Violence against persons with disabilities and assistive technology: A scoping review protocol
Creators: name: Guinness, Elizabeth Mc
Publisher: name: OSF Registries
Year: 2023
Subjects: subject: Psychiatry and Psychology
subject: Women's Health
subject: Public Health
subject: Medicine and Health Sciences
subject: Epidemiology
subject: Social and Behavioral Sciences
subject: Domestic and Intimate Partner Violence
subject: Sociology
subject: FOS: Sociology
subject: Assistive products
subject: Assistive technology
subject: Institutional violence
subject: Interpersonal violence
subject: Intimate partner violence
subject: Persons with disabilities
subject: Violence against persons with disability
subject: Violence against women

description: Persons with disabilities are estimated to be at higher risk of exposure to interpersonal violence, compared to the general population.(Hughes, Bellis et al. 2012, Jones, Bellis et al. 2012) Similarly, women with disabilities are estimated to experience interpersonal violence at higher rates than non-disabled women. Indeed, a bi-directional trend is apparent between intimate partner violence (IPV) victimisation and chronic and/or disability conditions, including neurocognitive conditions.(Galovski, Werner et al. 2021).(Kwako, Glass et al. 2011, Hunnicutt, Lundgren et al. 2017, Costello and Greenwald 2022, García-Cuéllar, Pastor-Moreno et al. 2022, Manoranjan, Scott et al. 2022) This infers that women with chronic illness and/or disabilities are more likely to experience IPV victimisation, and conversely, that women victimised by IPV are more likely to themselves develop chronic or disabling conditions.(Wuest, Merritt-Gray et al. 2008, Barrett, O'Day et al. 2009, Rees, Silove et al. 2011, Hasan, Muhaddes et al. 2014, Valentine, Akobirshoev and Mitra 2019) Furthermore, evidence suggests that women reporting chronic illness and/or disabilities face IPV of greater severity, (Howard, Trevillion et al. 2010, Chirwa, Jewkes et al. 2020) and are more likely to attempt suicide, than those who do not report chronic illness and/or disability.(Khalifeh, Oram et al. 2015) 

Traditional measurement of violence against women has failed to adequately capture the extent of violence against women with disabilities.(Meyer, Stöckl et al. 2022) For example, women with disabilities may be targeted by a broader range of perpetrators than captured in national surveys or occur in closed settings (such as institutions), to which researchers lack access.(Barnett 2020) Additionally, research protocols may not be adapted to the needs of women with disabilities. Violence against persons disabilities can also take on specific forms, particularly hospital-based or institutional settings, which instruments are often not equipped to capture.(Foley and Cummins 2018) As violence against persons with disabilities more broadly are evidenced to take on gendered, as well as other dimensions, this phenomenon necessitates analysis from a gendered lens.

Mechanisms of violence perpetration and victimisation against women with disabilities remain poorly understood. (Meyer, Stöckl et al. 2022) Existing evidence accounting for higher rates and greater severity of violence against women with disabilities points to abusive partner’s capacity to harness social isolation often encountered by persons with disabilities, to further controlling behaviours, and limit attempts at help-seeking. (Curry, Hassouneh-Phillips and Johnston-Silverberg 2001, Brownridge 2006, Hague, Thiara and Mullender 2010, Bonomi, Nichols et al. 2017). Lack of understanding of mechanisms is thought to contribute to failure of interventions formulated to prevent VAW with disability evaluated to date from showing effectiveness in reduction of incidence (Van Der Heijden 2014) (Mikton, Maguire and Shakespeare 2014). Despite facing elevated prevalence of violence, women with physical and/or cognitive disabilities are often intentionally excluded from trials of structured psychological interventions for survivors. Therefore, questions remain regarding the relevance of these interventions for women with disabilities. As such, an understanding of mechanisms involved in the perpetration and victimisation of women with disabilities, of various forms, is urgently required to shape areas for intervention, and tailor existing evidence-based psychological interventions for acceptance and appropriateness among women with disabilities.(Mikton, Maguire and Shakespeare 2014)

While gaps in the knowledge base pervade, several studies unpacking patterns of violence against disabled women and girls highlight the use of assistive technology (AT) in violence perpetration.(Milberger, Israel et al. 2003, Hassouneh-Phillips and McNeff 2004, Curry, Renker et al. 2009) AT is understood as an umbrella term for assistive products, and their related systems and services.(World-Health-Organization 2022) This may take the form of denial of use of assistive products, which can serve to isolate users, and/or act as a means of physical restraint for women and girls with disabilities. A prominent example of this relates to denial of access to prosthesis, i.e. by placing them out of reach, or placing of breaks on wheelchairs.(Sailas and Wahlbeck 2005, Raboch, Kalisová et al. 2010) A reviewing exploring measurement of violence against women with disabilities found that items referring to (mis)use of assistive products were included within seven out of eleven measures examining disability specific violence. (Meyer, Stöckl et al. 2022)However, the eleven studies including items on disability-specific violence, were out of a total of one hundred and seventy-four studies measuring violence against women with disabilities included in the review. Denial of use of assistive products is a manifestation of both forms of physical and psychological violence. If denial of assistive products serves to interfere with users’ economic opportunities, this also constitutes a form of economic violence. Indeed, violence against women using assistive technology may relate physical, sexual, emotional/psychological, and economic forms. However, little is known about how use of assistive products manifests in each of these forms of violence. 

A modest body of evidence has been built in the past decade surrounding violence facilitated by ICT, often referred to as technology-facilitated violence against women (TFVAW).(Henry, Flynn and Powell 2020, Kim and Ferraresso 2023, Bansal, Rezwan et al. 2024) Comparatively less focus has been placed either on assistive technology facilitated violence, or on how TFVAW is experienced specifically by women and girls with disabilities. For example, AT supported through ICT may also be used to track, surveille, for example through accessing histories associated with text to speech generating devices, braillers etc. or even impersonate users. Similarly, technology associated with aging in place, including use of smart homes, may be used to physically entrap women with disabilities or older women, and control social interactions. 

As with other forms of TFVAW, violence using assistive technology can be conceived of not as a distinct form of violence per se, but as a continuum.(Mitchell, Wood et al. 2022, Afrouz 2023) For many persons with disabilities, assistive products constitute extensions of the body and self. Therefore, unwanted touch, or interference with an assistive device may be experienced as an act of physical violence by its user. While campaigns such as #JustAskDon’tTouch aim to bring awareness to the issue of non-consensual touch of assistive products, synthesis of evidence is needed to understand the scope and dynamics of violence perpetration using these products. (Kavanagh)

This systematic review will be the first to synthesize quantitative, qualitative, and mixed-methods evidence surrounding use of assistive products as a mechanism of perpetration for IPV, alongside other forms of family violence, such as elder abuse, and other forms of interpersonal violence, such as non-partner sexual violence, violence from caregivers, and violence in institutional settings against persons with disabilities. 

Results will inform hypotheses on mechanistic pathways operating in dynamics of violence against persons, and particularly women, with disabilities, including as they relate to harnessing of assistive technology.(Josephine, Georgios et al. 2023) Consolidation of existing evidence, as well as generation of new data, is needed to ensure potential of assistive devices within violence perpetration are embedded in design, and/or addressed in service provision for AT. In doing so, areas of inquiry for future research in violence prevention will also be identified, toward enhanced equity in healthcare for women with disabilities. (Mikton, Maguire and Shakespeare 2014) This review may also elucidate how violence is differentially perpetrated based on forms of disability, including in relation to different forms of assistive products. This is important considering recent evidence that certain forms of disability are associated with higher prevalence of violence, and violence of greater severity. (Josephine, Georgios et al. 2023)

In addition, findings may support clinicians to tailor existing best-practice in clinical violence intervention, to suit the needs of women with disabilities who use assistive technologies, for example, by embedding assistive products within safety planning. This could be done for example by ensuring access to duplicate products where possible, and storing them in safe locations, as a contingency. 

Finally, findings may serve to strengthen current practice surrounding ethics and safety of inclusion of women with disabilities in research on both violence against women and AT. This may support researchers to feel more confident in inclusion of women with disabilities within trials of psychological interventions for violence survivors, or those testing design of AT. Inclusion of a lived experience synthesis/commentary will bolster relevance of findings and encourage mainstreaming of integration of lived experience within data synthesis in epidemiological research.(Beames, Kikas et al. 2021)

Preliminary searches with OVID, the Cochrane Database of Systematic Reviews, and Google Scholar were conducted and no current or underway systematic reviews or scoping reviews on the topic were identified. To the authors knowledge, this shall represent the first scoping review to systematically identify and synthesise evidence surrounding use of assistive products in violence victimisation. A scoping review is appropriate given the broad interest in the proposed subject matter and relative novelty/sparseness of the evidence-base, combined with the overarching aim to identify gaps within. (Munn, Peters et al. 2018)