A-PATH: Adapting Psychological Advocacy Towards Healing for older women affected by domestic abuse

Domestic abuse (DA) affects many women over the age of 60 and has a profound effect on their well-being. Older women face distinct and often overlooked barriers to seeking help, such as ageist attitudes, stigma and assumptions that DA does not happen in later life. Older women are more likely to be financially dependent or live with the perpetrator, making it harder to access support and cope with the abuse. Psychological Advocacy Towards Healing (PATH) is a trauma-informed intervention delivered by DA practitioners that improves psychological outcomes in younger women. However, its effectiveness for older women remains unclear. In this programme of research, our aim is to adapt the PATH programme (A-PATH) to meet the unique needs of older women, and assess its feasibility and acceptability for a future large scale randomised controlled trial (RCT). We will address two key research questions: a) is it possible to adapt PATH in a way that is accessible to a diverse range of older women affected by DA to empower and support their wellbeing, and recovery? b) is it feasible and acceptable to deliver A-PATH in primary care, and community settings? Our mixed-methods programme of research will include three interlinked Work Streams, with a Lived Experience Advisory Panel (LEAP) contributing throughout. Work Stream 1: We will conduct two survivor-led focus groups (n = 16) with older women affected by DA to tailor the components of PATH to better meet the needs of older women. Practitioner focus groups (n = 10) will further inform the adaptation of PATH, help identify training needs, and enhance practitioners’ ability to recognise the needs of older women. Work Stream 2: Using individual interviews with survivors (n=10), and shadowing helpline phone calls (n=10) through our partner Hourglass, we will explore the barriers older women face in accessing support. We will work with frontline professionals and clinicians (n = 15) to identify and develop referral pathways, that improve visibility and accessibility of services for older women in both primary care and community settings. Work Stream 3: We will test the feasibility and acceptability of A-PATH in a pilot RCT (n = 76 women), by randomly allocating 38 women to DA advocacy and 38 to DA advocacy plus A-PATH. We will measure rates of recruitment, randomisation, retention, and participant engagement with the intervention. We will identify and administer measures which we think may be suitable as primary and secondary outcomes in a full trial at baseline, 4, 8, and 12 months. This will include: psychological distress, depression, and post-traumatic stress. We will assess the acceptability of collecting health-related quality of life data to inform a future economic evaluation and conduct interviews with older women and practitioners to explore lived experiences and contextual factors influencing outcomes. We will work closely with community providers to engage women affected by multiple inequalities and explore how these intersecting factors influence access to support services. Findings will be shared through a series of accessible reports tailored for diverse audiences, alongside a public engagement event to communicate key learning. If feasible, this study will provide the foundation for a future large scale RCT evaluating the effectiveness of the adapted PATH, generating much needed evidence to improve trauma-informed care and support for older women affected by DA.