Contextual Considerations for Implementing a Sustainable Church-Based Depression Intervention for Black Women Intimate Partner Violence Survivors

Background and Purpose: Black women intimate partner violence (IPV) survivors in the United States (US) experience a disproportionate burden of depression. Depression is the leading cause of disability in the US with women are twice as likely to suffer from it. Depression is particularly pernicious for Black women IPV survivors. The intersections of their race, class, and gender makes it more difficult for them to obtain immediate aid, leading to a more protracted course. The Black church is a well-known trusted pathway for providing a range of services. It may be a novel pathway for providing MH care to this underserved population of survivors. Fundamental to doing so is understanding the contextual factors that influence uptake.

Methods: Thirty in-depth, semi-structured interviews were conducted with women who have histories of IPV victimization (n=10), members of clergy (n=10), and mental health providers who deliver services to Black women IPV survivors (n=10). Purposive and snowball sampling methods were employed. Data was collected during one 60-75-minute interview. Interviews were conducted via Zoom. To avoid the risk of coercion, audio recordings commenced upon obtaining participants’ approval. The Integrated Sustainability Framework was used to understand the inner and outer contextual factors, along with characteristics of interventionist and intervention. Data collection occurred until saturation. Data was triangulated via demographic surveys, semi-structured interviews, and field notes. All eight techniques were employed to establish trustworthiness. Atlas.ti was utilized for data management.

Results: Findings suggest that survivors experiences with the Black church influence uptake. Survivors further noted they are willing to obtain MH care from lay providers within the Black church if the person is empathic and has lived experience with IPV victimization or are trauma informed. Participants agreed that discretion is fundamental to successful implementation and sustainability. Women noted the need to balance their proclivity for privacy with increasing access to care. Specifically, women noted they prefer to have the option of choosing between 1) a member of their church, or 2) a member of their community for MH care. Participants also agreed that the intervention should be brief, flexible and include psychoeducation about the dangers of IPV victimization.

Conclusions and Implications: To our knowledge, this is the first to employ the Integrated Sustainability Framework to understand the contextual factors that influence the implementation of a sustainable church-based depression intervention for Black women IPV survivors. Findings suggest that contextual factors related to women’s previous experiences with the Black church, as well as church leaders’ awareness and understanding of the intricacies of IPV victimization are correlated with uptake. Findings further suggest the need to educate members of clergy and lay leaders about the dangers IPV victimization. Importantly, women noted they are willing to obtain MH care from lay providers in the Black church who are trained to provide a trauma-informed, brief evidence-based intervention.