The goal of this clinical trial is to learn if a photo-elicitation intervention called PEARL (Photo-experiencing and Reflective Listening) can promote healing engagement in survivors of interpersonal violence. It will also learn about the feasibility and acceptability of PEARL. The main questions it aims to answer are: Does PEARL reduce barriers to help-seeking for trauma? Does PEARL improve trauma coping self-efficacy? Does PEARL change post-trauma cognitions and readiness for recovery? Is PEARL feasible and acceptable to survivors of interpersonal violence? Researchers will compare people who receive PEARL immediately to people on a waitlist (who receive PEARL three months later) to see if PEARL improves healing engagement and help-seeking behaviors. Participants will: * Complete baseline surveys about their trauma history, mental health, healing, and help-seeking behaviors * Be randomly assigned to receive PEARL immediately or after a 3-month wait * Receive a photography-focusing prompt and create photos over two weeks (those in the immediate group or after the waiting period) * Participate in a reflective listening interview about their photos * Complete follow-up surveys immediately after the intervention and one month later * Participate in a one-month follow-up interview about their experience
This is a randomized waitlist control feasibility study of the PEARL (Photo-experiencing and Reflective Listening) intervention for women survivors of interpersonal violence. The study will enroll 40 participants recruited through local community organizations, interpersonal violence email listservs, and social media platforms. Randomization and Study Arms: Interested participants will complete an online baseline questionnaire through Qualtrics and be randomly assigned (1:1) to either: 1. Immediate Intervention Group (n=20): Receives PEARL within two weeks of enrollment 2. Waitlist Control Group (n=20): Receives a resource referral list (standard of care) and completes PEARL three months later Intervention Protocol: The PEARL intervention consists of two components: 1. Participants receive a photography-focusing prompt and have two weeks to create photographs 2. Participants complete a reflective listening interview about their photographs Assessment Schedule: * Baseline: Demographics, trauma history, and outcome measures * Post-intervention: Outcome measures completed immediately after the intervention (trauma coping self-efficacy, post trauma cognitions, healing) * One-month follow-up: Outcome measures and qualitative interview (trauma coping self-efficacy, post trauma cognitions, healing, help-seeking actions, depression, anxiety, PTSD). The waitlist control group completes an additional baseline survey three months after initial enrollment, which serves as their pre-intervention assessment. Data Analysis: Feasibility will be assessed through completion rates, and research assistant evaluations. Acceptability will be evaluated through participant surveys and follow-up interviews. Preliminary impact on healing engagement and help-seeking will be analyzed using descriptive statistics and nonparametric tests. Qualitative data from open-ended survey questions, research assistant evaluations, and follow-up interviews will undergo thematic analysis. Quantitative and qualitative findings will be integrated to provide a comprehensive understanding of PEARL's feasibility, acceptability, and potential impact. Community Engagement: The study incorporates feedback from Community Advisory Board (CAB) and Scientific Advisory Board (SAB) members throughout the research process. Purposive sampling strategies will be employed to achieve maximum diversity in participant age.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
40
PEARL is a two-component behavioral intervention designed to promote healing engagement among survivors of interpersonal violence. Participants receive a photography-focusing prompt and are given two weeks to create photographs that reflect their healing journey and experiences. After the two-week photography period, participants engage in a one-on-one reflective listening interview where they discuss the photographs they created and co-create a healing action plan based on these discussions. The interview provides a structured opportunity for participants to explore and articulate their healing process through photo-elicitation, allowing them to express their experiences visually and verbally. The intervention is delivered by trained research assistants with fidelity monitoring through audio recording and independent evaluation of a random sample of sessions.
Women in Transition
Philadelphia, Pennsylvania, United States
RECRUITINGPost-trauma Cognitions Inventory (PTCI)
The PTCI is a self-report measure used to assess posttraumatic cognitions. It is composed of three subscales: Negative Cognitions about the Self, Negative Cognitions about the World, and Self-Blame. Higher scores indicate more negative trauma-related cognitions. The minimum score one can receive is 33 and the maximum score is 231.
Time frame: Baseline, immediately post-intervention (approximately 2-4 weeks after baseline), and 1-month follow-up (approximately 6-8 weeks after baseline)
Trauma Coping Self-efficacy Scale
The Trauma Coping Self-efficacy Scale is a 7-item measure that covers trauma-related coping self-efficacy including: dealing with reminders of the event, dealing with emotions associated with the event, employing active coping strategies, and resuming normal functioning. Higher scores indicate greater confidence in ability to cope with trauma. The minimum score one can receive is 0 and the maximum score is 63.
Time frame: Baseline, immediately post-intervention (approximately 2-4 weeks after baseline), and 1-month follow-up (approximately 6-8 weeks after baseline)
Healing after Gender-based Violence Scale
This 18-item scale measures holistic healing after trauma. Items are rated on a 5-point Likert scale from 1 ('Not at all') to 5 ('To a great extent'). Respondents are asked to evaluate each statement in reference to their perceived lowest point and their current feelings. This measure captures holistic healing outcomes beyond symptom reduction. Higher scores indicate greater levels of healing.
Time frame: Baseline, immediately post-intervention (approximately 2-4 weeks after baseline), and 1-month follow-up (approximately 6-8 weeks after baseline)
PTSD Checklist for DSM-5 (PCL-5)
The PCL-5 is a 20-item self-report measure that assesses the presence and severity of PTSD symptoms according to DSM-5 criteria. Response options are on a 5-point Likert scale with anchors: 0 = not at all, 4 = extremely. Items assess intrusion symptoms, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. A total symptom severity score (range 0-80) can be obtained by summing the scores for each of the 20 items. A score of 33 is the current clinical cut-off for probable PTSD.
Time frame: Baseline and 1-month follow-up (approximately 6-8 weeks after baseline)
Patient Health Questionnaire-8 (PHQ-8)
The PHQ-8 is an eight-item, self-administered scale based on DSM-IV diagnostic criteria for major depression, identical to the PHQ-9 but without the suicide item. Each item is scored on a four-point scale with responses ranging from 0 (not at all) to 3 (nearly every day), assessing depression symptom frequency over the past two weeks. Total scores range from 0-24. A PHQ-8 score of 10 or more has been found to have 88% sensitivity and 88% specificity for diagnosis of major depression based on clinical interview. This measure captures depression as a healing outcome related to symptom reduction.
Time frame: Baseline and 1-month follow-up (approximately 6-8 weeks after baseline)
Generalized Anxiety Disorder-7 (GAD-7)
The GAD-7 is a 7-item self-report questionnaire for screening and measuring the severity of generalized anxiety disorder. Response options are identical to the PHQ-8, with items scored from 0 (not at all) to 3 (nearly every day), assessing anxiety symptom frequency over the past two weeks. Total scores range from 0 to 21, with scores of ≥5, ≥10, and ≥15 representing mild, moderate, and severe anxiety symptom levels, respectively. This measure captures anxiety as a healing outcome related to symptom reduction.
Time frame: Baseline and 1-month follow-up (approximately 6-8 weeks after baseline)
Trauma Recovery Actions Checklist (TRAC)
The TRAC is a 35-item checklist of recovery actions that participants are currently using, want to use, or do not want to use. The checklist provides a comprehensive assessment of various recovery strategies and actions. Subscales include: building positive emotions, sharing and connecting with others, reflecting and creating healing spaces, establishing security, and futuring (planning for the future). This measure captures the range of recovery actions participants are taking or considering to support their healing journey.
Time frame: Baseline and 1-month follow-up (approximately 6-8 weeks after baseline)
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