ensure privacy. After the individuals' TM change stage was determined with PROCAWS, training and consultancy approaches were applied together with the targets for the needs of the woman in the change stage she was in. Individual training and consultancy are structured to enable each woman to rise to a higher level than she is currently at. During our research (before training and counseling) or after, victims had access to the specialist nurse by phone or in person for 6 months. The program started with giving the DVQ and PROCAWS to the abused women to fill out. A program suitable for TM was implemented in line with different targets set for abused women, each at various stages of change. The relevant training, counseling, and motivational interviewing were carried out by a nurse practitioner who had received training on women victims of IPV and who had observed the victims in the courthouse for 6 months. The same professional worked at all stages. To create a therapeutic environment, an individual training program was applied to each abused woman. This consisted of four 45‐minute sessions planned at different time intervals. The content of the intervention was that women received individual training and counseling appropriate to them in the stages determined according to the TM. The workers created training and counseling modules appropriate to each stage. The training and counseling program on IPV given as part of the study dealt with topics such as social sexuality, violence against women, healthy communication in the family, legal mechanisms to combat IPV, self‐efficacy, and problem‐solving. The methods used in the training program were narrations, questions and answers, discussions, and watching videos. As a result of the training and counseling provided, victims were helped to chart the appropriate path in their own lives and their struggle against IPV.

In the second stage of the research, monitoring, motivational interviews, and counseling were conducted to evaluate the effect of the training program. In this regard, the DVQ and PROCAWS were again given to the abused women at the 1st‐ and 3rd‐month follow‐ups. In addition, motivational interviews by telephone were conducted in the 4th and 5th months after the training to reinforce the women's progress. Since it is known from other studies using the TM that the effect of the intervention can only be seen in 6 months at the soonest, the last follow‐up was performed in the 6th month (Prochaska JO and Velicer 1997). The training was concluded by administering the DVQ and PROCAWS qualitative data collection instruments for the last time (Figure 1).

FIGURE 1.

FIGURE 1

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Research design and process. [Colour figure can be viewed at wileyonlinelibrary.com]

2.9. Participant Safety and Risk Management

The intervention was held in the Investigation Bureau of Domestic Violence at the Court of Justice rather than a high‐crime trial court, a setting an institutionally guaranteed venue in which women had already been presented to legal systems under Law No. 6284. Training and follow‐up held in this setting minimized the safety risks of unintended contacts or unsafe outreach to violent partners.

Emotional harm, threat retaliation, or forcing women to make premature decisions about endangering relationships was avoided by the voluntary nature of participation, guarantees of confidentiality, and, most importantly, the premise that following stages of change does not involve exercise of the behavior change. The intervention was restricted to cognitive and motivational training, not any expectation of the dissolution of relationships, in order to minimize the maximization of safety risks. The follow‐up was conducted within a time period that matched women's engagement with legal and other support systems, and referrals were provided for psychosocial or other social service needs.

2.10. Data Analysis

The program package SPSS 24.0 (Statistical Package for Social Science) was used in the statistical evaluation of data. Statistical significance was evaluated at a 95% confidence interval. In the data analysis; percentage, The Friedman test, the ANOVA, Bonferroni corrected Wilcoxon Marked Ranks Test, and The Paired Samples t‐test were used for advanced analysis. Analyses were conducted using complete‐case data from participants who completed both baseline and 6‐month follow‐up assessments.

2.11. Ethical Aspects of the Research

Written permission to conduct the research was obtained from the Izmir Court of Justice and the Ministry of Justice, and oral permission was obtained from the prosecuting attorney and public prosecutors responsible for the Bureau of Investigation of Family Violence Crimes. Also, written approval was obtained from the participants. Victims were informed of their right to refuse to participate in the research/program.

3. Findings

3.1. Findings Concerning the Abused Women's Descriptive Characteristics

The mean age of the abused women was 36.1 ± 1.57 years; 5% had basic literacy, 27.5% were primary school graduates, 25% were middle school graduates, 25% were high school graduates, and 17.5% had higher training. It was found that 87.5% of the abused women were married, and 52.5% were in some employment. Also, 30% of the women had an income lower than their expenses; their income and expenditure of 60% were equal, and 10% had an income more significant than that. The length of time over which the abused women had been exposed to IPV from their partners was 1–5 years for 32.5%, 6–10 years for 12.5%, 11–15 years for 17.5%, 16–20 years for 20%, 21–12 years for 7.5%, and 26–30 years for 10%.

Examining the stages of change of the abused women before the intervention according to their scores on the Problems in the Relationship Scale of PROCAWS, it was found that 7.5% were at the stage of precontemplation, 77.5% were in contemplation, 10.0% were at the preparation stage, and 5.0% were in the action stage. None of the abused women was at the maintenance stage. At the final monitoring performed in the 6th month after completion of the intervention program, it was found that 14.7% of the women were at the action stage, and 85.3% were at the maintenance stage. A statistically significant difference was found in the abused women's stages of change between pre‐intervention and at the 6th‐month follow‐up (Z = −5.17, p < 0.01) (Table 1).

TABLE 1.

Comparison of the abused women's mean stage of change scores before the intervention and in the monitoring 6 months after the intervention.

Stages of change Before intervention After intervention (6th month)
n = 34 % X ± SD n = 34 % X ± SD
Precontemplation 3 8.8 6.3 ± 2.28 0 0 5.7 ± 1.75
Contemplation 27 79.4 19.3 ± 2.27 0 0 18.8 ± 1.81
Preparation 3 8.8 10.1 ± 1.75 0 0 9.9 ± 1.71
Action 1 3.0 15.1 ± 2.15 5 14.7 14.9 ± 2.19
Maintenance 0 0 17.4 ± 2.81 29 85.3 24.0 ± 2.44
Pre‐intervention Post‐intervention difference in stage of change

Z = −5.17

p = 0.001 *

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*Wilcoxon Signed Ranks Test (Bonferroni correction) p < 0.01.

Comparing the abused women's subscale mean scores before and in the 6th month after the training and counseling program, it was found that the differences in the mean scores of the subscales Pros in the Relationship (t = 3.99, p ˂ 0.05) and Cons in the Relationship (t = 3.38, p ˂ 0.05) were statistically significant (Table 2).

TABLE 2.

Comparison of the abused women's scores on the pros and cons of relationships on the PROCAWS scales before and in the 6th month after the intervention.

Before the intervention n = 34

After the intervention (6th month)

n = 34
Pros in relationships subscaleX 18.00 13.41
SD 5.93 7.68
t and p‐value 3.99 p = 0.00*
Cons in relationships subscaleX 23.02 17.64
SD 5.54 8.97
t and p‐value 3.38 p = 0.02
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*

p < 0.05.

According to the abused women's scale scores before and after the training and counseling program in Table 3, the difference between Tempting Situations in Relationships (t = −3.74, p ˂ 0.05) before and after the intervention was found to be significant at the α = 0.05 level (Table 3).

TABLE 3.

Comparison of the abused women's mean scores on the tempting situations in relationships scale before and in the 6th month after the intervention.

Before the intervention

n = 34

 After the intervention (6th month) n = 34
Tempting situations in relationships X 16.76 23.17
SD 7.70 5.81
t and p‐value −3.74 p = 0.01 *
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* p < 0.05.

According to Table 4, a significant difference of α = 0.05 can be seen between the mean scores of the abused women in terms of Confidence in Tempting Situations in Relationships Scale before and after the training and counseling program (t = −5.64, p ˂ 0.05) (Table 4).

TABLE 4.

Comparison of the item mean scores before and after (6th month) the intervention of the abused women on the tempting situations in relationships and the confidence in tempting situations in relationships scales.

Before the intervention n = 34 After the intervention (6th month) n = 34
Confidence in tempting situations in relationships X 15.35 24.41
SD 5.69 8.97
t and p‐value −5.64 p = 0.00 *
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* p < 0.05.

4. Discussions

The current study considers change in abused women's Problems in Relationships, Pros and Cons of Relationship, Tempting Situations in Relationships, and Confidence in Tempting Situations in Relationships before vs. after a Transtheoretical Model‐based training and counseling program. Consistent with the Transtheoretical Model, evaluation of women's stage‐related perceptions of the problems in their relationship, decisional balance regarding the relationship, reactions to tempting/high‐risk situations, and confidence in such situations is relevant to fostering stage appropriate change (Brown 1998). The following variables are described below in relation to the study's results.

4.1. Problems in Relationships

Assessment of the stages of change suggested that pre‐intervention, the majority of women were in earlier stages of change, stages of contemplation, which is reflective of high ambivalence about their relationships. Following the TM based training and counseling program, women were in later, action‐oriented stages of change, many having reached the action and maintenance stage by 6‐month follow‐up. Such a pattern of stage progression suggests movement from ambivalence, to increased desirability of change. Stage progression has also been observed in previous IPV interventions that employ stage‐matched, theory‐based intervention designs. For example, Devine (2003) observed such progression into later stages of change within an IPV‐exposed female sample following a TM intervention, despite the intervention's pronounced attrition at follow‐up. Therefore, these findings, along with others, indicate the effectiveness of stage‐matched, theory‐based interventions for promoting efficacy in the change processes among abused women.

Previous research has demonstrated that TM based interventions can facilitate women's progression through the stages of change after the identification of IPV. Consistent with this finding, progression in the stages of change from pre‐action to action and maintenance was evident after TM enhanced training and counseling. Progression in the stages of change has also been found in both shelter and hospital based studies using stage matched interventions, suggesting that women may benefit from this type of scaffolding when attempting to progress towards change (Weisz 2003; Burkitt and Larkin 2008).

Contextual variables related to women's decision making have also been explored in the literature. Kelley (2003) examined the role of motherhood in women's stay, positing that children can be a source of ambivalence and a reason to postpone change. This was relevant to the current study, as all women had children, indicating that interventions should be aimed at relational change at a family/societal level.

While TM‐based studies have demonstrated significant stage progression, results have not been uniform across samples. Schrager et al. 2013) found little stage change in a sample of women who visited the emergency room and concluded that the stages of change model does not apply to a model of acute care. Differences in samples, intervention intensity, duration, and modality may explain some of the observed differences in findings. The current study employed a follow‐up oriented training and counseling intervention rather than a brief or technology‐based intervention which may have helped the women stay engaged and move forward.

However, the research also supports contextual/institutional support in the process of stage advancement. Zapor et al. (2018)’s study on Advanced Care Planning demonstrated that women of advanced stages had a higher degree of institutional support and satisfaction, demonstrating that environmental factors can help maintain change. However, another case study by Cicek et al. (2019), however, progressed from precontemplation to maintenance after professional, tailored training and counseling, much like the nurses offered. Therefore, this study's findings also supported the research, by including the factor of prolonged, nurse‐led support in addition to these stages of advancement.

4.2. Evaluating Relationships by Their Pros and Cons

We found in our study that the abused women became more aware of the pros and cons of their relationships after the training and counseling program, and positive changes were seen in their relationships. This is evidence that the TM‐supported program was instrumental in changing relationships.

In Kellye's (2003) study indicated that women had become aware of the pros of their relationships and wanted to continue in non‐violent relationships with their partners. Devine's study results showed an increase in the average scores on the positive aspects of the relationship subscale. While the average scores on the negative aspects of the relationship subscale were high before the intervention, they decreased to lower levels after the intervention (Devine 2003). They have seen that the intervention applied gave the women an awareness of their relationships and made it easier for them to see the pluses of their relationships. The women turned the negativities that had destroyed the relationship in a positive direction with their gains after the intervention. In Weisz's study, it was reported that the average scores on the positive aspects of the relationship subscale decreased after the intervention, while the average scores on the negative aspects of the relationship subscale increased. It is thought that the fact that Weisz conducted the study in a women's shelter and that these women were living separately from their partners may have influenced the results (Weisz, 2003).

In our study, the mean scores on the pros in the relationship subscale after the intervention fell compared intervention to before. We believe that because the legal process had started of womens had either been divorced or left their homes, this affected the result. Also, the reasons for the decline in scores may have stemmed from the women's overcoming their fear of being alone, losing hope that the relationship could continue, falling out of love with the partner, and not regarding the end of the relationship as a lack of success, and no longer believing that the partner needed her. In a follow‐up study conducted in the emergency service of a hospital, Burkitt and Larkin (2008), finding an increase in the mean scores of the pros in the relationship subscale and a decrease in the mean scores of the cons in the relationship subscale. Also, when the stages of change were compared in terms of the mean scores of the pros in the relationship subscale and the cons in the relationship subscale, it was seen that the women with the highest mean scores on the pros of the relationship subscale were at the stage of contemplation. The women with the highest mean scores on the subscale of cons in the relationship were at the stage of precontemplation (Burkitt and Larkin 2008). As can be seen in similar studies in the literature, the process of decision‐making in terms of the pros and cons of a relationship at the end of a TM‐supported training and counseling program is mixed for abused women. The results of our study are consistent with the literature.

4.3. Tempting Situations in the Relationship

Our study showed that women exposed to IPV experienced a more conscious change, and this led them to look at themselves, their relationship, and their partners more closely. The questions directed at abused women on tempting situations in the relationship are related to changes in the partner. After the intervention, the women who had been exposed to IPV tended to want a change in the partner inflicting the violence. In a study by Devine (2003) conducted in a shelter, it was seen that the abused women's mean scores on the tempting situations in the relationship scale declined after counseling (Devine,2003). In our study, we saw that the mean scores of the women who had experienced IPV increased after the training and counseling program on the tempting situations in relationships scale. Like Devine, Kelley's study also showed that the mean scores on the tempting situations in relationships scale fell after the completion of the program (Kelley 2003). According to Kelley, struggles with dependency, child loss, depression, a tendency toward suicide, and a shortage of resources, as well as problems with merely staying alive, affected the result in the case of many of the women in the research group. Like our study, it was found in the study by Weisz with women in a shelter that after the intervention, the mean scores of the women increased on the tempting situations in relationships scale (Weisz, 2003). It was also found in the studies with abused women by Shroeder (2004) and Burkitt and Larkin (2008) that there was an increase in the women's mean scores on the tempting situations in relationships scale after the intervention (Shroeder 2004).

4.4. Confidence in Continuing the Relationship

The TM has made a difference in relationships that harbor violence. For example, the model is frequently used for issues such as smoking and obesity and is directed at individual change and control (Brown 1998). Since IPV is not entirely under individual control, evaluating it in a two‐person relationship can lead us as researchers to make varying assessments about individual confidence. Our study found that the mean scores on the confidence scale in tempting situations in the relationship increased. This result indicates that after the training and counseling program, the abused women displayed increased self‐efficacy in continuing the relationship. In the study by Devine, an increase was seen after the intervention program in the mean scores on the confidence in tempting situations in relationships scale (Devine 2003). In Kelley's study, a post‐test increase was also found in mean scores on the confidence in tempting situations in relationships scale (Kelley 2003). It was seen in both studies that the intervention made a positive change in abused women's relationships. In the study by Weisz with women in a shelter, it was reported that the women's scores on the scale of confidence in tempting situations in relationships increased after the intervention (Weisz, 2003). Shroeder also showed in a study conducted in 2004 with abused women that the mean scores of the women on the scale of confidence in tempting situations in relationships increased after the intervention (Shroeder 2004).

4.5. Implications for Interdisciplinary Practice, Policy, Education, and Future Research

The present study was conducted in a legal setting, where IPV women had already engaged with the law services through the initiation of Law No. 6284. This demonstrates the cross‐sectoral multi‐disciplinary response to IPV. In Türkiye, women appear to engage with the network of services primarily through the Court of Justice and not the health system. The introduction of a nurse‐led Transtheoretical Model intervention at this “entry point” suggests potential routes for linking a behavioral intervention into the existing service structure. Legal services, social services, dedicated violence prevention centers (e.g., ŞÖNİM), and health professionals can work together to improve the connectivity and continuity of care and messaging across system “silos.” This enhances the acceptability and sustainability of the intervention; there is no need to build a new service, but to strengthen the links between those that already exist.

These results have implications for policy development and nursing practice in patriarchal countries like ours. Policy should focus on modifiable factors, such as stage‐of‐change, decisional balance, and self‐efficacy, rather than behavioral outcomes (e.g., leaving). National domestic violence intervention policy might include stage‐of‐change counseling, safety planning, and follow‐up in a culturally congruent and ethical way.

From a nursing viewpoint, these findings suggest that TM‐based counselling could be integrated into the existing framework of practice guidelines for community health, emergency, women's health and forensic nursing. Furthermore, if stage‐of‐change assessment and motivational interviewing were taught to nurses in undergraduate and post‐graduate nursing education, it may become feasible for nurses to manage IPV more consistently if these skills were applied to all nursing encounters with women, thus integrating the nursing sector into a coordinated multisctoral response for IPV.

Future studies should utilize these process measures to assess whether these changes in readiness for change and self‐efficacy are stable process measures of long‐term behavioral outcomes. Will longitudinal and mixed methods designs be able to capture cognitive changes reflected in stable safety behaviors, legitimate behaviors, or relationship choices over time? Longer follow‐up periods and (where safety permits) behavioral outcome measures would also be a welcome addition to the stage‐based domestic violence treatment literature.

5. Conclusion and Recommendations

This study shows that a nurse‐led TM‐based training and counseling intervention in the Domestic Violence Office of the Court of Justice can successfully augment the change processes of women experiencing IPV. The intervention provided in the “window of opportunity” after legal system help sought increased the efficacy by addressing ambivalence, reinforcing self‐efficacy, and developmentally staging progression through the stages of change. These findings suggest that integrating TM‐based, stage specific counseling into existing support structures aligned with legal protections can maximize the consistency of legal processes with women's post‐protection IPV‐related needs across the stages of change.

5.1. Limitations

Because there are only a few institutions in Turkey that can reach and establish contact with women who are victims of IPV, the study could only be conducted at a single center, with women applying to the Court of Justice. We believed that women applying to the public prosecutor would be more liable to expending an effort to change their situation. So, we predicted that they would not be at the first stage of precontemplation in the stages of change in the TM. A comparison with a control group could not be made in this study due to reasons such as the inappropriateness of the physical environment and the fact that women victims of IPV live in different sociocultural characteristics. The period in which we evaluated the effectiveness of the intervention was limited to 6 months in line with TM. Some of the women who agreed to participate in the study later withdrew after the start of their training, excusing themselves because of various problems in their lives. Attrition associated with time and travel during the follow‐up; therefore, without post‐test data from these individuals, the researchers could not assess if differences existed between completers and non‐completers. Limitations in this study include a lack of a control group; however, in the case of IPV, it's often unethical to withhold an intervention from women who are known to be at risk. One limitation of this study also was that behavioral outcomes were not assessed, only change processes which come before behavior in the model.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Conflicts of Interest

The authors declare no conflicts of interest.

Endnote

1

Law No. 6284 (2012) establishes protective and preventive measures to safeguard women and family members from domestic and intimate partner violence.

Data Availability Statement

The authors have nothing to report.

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