Psychiatry · Medical Literature
Mapping ecological targets and outcome evaluations in arts-based interventions for women survivors of domestic violence: a scoping review.
Abstract
Domestic violence remains a major public health challenge with profound consequences for women survivors. Arts-based interventions are increasingly incorporated into community services as culturally responsive recovery approaches for marginalized populations; however, it remains unexamined whether quantitative evaluation frameworks adequately capture their broad intended outcomes. This scoping review mapped the literature on arts-based interventions for survivors, examining the ecological alignment-or potential evaluative tension-between stated objectives and quantitative evaluation metrics. Conducted following established scoping review methodology and reporting guidelines, systematic searches of Web of Science, Scopus, PubMed, and PsycINFO identified 12 eligible empirical studies. Data were charted using the Social Ecological Model across individual, interpersonal, and community levels. Findings revealed interventions were predominantly community-integrated, with objectives extending beyond psychological symptom reduction to encompass peer connection, cultural belonging, and collective healing. While individual-level recovery was evaluated using congruent psychological measures, broader interpersonal and community-oriented goals were less consistently represented. This revealed an evaluative tension, wherein relational and community outcomes were only partially reflected in formal quantitative assessments. Although arts-based interventions operate across multiple ecological levels, current evaluations remain disproportionately focused on individual psychological outcomes. Future research and policy initiatives may benefit from developing ecologically responsive measurement approaches that capture relational and community-level outcomes alongside clinical measures, thereby providing rigorous evidence to inform the funding, implementation, and evaluation of public health programs for women survivors of domestic violence.
Clinical relevance
Do quantitative evaluation frameworks adequately capture the full spectrum of ecological outcomes—spanning individual, interpersonal, and community levels—targeted by arts-based interventions designed for women survivors of domestic violence? __SNAPSHOT__ {"studyDesign":"Scoping review with evidence mapping using the Social Ecological Model (SEM) as an organizing framework; narrative synthesis following SWiM (Synthesis Without Meta-analysis) guidelines; meta-analysis deemed unfeasible due to methodological heterogeneity across included studies","setting":"International; community-based and shelter-based service settings represented in included primary studies; specific countries not reported in abstract","sampleSize":"n=12 eligible empirical studies identified from systematic searches of Web of Science, Scopus, PubMed, and PsycINFO","population":"Women survivors of domestic violence enrolled in arts-based intervention programs; specific demographic characteristics (age, ethnicity, geographic distribution) not reported in the abstract","intervention":"Arts-based interventions (modalities not individually specified in abstract) incorporated into community services as culturally responsive recovery approaches for marginalized populations","comparator":"Not applicable; this is a scoping review mapping the literature, not a comparative efficacy trial","primaryOutcome":"Ecological alignment—or evaluative tension—between explicitly stated intervention objectives and quantitative outcome evaluation metrics, organized across individual, interpersonal, and community levels of the Social Ecological Model","followUp":"Not reported (scoping review design; individual study follow-up durations not extracted in the abstract)","fundingSource":"Not reported"}
Key findings
The review identified 12 eligible empirical studies and mapped their intervention objectives and quantitative evaluation approaches across three ecological levels of the Social Ecological Model. Interventions were predominantly community-integrated, with objectives extending beyond individual psychological symptom reduction to encompass peer connection, cultural belonging, and collective healing. Five studies demonstrated 'Congruent' alignment: their quantitative metrics directly matched individual-level intervention foci, effectively capturing targeted clinical outcomes including PTSD, depression, anxiety, and compromised self-esteem. Three mixed-methods studies demonstrated 'Partially Congruent' alignment, wherein qualitative methods partially captured broader outcomes not measured quantitatively. The remaining studies (number not specified in the abstract or retrieved full-text excerpts) were classified as incongruent or otherwise misaligned. Qualitative themes across the included studies frequently reported peer support, community solidarity, identity reconstruction, and collective healing—spanning all three SEM levels—yet these broader ecological dimensions were rarely captured through dedicated quantitative outcome measures. No pooled effect sizes, p-values, confidence intervals, or NNT/NNH values are reportable; this is a descriptive scoping review without quantitative synthesis. All numerical alignment classifications are as reported by the authors; no values were independently calculated.
Practice implications
This scoping review establishes that arts-based interventions for domestic violence survivors are designed with multi-level ecological goals—including relational and community outcomes—but are primarily evaluated using individual-level psychological instruments (e.g., PTSD scales, depression inventories, self-esteem measures). The central finding is an 'evaluative tension': relational and community-level outcomes, which are core to many of these programs' stated objectives, are only partially or rarely reflected in formal quantitative assessments. The review does NOT establish the clinical efficacy or effectiveness of any specific arts-based intervention. It does not provide effect sizes, symptom reduction data, or comparative outcomes. Findings are applicable to the landscape of published empirical literature on this topic and should not be interpreted as evidence that arts-based interventions improve specific clinical outcomes. Populations not adequately represented include diverse subgroups (racial/ethnic, age-stratified, geographically diverse, LGBTQ+ survivors), as the breadth of 12 included studies limits generalizability. Clinicians and program planners should note this is a scoping review, not a systematic review or meta-analysis; its purpose is landscape mapping, not effect estimation. IMPORTANT: Only the abstract and partial full-text content were retrievable; additional nuance regarding study-level characteristics, individual intervention descriptions, and complete alignment classifications may be present in the full publication. __LIMITATIONS__ 1. Very small evidence base: only 12 empirical studies were eligible, substantially limiting the breadth and representativeness of conclusions. 2. Scoping review design cannot establish efficacy, causality, or comparative effectiveness of arts-based interventions. 3. Substantial methodological heterogeneity across included studies precluded meta-analysis, limiting quantitative synthesis. 4. Publication bias: studies with null or negative outcomes may be underrepresented in the literature. 5. Restriction to English-language databases may have excluded relevant international literature. 6. Individual study quality was not formally assessed or risk-of-bias appraised, as is standard in scoping reviews but limits interpretive confidence. 7. The Social Ecological Model, while providing an organizing framework, is applied post hoc to studies not necessarily designed around it, which may introduce interpretive subjectivity in alignment classification. 8. Funding sources of included primary studies and of this review itself are not reported, precluding assessment of potential sponsorship bias. 9. Specific arts modalities (e.g., visual art, music therapy, dance/movement, drama) are not differentiated in the abstract, obscuring potential modality-specific effects. 10. Only the abstract and partial full-text were accessible for this summary; complete findings, tabular data, and recommendations are drawn from the published article which should be consulted directly. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This scoping review of 12 empirical studies identifies a systematic evaluative tension in arts-based domestic violence interventions: while individual-level psychological outcomes are measured congruently, the interpersonal and community-level objectives that characterize most of these programs—peer support, cultural belonging, collective healing—are rarely captured by quantitative metrics. The review does not establish the efficacy of arts-based interventions but highlights a critical methodological gap: current evaluation frameworks are misaligned with the ecological scope of the programs being studied. Clinicians, program evaluators, and public health policymakers should advocate for the development of validated, ecologically responsive outcome measures that encompass relational and community-level constructs alongside standard clinical instruments.