Gastrointestinal DiseasesGroup 5Leticia Bernal LeonDayd

Gastrointestinal Diseases
Group 5:
Leticia Bernal Leon
Daydig Rodriguez
Maria Rodriguez
Karina Silveira
Instructor:
Dr. Alain Llanes Rojas, DNP, APRN, FNP-BC
Miami Regional University
Diagnosis, Symptoms & Illness Management
MSN5600
Gastroesophageal Reflux
Gastroesophageal reflux that does not cause symptoms is known
as physiologic reflux. In nonerosive reflux disease (NERD),
individuals have symptoms of reflux disease but no visible or
minimal esophageal mucosal injury
Gastroesophageal reflux disease (GERD) is the reflux of acid
and pepsin or bile salts from the stomach to the esophagus that
causes esophagitis. The severity of the esophagitis depends on
the composition of the gastric contents and esophageal mucosa
exposure time.
Definition & Classification
Causes
GERD can be caused by abnormalities or alterations in
1. Lower esophageal sphincter function
2. Esophageal motility

3. Gastric motility or emptying
Esophageal function studies include the following:
Determination of the lower esophageal sphincter (LES) pressure
(manometry)
Graphic recording of esophageal swallowing waves, or
swallowing pattern (manometry)
Detection of reflux of gastric acid back into the esophagus (acid
reflux)
Detection of the ability of the esophagus to clear acid (acid
clearing)
An attempt to reproduce symptoms of heartburn (Bernstein test)
Risk Factors
Obesity
Hiatal hernia
Use of drugs or chemicals that relax the LES (anticholinergics,
nitrates, calcium channel blockers, nicotine)
Cigarette smoke.
Trigger Factors
Coughing
Vomiting
Straining at stool
Asthma
Chronic cough
Sinusitis.
Common Symptoms
Heartburn that occurs 30 to 60 minutes after meals and when the
patient bends over or lies down.
Regurgitation of sour or bitter gastric contents
Belching, and fullness of the stomach
Upper abdominal pain within 1 hour of eating.

Atypical Symptoms
chronic cough
asthma attacks
chronic laryngitis
sinusitis
discomfort during swallowing.
Noncardiac chest pain.
Dysphagia
Clinical manifestations are related to mucosal injury from acid
regurgitation and the frequency and duration of reflux events.
The symptoms worsen if the individual lies down or if
intraabdominal pressure increases because of coughing,
vomiting, or straining at stool.
Uncomplicated GERD that is responsive to first-line therapy
does not require an endoscopy.
Patients who do not respond to therapy and those with suspected
complications should undergo an endoscopic examination
Management & Evaluation
Differential diagnosis
Gastritis
Peptic ulcer
Gastric cancer
Cholelithiasis
Angina pectoris.
Diagnosis of GERD is based on the history and clinical
manifestations.
An upper endoscopy with biopsy is the standard diagnostic

procedure for GERD. It confirms the diagnosis and documents
the type and extent of tissue damage.
Esophageal endoscopy: shows hyperemia, edema, erosion, and
strictures. Esophagitis is divided into four grades, which are
determined endoscopically:
Grade 1 is defined by erythema of the distal esophagus.
Grade 2 consists of scattered erosions.
Grade 3 involves confluence of erosions involving less than
50% of the diameter of the esophagus.
Grade 4 involves confluence of erosions involving greater than
50% of the diameter.
Tissue biopsy: Dysplastic changes can be identified (Barrett
esophagus)
Impedance/pH monitoring measures the movement of stomach
contents upward into the esophagus and the acidity of the
refluxate.
H. pylori Test: it is detected using the urea breath test, this is
the most accurate method.
H. pylori–specific serum immunoglobulin G (IgG) and
immunoglobulin A (IgA) antibodies.
Measurement of H. pylori stool antigen levels.
Diagnosis
For most patients, empiric treatment is initiated based on the
severity of symptoms, history, and physical examination.
If H. pylori bacterium is present
Combination of antibiotics to kill the bacterium will be ordered
for two weeks
(amoxicillin, clarithromycin, metronidazole, tinidazole,
tetracycline and levofloxacin)
The antibiotics used will be determined by patient
characteristics and current antibiotic resistance rates.
Eliminating or reducing use of injurious drugs, alcohol
consumption and smoke cessation

Help the ulcer to heal with medication.
Proton pump inhibitors are the agents of choice for controlling
symptoms and healing esophagitis. These drugs require at least
30 minutes to take effect; they also can be taken before a meal
(omeprazole, lansoprazole, rabeprazole, esomeprazole and
pantoprazole)
Histamine H2-receptor antagonist to reduce acid production
(famotidine, cimetidine and nizatidine)
Antacids to neutralize stomach acid it can provide symptom
relief
Cytoprotective agents to protect the lining of GI Tract
(sucralfate and misoprostol)
Prokinetics to reduce reflux by increasing LES tone and
promoting peristalsis and gastric emptying.
(metoclopramide or bethanechol)
Treatment
Laparoscopic fundoplication is the most common surgical
intervention when medical treatment fails.
Nonpharmacological Treatment (Lifestyle Modification
Treatment)
Sit up for at least 1 hr after eating.
Elevate head of bed 6-8 in, using blocks.
Avoid straining, lifting, bending over, and wearing tight belts,
especially on a full stomach.
Avoid drugs that decrease lower esophageal sphincter pressure
such as theophylline, nitrates, calcium channel blockers, α-
adrenergic antagonists, β-agonists, and benzodiazepines.
Avoid anticholinergics and other drugs that decrease salivation;
avoid drugs that decrease peristalsis.
Avoid foods that decrease lower esophageal sphincter pressure
such as onions, garlic, mint, and alcohol.
Avoid foods that are esophageal irritants such as citrus, vinegar,
caffeine, chocolate, peppermint, red sauces, spicy and high-fat

foods, and large meals, as well as excessive fluid intake with
meals.
Cease smoking and alcohol use to reduce GI and esophageal
irritation.
Strive for a gradual, sustained loss of 2 lb per month if
overweight.
Most patients have very mild disease, although it is possible for
the patient to develop rare complications such as:
Active erosive esophagitis: Severe esophagitis causes mucosal
injury and inflammation with hyperemia, increased capillary
permeability, edema, tissue fragility, erosions, and ulcerations
Fibrosis and thickening may develop. Edema, fibrosis
(strictures), esophageal spasm, or decreased esophageal motility
may result in dysphagia with weight loss.
Esophageal adenocarcinoma: In all, 10% of patients with GERD
develop Barrett's esophagus, precancerous lesions (Barrett
esophagus) with progression to adenocarcinoma can be a long-
term consequence.
Complications
Gastritis
Definition
Gastritis is an inflammatory disorder of the gastric lining. This
injury to the mucus lined barrier that protect the stomach wall
allows digestive juices to damage the stomach. It can affect the
corpus, fundus or antrum, or the entire mucosa (pangastritis).
The most common Causes are:
Drugs and chemicals like Nonsteroidal anti-inflammatory drugs
(ibuprofen, naproxen, or indomethacin), aspirin,
chemotherapeutic agents, alcohol, and cigarette smoke
Helicobacter pylori infection–Shock and hypotension can
decrease mucosal blood flow contributing to acute gastritis.

Gastritis can be:
Acute: occur suddenly.
Chronic: appear slowly over the time and involves chronic
inflammation, mucus atrophy, and epithelial metaplasia that
progresses over years.
Classification
Gastritis
Gastritis
Chronic gastritis is usually classified as:
Type A, or immune (fundal) is the most rare and severe form of
gastritis and is associated with loss of T-cell tolerance and
development of autoantibodies against parietal cells or intrinsic
factor, or both. Pernicious anemia can develop from decreased
vitamin B12 absorption and is a risk factor for gastric
carcinoma
Type B, nonimmune (antral) associated with H. pylori that may
trigger the immune response. Chronic use of alcohol, tobacco,
and nonsteroidal anti-inflammatory drugs are contributing
factors. H. pylori can also progress to autoimmune atrophic
gastritis and involve the fundus, thus becoming pangastritis
Type AB, or pangastritis (types of chronic gastritis occur and
the antrum is more severely involved.
Type C, is associated with reflux of bile and pancreatic
secretions into the stomach, causing chemical injury.
Gastritis
Symptoms can usually be managed with consumption of smaller
meals, and including a soft, bland diet.

Burning ache in upper abdomen
Nausea
Vomiting
Anorexia
Feeling of fullness in upper stomach after eating
Epigastric tenderness
bleeding
Symptoms
Gastritis
Doctor may first take a medical history and perform a physical
exam, then diagnostic tests will be ordered, such as:
Laboratory tests for H. pylori.
H. pylori is detected using the urea breath test, this is the most
accurate method.
Measurement of H. pylori stool antigen levels.
Endoscopy. An endoscopy with biopsy is the standard
diagnostic procedure. It confirms the diagnosis and documents
the type and extent of tissue damage.
Upper gastrointestinal series (barium swallow): creates images
of your esophagus, stomach, and small intestine. During the X-
ray, you swallow a white liquid (containing barium) that coats
your digestive tract and makes an ulcer more visible.
Diagnosis
Differential Diagnosis
GERD
PUD
Cholecystitis
Pancreatitis
Diverticulosis
IBS

Usually, treatment will involve killing the H. pylori bacterium
if it is present:
Combination of antibiotics to kill the bacterium will be ordered
for two weeks
consumption and smoke cessation.
Proton pump inhibitor to block acid production and promote
healing.
pantoprazole)
relief
Gastritis
Treatment
In some cases, gastritis can lead to :
Peptic Ulcers Disease
GI bleedings inducing iron deficiency anemia
Pernicious anemia can develop because intrinsic factor is less
available to facilitate vitamin B12 absorption. Gastric secretion
analysis confirms achlorhydria and loss of intrinsic factor
Gastritis
Complications

Peptic Ulcer Disease
Definition
Your digestive tract is coated with a mucous layer that normally
protects against acid. But if the amount of acid is increased or
the amount of mucus is decreased, you could develop an ulcer.
Peptic ulcers are open sores that develop on the inside lining of
the lower esophagus, stomach, or upper portion of the small
intestine.
The most common Causes are
infection with the Bacterium H. Pylori
habitual use of aspirin and NSAIDs
secondary to some diseases and certain lifestyles
Excessive use of alcohol, smoking, obesity
Gastritis, acute pancreatitis, COPD, Cirrhosis
Genetic predisposition
Age greater than 65 years and socioeconomic status.
Psychologic stress but the exact mechanism of causation is not
known
Risk factors include
Peptic ulcers can be
Single or multiple,
Acute or chronic,
Superficial or deep.
Superficial ulcerations are called erosions because they erode
the mucosa but do not penetrate the muscularis mucosae.
True ulcers extend through the muscularis mucosae and damage
blood vessels, causing hemorrhage or perforating the
gastrointestinal wall.

Gastric or duodenal
Gastric Ulcer: that occur on the inside of the stomach – typical
“food-pain “pattern
Duodenal Ulcer: that occur on the inside of the upper portion of
the small intestine (duodenum)-- typical “pain-food-relief”
pattern.
Classification
Burning stomach pain
Feeling of fullness, bloating, or belching
Intolerance to fatty foods
Heartburn
Anorexia, nausea and vomiting
Dark blood in stools, or stools that are black or tarry (melena)
Trouble breathing
Feeling faint
Unexplained weight loss
Symptoms
CHARACTERISTICSGASTRIC ULCERDUODENAL
ULCERIncidenceAge at onset50–70 years20–50 yearsFamily
historyUsually negativePositive Sex (prevalence)Equal in
women and menEqual in women and menStress
factorsIncreasedAverageUlcerogenic drugsNormal useIncreased
useCancer riskIncreasedNot
increasedPathophysiologyHelicobacter pylori infectionOften
present (60%–80%)Often present (95%–100%)Abnormal
mucusMay be presentMay be presentParietal cell massNormal or
decreasedIncreasedAcid productionNormal or
decreasedIncreasedSerum gastrinIncreasedNormalSerum
pepsinogenNormalIncreasedAssociated gastritisMore
commonUsually not presentClinical Manifesta tionsPainLocated
in upper abdomenLocated in upper
abdomenIntermittentIntermittentPain-antacid-relief patternPain-

antacid or food-relief patternFood-pain patternNocturnal pain
commonClinical courseChronic ulcer without pattern of
remission and exacerbationPattern of remissions and
exacerbations for years
Table 1. Characteristics of Gastric and Duodenal Ulcers
To detect an ulcer, doctor may first take a medical history and
perform a physical exam. Then diagnostic tests will be ordered,
such as:
Laboratory tests for H. pylori.
H. pylori is detected using the urea breath test, this is the most
accurate method.
Measurement of H. pylori stool antigen levels
Diagnosis
Endoscopy. An endoscopy with biopsy is the standard
diagnostic procedure for PUD. It confirms the diagnosis and
documents the type and extent of tissue damage.
Upper gastrointestinal series (barium swallow): creates images
of your esophagus, stomach, and small intestine. During the X-
ray, you swallow a white liquid (containing barium) that coats
your digestive tract and makes an ulcer more visible.
GERD
Gastritis
Nonulcer Dyspepsia
Cholecystitis
Pancreatitis
Diverticulosis

IBS
Differential Diagnosis
Treatment for peptic ulcers depends on the cause.
If Patient is positive for H. pylori an antibiotic combination
therapy is ordered for two weeks
consumption and smoke cessation
Proton pump inhibitor to block acid production and promote
healing
pantoprazole)
relief
Surgery
The primary objectives are to reduce stimuli for acid secretion,
decrease the number of acid-secreting cells in the stomach, and
correct complications of ulcer disease.
Treatment
Bleeding. Bleeding can occur as slow blood loss that leads to
anemia or as severe blood loss that may require hospitalization
or a blood transfusion. Severe blood loss may cause black or

bloody vomit or black or bloody stools (hematemesis or melena)
Perforation. Peptic ulcers can eat a hole through (perforate) the
wall of your stomach or small intestine, putting you at risk of
serious infection of your abdominal cavity (peritonitis).
Obstruction. Peptic ulcers can block passage of food through
the digestive tract, causing you to become full easily, to vomit
and to lose weight either through swelling from inflammation or
through scarring.
Gastric cancer. Studies have shown that people infected with H.
pylori have an increased risk of gastric cancer.
Complications
Protect yourself from infections: You can take steps to protect
yourself from infections, such as H. pylori, by frequently
washing your hands with soap and water and by eating foods
that have been cooked completely.
Use caution with pain relievers drugs: for instance, take
medication with meals and find the lowest dose possible that
still gives you pain relief. If you need an NSAID, you may need
to also take additional medications such as an antacid, a proton
pump inhibitor, or acid blocker
Prevention
Cirrhosis
Is an irreversible inflammatory, fibrotic liver disease. Structural
changes result from injury (alcoholism, viruses (hepatitis),
steatosis, chemicals) and fibrosis. The liver may be larger or
smaller than normal and is usually firm or hard when palpated.
Cirrhosis develops slowly over a period of years. Its severity
and rate of progression depend on the cause.
Hepatitis virus B and C

Excessive alcohol intake
Idiopathic
Nonalcoholic fatty liver disease (NAFLD), also known as
nonalcoholic steatohepatitis (NASH)
Autoimmune disorders
Hereditary metabolic disorder
Prolonged exposure to chemicals
Right-sided heart failure
Definition
Causes
Earliest symptoms pruritus, weight loss, fatigue, weakness,
malaise, dark urine, pale stool.
Advanced Symptoms anorexia, nausea, vomiting, hematemesis,
abdominal pain, chest pain, menstrual abnormalities , impotence,
sterility, neuropsychiatric symptoms (difficulty concentrating,
irritability, and confusion)
Late-stage: Jaundice
Cirrhosis
Signs and Symptoms:
Complications
Jaundice, portal hypertension, ascites, hepatic encephalopathy,
varices with gastrointestinal bleeding, hepatorenal syndrome,
hepatopulmonary syndrome, and portopulmonary syndrome.
Cirrhosis
Diagnostic
The diagnosis is based on the individual's history and clinical
manifestations.
The results of liver function tests are abnormal, and serologic
studies show elevated levels of serum enzymes (i.e., alanine

aminotransferase (ALT), aspartate aminotransferase (AST), and
γ-glutamyltransferase) and bilirubin, and decreased serum
albumin levels.
Prolonged prothrombin time cannot easily be corrected with
vitamin K therapy. Malnutrition is often present.
Liver biopsy can confirm the diagnosis of cirrhosis, but biopsy
is not necessary if clinical manifestations of cirrhosis are
evident.
US, CT scan, MRE
Treatment
There is no specific treatment, but many of the complications
are treatable. Rest, nutritious diet, corticosteroids, antioxidants,
drugs that slow fibrosis, and management of complications such
as ascites, gastrointestinal bleeding, anemia, infection, and
encephalopathy slow disease progression. Liver transplant is the
treatment for liver failure, and artificial liver support systems
are being developed.
Cirrhosis
Management
Immunizations (Pneumococcal, influenza, Hepatitis A and B)
Ascites (Paracentesis, sodium restriction of 1 to 2 g/day,
Spironolactone, Furosemide, Monitor electrolytes, BUN, and
creatinine level. The serum-ascites albumin gradient (SAAG)
paracentesis to remove 1 or 2 L of ascitic fluid and relieve
respiratory distress.
Encephalopathy (Lactulose is useful for reducing urea
production in the colon, thus lowering blood ammonia levels in
patients with portal systemic encephalopathy d/d cirrhosis.
Rifaximin decreases intestinal production of ammonia and is
used for lactulose non responders.
Jaundice (total plasma bilirubin concentrations greater than 2.5
to 3 mg/dL). The treatment for jaundice consists of correcting
the cause). Refractory edema (thiazide, loop diuretic and
sodium restriction)

Cessation of alcohol consumption slows the progression of liver
damage, improves clinical symptoms, and prolongs life.
Cirrhosis
Primary biliary cirrhosis
Secondary biliary cirrhosis
Hepatocellular carcinoma
Hemochromatosis
NASH
Primary sclerosing cholangitis
Parasitic infection (e.g., Schistosoma mansoni)
Differential Diagnoses
Cholelithiasis (Gallstones) and Cholecystitis
Gallstone formation is termed cholelithiasis. Inflammation of
the gallbladder or cystic duct is known as cholecystitis.
Definition
is Inflammatory or infectious conditions causing gallstone
formation and bile duct obstruction. Stone formation in the
gallbladder occurs when certain substances reach a high
concentration in bile and produce crystals.
Gallstones are formed from impaired metabolism of cholesterol,
bilirubin, and bile acids. All gallstones contain cholesterol,
unconjugated bilirubin, bilirubin calcium salts, fatty acids,
calcium carbonates and phosphates, and mucin glycoproteins.
Gallstones are of three types depending on chemical
composition: cholesterol (70% cholesterol and the most
common [70% to 80% of gallstones]); pigmented (black [hard]
and brown [soft] with less than 30% cholesterol); and mixed.
Risk factors

Obesity; rapid weight loss in obese individuals; middle age;
female sex; use of oral contraceptives; Native American
ancestry; genetic predisposition; gallbladder, pancreatic, or ileal
disease; low high density lipoprotein (HDL) cholesterol level
and hypertriglyceridemia; and gene-environmental interactions.
Clinical Manifestations
Heartburn, flatulence, epigastric discomfort, pruritus, jaundice,
and food intolerances, particularly to fats and cabbage. The pain
(biliary colic) is most characteristic, occurs 30 minutes to
several hours after eating a fatty meal, and is caused by the
lodging of one or more gallstones in the cystic or common duct
with obstruction and distention. It can be intermittent or steady
and usually is located in the right upper quadrant and radiates to
the mid-upper back. Jaundice indicates that the stone is located
in the common bile duct. Abdominal tenderness and fever
indicate cholecystitis.
Complications
Can include pancreatitis from obstruction of the pancreatic duct.
Diagnosis
Is based on the medical history, physical examination, and
imaging evaluation. Imaging techniques include transabdominal
ultrasound, endoscopic ultrasound, and magnetic resonance
cholangiopancreatography.
Evaluation and Treatment: Cholelithiasis
Oral bile acids (ursodeoxycholic acid or chenodeoxycholic acid)
may dissolve cholesterol stones, but the stones may recur when
the drug is discontinued.
Laparoscopic cholecystectomy is the preferred treatment for
gallstones that cause obstruction or inflammation. Use of
transluminal endoscopic surgery is advancing rapidly.

Endoscopic retrograde cholangiopancreatography and
sphincterotomy with stone retrieval are used for the treatment of
bile duct stones. Large stones, or intrahepatic stones, may be
managed with open surgery or lithotripsy.
Ursodiol
Gallstone dissolution: 8 to 10 mg/kg/day in two or three divided
doses
Gallstone prevention: 300 mg 1 tablet PO BID
Patients with stones larger than 2 mm, acute condition in the
abdomen, known sensitivity to the drug, acute pancreatic
gallstones, or acute cholecystitis are not candidates for the
drug.
Milk Thistle: has been shown to protect the liver after exposure
to hepatotoxins such as acetaminophen, ethanol, and halothane,
and to restore liver function in patients with hepatitis and
cirrhosis
Treatment more specific for Cholecystitis
Treatment includes pain control, replacement of fluid and
electrolytes, and fasting. Antibiotics (penicillin and
aminoglycoside) are often prescribed to manage bacterial
infection in severe cases. Acute attacks usually require
laparoscopic gallbladder resection (cholecystectomy).
Obstruction also may lead to reflux of bile into the pancreatic
duct, causing acute pancreatitis.
CBC with differential
UA
LFTs
Serum pancreatic enzymes
Serum electrolyte values
BUN and creatinine

Blood cultures
hCGs
Electrocardiography
Ultrasound
CT scan with contrast
Diagnostics
Bowel obstruction
Chronic cholecystitis
Diverticulitis
Gastroenteritis
Irritable bowel syndrome
Pancreatitis
Renal colic
Appendicitis
Differential Diagnostics
Ulcerative colitis
Is a chronic inflammatory disease that causes ulceration of the
colonic mucosa, in the inner lining of Colon and rectum.
Those ulcers produce pus and mucous, which cause abdominal
pain and the need to frequently empty your colon.
Definition
Causes of Ulcerative Colitis
Abnormal immune response
Genetics
Environmental factors (Diet, stress, viral/bacterial infection,
NSAID use)
Ulcerative Colitis
Frequent bloody diarrhea with passage of purulent mucus
Abdominal cramps and pain
Persistent diarrhea accompanied by abdominal pain and blood in
the stool

Fever
Elevated heart rate
Urgent bowel movements
Bloody stools
Dehydration
Weight loss
Anemia
Ulcerative colitis
Signs and Symptoms
Types of Ulcerative Colitis
Ulcerative colitis
Ulcerative Proctitis
Bowel inflammation limited to less than six inches of the
rectum
Symptoms
Rectal bleeding
Rectal pain
Urgency in your bowel movements
Left-Sided Colitis
Continuous inflammation begins at the rectum and extends as
far into the colon as the splenic flexure
It also includes proctosigmoiditis, which affects rectum and
the sigmoid colon.
Symptoms
Loss of appetite
Weight loss
Bloody diarrhea
Pain on the left side of the abdomen
Ulcerative colitis

Extensive Colitis
Affects the entire colon.
Continuous inflammation begins at the rectum and extends
beyond the splenic flexure.
Symptoms
Loss of appetite
Bloody diarrhea
Abdominal pain
Weight loss
Diagnostic test
Colonoscopy
Barium enema
X-ray, CT scan
Blood test: It shows low hemoglobin values, hypoalbuminemia,
and low serum potassium levels.
Stool studies: White blood cells or certain proteins in your stool
can indicate ulcerative colitis
Ulcerative colitis
Rupture of bowel
Toxic Megacolon
Weigh loss, dehydration
Anemia
Loss of form of haustra (“lead-pipe sign”)
Complications
Crohn Disease
Infectious colitis
Chronic schistosomiasis
Amebiasis
Intestinal tuberculosis
Infectious, ischemic, or radiation colitis
Acute self-limiting colitis (ASLC)
Colon cancer

Ulcerative colitis
Treatment
Anti-inflammatory drugs:
Aminosalicylates:5-aminosalicylic acid (5-ASA)First line
ttx Sulfasalazine (Others: Mesalamine, Balsalazide, Olsalazine)
Corticosteroids: (Prednisone, Budesonide, Hydrocortisone,
Methylprednisolone)
Immunosuppressors/modulators: To reduce immune system
activity when other drugs don’t work/off steroids. Take several
weeks to 3 months to start working.
Immunosuppressors(azathioprine, cyclosporine, methotrexate)
Immunomodulators: Target proteins made by the immune
system. Neutralizing these proteins decreases inflammation in
the intestines. (Adalimumab, Infliximab, etc)
Treatment UC
Antibiotic, antidiarrheal, tylenol (NO NSAIDS)
Severe cases: Surgery
Proctocolectomy: removal of colon and rectum, patient will
have permanent ileostomy
or
Ileorectal anastomosis:Colon and rectum removal, and pouch
created that attaches to ileum which allows stool to pass from
small intestine to anus.
Crohn Disease
Signs and Symptoms
Right lower quadrant intermittent abdominal pain.
Ulcers (mouth and GI tract)
Lower abdominal pain 1 hour after eating.
Diarrhea (may have pus, blood, or mucus).
Fever
Fissure (anal that bleeds)
Bloating

Weight loss.
Abnormal liquid stools.
Types of Crohn Disease
Ileocolitis: Inflammation in the ileum and colon, is the most
common type of Crohn’s disease.
Ileitis: Inflammation in the small intestine (ileum).
Gastroduodenal: Inflammation affect the stomach and the
duodenum’
Jejunoileitis: Patchy areas of inflammation develop in jejunum).
Crohn Disease
Diagnostic test
Complications
Colonoscopy
Barium Enema (BE, Lower GI Series)
CT scan
Small bowel series or a capsule endoscopy (camera pill)
Anti–Glycan Antibodies (Crohn Disease Prognostic Panel)
Intestinal obstruction.
Fistulas.
Abscesses.
Anal fissures.
Ulcers.
Malnutrition.
Sepsis
Amebiasis
Appendicitis
Bacterial Gastroenteritis
Diverticulitis
Giardiasis
Irritable Bowel Syndrome
Ulcerative Colitis
Viral Gastroenteritis

Crohn Disease
Treatment
Anti-inflammatory drugs:
Aminosalicylates:5-aminosalicylic acid (5-ASA)First line
ttx Sulfasalazine (Others: Mesalamine, Balsalazide, Olsalazine)
Corticosteroids: (Prednisone, Budesonide, Hydrocortisone,
Methylprednisolone)
Immunosuppressors/modulators: To reduce immune system
activity when other drugs don’t work/off steroids. Take several
weeks to 3 months to start working
Immunosuppressors(azathioprine, cyclosporine, methotrexate)
Immunomodulators: Target proteins made by the immune
system. Neutralizing these proteins decreases inflammation in
the intestines. (Adalimumab, Infliximab, etc)
Acetaminophen for mild pain
Antibiotics to prevent or treat complications that involve
infection, such as abscesses and fistulas.
Loperamide: severe diarrhea.
Surgery is generally performed to manage complications
Crohn Disease
Non-pharmacological intervention
Avoid carbonated drinks, popcorn, vegetable skins, nuts, and
other high-fiber foods, lactose
Drink more fluids
Eat smaller meals more often
Keep a food diary to help identify foods that cause problems
High calorie, low fat, low fiber, and low salt diet
Crohn Disease
Differences
Ulcerative Colitis

Only the colon and rectum (large intestine) are affected
Affects the inner-most lining of the large intestine (submucosa
to mucosa)
Cure is surgery
Continuous lesions
Crohn Disease
Can affect any part of the GI tract from the mouth to the anus
Can affect the entire lining of the intestinal wall to serosa
No cure, surgery helps with quality of life
Skip lesions
Definition
Disorder of brain-gut interaction characterized by abdominal
pain with altered bowel habits.
Causes
Still unknown but some factors can lead to IBS like:
Dysmotility: Problems with how your GI muscles contract and
move food through the GI tract.
Visceral hypersensitivity: Extra-sensitive nerves in the GI tract.
Brain-gut dysfunction: Miscommunication between nerves in
the brain and gut.
Factors associate
Stressful or difficult early life events.
Depression/anxiety
Alcohol consumption/smoking
Signs and Symptoms
Abdominal pain or cramps, usually in the lower half of the
abdomen.
Bloating.
Bowel movements that are harder or looser than usual.
Diarrhea, constipation or alternating between the two.

Excess gas.
Mucus in the stool(may look whitish).
Types of IBS
Celiac disease
Lactose intolerance
Ulcerative Colitis.
Microscopic Colitis.
Rome IV Criteria: Recurrent abdominal pain, on average, at
least 1 day per week in the last 3 months, associated with two or
more of the following criteria:
1. Related to defecation
2. Associated with a change in frequency of stool
3. Associated with a change in form (appearance) of stool
CBC
C-reactive protein
Fecal calprotectin
Colonoscopy, X-ray, CT scan
Stool test
Lactose intolerant test
Crohn's Disease.
Stress.
Diverticulitis.
Gallstones.
Treatment

Pharmacotherapy is based on severity and is targeted at specific
symptoms.
All patients with alternating constipation/diarrhea:
Increased dietary fiber (25 g/day)
Pain
Antispasmodic (anticholinergic) medication—short term
TCAs—long term
Diarrhea
Loperamide—short term; often used for breakthrough diarrhea
Antidepressants (TCAs)—long term
Alosetron (ordered by GI specialists) if resistant to all other
interventions
Constipation
Fiber
Laxatives
Non-pharmacologic Treatment
Dietary changes:
Fluids should not be taken with foods
Increase fiber in the diet (fruits, vegetables, grains and nuts).
Drink plenty of water
Avoid : caffeine, chocolate, teas and sodas.
Limit cheese and milk.
Make sure to get calcium from other sources, such as broccoli,
spinach, salmon or supplements.
symptoms.
Activity changes:
Exercise regularly.
Don’t smoke.
Try relaxation techniques.
Eat smaller meals more often.
Food diary to know which foods trigger flare-ups. Common
triggers are red peppers, green onions, red wine, wheat and
cow’s milk.

Behavioral and psychological therapies, stress management, and
meditation.
Cancer of the Digestive System
Esophagus : (2.6 percentage of deaths)
Stomach: (1.8 percentage of deaths)
Colorectal: (8.25 percentage of death)
Cancer of the tube that runs from the throat to the stomach
(esophagus).
Definition
The most common cells are Squamous cells and
Adenocarcinoma. Chronic inflammation, intestinal metaplasia,
and dysplasia (Barrett esophagus [columnar rather than
squamous epithelium in the lower esophagus]) induced by
gastroesophageal reflux accelerates the formation of esophageal
adenocarcinoma. Both adenocarcinoma and squamous cell
carcinoma develop neoplastic transformation after long-term
exposure to environmental irritants (basal and squamous cell
hyperplasia).
Pathogenesis
Esophageal Cancer
Causes
Factors that can increase your risk of esophageal cancer
include:
Smoking
Heavy alcohol consumption
Chronic heartburn or acid reflux
Gastroesophageal reflux disease (GERD)
Malnutrition
Barrett’s esophagus, a condition that sometimes develops in
people with GERD

Achalasia, a rare disorder of muscles in the lower esophagus
Not eating enough fruit and vegetables
Undergoing radiation treatment to the chest or upper abdomen
Signs and symptoms
Difficulty swallowing (dysphagia)
Weight loss without trying.
Chest pain, pressure or burning.
Worsening indigestion or heartburn.
Coughing or hoarseness.
Esophageal Cancer
Diagnostic Tests
Barium swallow test. If you're having trouble swallowing,
sometimes a barium swallow is the first test done.
Computed tomography (CT) scan.
Magnetic resonance imaging (MRI) scan.
Positron emission tomography (PET) scan.
Upper endoscopy.
Endoscopic ultrasound.
Bronchoscopy.
Thoracoscopy and laparoscopy.
Treatment
Treatment of gastroesophageal reflux is essential for the
prevention of Barrett esophagus.
Esophageal carcinoma is treated with endoscopic
radiofrequency mucosal ablation.
Radiation therapy: The use of X-rays, gamma rays and charged
particles to fight cancer
Chemotherapy: The use of anticancer drugs to treat cancerous
cells
Surgery: The use of an operation to remove the cancerous tissue
from the body.
Combination of therapies.
Esophageal Cancer

Esophageal Cancer
Obstruction of the esophagus. Cancer may make it difficult for
food and liquid to pass through your esophagus.
Pain. Advanced esophageal cancer can cause pain.
Bleeding in the esophagus. Esophageal cancer can cause
bleeding. Though bleeding is usually gradual, it can be sudden
and severe at times.
Complications
Prevention
You can take steps to reduce your risk of esophageal cancer.
For instance:
Quit smoking. If you smoke, talk to your doctor about strategies
for quitting. Medications and counseling are available to help
you quit. If you don't use tobacco, don't start.
Drink alcohol in moderation, if at all. If you choose to drink
alcohol, do so in moderation. For healthy adults, that means up
to one drink a day for women and up to two drinks a day for
men.
Eat more fruits and vegetables. Add a variety of colorful fruits
and vegetables to your diet.
Maintain a healthy weight. If you are overweight or obese, talk
to your doctor about strategies to help you lose weight. Aim for
a slow and steady weight loss of 1 or 2 pounds a week.
Cancer that occurs in the stomach.
Definition
Pathogenesis
Environmental factors and genetic predisposition combine to
cause injury, inflammation, and the progression to gastric
adenocarcinoma. About 1% to 3% of gastric cancers are
familial. Gastric adenocarcinoma usually begins in the glands of
the stomach mucosa, commonly in the prepyloric antrum.
Atrophic gastritis progresses to intestinal metaplasia, dysplasia,
and adenocarcinoma.

Stomach Cancer
Causes
Signs and symptoms
Infection with H. pylori that carry selected virulence factors. H.
pylori is causatively linked to mucosa- associated lymphoid
tissue (MALT) lymphoma (a low-grade B-cell lymphoma) that
can originate in the stomach.
Dietary factors, such as salt added to food, food additives in
pickled or salted foods and low intake of fruits and vegetables.
Dietary salt enhances the conversion of nitrates to carcinogenic
nitrosamines in the stomach. Salt is also caustic to the stomach
and can cause chronic atrophic gastritis.
Lifestyle factors, such as alcohol consumption and cigarette
smoking. Smokers have a higher incidence of H. pylori
infection.
The early stages of gastric cancer are generally asymptomatic or
produce vague symptoms such as loss of appetite (especially for
meat), malaise, and indigestion.
Later manifestations include unexplained weight loss, upper
abdominal pain, vomiting, change in bowel habits, and anemia
caused by persistent occult bleeding.
Stomach Cancer
Stomach Cancer
Diagnostic Tests
Treatment
Barium x-ray film shows the lesion.
Direct endoscopic visualization (microscopic examination of
exfoliated cells obtained by lavage during endoscopy).
Biopsy usually establish the diagnosis.
Surgery is the only curative treatment for early stages of
disease.
Screening and eradication of H. pylori infection are the best

preventive approaches to gastric cancer.
Early diagnosis and chemotherapy combined with radiation
improve post-surgical outcomes.
Abstinence from alcohol and smoking improves outcomes.
Dietary modifications include high intake of fruits and
vegetables, vitamin C, carotenoids, and fiber and reduced intake
of salt, salted food, and red meat.
Small Intestine Cancer
Definition
Small intestine carcinoma is rare and represents less than 3% of
gastrointestinal cancers. The most prevalent tumor type is
adenocarcinoma, which is followed by carcinoid tumors
(neuroendocrine serotonin-producing tumors), sarcomas, and
lymphomas (neuroendocrine serotonin-producing tumors).
Carcinoma is more common in people who have familial
adenomatous polyposis or Crohn's disease.
Abdominal pain
Yellowing of the skin and the whites of the eyes (jaundice)
Feeling unusually weak or tired
Nausea/Vomiting
Losing weight without trying
Blood in the stool, which might appear red or black
Watery diarrhea
Skin flushing
Signs and symptoms
Risk factors
Gene mutations passed through families. Some gene mutations
that are inherited from your parents can increase your risk of
small bowel cancer and other cancers.
Other bowel diseases. Other diseases and conditions may
increase the risk of small bowel cancer, including Crohn's

disease, inflammatory bowel disease and celiac disease.
Weakened immune system. If your body's germ-fighting
immune system is weakened.
Diagnosis
CT
MRI
Positron emission tomography (PET)
X-rays of the upper digestive system and small bowel after
drinking a solution containing barium (upper gastrointestinal
series with small bowel follow-through)
Nuclear medicine scans, which use a small amount of
radioactive tracer to enhance imaging tests
Endoscopic tests involve placing a camera inside your small
intestine so that your doctor can examine the inside walls.
Endoscopic tests may include:
Surgical resection followed by tumor types specific treatment.
Surgery can involve one large incision in your abdomen
(laparotomy), or several small incisions (laparoscopy).
Chemotherapy. Chemotherapy uses powerful drugs to kill
cancer cells.
Targeted drug therapy. Targeted drug treatments focus on
specific weaknesses present within cancer cells.
Immunotherapy. Immunotherapy is a drug treatment that helps
your immune system to fight cancer.
Treatment
It's not clear what may help to reduce the risk of small bowel
cancer, since it's very uncommon.
Eat a variety of fruits, vegetables and whole grains.
Drink alcohol in moderation
Stop smoking.
Exercise most days of the week at 30 min.

Maintain a healthy weight.
Complications
Prevention
An increased risk of other cancers. People who have small
bowel cancer run a higher risk of having other types of cancers
Cancer that spreads to other parts of the body.
Colon and Rectum Cancer
A cancer of the colon or rectum, located at the digestive tract's
lower end. Is the third most common cause of cancer and cancer
death.
Stage 0 (carcinoma in situ): involves only the mucosal lining.
Stage I: Extension of cancer to the middle layers of the colon
wall, no spread to lymph nodes.
Stage II: Extension beyond the colon wall to nearby tissues
around the colon or rectum, and through the peritoneum.
Stage III: Spread beyond the colon into lymph nodes and nearby
organs and through the peritoneum.
Stage IV: Spread to nearby lymph nodes and has spread to other
parts of the body, such as the liver or lungs.
Definition
Risk Factors
Hereditary and Medical Factors
Family history of colorectal cancer
Familial adenomatous polyposis
Hereditary non-polyposis colorectal cancer
Inflammatory bowel disease after 10 years
Type 2 diabetes mellitus
Modifiable Risk Factors
Smoking or chewing tobacco
Obesity

Physical inactivity
Moderate to heavy alcohol consumption
High consumption of processed meat
Red meat consumption (large variations among studies) High-
fat, low-fiber diet
Lower Risk
Diets high in cereal grains, vegetables, milk; fish; folic acid,
calcium, and vitamin D; magnesium and selenium; and low in
fat.
Postmenopausal estrogen use Physical activity
Use of NSAIDs
Signs and symptoms
A change in bowel habits.
Blood in or on your stool (bowel movement).
Diarrhea, constipation, or feeling that the bowel does not empty
all the way.
Abdominal pain, aches, or cramps that don't go away.
Weight loss and Anemia.
Diagnosis
Blood tests (Complete blood count, tumor markers and liver
enzymes)
Imaging tests (X-rays, CT scan, MRI scan, PET scan ultrasound,
angiography)
Biopsy
Diagnostic colonoscopy (done after you show symptoms, not as
a routine screening test)
Proctoscopy.
Treatment for colon cancer usually involves surgery to remove
the cancer. Removing polyps during a colonoscopy
(polypectomy).

Endoscopic mucosal resection.
Minimally invasive surgery (laparoscopic surgery).
Other treatments, such as radiation therapy and chemotherapy,
might also be recommended.
Treatment
Anal carcinoma
Definition
Is very uncommon cancer. Anal cancer is a disease in which
malignant (cancer) cells form in the tissues of the anus.
The squamous cell carcinoma is the most prevalent tumor type.
Other anal malignancies include adenocarcinoma, lymphoma,
and sarcoma.
Most common, infection with the human papillomavirus (93
percent).
Followed by anal involvement in Crohn's disease.
Squamous cell anal cancer is more likely in people who have
been infected with the human immunodeficiency virus.
Having a personal history of vulvar, vaginal, or cervical
cancers.
Having many sexual partners or repetitive anal intercourse.
Risk factor
Anal carcinoma
Signs and symptoms
Diagnosis
Bleeding from the anus or rectum.
A lump near the anus.
Pain or pressure in the area around the anus.
Itching or discharge from the anus.
A change in bowel habits
Physical exam and health history.
Digital rectal examination (DRE).
Anoscopy.

Proctoscopy.
Endo-anal or endorectalultrasound.
Biopsy: The removal of cells or tissues with signs of cancer
Surgery and combination chemoradiation are used to treat anal
carcinomas, depending on their stage.
Treatment
Burisch J, Munkholm P. Inflammatory bowel disease
epidemiology. Current Opinion in
Gastroenterology. 2013;29(4):357–362.
Edmunds, M., & Mayhew, M. (2013). Pharmacology for the
Primary Care Provider (4th Edition). Elsevier Health Sciences
(US). https://online.vitalsource.com/books/9780323087902
Kappelman MD, Moore KR, Allen JK, Cook SF. Recent trends
in the prevalence of Crohn’s disease and ulcerative colitis in a
commercially insured U.S. population. Digestive Diseases and
Sciences. 2013;58:519–525.
McCance, S.H. K. ([Insert Year of Publication]).
Pathophysiology (8th Edition). Elsevier Health Sciences (US).
https://online.vitalsource.com/books/9780323583473
Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence
and prevalence of the inflammatory bowel diseases with time,
based on systematic review. Gastroenterology. 2012;142(1):46–
54.
Pagana, K.P.T.P. T. ([Insert Year of Publication]). Mosby's
Manual of Diagnostic and Laboratory Tests (7th Edition).
Elsevier Health Sciences (US).
https://online.vitalsource.com/books/9780323697057
References

Doctoral Project Plan (DPP)SCHOOL OF
COUNSELING AND HUMAN SERVICES DOCTORAL
PROJECT PLANSTATEMENT OF ORIGINAL WORK
I understand that Capella University’s Academic Honesty Policy
(3.01.01) holds learners accountable for the integrity of work
they submit, which includes, but is not limited to, discussion
postings, assignments, comprehensive exams, and the Capstone.
Learners are expected to understand the policy and know that it
is their responsibility to learn about instructor and general
academic expectations concerning the proper citation of sources
in written work as specified in the APA Publication Manual, 6th
Ed. Serious sanctions can result from violations of any type of
the Academic Honesty Policy, including dismissal from the
university.
I attest that this document represents my work. Where I have
used the ideas of others, I have paraphrased and given credit
according to the guidelines of the APA Publication Manual , 6th
Ed. Where I have used the words of others (i.e., direct quotes), I
have followed the guidelines for using direct quotes prescribed
by the APA Publication Manual, 6th Ed.
I have read, understood, and abided by Capella University’s
Academic Honesty Policy (3.01.01). I further understand that
Capella University takes plagiarism seriously; regardless of
intention, the result is the same.
Signature for Statement of Original Work (MUST
COMPLETE)Learner Name
Ashley CookMentor Name
Dr. Amy LyndonLearner Email
[email protected]Mentor Email

[email protected]
Learner ID
1367748
Date
11/23/2021
Capstone Project Plan ProcessYou will use this form to
complete your keystone class, obtaining Milestone 1, and
obtaining Milestone 2 approval. The goals of this process are:
(1) facilitate the planning of the details of your doctoral
research project, (2) allow for scientific merit review, and (3)
facilitate your progress through the Capstone. You must obtain
approval of your Doctoral Project Plan before seeking IRB
approval, collecting data, and writing your Capstone
manuscript. Approval of your Doctoral Project Plan (DPP) will
satisfy the Capstone Milestone 2, indicating that the Doctoral
Project Plan (DPP) has passed the scientific merit review part of
the IRB process.The scientific merit process is designed to
ensure that a proposed research study contains an appropriate
level of scientific rigor and merit before ethical review. Rigor
is achieved if the study is well-designed and has adequate
resources so that participants are not exposed to unnecessary
harm. Merit is achieved if the rights and welfare of the human
research participants are protected
**Obtaining Scientific Merit approval for the Doctoral Project
Plan (DPP) does not guarantee you will obtain IRB approval. A
detailed ethical review will be conducted during the process of
IRB approval.How to Use This FormThis Doctoral Project Plan
(DPP) form is intended to help you plan the details of your
Capstone Project. It provides a space for you to work out all
the details of your design. Once you have obtained Doctoral
Project Plan (DPP) approval, you should be able to easily
expand on the information you have submitted here to complete
the deliverable of your proposed Capstone Project and write the
Capstone Final Report because these sections follow the outline

of the Doctoral Capstone Report. It is recommended that you
use this form in a step-by-step way to help you design your
study. Expect that you will go through several revisions before
obtaining approval of this form. Research planning is an
iterative process; each revision often sparking the need for
further revisions until everything is aligned. These iterations
and revisions are a necessary and customary part of the research
process.
Do’s and Don’ts
· Do use the correct form!
· Don’t lock the form. That will stop you from editing and
revising the form.
· To complete the “Learner Information” and Section 1 first.
· Don’t skip items or sections. If an item does not apply to your
study, type “NA” in its field.
· Don’t delete the descriptions and instructions in each section!
· Do read the item descriptions carefully. Items request very
specific information. Be sure you understand what is asked.
· Do use primary sources to the greatest extent possible as
references. Textbooks are NOT acceptable as the only
references supporting methodological and design choices. Use
textbooks to track down the primary sources.
· If you change any design elements after your DPP is approved,
you must submit a revised Doctoral Project Plan. A current
DPP must be on file before your IRB application is submitted.
GENERAL INSTRUCTIONS
Complete the following steps to prepare and submit your DPP
for Scientific Merit Review (SMR) approval for your doctoral
Capstone Project.
· Keystone Learners: Your Keystone Instructor will facilitate
the initial process.
· Capstone Learners: Your Mentor will facilitate this process.
CITI Research Training
Mentees must complete the CITI Research training and submit

their CITI completion certificate to your Keystone Instructor.
CITI Training Module
Milestone 1: Topic Approval
Complete Section 1 (1.1 and 1.2) of the DPP form for topic
approval.
There are two ways to achieve Milestone 1:
1. If Section 1 of your DPP meets the rigor for a viable topic,
your keystone instructor will submit it for school review.
Receiving 80% on the DPP does not mean that it is ready for the
topic plan review.
a. You will work on all sections of the DPP during the Keystone
Course, even if you do not achieve topic approval. This will
allow the Keystone Instructor to introduce you to the necessary
components of the Doctoral Project Plan.
2. If Section 1 is not submitted for topic approval during the
Keystone Course (HMSV8700), your Mentor will submit the
topic plan in the Capstone Course – HMSV9971.
Milestones 2: Doctoral Project Plan
1. Work with your Capstone Mentor to complete and make any
necessary refinements to the DPP form.
a. If you did not receive topic approval in the Keystone Course,
you will refine sections 1 (1.1 and 1.2) and submit it to your
Capstone Mentor. Your Capstone Mentor will submit section 1
for topic approval. After topic approval, you will proceed to
step 2.
2. Once you have topic approval (whether in the Keystone or
Capstone Course), you will refine and complete sections 2 – 7
in the DPP form. Make sure all sections are aligned with the
DHS Programs of Professional Practice and the DHS Doctoral
Capstone Handbook. —changes in one section could necessitate
changes in another section.
3. After you have a polished version, you should review the
DPP criteria with the rubric to ensure you have provided the
required information to demonstrate you have met each of the
scientific merit criteria.

4. Submit the completed form to your Capstone Mentor.
Scientific Merit Review(SMR)
The scientific merit reviewer will review each item against a
rubric to determine whether you have met each of the criteria.
You must meet all the criteria at a level of “Proficient” or
greater to obtain reviewer approval. The reviewer will designate
your Doctoral Project Plan (DPP) as one of the following:
· Approved
· Deferred
· Not Ready for Review
If the Doctoral Project Plan (DPP) is Deferred or Not Ready for
Review:
· The SMR reviewer will provide feedback on any criteria that
you have not met.
· You are required to make the necessary revisions and obtain
approval for the revisions from your Mentor.
· Once you have Mentor approval for your revisions, your
Mentor will submit your Doctoral Project Plan (DPP) for a
second review.
· You will be notified if your Doctoral Project Plan (DPP) has
been approved or deferred for revisions.
· Up to three attempts to obtain Scientific Merit Review (SMR)
approval are allowed. Researchers, Mentors, and Reviewers
should make every possible attempt to resolve issues before the
Doctoral Project Plan (DPP) is deferred for the third time. If a
learner does not pass the scientific merit review on the third
attempt, then the case will be referred to the Research Chair
and/or Program Chair in your School for review, evaluation, and
intervention.
· While you await approval of your Doctoral Project Plan
(DPP), you should begin working on your Ethics Paper. Your
Mentor has a template for you to follow.
· Once you have gained approval on your DPP (Milestone 2),
you are ready to submit your Ethics Paper and IRB application

and supporting documents for review by the IRB Committee.
Milestone 3: IRB Approval
1. Once you obtain SMR approval, you will begin and complete
an eight to 10-page ethics paper. This paper is a conceptual
analysis of ethical principles typically related to all professional
Capstone Projects. Your Mentor has a template for you to
follow.
2. Once your Mentor has approved your Ethics Paper, you will
complete your IRB application through IRBManager and submit
any accompanying materials.
3. Consult the Research and Scholarship area within iGuide for
IRB forms and detailed process directions.
**You are required to obtain scientific merit approval (SMR)
before you may receive IRB approval. Obtaining SMR approval
does not guarantee that IRB approval will follow.
Milestone 4: Pre-Data Collection Call
1. Once you have gained approval from the IRB, you are ready
to schedule your Pre-Data Collection Conference Call. You may
not proceed to data collection until you have completed this
call.
2. Work with your Mentor and Doctoral Committee to set a date
for the conference call.
3. Upon successful completion of the Pre-Data Collection
Conference Call, your Mentor will mark Milestone 4 complete,
and you may proceed with data collection.
Learner and Specialization Information
(MUST BE COMPLETED)
Learners, please insert your answers directly into the
expandable boxes that have been provided.

Learner Name
Ashley Cook
Learner Email
[email protected]
Learner ID Number
1367748
Mentor Name
Dr. Amy Lyndon
Mentor Email
[email protected]
Specialization (check one)
|_| Leadership and Organizational Management
|X| Program Evaluation and Data Analytics
Specialization Chair Name
Specialization Chair Email
Committee Member #1 Name
Dr. Ryan Dunn
Committee Member #1 Email
[email protected]
Committee Member #2 Name
Dr. Andrea Muse
Committee Member #2 Email
[email protected]
Capstone Type (check one)
|_| Research Paper
|X| Professional Product
Deliverable (check one)
Research Paper
|_| Action Research Monograph
|_| Program Evaluation
Professional Product
|X| Service Project
|_| Change Management Plan

Section 1. Topic Endorsemen
Please, use single-spaced, Times Roman 11 pt. throughout the
form – the boxes will expand as you input text.
1.1 Capstone Topic (2 paragraphs)
Clearly describe the topic of the Capstone Project.
This section should include: · FIRST PARAGRAPH: State the
topic of the capstone project. The topic statement shoul d
include the problem or opportunity for improvement in the
project. The concepts of the topic must be clear and focused
and well supported in the literature. · Begin this paragraph
with, “The topic is…”
· SECOND PARAGRAPH: Describe the significance of this
topic to Human Services AND the specialization within your
program. Include a statement about the practical implications of
the project by describing the impact of this Capstone Project on
the organization or community of interest· Example - The topic
of this capstone project is the effectiveness of a transitional
summer program, Helping Others, Inc., on middle school
student's chance of success (graduation) in high school.
The topic should be correctly formed:
· The topic should be appropriate for the specialization.
· The topic should use appropriate language for key
concepts/phenomena.
· The type of action proposed should be specified.
· The community of interest/organization/program or
community and target population should be named.
· The concepts should be appropriately focus
· The topic should be supported by at least ten (10) citations.
· The topic should be in alignment with current literature and

the DHS Programs of Professional Practice.
Use current (within 5-7 years), scholarly, PRIMARY resources
to support statements. Textbooks are not primary resources.
Theses and dissertations are not considered peer-reviewed
published articles. Use APA style in citing all resources.
The topic of this capstone project is improving The Haven’s
ability to assist victims to establish these women’s independent
financial ability through developing a financial literacy training
program. The Haven looks at making the current housing more
reasonably priced, building improved, and low moderate-income
houses using the existing building materials to help create a
community where every person can live in The Haven (The
Haven, n.d.). The Haven is a local non-profit agency that
provides emergency temporary shelter and services to victims of
family violence and sexual assault. The Haven is dual-
programmed and has two emergency facilities: The Battered
Women’s Shelter, which serves victims of family violence, and
the Rape Crisis Center, which serves victims of sexual assault.
Both programs have a 24-hour toll-free crisis line, staffed by
trained personnel, that is available to anyone wishing to utilize
the emergency facilities or the outreach programs (The Haven,
n.d.). This capstone will explore domestic violence and
economic or financial abuse as the background for creating
training protocol on financial literacy for domestic violence
victims for use by The Haven. Financial impediments play a
major role in restricting the freedoms enjoyed by women who
are abused by their intimate partners (Juing et al., 2021). A
batterer is empowered by his partner’s financial dependence,
and a woman’s autonomy is diminished by her abuser’s
financial control. Moreover, financial instability is one of the
greatest reasons why, after gaining freedom, a woman who
experiences battering has limited choices and mayultimately
acquiesce to her partner’s attempts to reconcile (Ortiz-Ospina &

Roser, 2017). Economic instability is a link that binds a woman
to her abuser (Carla Moretti, 2017). Regardless of the
interventions, law enforcement, family, friends, or The Haven,
as long as she remains financially dependent upon her abuser, it
is exceedingly difficult for a woman who experiences intimate
partner violence to stop the batterer’s control. Economic
independence can provide freedom from abuse (Bramley &
Fitzpatrick, 2018). Comment by Muse, Andrea: Great topic!
The significance of this topic to human service is to help human
services personnel to use their resources more effectively by
providing victims training on how to use these financial
resources. The majority of abusers use economic abuse to
control victims (VothSchrag et al., 2020). The impact of this
project is to people of the community of interest helping victims
of domestic violence and their families remain in stable housing
and have financial independence. Through this capstone topic,
the aim is to empower women with financial literacy that would
help them in their lives.
Most victims experience some type of financial abuse, which
reduces their financial literacy (VothSchrag et al., 2020). Thus,
they will need assistance with maintaining the long-term
shelter. Without having many organizations that are willing to
take care of the plight the people are facing, the goals of the
human services field would not be easily fulfilled (Juing et al.,
2021). Human service programs can help victims through the
programs that have been put in place along with hotlines that
are focused directly on these issues. Housing is among the three
most essential life requirements. Haven helps victims who have
been financially abused by building a healthy, empowering, and
strengthening them by looking into what is the cause of the
situation and how they can come up with an idea that can
change it (Soibatian, 2017). The Haven has many programs like
housing, children support, women support groups, income, and
employment service groups. The supporting services try to

assist the individuals with materials and supplies that will help
the individuals with low income to have daily needs. The
victims sometimes are helped by social workers or churches that
focus on stabilizing them and creating a budget that will finance
the living (Jennifer, Patrick, 2011). However, it is projected
that over one billion people are today living in insufficient
housing conditions in urban areas. “In most cities, there are
more than half of the population who lives in informal
settlements in what can be described as life and health-
threatening” (Ortiz-Ospina & Roser, 2017, p 3). More than 100
million people are homeless globally, and data shows that there
are increasing propositions of women and children. The
statistics given give a clear picture of the dire need for having
quality housing globally.
It is indisputable that homelessness continues to be a grand
challenge in our country and globally. In addressing the
problem of homelessness, our organization has been putting up
measures to ensure that we prevent people from becoming
homeless in the first place. This includes outreach efforts
targeting at-risk people in short-term case management
(Moretti, 2017).
1.2 Research Problem (2 Paragraphs)
Write a brief statement of the problem or need for improvement
at the capstone site or program. Clearly describe the gap in
current practice, service, process, policy, and/or the identified
outcome. Identify the performance gap you wish to close and
the potential root causes of the problem.
This section should include:· FIRST PARAGRAPH: Write a
brief statement that fully describes the problem being
addressed. This paragraph introduces the problem that is
informing the research and warrants the need for this study. ·

Begin this paragraph with the statement, “The problem is…”
Example: The problem is that Helping Others, Inc’s transitional
summer program has not consistently improved high school
graduation rates.
· SECOND PARAGRAPH: Identify the need for the study. The
need should be directly related to the problem presented in the
first paragraph. It must identify a gap in current practice,
service, process, policy, or programs. It must identify the need
for the research and the desired outcome.
Example: This study is needed because high school graduation
rates are decreasing in the service community where Helping
Others Inc. provides its transitional summer program.
Decreased graduation rates have negatively affected the
unemployment rate in the area.
The problem is that the victims of domestic violence lack
financial literacy and knowledge to retain long-term housing.
While shelters assist with housing insecurity, the outcomes are
limited by survivors’ abilities to gain and retain control of their
financial ability to remain housed (Klein et al., 2020). Access to
stable housing is linked with better mental health for victims
and their families (Bomsta & Sullivan, 2018). The human
services field increasingly recognizes economic and financial
abuse within intimate partner relationships (Shinn & Khadduri,
2020); for this reason, the human services field has worked to
develop financial empowerment programs to empower survivors
for their financial future (Sikorska, 2021). The problem is
domestic violence and intimate partner violence (IPV) victims
struggle with financial independence. Financial literacy in the
female population is significantly lower compared to the male
population – i.e., the gender gap in financial literacy (Fonseca

et al., 2012; Hasler & Lusardi, 2017; Lusardi & Mitchell, 2008,
2014). This inequality makes women susceptible to financial
abuse by their partners. In recent years, researchers have come
to recognize economic and financial abuse as a unique form of
abuse commonly used by IPV perpetrators to gain and maintain
control over their victims (Polvere et al., 2018). Broadly
defined, financial abuse includes behavior’s that control a
victim’s “ability to acquire, use, and maintain resources thus
threatening her economic security and potential for self-
sufficiency” (Adams et al., 2008, p. 564) and is frequently a
precursor to physical abuse. For example, Adams (2011)
reported that 99% of IPV victims experience financial abuse.
Similarly, Postmus et al. (2012) reported that 94% of the IPV
survivors they surveyed experienced some form of financial
abuse. The Haven can provide short-term housing needs to
victims for up to three months, but once the short-term shelter
ends, victims struggle with maintaini ng the housing
independently (The Haven (valdostaharven.org). Many victims
suffer because their credit scores have been destroyed by their
partners or simply because of a lack of knowledge. Partners
often destroy victims’ credit by harassing them to use their
social security numbers. Victims are not able to retrieve this
information of their resources because many of the abusers
closely monitor the websites that they will visit. The lack of
financial security is brought by a lack of access to safety, so the
housing takes the initiative of educating the victims on how to
secure their homes (Robin & Osub,2020).
The Haven explores a variety of options through local resources
and the needs of the victims (MacKenzie et al., 2020). This
helps The Haven address the most affected people and use the
available local resources, making access to affordable houses
easier (Polvere et al., 2018). The major goal is to ensure that
everybody can live in a house that is decent and affordable
(Benerjee & Bhattacharya, 2020)
In response, this capstone is needed because financial literacy
training is needed to help survivors of domestic violence gain

financial independence. This project seeks to empower women
so that they may be less likely to return to an abuser if they are
to stay financially independent. This capstone fills a gap by
developing training to improve the financial literacy of
domestic violence victims. The rate of domestic violence is 185
incidents per 100,000 population annually (Shinn & Khadduri,
2020); these estimates suggest improving financial literacy can
prevent between 6 to 20 domestic violence incidents per
100,000 population from occurring each year. This capstone
will help The Haven improve women’s financial literacy and
hopefully increase the ability of domestic violence victims to
remain economically independent.
Learners
Specialization Chair Topic Approval
· After completing Section 1, Keystone or Capstone Learners
should submit the DPP form to your Keystone Instructor or
Capstone Mentor for approval.
· Collaborate with your Keystone Instructor or Capstone Mentor
until you have approval for Section 1, “Topic Approval.”
· After you have received your Mentor’s approval for Section 1,
your form will be submitted for SMR review.
|X| Approved
|_| Deferred
|_| Not Ready For Review
Reviewer Name: Dr. Elissa Dawkins
Reviewer signature: Elissa Dawkins
Date: 3/13/2021
Comments: Thank you for submitting your topic plan for
review. Your topic is approved. Please review my comments
above. In addition, you will need to obtain newer, primary
references to support your topic. You will need to include
scholarly literature to back up the need for the program

evaluation. Schedule some time with a librarian and the writing
center to tweak this.
Section 2. Rationale for Study
2.1 Capstone Project Problem Background
This section should further expound on the research problem
and will include a SUMMARY of the review and synthesis of
the research literature on the topic. This should include
citations from at least 15 Articles but should indicate that you
have performed a full review of the literature on the topic.
This section should include:
· A statement about the body of existing literature on the topic.
· A summary of recent research findings on the topic highlights
the most relevant findings of the proposed study.
· A demonstration of how the proposed research could add to
the existing literature on the topic.
Be sure to provide appropriate in-text citations and include
references in the reference section.
*This will not be your Capstone Project literature review but an
initial foundation. You will continue to add to your literature
review throughout your Capstone.
Financial literacy means the victims could understand and use
various financial skills effectively (Kottke et al., 2018).

Financial literacy will lead to overall financial well -being, it is
a lifelong journey of learning and is the foundation of the
relationship that the victims will have with their money
(Khan & Brewer, 2021). Economic abuse may lead to lower
financial literacy; such abuse may also be long-term, as it is not
contingent upon a physical encounter (Krigel & Benjamin,
2020). Economic abuse includes the issues of economic control,
employment sabotage, and economic exploitation (Stylianou,
2018). Financial education provides victims with budgeting
skills, the know-how to balance checkbooks, understanding how
to prevent identity theft, and understanding the lending activity,
and knowing how to manage their debts (NCDAV, n.
d.). Women are not given enough opportunities and properties
that would help them live a comfortable life and support their
children (Bramley & Fitzpatrick, 2018). Such programs also
help them to get a stable job and can get insurance through them
(Kottke et al., 2018).
Strong leadership is very important in helping in effectively
engaging the public and surmounting barriers that are met while
enhancing affordable housing. Strong leadership can motivate
and inspire people to reach financial independence (Kottke et
al., 2018). Financial literacy can help people to manage their
money and finances effectively and afford their housing
(Katula, 2012). Many people have limited knowledge of
investing that leads them to make poor financial decisions.
Many people struggle with investing and saving due to a lack of
financial literacy (Bullock et al., 2020). It requires addressing
two very great challenges: defining the problem and creating a
very strong and long-lasting solution (Fowler et al., 2019).
Leaders are required to articulate and create a compelling vision
for the solution to the housing problem. If this is not ensured,
the affordable housing efforts may get lost among the
competing needs of the community (Mackenzie et al., 2020).
Therefore, the leaders have a great role in assuring that their
cause receives the attention that it deceives as well as the
necessary funding for the program (Quests et al., 2016).

If a program is sufficiently funded, it would mean that the
chances of more people benefiting from the program increase.
Women are more affected by gender violence than are men
(Bullock et al., 2020). Many female IPV victims are left
stranded after domestic violence with nowhere to go, some with
limited or no financial literacy to manage their finances
(Bramley & Fitzpatrick, 2018). Women are more affected by
IPV, The female victims of IPV, especially domestic violence.
This is the group that needs significant help regarding financial
literacy (Benerjee & Bhattacharya, 2020).
2.2 Need for the Project and Evidence to Make Change
Provide a rationale supported by current information regarding
the need for this Capstone Project.
· The results of a needs assessment or an analysis for the
project.
· A description of issues identified in the workplace, project, or
community.
· Any relevant population and organizational demographics and
statistics related to the proposed Capstone Project.
· A description of why the study is important.
· A description of whom the study will benefit.

For financial planning for their clients, The Haven gathers
financial information of their clients. They conduct a financial
survey to analyze the collected data, the data is summarized
based on the goals of the clients. The plan also involves
meeting in person to discuss and review the plans to make a
recommendation for short and long-term goals achievements.
The Haven's financial plans to their clients give the clients
options to consider their way forward based on their goals and
objectives. The client is helped to stay organized and help them
complete the tasks that are in alignment with their goals (The
Haven, n.d.). This may include helping the victims to escape the
abuse and create safer lives for themselves (Muir et al, 2017).
Most of the women The Haven helps struggle after divorce
because they may have been used to stay-at-home mothers and
also limited financial literacy. After divorce, most women have
no savings and are left on their own. Even after divorce, women
struggle with legal and financial issues (Polvere et al., 2018).
The research will help The Haven get more information and data
to work with improving victims’ ability to maintain their
housing, along with other financial benefits (Quests et al.,
2016).
The Haven looks at various options through local resources and
the needs of the victims (Mackenzie et al., 2020). This helps
The Haven address the most affected people and use the
available local resources, making the construction of affordable
houses easier (Muir et al., 2017). The major goal is to ensure
that everybody can live in a house that is decent and affordable
(Shinn & Khadduri, 2020). “The problem requires to be
addressed urgently so that communities can have an effective,
caring system for providing to the needs of the homeless
people” (Gan et al., 2017, p. 23).
Through proper leadership and the training protocol I look to
incorporate, The Haven has a hand in helping victims of
domestic violence and sexual assault to acquire financial

literacy that would enable to manage their finance and budget
(Polvere et al., 2018). However, a training program specifically
geared towards domestic violence victims that is informed by
scholarly and practitioner-based beset practices would
strengthen their ability to help their clients. This would include
them being able to pay for their houses and other daily
expenses. Financial literacy would be a tool that would assist
the victims to be able financially independent and live better
lives and ensure that the problem of homelessness is addressed
(Quests et al., 2016). The issue of housing is especially relevant
for survivors, as abusers deliberately cause housing insecurity
(Valentine & Breckenridge, 2016). Housing can be considered
to be affordable if it is below 30% of the total income.
According to the U.S. Department of Housing and Urban
Development, if a family pays for a house for more than 30%,
this becomes a burden to the family. This gives a clear picture
of the dire need for having quality housing globally (Ortiz-
Ospina & Roser, 2017). Most importantly, the rapid
urbanization necessitates more access to housing as more than
half of humanity is now living in the cities (Morton, et al.,
2018). It is important examining the ways of enhancing the
quality of housing, which means ensuring that everybody is
capable of finding a safe, decent, and affordable house within
the areas where they work, shop, study, and play (Kottke et al.,
2018).
2.3 Theoretical Foundations
Briefly describe the primary theoretical framework or model to
be used for the study that will serve as the lens through which
you will view the research problem and research questions.
NOTE: The theoretical foundation should be a theory from your
discipline that supports the topic and should reflect on how you
understand the topic and constructs in the study. To select the

theory of model for the study, review the DHS Programs of
Professional Practice.
· A review or discussion of the theory that will guide the
project.
· An explanation of how the theory or model defines the
variables or constructs of the study.
· An explanation of how the theory or model will guide the
study.
· A list and explanation of any study assumptions.
Economic empowerment theory will be used in the study and
will also serve as a lens through which the research problems
and research questions will be viewed (Baumol, 1977). This
theory will work to achieve the goal of empowering women and
especially the victims and the survivors of domestic violence
and sexual assault by empowering them with financial literacy
and also with affordable housing. With financial literacy
training, survivors will be empowered to lead better lives for
themselves and their families. . Economic empowerment theory
involves promoting women in their social and economic
development (Haque & Zulfiqar, 2015). This means simply
giving power to women (Karaa, 2019), giving financial literacy
to women by helping them to manage their finances. Training
for victims of domestic violence include empowering women by
acknowledging the economic abuse, along with specific
suggestions on how to develop financial capability and asset
building (Tlapek et al., 2021). In many cases of domestic
violence, and men control all the finances in homes (Lee, 2017).

In addition, traditional gender roles where women were
expected to be just stay-at-home moms and were not mostly
involved in the financial decisions (Hamdar et al., 2015).
Women have long been denied personal control over their
finances. Economic empowerment to women removes the
constraints to lack of opportunities for their development and
their confinement to household environments (Hamdar et
al., 2015).
The Haven gives financial education to women to help them
overcome the homeless problem. The Haven gives personal
attention to ensure that they have paramount success in their
finances. They give investment advice to their clients that are
personalized based on their financial goals (The Haven, n. d.).
The study assumptions of the study are that all women are not
financially literate and that men have more financial literacy as
compared to women. Globally, most finances are handled by
men (Voth Schrag et al., 2019) and a majority of abusers exert
financial control (Postmus et al., 2020).
The other assumption is that all women struggle to get
affordable houses and manage their finances after divorce. It is
assumed that most women are confined to home duties in the
household environments (Lu, 2021).
2.4 Researchers Positionality
In this section, you will define your role, position, and how
positionality will impact your research study.
· The title of your role or position in the organization, program,
or community in your site.
· A description of your job duties at the site.
· A description of how your position will impact the research
project.
· A statement that identifies if you are an insider (work or
volunteer with the organization) or outsider, or a collaborator
with insiders (no affiliation, but working with stakeholders
within the organization).

Current position: Non-affiliated community researcher
My current position with The Haven is as an outsider. I have no
affiliation with The Haven at this time but may apply with the
organization as a human service volunteer. Volunteers with The
Haven help the organization improve the quality of victims’
care and support in their day-to-day operations and assist
victims with immediate needs. Volunteer tasks may include
assisting victims with housing needs, literature reviews,
completing applications, filing papers, assisting staff with
errands, and other miscellaneous things that can be assigned to
help The Haven run smoothly.
The training will be another resource that The Haven will be
able to provide to all victims that are serviced through the
Haven.
2.5 Practical Implications
Please describe the specific practical implications of your
findings that can be used by the stakeholders.
· Minimum of (2) paragraphs. Every statement must be
supported by the literature
· A description of the specific practical implications (who may
benefit) from the research that can be used by any or all of the
following stakeholders:
· the population being studied,
· practitioners, clinicians, or medical practitioners,
· community-based service providers or health organizations,

· educators, colleges/universities or
· the wider community itself.
published articles. Use APA style in citing all
resources.REMEMBER
NOTE: Be cognizant of the limitations and scope of the
proposed research. Do not promise practical implications that
are beyond the scope of the research.
The information gathered from the literature will help providers
conduct important financial literacy training for domestic
violence victims. These providers, specifically at The Haven,
will be in a better place to help the victims of sexual assault and
domestic violence. The Haven foundation aims at the treatme nt
and prevention of sexual assault and domestic violence.
The mutual support from the wider community has helped the
foundation be a success. With the support of the wider
community, the victims feel comfortable having access to the
support needed for their recovery. The practitioners in The
Haven counselling program benefit from a training program, as
they can serve individuals of all ages who have experienced
sexual assault and domestic violence (The Haven, n.d.). The
councilors need the information to address the safety concerns
and needs of sexual assault and domestic violence survivors.
The research will make it easier for the counseling clients to be
identified and assisted referral for health and financial
assistance, personal protection orders, and housing resources.
Victims of domestic violence often make several attempts to
leave an abusive partner and are forced to return for economic
reasons (Shackelford, 2020). Economic self-sufficiency is
frequently the difference between violence and safety for many
victims. Yet financial literacy training can improve survivors’

long-term outcomes (Warren et al., 2019). Domestic violence
advocates must be prepared to address many of the economic
issues that victims face and facilitate opportunities for victims
to learn how they can improve their economic situation. A
financial literacy training program may help most with the
issues of economic control (i.e., controlling access to financial
knowledge) and economic exploitation (i.e., perpetrator
destroys victims’ financial resources or credit) (Stylianou,
2018). Issues such as budgeting, identity theft, banking,
predatory lending, violence in the workplace, housing, and
credit, all play a role in ending domestic violence (NCDAV,
n.d.). In addition, research shows that the resource loss
experienced by IPV victims mediates the relationship between
psychological abuse and mental health (Sauber & O’Brien,
2020), indicating that financial literacy and subsequent
economic success may help alleviate victims’ poor mental
health outcomes.
The people who benefit most from these implications are the
individuals from the community of interest who have been
enrolled in the program. The practitioners are considered the
employees of The Haven, caseworkers, social workers, intake
coordinators, and others. The victims and their families will
benefit because they will be able to manage their finances.
Financial literacy gives the ability to be able to effectively cater
for their expenses in addition to being able to afford housing
stability (). The wider community would be the landlords and
the other people in the community who help with the housing
needs. When financial literacy is best understood by the victims
and their families, they would be on the right path to financial
freedom addition, The Haven has also a residential program that
is exclusively for sexual assault and domestic violence victims
and their children (Shackelford, 2020). Comment by Muse,
Andrea: Is there a citation missing?
Recognizing that a lack of financial stability is one of the
biggest deterrents for women who are considering leaving an
abusive relationship, the Kentucky Domestic Violence

Association (KDVA) formed its Economic Justice Project in the
early 2000s. The program has domestic violence shelters. It is
committed to providing community domestic violence services.
Their purpose is to offer mutual support to the victims of
domestic violence that would collectively advocate for the
victims and their children. Through a network of member
organizations, the Economic Justice Project offers Individual
Development Accounts, free tax preparation, financial
education, and other asset-building services to survivors of
domestic violence (Economic Justice Project, 2021) The
survivors of domestic violence are taught how to effectively
manage their finances. The Haven continues to connect with the
community through engagement, advocacy, and education to
ensure that the survivors are in a better position to support
themselves.
Section 3. Research Theory
3.1 Purpose of the Study
State the purpose of the study. The purpose of the study is to
answer the research question or provide practical answers to a
problem or weaknesses of the current practice, service, or
process, policy.
· A summary of the intended outcomes of the study.
· An identification of who can benefit from this research and
how they might benefit.
· A statement of the purpose of the study and the need that it
addresses.
· A statement about the outcomes or findings of the Capstone
Project and how they will be sustained.

The purpose of the training program is to create economic
empowerment. People that can benefit from this training
program are the victims and survivors of sexual assault and
domestic violence. The emphasis is on empowerment from
survivors and the staff (Finley, 2016). The program saves lives
and continues to provide support and help them to move forward
and have better lives. The purpose is to make as many people as
possible know and benefit from the program. The training
program helps the victims to have financial literacy that would
make them be able to manage their finance and manage their
expenses (McOrmond-Plummer et al., 2016). The training
program will offer critical support and services. Human services
personnel stand in solidarity to eradicate sexual assault and
domestic violence (Ngo & Puente Moncayo, 2021). The people
who benefit most from these implications are the individual
victims of domestic violence who are enrolled in the program at
The Haven. The practitioners are considered the employees of
The Haven, and such practitioners can include caseworkers,
social workers, intake coordinators, and others (Sanders, 2013).
The victims and their families will benefit because they will be
able to manage their finances. Financial literacy helps people to
effectively care for their expenses, in addition to being able to
afford to house (Fan, 2019).
3.2 Research Question(s)
List the primary research question and any sub-questions that
the proposed study will address. The research question(s)
should be correctly formed.
This section should include a research question(s) or sub-

questions that:
· Align with the research problem, the research topic, and the
Capstone title.
· Identify the intended analysis.
· Is phrased in a way that will be answered by the intended
methodology and analyses.
· Identify the specific variables to be explored, use language
consistent with the research design or approach, and identify the
population being studied.
Qualitative Example: How can DHS caseworkers help the
homeless population become self-sufficient?
Quantitative Example: How does employee morale in millennial
research analysts affect creativity?Use current (within 5-7
years), scholarly, PRIMARY resources to support statements.
Textbooks are not primary resources. Theses and dissertations
are not considered peer-reviewed published articles. Use APA
style in citing all resources.
What parts of financial literacy do domestic violence victims
need help within a training protocol?
What are the best means of providing that financial literacy
training to domestic violence victims?
3.3 Capstone Project TitleThe Capstone Project Title should be
correctly formed:· The title should be aligned with the Research
Problem (1.2) and Research Question (2.2), (use the same
terminology for all).· The title should reflect the key variables
or constructs to be studied.· The title should reflect the method
to be employed in the research.· The title should be concise (12
words or less).
Financial Literacy Training: Rebuilding Financially After
Domestic Violence

Section 4. Research Methodology
4.1 Summary of methodology
Briefly describe the Capstone Project research design.
· A description of the methodology (qualitative or quantitative).
· A description of the design (case study, generic qualitative,
correlation, etc.).
· A description of the type of action research (participatory
action, critical action research, action science research, or
appreciative inquiry).
· A description of what data will be collected (validated
instruments, interviews, archival data, organization policies,
and procedures, etc.).
· A description of data analysis that will be used (thematic
analysis, descriptive statistics, inferential statisti cs).
No data will be collected. This is a service project providing a
training program material. For this project, the information will
be collected from The Haven staff and the literature. There will
not be an empirical study; thus, there will be no qualitative or
quantitative methodology. All information received will come
staffing, personnel, the mission statement, the trainer, and
trainees after the training has been provided. All information
will be kept confidential. Comment by Muse, Andrea: An
overview of your training would be helpful: format, materials,
duration, etc.
4.2a Quantitative Measures and Instruments
List and describe each variable and the data collection
instrument or measurement tool you will use to collect these
data. These should include standardized questionnaires,
demographic data, and surveys, etc. See Appendix A for an
example of a completed chart. Only standardized instruments
can be used in quantitative studies.

Attach a copy of each instrument you plan to use as an appendix
to the Capstone research form.
Variable Type
Variable Name
Survey/Questions/ Calculations
Variable Level of Measurement
Instrument Name
Reliability Estimates

*Insert more rows as needed
There are no quantitative instruments for this service project, as
this is not study.
4.2b Qualitative Constructs and Interview Guide
List and describe each qualitative construct and the data
collection method you will use to collect these data. Include the
alignment of the data collection source with the concept. See
Appendix B for an example of a completed chart.
Attach a copy of the interview guide you plan to use
as an appendix to the Research Plan.
Data Source
Specific Data Source
Constructs of Interest
Specific Interview Question
Interview
Interviews with Staff Members
Financial Literacy
Domestic Violence

No qualitative interview questions. There are constructs
involved in the development of this service project, but are not
attached to any interview questions.
*4.3 Field Tests
Only complete if the research study is greater than minimal risk.
Field tests must be completed for qualitative interview
questions if the study is greater than minimal risk.
According to 45 CFR 46.102(i), minimal risk means, "The
probability and magnitude of harm or discomfort anticipated in
the research are not greater in and of themselves than those
ordinarily encountered in daily life or during the performance of
routine physical or psychological examinations or tests."
If you are unclear about the nature of the study, please consult
with the Research Chair or Capella’s IRB. IRB approval is not
required before a field test is conducted. The results of the
field test should be submitted as part of the IRB application
once the DPP is approved. Field test experts should be
practitioners in the field that are knowledgeable about the topic.
You may use a Capella faculty who has a relevant background.
· A list of the original interview questions (before the field
test).
· A rationale for each original interview question that explains
how the question will provide answers to the specific research
question.

· The identification of field test experts (name and credentials).
· A description of the suggestions, comments, or
recommendations from the field test experts.
· A list of the final, updated interview questions.
N/A; There is no field test, because there is no study or
interview questions. Therefore there are no participants to be at
risk.
4.4 Data Analysis
Detail the actual data analyses to be conducted to address each
research question.
For each research question and sub-question provide the
following:
· A description of the data source.
· A description of how raw data will be analyzed (transcription,
calculation of scaled variables, etc.).
· A description of how data will be managed, processed, and
prepared.
· The method of qualitative analysis or statistical analysis.
· A description of how data will be stored and protected.
1. Looking in ProQuest, PsycINFO, etc. I will also look at
federal, state, and local governmental agencies like the U.S.
Department of the Treasury’s Financial Literacy and Education
Commission (FLEC, n.d.). Nonprofit entities such as the
National Endowment for Financial Education (NEFE, n.d.) will
also be examined for professional, scholarly, and governmental
information.
2. Here’s a list of questions I will ask as I read each source:
a. Did they identify any best practices?
b. What were their training recommendations? Did they test any

training materials?
c. How well did each source look at subgroups of gender, race,
sexuality, etc.?
3. I will keep track of information by using a synthesis matrix
to review content across multiple sources to identify
commonalities and differences between source information.
4.5 Sample Size
For each data source, describe the sample size, and provide
references to support sample size decisions.
For financial literacy, the terms that I would search for would
be credit report, credit score, assets, bankruptcy, domestic
violence, and financial hardships.
4.6 Assumptions
Identify the key (A) theoretical, (B) topical, and (C)
methodological assumptions of the Capstone Project.
A. A description of the theoretical assumptions will include the
fundamental constructs of the theoretical foundation that you
selected in Section 2.3.
B. A description of the topical assumptions will include the
assumptions revealed from previous research, the literature on
the topic, and assumptions made by researchers in the field.
C. A description of the methodological assumptions will include
an explanation of the epistemological, ontological, and
axiological philosophical assumptions that support the research
methodology.
A. Theoretical assumptions
The theoretical assumption of economic empowerment

theory is that disempowerment is created through structural
oppression, powerlessness, and marginalization through
structural oppression and economic privation (Brenton, 1994;
Gutierrez & Nurius, 1994; Hasenfeld, 1987). The theory aims to
reduce the powerlessness that has been created for the
oppressed and the vulnerable. The other assumptions that are
controversial are that economic empowerment promotes
individualism and that it is a source of unmitigated competition
which may bring conflicts among those that have been
empowered (Wilkinson, 1998).
B. Topical assumptions
The assumption is that women have less financial literacy
than men. Most of the victims of domestic violence are women.
The other assumption is that the survivors will be helped, and
they will have financial literacy that enables them to budget and
manage their finances to cater to their expenses and housing.
The training may not be able to help survivors overcome
structural barriers, such as sexism and racism that disempower
women.
C. Methodological Assumptions
The assumption is that the social reality exists
independently of human interpretation and understanding. There
is an external reality that is independent of what one may
understand or think. The Haven staff or volunteers who would
conduct the training may understand and things differently from
external reality. Thus, all training materials will include
detailed instructions. The other assumption is that reality can
only be understood through the human mind. Ontology deals
with existing things while epistemology deals with what can be
known and how it can be known. One assumption is that the
women who take part in this training are able to retain the
knowledge and are able to practice these financial literacy
skills.
4.7 Limitations
Evaluate the weaknesses of the Capstone Project at this time.

· The areas that need to be improved before starting the
Capstone Project.
· The areas that cannot be improved.
· The reasons for not redesigning to address any of the
limitations identified.
One limitation is the file drawer effect, where the literature may
have more articles that find significant differences or effects
because those are more likely to be published than research that
finds no significant differences or effects. Only research that
finds significant differences or significant results tend to be
published (the rest languish in filing cabinets). Research on best
practices may show a bias. One way you can address this is to
keep a log of how often a result is found.
Some sources may be behind a paywall; solution is to use
interlibrary loan. If the source is from a for profit business, I
may email and ask to get access to it.
Section 5 Sample and Design (Approach)
5.1 Sampling and Recruitment
For each data source, describe the sampling plan. Describe how
you plan to select the sample. Include the steps you will take to
recruit participants.
· A brief description of the data source, the sampling plan, and
inclusion and exclusion criteria.
· The recruitment strategies (where applicable).
The data sources are articles not participants. Inclusion: The
sources are peer reviewed journal articles, government sources,
nonprofit organizations,
Exclusions: Dissertations because they are not peer reviewed.
5.2 Expected Site

Describe the organization or site(s) from which you expect to
draw the sample.
· The name of the agency.
· The type of agency (profit, non-profit) government).
· (The population served.)The agency’s mission and/or human
services they provide.
The Haven's mission is to empower the survivors of domestic
violence and help the individuals heal by addressing sexual
assault and domestic violence by intimate partners heal by
addressing and preventing sexual assaults and domestic
violence. As a non-profit organization, I have a comprehensive
program that caters to DV and sexual assault victims. All people
in society have rights regardless of their traditions, and they are
out to be protected from abusive perpetrators. The organization
and the program are survivor-centered and help the victims live
safely without fear.
Non-profit organization
The Haven is a temporary shelter that assistance to victims of
domestic violence and sexual assault.
Mission Statement: It is our goal at The Haven to provide
victims with the necessary information, resources, protected
head start, and supportive follow-up to transition out of a
violent lifestyle and into successful independent living. The
Haven aims to provide for the immediate primary needs
of family violence and sexual assault clients, including
food clothing, legal advocacy, mental health assistance, and
referral for medical care. The Haven interfaces with local, state,
and national resources, provides transitional assistance along
with the re-education of the victim and family to promote a non-
violent lifestyle and educates all aspects of the local community
regarding family violence and sexual assault (The Haven, 2021,
para 1).

5.3 Site Permission
· The name of the authorized individual allowing the use of the
organization or site.
· A statement of whether the site has an IRB.
· The process to obtain permission to access the stakeholders,
population, or data source.
The two people below are authorized to give permission – and
have done so – on behalf of The Haven are:
Lola Rivera, Volunteer Coordinator, and Tiffanie Thomas, Case
Manager
The site does not have an IRB.
5.4 Participant Contact
How will potential participants first be contacted? How will
participants be contacted following the study?
N/A, there are no participants.
5.5 Action Plan and Time Frame
Describe the steps and time it will take to complete the
Capstone Project. Provide a quarter-by-quarter listing of
activities from start to finish. Describe the exact procedures that
will be needed to carry out this study. This should read like a
recipe for conducting the study. Be sure to include all the
necessary details so that someone else would be able to follow
this to replicate the study. (See Appendix C for an example of a
completed chart.)
· A step-by-step description of exactly how the research will be
conducted.

Quarter
Activity
Estimated time frame
Q4 Fall 2021
Complete MS 2
Week 10
Q1 Winter 2022
Ethics paper
Week 2
Q1 Winter 2022
IRB review
Week 4
Q1 Winter 2022
Mid-point “data” review of training notes
Weeks 5-10
Q2 Spring 2022
Draft of the capstone report
Week 1
Q2 Spring 2022
Draft of training materials
Weeks 2-5
Final “data” check (pivot to training materials instead of taking
notes on it)
Week 6
Q1 2022
Second draft of capstone report
Weeks 7-9
Q1 2022
Mid-point capstone review and alignment check
Week 10
Q2 Summer 2022
Second draft of training materials
Week 1
Q2 Summer 2022
Final draft of training materials

Week 4
Q2 Summer 2022
Final draft of capstone report
Week 5
Q2 Summer 2022
Committee review and school review
Week 7
Q2 Summer 2022
Publications review
Week 8
Q2 Summer 2022
Dean review
Week 9-10
5.6 Action Research Feedback Loop and Dissemination Plan
Describe the plan for providing feedback to stakeholders and
the dissemination of the Capstone Project findings.
The specific type of meeting (focus group, board meeting,
community meeting, presentation meeting, etc.).
· The specific audience (executive administrators, directors,
board members, stakeholders, etc.).
· The type of information that will be disseminated (written
executive summary, verbal presentation of results, etc.).
· The key messages are based on stakeholder feedback.
· The timeline for the feedback.
The training program will be shared with the board members at
The Haven in a board meeting as coordinated by eitherLola
Rivera (Volunteer Coordinator) or Tiffanie Thomas (Case
Manager). The presentation will be a digital copy (if board
meeting is web-based) or either digital or as hardcopy if
preferred by the board. I will have a short PowerPoint
presentation (digital or hardcopy as requested) about the

training program as well.
If the board has feedback, I will incorporate those changes
within weeks, following up with the chosen board
representatives.
Once approved, the board members would choose to disseminate
it to the trainers who will be the case workers employed by The
Haven. Case workers are currently responsible for the
connecting of the victims to the finance and ensuring all
conditions are met for release of the money and housing
information.
5.7 Action That Will Result from This Project
Describe the action sought by the project and how the action
plan will be implemented.
For example, the development of a task force that will be
implemented by the organization with community members.
The case workers will schedule the training for their clients
according to their need, either as individual or group sessions
(depending upon the outcome of the recommendations for such
training). Ideally, this training will occur regularly and build in
follow-up testing and evaluation by The Haven.
Section 6. Ethics
6.1 Ethical Considerations
Describe any ethical considerations given the sample and/or
topic.
· An explanation of how you plan to protect participants during
recruitment, data collection, and data analysis.
· A description of any ethical concerns related to researcher

positionality and how the concerns will be addressed.
· A description of any possible coercion and how it will be
avoided.
Communications will be between the researcher/learner and the
volunteer coordinator and the case worker employed by The
Haven. Since there’s no data and you will not be communicating
with victims. No interactions with their clients, etc. No one in a
vulnerable position will be contacted, let alone at risk. All
training choices will be made with care to protect the clients
who are survivors.
6.2 Risk Assessment
Describe any risk to the participants and/or the organization.
Reference the CITIT course for more information about minimal
risk studies.
· A statement of whether the study is more than minimal risk.
· A statement of whether the study collects data from a
vulnerable population.
· A description of any special steps will be taken to protect
participants.
There will be no contact with any victims who are clients of the
Haven. Any conversations will be held with employees of The
Haven. All conversations with personnel will be respectful of
their time and efforts.
Section 7. References
List all references used in proper APA Style. You should
include a minimum of 30 for the research plan but will need at
least 50 for the Final Capstone Project.

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5
Version 6.0 effective April 2020

Journal of Interpersonal Violence
2021, Vol. 36(3-4) NP1625 –1651NP
© The Author(s) 2017
Reprints and permissions:
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DOI: 10.1177/0886260517743547
journals.sagepub.com/home/jiv
Original Research
“It’s Not All About
Money”: Toward a
More Comprehensive
Understanding of
Financial Abuse in the
Context of VAW
Marie Eriksson1 and Rickard Ulmestig1
Abstract
Men’s violence against women (VAW) is multifaceted and
complex. Besides
physical, psychological, and sexual violence, women subjected
to VAW often
suffer from economic hardship and financial abuse. Financial
abuse involves
different tactics used to exercise power and gain control over
partners.
Experiences of financial abuse make it difficult for women to

leave an abusive
partner and become self-sufficient. From an intersectional
perspective,
applying the concept of the continuum of violence, the aim of
this article is
to develop a more comprehensive understanding of how women
subjected
to men’s violence in intimate relationships experience the
complexity of
financial abuse in their lives, in the context of VAW. Based on
19 in-depth
interviews with women surviving domestic violence, the study
describes how
intertwined women’s experiences of financial abuse are with
other forms
of abuse, influencing each other, simultaneously experienced as
a distinct
form of abuse with severe and longstanding consequences.
Women in the
study describe how men’s abuse affects them financially,
causing poverty and
affecting their ability to have a reasonable economic standard.
Financial abuse
also causes women ill health, and damages their self-esteem and
ability to
work, associate, and engage in social life. The interviewed
women describe
1Linnaeus University, Växjö, Sweden
Corresponding Author:
Marie Eriksson, Department of Social Work, Linnaeus
University, Växjö 341 95, Sweden.
Email: [email protected]
743547
JIVXXXXXX10.1177/088626051774354710.1177/08862605177

43547Journal of Interpersonal ViolenceEriksson and Ulmestig
research-article20172017
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mailto:[email protected]
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17743547&domain=pdf&date_stamp=2017-12-24
NP1626 Journal of Interpersonal Violence 36(3-4)
how experiences of financial abuse continue across time, from
their past
into their present situation and molding beliefs about the future.
According
to the interviews, financial abuse in private life sometimes
continues into
the public sphere, reproduced by social workers mimicking
patterns of ex-
partners’ abuse. Bringing out a more comprehensive
understanding of the
dynamic continuum of financial abuse, our results deepen
knowledge about
the complexity of VAW in women’s lives, and thereby are
important in
processes of making victims of violence survivors of violence.
Keywords
men’s violence against women in intimate relationships, VAW,
domestic
violence, financial abuse, continuum of violence, intersectional
perspectives
Introduction

In the context of men’s violence against women in intimate
relationships
(VAW), financial abuse occurs when men “control and limit
women’s access
to, and use of, money” (Branigan, 2004, p. 11). Financial abuse
is one impor-
tant tool in exercising power and gaining control over a partner,
depriving her
of financial resources to fulfill her basic needs, diminish her
ability to live
independently and deter her from leaving or ending the
relationship (Adams,
Sullivan, Bybee, & Greeson, 2008; Anderson & Saunders, 2003;
Barnett,
2000; Branigan, 2004; Chronister, 2007; Green, 2014; Hughes,
Bolis, Fries,
& Finigan, 2015; Postmus, Plummer, McMahon, Murshid, &
Sung, 2012;
Purvin, 2007). Financial abuse and the economic hardship that
follows can
also force women who are its victims to return, sometimes
risking their lives
(Haeseler, 2013a; Purvin, 2007; Sanders & Schnabel, 2006).
According to
Stylianou, Mathisen, Postmus, and McMahon (2013), many
studies of VAW
neglect financial abuse or make it invisible when describing it
as a form of
psychological abuse. One explanation for this negligence could
be that early
radical feminist researchers on VAW focused on sexuality and
the body, with
little interest in financial exploitation as a dimension of
women’s subordina-
tion—in contrast to their Marxist and socialist sisters (Gemzöe,
2002).

Branigan (2004) puts forward another interpretation, arguing
that economic
abuse can remain unseen because of an ideology of marriage
and money that
presumes that partners—men and women—have the same
interests and share
financial resources for the common good. Näsman and Fernqvist
(2015)
argue that scholars’ unwillingness to connect financial
vulnerability and gen-
der-based violence can be understood in the light of a feminist
critique of
socioeconomic explanations that dominate the research on
financial
Eriksson and Ulmestig NP1627
vulnerability and to some degree disregard gender.
Consequently research on
financial abuse in the context of VAW is still limited. Most
studies on the
subject are from the United States and Australia, based on a
quantitative
approach. Hence, to deepen our knowledge, we argue it is
relevant to explore
the relationship between financial abuse, its different forms,
and other forms
of abuse by using qualitative methods and by focusing on other
welfare
contexts.
Sweden, one of the Nordic welfare states and the context of this
study, is
often perceived as a haven of gender equality, with small

socioeconomic dif-
ferences and an inclusive and strong welfare state (see
Borchorst, 2012;
Hakovirta, Kuivalainen, & Rantalaiho, 2013). Sweden has also
adopted
strong legislative intent to prevent VAW and to support victims
of crime
(Ljungwald, 2011; Peters, 2006). For example, the Social
Service Act
includes a particular section on municipalities’ responsibility to
support vic-
tims of crime, especially women and children who are victims
of men’s vio-
lence in intimate relationships (Social Service Act, 2000, 5§ 11
cap). Yet
some critics argue the legislation is mainly symbolic (Elman,
2001;
Ljungwald, 2011). However, Sweden ranks high in international
compari-
sons on many aspects of gender equality (Global Gender Gap
Report, 2015)
and the level of women’s participation in paid work is among
the highest in
the world (Harsløf & Ulmestig, 2013). The socioeconomic
differences among
the population used to be low, but are now getting closer to an
average
European level (see Fritzell, Bäckman, & Rotakallio, 2012).
Like other forms of VAW, financial abuse is characterized by a
repeated
pattern of abuse, embedded in “a continuum of control and
coercion,” some-
times as extreme as the term “surveillance” implies (Branigan,
2004, pp.
23-24). Liz Kelly developed the concept continuum of violence

to understand
the complexity in abused women’s experiences of violence,
which did not
neatly fit into the ordinary categories used by researchers or the
judicial sys-
tem (Kelly, 1988, 2012). Using the concept of continuum of
violence, the aim
of this article is to understand financial abuse, by analyzing
women’s experi-
ences of financial abuse in relation to other forms of VAW. Are
financial
abuse and other forms of VAW related, and how? Is financial
vulnerability
among survivors of VAW linked to other forms of
vulnerability? If so, can
their situation be understood as a continuum? If so, then how?
Literature Review
As research on VAW has shown, women’s experiences of
violence in intimate
relationships are complex, involving physical, psychological,
sexual, emo-
tional, and financial abuse—often related, co-occurring in their
lives,
reinforcing each other (Johnson & Ferraro, 2000; Kelly, 1988,
2012;
Lundgren, Heimer, Westerstrand, & Kalliokoski, 2001; Postmus
et al., 2012;
Sokoloff & Dupont, 2010). Nevertheless, scholars argue that
financial abuse

is also a specific form of abuse, which comprises characteristics
distinct from
other forms of VAW (Adams et al., 2008; Branigan, 2004;
Postmus et al.,
2012).
In a pioneering study, Adams et al. (2008) concluded that
financial abuse
is when the offender in different ways interferes with the
victim’s ability to
acquire, use, or maintain financial resources. Related to how
financial abuse
interferes with abused women’s ability to acquire financial
resources, schol-
ars have, for example, explored how men’s violence affects
their partners’
employment and capacity to work or study, and thus their
ability to earn an
income and be self-sufficient (Moe & Bell, 2004; Postmus et
al., 2012; Riger,
Ahrens, & Blickenstaff, 2000; Riger & Staggs, 2005; Swanberg,
Macke, &
Logan, 2006; Tolman & Raphael, 2000). Tactics or strategies of
financial
abuse can, for example, include withholding of earnings or
information about
finances, constraining involvement in paid work, and limiting
the control of
money or financial decisions, creating debt or ruining credit,
stealing, and
destroying property (Branigan, 2004; Postmus et al., 2012;
Sanders, 2015;
Stylianou et al., 2013; Swanberg, Logan, & Macke, 2005).
Exploring the correlation between different forms of VAW,
Stylianou et al.

(2013) found that 75% of women in their study who suffered
from physical
and/or psychological abuse from a male partner also
experienced financial
abuse. This supports the results of Postmus et al. (2012), who
also found a
strong correlation between financial abuse and other forms of
abuse in analy-
ses of VAW. Branigan’s (2004) study shows that women’s
experiences of
financial abuse are similar to other forms of abuse by being
both “a contin-
uum of control and coercion,” and “a repeated pattern of abuse,
rather than
isolated incidents.” Furthermore, studies have shown that
financial abuse
also can work as a risk factor in women’s lives, increasing their
vulnerability
to other forms of violence or having consequences such as
physical violence,
sexual abuse, trafficking, HIV, drug usage, and other criminal
activities
(Fawole, 2008; Haeseler, 2013b). As Sanders’s (2015) results
demonstrate,
financial issues are frequently “an impetus” to other forms of
abuse in the
context of VAW, including physical, sexual, and verbal abuse.
According to Kelly (2012), the meaning of her concept
continuum of vio-
lence most commonly referred to derives from the original
definition of the
term, emphasizing that it is “‘a basic common character that
underlies many
different events’—that the many forms of intimate intrusion,
coercion, abuse

and assault [are] connected” (preface, p. xviii). Less used is
another definition
of the concept pointing out that “the categories used to name
and distinguish
forms of violence . . . in research, law or policy, shade into and
out of one
another” (Kelly, 2012, preface, p. xviii). In line with Kelly,
then, one argument
for applying the concept of continuum in analyses of women’s
experiences of
financial abuse is that it is still a challenge to explore the
meaning of the con-
tinuum and how women’s—and men’s—lived experiences of
violence are
intertwined—when constructed as distinct categories in law and
policy (Kelly,
2012).
Building on Kelly’s continuum of violence, other feminist
scholars have
pointed out the importance of what they call a “comprehensive”
interpreta-
tion of violence, in avoiding a fragmented view that tends to
trivialize or
ignore some forms of violence, making them invisible as actions
of vio-
lence (Lundgren et al., 2001; Lundgren & Westerstrand, 2005).
From this
feminist position, we want to argue that financial abuse is a
distinct form of
VAW, yet sometimes entwined with its other forms. In a study

on financial
abuse, Sanders shows how women’s experiences of VAW are
related—for
example, by describing how conflicts over financial issues often
escalate
into other abusive acts. Yet, without applying the concept
continuum of
violence, it appears implicit when Sanders concludes that
“women’s access
to financial resources is often restricted, monitored or
completely con-
trolled by an abusive partner” (Sanders, 2015, p. 23). Sanders’s
results
strengthen our argument that the concept of continuum of
violence (Kelly,
1988, 2012) can be fruitful to apply also in analyses of financial
abuse, to
achieve a more comprehensive and integrated understanding of
VAW
(Lundgren & Westerstrand, 2005).
The opportunities women have to leave abusive men, be self-
sufficient,
and live a life free from violence are not only related to their
individual
resources but also depend on society’s welfare system (e.g.,
Gordon, 2002).
Today’s Sweden is a mature welfare state with welfare systems
that are well
developed by international standards (Harsløf & Ulmestig,
2013; Kvist,
Fritzell, Hvinden, & Kangas, 2012). A general conclusion has
been that the
Nordic institutional welfare model has enabled women to
strengthen their
social and economic position in society. Still, feminist

researchers have been
more critical and pessimistic about its potential to form a
“women-friendly
state,” arguing that it reproduces a new form of patriarchy with
changed
structures of inequality rather than bringing real gender equality
(e.g.,
Hirdman, 2003; Siim, 1990).
Concerning VAW, Swedish legal reform has gradually been
improved to
protect women from men’s violence, but the process has also
been character-
ized by a continuous questioning of gender-specific legislation,
worries about
rule of law, and a conservative defense of (men’s right to)
privacy in family life
(Wendt Höjer, 2002). In Sweden today, men’s VAW is officially
recognized as
a political problem, a prioritized subject in policies on gender
equality, and
considered as one consequence of unequal gender-based power.
Still, in prac-
tice, many politicians and officials look upon the problem as
social, not politi-
cal, thus abdicating from their legal responsibility for all
inhabitants in the
municipality (Holmberg & Bender, 2001, 2003). Consequently,
women suffer
from men’s violence and its long-term negative financial
consequences also in

a Swedish context (Lövgren, 2014; Näsman & Fernqvist, 2015;
Trygged,
Hedlund, & Kåreholt, 2013).
Method
This study is based on 19 interviews conducted with women in
three Swedish
municipalities of different size and character. These in-depth
interviews (see
Irvine, 2011; Lucas, 2014) were semistructured, and lasted
about 1 hr and
sometimes a bit longer. Two of the interviewed women were
recruited through
ads in local newspapers and 17 of them via contact with
women’s shelters.
Most of the interviews were conducted at a women’s shelter, but
in a separate
and private space. In three of the interviews, women were
accompanied by
their small babies. One of the interviews was performed via
telephone and
another one where an interpreter translated via telephone.
Notable is that all the interviews were conducted in Swedish—
including
the one that involved an interpreter—but are presented here in
English. Such
processes of translation inevitably involve the risk distorting
meanings and
nuances in language. To reduce such risks, we have
continuously reflected
upon nuances and meanings in translating the interviews,
including the
engagement of a professional translator, native English, who
has lived in

Sweden for a long time.
All the interviewed women had left a relationship with a violent
male
partner between 1 month and 7 years before. In most cases, the
breakup was
less than 18 months ago. The women were aged 25 to 55, and 18
of them had
children, most of whom lived together with their mothers at the
time of the
interviews. A majority of the women had a small, fragile
personal network,
for example, with friends and family. With a few exceptions,
the women
interviewed were working-class according to their education,
socioeconomic
background, and position on the labor market. Eight were born
abroad, three
were born in Sweden with parents born abroad, and eight were
born in
Sweden with Swedish-born parents.
When the women were interviewed about the financial
consequences of
breaking up from a violent male partner, they also described
experiences of
financial abuse, its different aspects, consequences, and
associations with
other forms of abuse. Loaded with feelings such as anger,
sadness, anxiety,
and relief, the interviews often became emotional, and affected

both the inter-
viewer and the woman interviewed. When the participants were
informed
about the study, all of them said they had someone to turn to
after the inter-
view if in need of support. Nevertheless, written information
handed over to
the participants included information on how to contact local
women
shelters.
Applying the concepts of the continuum of violence and
intersectional-
ity to our interviews on financial abuse, we have worked out an
analysis
based on a reflective approach (see Alvesson, 2003; Alvesson,
Hardy, &
Harley, 2008). This analytical approach can be described as a
process
where the researchers alternate between the empirical data,
earlier research,
and theory. More precisely, the analytical process already began
with the
transcription of each interview, followed by close readings of
the material
where the researchers also alternated between analytical
proximity and
distance. Then empirical themes were identified and analyzed in
a reflec-
tive dialogue involving the researcher, existing research, and
the empirical
evidence—a method inspired by Alvesson and Kärreman (2007).
In the
readings, certain themes were immediately evident, while others
appeared
after a more in-depth analysis. Overall, this approach helps to

meet the
complexities of the interview material, by allowing different
understand-
ings, meanings, and categories to emerge (Alvesson, 2003;
Alvesson et al.,
2008). It also encourages researchers to distance themselves
from earlier
research and biases. By using this structured data analysis
strategy, we aim
to reflect on our own understandings, and problematize our
positions, min-
imizing the negative effects on the analysis. This mode of
analysis attaches
great importance to earlier research and the extensive literature
review
motivated by a need to put our results in a context of what we
already
know about financial abuse. However, presenting our material
with refer-
ence to long summaries from the interviews instead of more but
shorter
quotations is due to our theoretical position and the importance
we attri-
bute to giving voice to survivors’ experiences in our study.
Based on the ethical principles of the humanities and social
sciences
(Swedish Research Council, 2005), the study was granted
permission by the
Regional Board of Ethics of research involving humans in
Linköping (No.
2012/396/31). When trying to get access to the field, we
brought written
information about the research project, including ethical
reflections on risks
involved for participating informants, for example, the risk of

bringing
repressed memories and experiences of abuse to the surface. To
resolve this,
we stated that a female researcher with theoretical and practical
knowledge of
domestic violence conducted the interviews with the survivor s,
well prepared
to give them further support if needed.
Theoretical Frame: Continuum of Violence and
Intersectionality
From an integrated and comprehensive feminist interpretation of
violence,
violence as a continuum means that there are no sharp
boundaries between
different forms of abuse. Controlling acts, insults, threats, and
verbal, psy-
chological, physical, and sexual abuse are not understood as
distinctly
separated categories, but as interconnected acts and
manifestations with
blurred boundaries, reinforcing each other—influencing the
abused woman
in negative ways (Kelly, 2012; Lundgren & Westerstrand,
2005). The con-
cept also brings a perspective where violence can be analyzed
as a process,
and in a wider context, emphasizing the intersections between
different
violent acts and behaviors—and their consequences—placing
serious

criminalized physical acts of violence on the same sliding scale
as legiti-
mate and accepted forms of violence (Kelly, 1988, 2012). A
continuum
perspective on VAW also influences our ethical position as
researchers,
understanding that “all forms of gender-based violence are
serious, but all
forms of violence are not ‘the same’” (Lundgren &
Westerstrand, 2005, p.
493, our translation).
Lynn Segal (1990) has argued that the concept of continuum
blurs bound-
aries too much, without a differentiation between men and
violence—making
all men guilty and making violence an inherent essence of
masculinity. In a
comment on Segal’s critique, Kelly contends that it is clichéd,
and involves a
misconception that a radical feminist like her cannot share a
social construc-
tivist epistemology (Kelly, 2012). Another criticism of Kelly’s
concept has
questioned why certain forms of violence, such as honor-based
violence and
female genital mutilation/cutting, are excluded. According to
Kelly, this lack
of intersectional aspects of women’s experiences of violence in
her develop-
ment of the concept does not prevent such practices from being
included
(Kelly, 2012).
With the aim of underscoring the “multidimensionality” of
abused wom-

en’s lived experiences, Kimberlé Crenshaw (1993) coined the
concept inter-
sectionality. Focusing on domestic violence and rape, she
showed that
systems of race, gender, and class converged in the experiences
of battered
women of color. From an intersectional perspective (see
Bograd, 2010;
Crenshaw, 1993; Sokoloff & Dupont, 2010), we want to
acknowledge that
though men’s VAW is a universal problem, neither gender nor
violence are
universal categories. Women—and men—have specific
experiences, inter-
ests, and needs depending on how they are situated and
positioned in relation
to categories and power asymmetries such as class, ethnicity,
sexuality, age,
civil status, and so on.
Thus, women subjected to financial abuse experience the abuse
and its
consequences in different ways, not only because of their
gender but also
because of their class position, ethnicity, age, and so on. Worth
noting here is
that the welfare state has mainly developed to financially
equalize power
relations based on class, not gender (see Fraser, 1998).
Result and Discussion

This section starts with an analysis of how financial abuse
relates to other
forms of abuse in the context of VAW, and how the interviewed
survivors
experience this. Following on from that is a section on how
financial abuse,
as described by the survivors, also can be understood as a
distinct form of
abuse. Finally, there is an analysis of how women’s experiences
of financial
abuse relates to financial vulnerability.
Financial Abuse From a Continuum Perspective
From our interviews, it is evident that financial abuse is
connected to and
intertwined with other forms of abuse in women’s lives.
Analyzing wom-
en’s experiences of financial abuse from a continuum
perspective and with
a comprehensive understanding of violence makes visible how,
for exam-
ple, the physical violence the women have been subjected to i s
intertwined
with financial abuse, or the ways in which men’s violence has
affected
their financial situation. The financial consequences of having a
relation-
ship with an abusive man vary but can be far-reaching and
continue across
time, into the future, thus reducing women’s financial ability
and their
possibility to empower themselves. Margaret is one example.
She is a
57-year-old, well-educated and “settled” woman with three
children.

Margaret has also experienced psychological, physical, and
sexual abuse
from their father, her ex-husband. When describing him, she
says he is
well established in the local community, and has a good
economy, which
he uses to fight her in court.
As with several women in our study, Margaret has become poor
within the
relationship. Now she has to pay lawyers to get custody of her
children and
thereby be free from the ties to her violent ex-husband. Asked
about the con-
sequences of her new financial situation, she says,
My financial situation also means that I will never get into a
new relationship,
I can’t imagine myself, I don’t initiate contacts, I reject
invitations, it prevents
me from having a relation to anyone whatsoever, I can’t afford
it, to go out, to
go anywhere, I can’t afford to have a coffee, I have nothing to
offer.
Illustrating how financial abuse can be exercised through social
institu-
tions with endless custody cases as an example, Margaret’s
story fits well
with research that shows how abusive men use courts to harass
their victims,
and how having an economic advantage makes their strategy

even more
effective (Morrow, Hankivsky, & Varcoe, 2004). Margaret’s
experiences also
reveal that financial abuse in the context of VAW can continue
long after the
relationship has ended; how the consequences of financial abuse
still confine
and circumscribe her possibilities to engage in social relations,
prevent her
from taking new contacts and dash her hope for a future
relationship. Many
of men’s various tactics of financial abuse not only undermine
women’s
financial independence, but also their freedom of mobility and
association.
Thus, it is also an abuse causing isolation, that sometimes ends
up in a depres-
sion that decreases the abused woman’s self-esteem, and further
adds to her
isolation, victimization, and difficulties in leaving the
perpetrator (Green,
2014).
Another example of how financial abuse circumscribes social
life we get
from Annie, who describes how becoming poor has disqualified
her from
both arranging and being invited to dinners and birthday parties,
because her
middle-class neighborhood requires a standard she “no longer
can match.”
Financial ability is important and a prerequisite for full
participation in soci-
ety (Cheng, 2012; Chronister, 2007), just as women’s freedom
from violence
and fear of violence is essential for democracy and citizenship

(Wendt Höjer,
2002). Some women interviewed tell of how experiences of
shame can com-
plicate social relations and participation in society—both the
shame of being
subjected to violence, and the shame of being poor or unable to
afford things.
According to Denise, shame of being poor arises not only in
contact with
welfare authorities, when asking for financial support, but also
when she is
out and her friends pay for her, well aware she cannot pay back:
“You’re
ashamed, avoiding [social situations] . . . you always take,
without giving
back, it’s not good.” Mira’s story of being subjected to a
husband’s violence,
and to poverty—as a consequence of his financial abuse—
exposes how dif-
ferent forms of abuse intersect, sometimes with long-lasting and
considerable
effects on the self: “I don’t forget this shame, how awful . . .
each time you
get smaller and smaller and lose your self-esteem and self-
confidence.”
Shame can also be a consequence of men’s conscious
humiliation related to
financial abuse. Lea, another woman interviewed, tells of her
husband: “[he]
often bought clothes for himself, sometimes quite expensive.”
But to “humil-
iate her,” he did not allow her to buy anything for herself, but
forced her to
wear worn and damaged clothes. Experiences of shame also
appear in other
abused women’s stories, sometimes conveying a double shame

that is a two-
fold effect of financial abuse, originating from experiences of
being a victim
of abuse and from being poor. Feelings of shame can be long-
lasting, just as
the precarious financial situation that many survivors of VAW
suffer from
often continues long after the breakup—due to the high costs of
divorce,
large debts, health problems, difficulties in housing, keeping a
job, and so on
(Branigan, 2004; Green, 2014; Haeseler, 2013b; Lindhorst,
Oxford, &
Gillmore, 2007).
Lisa is an example of how emotional fragility as an effect of
VAW can
have an impact on victims’ possibilities to get employed, and
how their
unemployment can be intertwined with partners’ desire for
power and con-
trol. A woman in her twenties with a 6-month-old baby, staying
at a women’s
shelter, Lisa describes how multifaceted her former boyfriend’s
financial
abuse was. Among other tactics he used was employment
sabotage, including
harassing her at work by endless calls and a constant nagging
demanding her
to be at home, serving him, instead of working. As an effect of
her partner’s

abuse, Lisa is still unemployed, more than a year after breaking
up from him.
At the time of the interview, she was on parental leave, taking
care of her
baby. When thinking of going back to work, Lisa says, “I am
afraid it will be
difficult.” She questions how to be able to handle smells and
sounds that
remind her of her abusive partner. She also explains how
experiences of her
boyfriend’s abuse and threats from his family make it difficult
for her to be in
public places at all, especially if there are many men, and if
they look at her.
An incident like that recently happened, that made her panic and
rush away.
Asked about her present financial situation, she concludes,
“Now I am more
dependent on social benefits than ever before, because I have
become very
much damaged.” Discussing her experiences of abuse, and how
they have
affected her, Lisa says,
The physical violence is not that hard, actually. The wounds
disappear, the
psychological lasts for years, many, many years . . . and every
time you see a
bill . . . it will immediately remind you of your past life, what
you want to put
behind you.
Lisa’s story reveals how experiences of men’s physical VAW in
intimate
relationships can be intertwined with psychological and
financial abuse, and

mutually affect women’s mental health for a long time. Hence,
cumulative
vulnerability and victimization as a consequence of VAW
hinder women
from managing a job and becoming self-sufficient (Cocker et
al., 2002;
Lindhorst et al., 2007).
For related reasons, Ellen (008), who has a protected identity
because of
death threats from her ex-husband, explains that her situation
makes it diffi-
cult to find a suitable job that does not reveal her identity.
Diagnosed with
posttraumatic stress disorder as a consequence of being abused
further com-
plicates her chances of getting a job, together with ignorance
among welfare
officers not taking her position as a victim of crime seriously.
Women sub-
jected to VAW often have higher absence from work because of
men’s vio-
lence (see Adams, Tolman, Bybee, Sullivan, & Kennedy, 2012;
Brandwein &
Filiano, 2000). Accordingly, the difficulties in finding and
keeping a job
make abused women dependent on welfare (Adams et al., 2008;
Roschelle,
2008). In a Swedish study, Trygged et al. (2013) conclude that
the abused
women in their sample had a lower education and a weaker

financial position,
even before they were assaulted, compared with the women in
the sample
who had not been assaulted. Yet, the results also show that all
the abused
women in the sample (no matter what their education level) who
received
hospital treatment for injuries caused by a male partner’s
assault also were at
greatly increased risk of having low incomes and of being in
need of welfare
support.
The stories of survivors that appear in our material offer
support for a
feminist understanding of violence, suggesting that abusive men
exercise
power and control over women also by means of financial
exploitation and
control (Adams et al., 2008; Branigan, 2004; Sanders, 2015).
Karin, a woman
in her fifties, who had suffered from psychological and
financial abuse, but
now is divorced from the perpetrator, gives her picture saying,
“For him I
don’t think it was so much about the money, but more about
breaking me
down.” Applying the concept of continuum of violence (Kelly,
1988, 2012)
to the survivors’ experiences helps us understand how different
forms of vio-
lence coexist and reinforce each other—“shade into and out of
one another in
complex ways” (Kelly, 2012, p. xviii)—turning physical and
psychological
violence into financial abuse with far-reaching consequences.

The women
interviewed give several examples of how violence works as a
continuum in
their lives, across time and place, and how these intertwined
experiences of
abuse mold a cumulative vulnerability (Scott-Storey, 2011). In a
longer per-
spective, disrupted employment records can result in abused
women’s diffi-
culties in getting work, earning a living, and establishing
financial
independence (Lambert & Firestone, 2000; Roschelle, 2008;
Tolman &
Raphael, 2000).
Financial Abuse as a Distinct Form of Abuse
In the United States, the pioneering research of Adams et al.
(2008) and
Stylianou et al. (2013) has yielded interesting results, making
important con-
tributions to the conceptualization of financial abuse by
showing that it is a
specific form of abuse, moderately correlated to the other
forms, and
therefore should be treated as a distinct construct. Some
research in the field
of VAW considers financial abuse as a distinct form of abuse, at
the same
time trying to conceptualize financial abuse vis-à-vis other
forms of abuse

women suffer from in relationships with men (Kim, 2015;
Sanders, 2015).
Parallel to this emerging field of research, the United Nations
has conceptual-
ized financial abuse as a distinct form of abuse when discussing
indicators of
VAW (UNSTATS, 2010). Yet, when concluding that the low
social and finan-
cial status of women can be both a cause and a consequence of
financial
abuse, they do not discuss it as a distinct theme in their report
(UNSTATS,
2010).
As mentioned, financial abuse can affect women’s chances of
finding
work. In the following, Anna’s story brings evidence of how
this form of
abuse can be understood as a distinct form of VAW. Anna, who
is a well-
educated middle-class woman in her fifties, describes the
complexity of
financial abuse and how it has affected her. Asked about how
her financial
situation was at the time of her relationship, Anna says it was
very good. She
had just sold an apartment and was financially independent.
However, as she
had her own company where she received most of her orders
through her ex-
partners’ contacts, she was still dependent on him for her
income.
Anna’s business was successful for many years. Asked about
how the rela-
tion to her partner developed, Anna describes how his violent

behavior started
with him “pushing her down,” complaining she did not do her
job, and claim-
ing she was not capable of running a business. The ex-partner’s
harassment
continued and ended up in two incidents when he assaulted her.
Then he and
Anna separated, and she moved from the house they owned
together. After
the separation, they no longer worked together. The number of
assignments
declined, and when Anna did not manage to run her business
anymore, her
savings soon ended. She says, “He was kicking at my skills and
that was what
provided my living.”
When her partner refused to pay the mortgage on the house,
Anna thought
she had no other option but to move back and stay with him
until they man-
aged to sell the house—which turned out to be difficult. After
another inci-
dent when he pressed a glass in her face, Anna moved again.
During a period,
she had to pay for the house, for long journeys to work and her
rent. Anna’s
savings then declined further. Now she says that her savings are
gone, and she
supports herself on a temporary employment.
Anna’s experiences are an example of how VAW and financial
abuse can
result in loss of professional self-confidence, work
opportunities, income,
and material belongings. Her story supports previous research

findings and
fits well into the concept of “employment sabotage,” a form of
financial
abuse defined by Stylianou et al. (2013). Women frequently
speak of being
subjected to different forms of employment sabotage in our
material.
Roschelle (2008) has found that a common tactic among abusive
men is to
harass their victims and their colleagues at work, putting
victims’ jobs at risk.
That is how Ellen lost her job. Repeatedly harassed at work by
her ex-partner,
her boss finally told her she had to quit. Maria, employed in
home-care ser-
vice, also had to resign from her job because of fear of her
violent ex-partner
who lived in the same area where she worked. Men’s
employment sabotage
can be long term, determining a woman’s entire professional
life. In Mira’s
case, it was a constant feature in her marriage to a violent
husband, lasting
more than 20 years:
When we moved to [a city] I immediately got a job, worked
there a couple of
years . . . it was jealousy, everyday life was very difficult, it
was hard all the
time, he prevented me from working and studying . . . he
became worse and

worse, he wanted me at home, I was expected to take care of
him.
Women subjected to violence report difficulties in concentrating
at work
and having poor attendance at the workplace as an effect of
being abused—
which puts their jobs at risk (Adams et al., 2012). Conversely,
Chronister
(2007) argues that women with social and psychiatric problems
seem to be
more vulnerable to domestic violence because of their problems
getting
access to the labor market. As we have seen, Anna’s partner
used the house
mortgage as a tool to threaten her financial independence, and a
device to
make her more dependent on him, forcing her to move back to
him. However,
shortly afterward, he was beating her and she moved out again.
Physically
abused, Anna was forced into a situation that increased her
expenses—and
her vulnerability—when having to pay double rents, buy new
furniture,
increased expenses for travels, and so on. Altogether, Anna is
an example of
how financial abuse has its own character and consequences,
sometimes
independently of other forms of abuse, sometimes intertwined.
Intersections of Financial Vulnerability
In our analysis, we link the concept of continuum of violence to
an intersec-
tional perspective, recognizing that structural forms of

oppression—such as
men’s VAW—intersect not only with gender but also with
structures such as
class, race, ethnicity, functioning, sexuality, age, and civil
status (e.g.,
Hetling, 2011; Hughes et al., 2015; Keskinen, 2011; Lindhorst
et al., 2007;
Mays, 2006; Sokoloff & Dupont, 2010). In recent years,
researchers have
criticized simplistic analyses of domestic violence, challenging
stereotyped
notions of battered women tainted by sexism, racism, and
classism (Bograd,
2010; Johnson & Ferraro, 2000; Mays, 2006; Sokoloff &
Dupont, 2010). For
example, Donna Cocker shows how an unstated norm for
battered women as
White and nonpoor is constructed when policy or law neglects
the relation
between poverty and violence, and ignores racialized
differences in battered
women’s experiences. Consequently, abused women’s needs are
constructed
as primarily psychological rather than material (Cocker, 2010).
Toni tells
another story.
Toni is a 24-year-old woman born in an African country who
has lived in
Sweden for 3 years. After fleeing an abusive husband, she is
now isolated

from friends and family. When asked whether there is anyone
who can help
her to get financial support, she says, “There is no one. My
mother got no
money; they are really poor in [an African country].” Toni has
two children.
One of them is newborn and the child of her abusive ex-
husband. From our
interviews, we conclude that lack of family support and other
social networks
makes women even more dependent on welfare and sometimes
women’s
shelters become their only support system—that lend them
money, offer
clothes and food, give advocacy support, and so forth.
Toni was forced into a marriage with a man known to her
family. He
turned out to be an alcoholic and subjected her to different
forms of violence,
for example, physical and financial abuse. During their
marriage, her hus-
band was unemployed; they lived on social assistance and were
in constant
need of money. Toni’s husband borrowed money from friends,
and he owed
them money for buying him alcohol. Toni was trying to manage
on the small
income she received from state parental benefits. She also tried
to save small
amounts without affording anything for herself and hardly
anything for her
children. About her husband’s financial abuse, she says,
He borrowed money all the time. When we had a little money he
took everything

and paid back to the people he owed money. I . . . we did not
have so much
money. I had a little account for savings in the bank. All the
time he said to me:
“Go fetch the money!” “Go fetch the money!” . . . But there was
only a little
money. I have brought some money to the bank. I go and I leave
some money
there. All the time [her husband says]: “Go fetch the money!” I
mean there is
only a little money in the bank. You know it is from the
parental benefit and my
child benefit. I only had one child before. I just use the money
to buy food and
go shopping to eat, nothing else.
Toni says she is stressed because her family of origin now is in
conflict
with her ex-husband’s family. Her ex-husband also stresses her
by being
drunk when he spends time with the children, using his
visitation rights. Toni
feels that she does not get any support from the social services
when com-
plaining about her situation, and she does not understand the
rules.
Nevertheless, the problem is not about Toni’s ability to
understand. Rather, as
Purvin (2007) argues, it is a policy failure when women “are not
being
informed of potential policy options that might have protected

them or helped
them leave an abusive situation” (p. 202). As with other women
in our study,
Toni’s story gives evidence of how men’s financial abuse
deprives women of
essential resources and housing (Branigan, 2004; Sanders,
2015). Toni has
hardly any furniture in her apartment because she had to move
hurriedly, and
only managed to bring the TV and some basic clothes for her
and the chil-
dren. Nevertheless, Toni says she is better off financially after
the separation
than before. Similar paradoxical experiences are expressed by
other women
in our study, describing both experiences of the exploiting and
damaging
effects of financial abuse—making them poor, vulnerable, and
dependent—
and simultaneously feelings of relief, control, and self-esteem,
being rehabili-
tated as capable economic subjects in charge of their own (yet
poor) finances.
Tina, for example, who has to live on social assistance after
escaping a
violent partner, explains that she is better off now —despite
being poor—than
before, when her partner was stealing her money: “[I]f I had
lived with him,
and had a full-time-job, he would have been taking all my
money.” Similar
experiences are expressed by Fia, a 26-year-old woman with
three small chil-
dren, recently separated from their violent father who is
addicted to gam-

bling. She describes a financial situation filled with stress,
where she has to
pay a large amount of her monthly income for many years to
come, because
of the debt her husband has left her with. Nevertheless, Fia also
expresses
feelings of relief and of getting control:
I know what I get every month . . . it’s my money . . . I make a
budget for every
month so I know I can save money if I don’t get anything from
the unemployment
insurance.
Yet the situation for financially abused women can be complex
and ambiv-
alent. Sanders concludes that abusive men may continue to
interfere even
when their partners are gaining more financial resources and
financial inde-
pendence. Consequently, women are vulnerable to abuse “not
only when
their resources are low and their dependence high” (Sanders,
2015, p. 23).
Studying a family context, Näsman et al. (2015) found that
women experi-
enced men’s ongoing financial abuse also after separation. For
example,
fathers refused to pay for their children, sabotaged women’s
possibilities to
receive welfare support, and delayed maintenance payments
(Branigan,
2004; Bruno, 2016; Näsman et al., 2015). Taken together,
problems in earn-
ing money and a lack of financial resources—as consequences
of VAW—

make it difficult for women to start over and establish a
household and an
economy of their own (Branigan, 2004; Strand Hutchinson &
Weeks, 2004;
Sanders, 2015). As in Sanders’s (2015) research, our material
gives many
examples of women who do not lack subjective agency when
being subjected
to financial abuse, but rather resist and respond to it in different
ways. Toni,
who both openly refused to obey her husband’s demands to
make withdraw-
als from her bank account, and secretly continued to save
money even when
the amounts were negligible and put under constant pressure
from him, is just
one example.
The continuum of violence does not mean that financial abuse
continues
across time forever, without ending, but rather emphasizes that
it seldom
ceases to exist when the abusive relationship ends. Then
financial abuse in
the context of VAW can lead to a feminization of poverty
within relationships
that continues into abused women’s future, with material as
well as social and
psychological consequences.
Whether the women in our study who are looking for work will

find
employment or not depends very much on their educational
background. The
Swedish labor market is characterized by high unemployment
among
unskilled workers, immigrants, and young people (SCB, 2014).
Women earn-
ing high wages also have greater significance for a family’s
overall financial
situation and are therefore “allowed” by husbands/partners to be
financially
active and gain experience in the labor market (Anderberg &
Rainer, 2012).
Class position also plays a role in how education can lead to a
higher-paid
job, greater life opportunities, and the ability to take charge of
one’s financial
situation (Postmus et al., 2012). This makes class a further
issue, both during
the relationship with an abusive partner and after leaving him.
Despite the fact that VAW exists in all socioeconomic classes,
and women
share experiences of financial hardship in relations with abusi ve
men, studies
have shown that poverty is a high predictive risk factor, making
poor women
especially vulnerable to men’s violence in intimate relationships
(Bassuk,
Dawson, & Huntington, 2006; Tolman & Raphael, 2000). For
example,
women in low-paid jobs are less prone to break up from
relationships to abu-
sive men (Gelles, 1976), and when abused women do not have
their own
income or access to financial resources, their dependency

increases and it
becomes more difficult to leave (Sullivan, 1991; Weis et al.,
2005). Being on
welfare can be an additional risk factor. Research by Kurz
(1998) shows that
divorced women on welfare experience higher rates of male
partner violence
than any other group, and the poorer the woman is, the more
serious is the
violence she is subjected to. Many abused women feel they have
no other
choice than to return to abusive men, so as to make financial
ends meet, while
other women cannot even afford to leave (Weis et al., 2005).
Nevertheless,
our empirical findings support earlier research showing that
irrespective of
socioeconomic background, financial hardship and financial
dependency are
major motivations for women enduring in relationships with
violent men
(Anderson & Saunders, 2003; Barnett, 2000; Purvin, 2007).
How a financial
situation—caused by an abusive man—can hinder women from
leaving in
other ways, is evident in Lea’s story. She says she was never
afraid of leaving
her husband because of fear of not managing financially on her
own. Still,
their financial situation and ideas about the importance of a
stable economy

for a happy marriage gave her “false hopes” of a better
relationship to her
husband and kept her from breaking up, thinking,
If we only get a little better finances, we can do things together,
and then he
may feel a bit better too, and become who he was in the
beginning of our
relationship . . . our first year . . . he was a very nice person . . .
you always had
a hope it would be better if only the economic situation
improved.
Conclusion
The theoretical framework in this study builds upon feminist
theories of vio-
lence and gender. Therefore, we use the concept “men’s
violence against
women” (VAW) and regard the gender relation as a relation of
power where
women structurally are socially and culturally subordinate to
men.
Consequently, gender inequality is considered a primary reason
for the exis-
tence of VAW, and VAW to be one way (of many others) to
maintain, repro-
duce, and restore the societal gender order (Hearn, 1998;
Walby, 2002). Our
results support feminist theory, suggesting that financial abuse
in its different
forms involves tactics and strategies for men to control women,
curtailing
their freedom and subjectivity. Financial abuse involves a
repeated pattern of
men controlling and limiting women’s ability to acquire, use, or

maintain
financial resources (Adams et al., 2008) with long-term effects
such as pov-
erty, ill health, and dependence for them and their chil dren
(Branigan, 2004).
Financial abuse occurs and is experienced along a continuumof
different
types of financial abuse, categorized as economic control,
employement sab-
otage and economic exploitation (Postmus et al., 2012, p. 418).
Often it is
intertwined with other forms of violence such as sexual,
physical, and psy-
chological, and continuing over time. However, the continuum
of violence
does not mean that the financial abuse lasts forever, but reveals
that it seldom
ceases to exist when the relationship ends. Financial abuse and
its effects can
continue for a long time, into women’s future, and shape it with
material as
well as social, psychological, and medical consequences.
The focus in the article has been on financial abuse.
Nevertheless, despite
the fact that financial abuse appears as a distinct category of
violence in
women’s narratives of men’s violence, all the women in our
study, besides
being subjected to financial abuse, have also been exposed to

other forms of
men’s abuse and control. From the interviews, it is also evident
how financial
abuse and other forms of violence are intrinsically
interdependent and mutu-
ally reinforcing in women’s lives. Hence, our results support
feminist theory
showing that financial abuse in its different forms and
interactions involves
tactics and strategies for men to control women, curtailing their
freedom and
subjectivity (Branigan, 2004). Nevertheless, and in accordance
with Sanders
(2015), our results also demonstrate that women, despite their
experiences of
financial abuse, did not lack subjective agency, but also
responded to and
resisted financial abuse in different ways. We argue that
financial abuse is
connected to other forms of abuse and that this understanding
gives the pos-
sibility for a comprehensive understanding of VAW and
different strategies
used by abusive men. However, financial abuse is also a distinct
form of
abuse with its own characteristics, affecting women and
children. Still, finan-
cial abuse is widely underrecognized both in research and in
society, making
further research and policy necessary.
The survivors in our study described how the financial
exploitation and
control they have been subjected to affect their ability to
achieve a reasonable
standard of living both during the relationship and long after the

relationship
had ended. Furthermore, their narratives are intertwined with
other power
relations than gender, showing that structures such as class and
ethnicity also
influence the effects and women’s experiences of financial
abuse. In the
interviews, women expressed experiences of being denied
agency and sub-
jectivity by men controlling and limiting their access to and use
of financial
resources in intimate relationships. Ending the relationship
seldom stopped
the financial abuse or its consequences, making it a form of
abuse “to be
continued.” This finding is supported by earlier research (see
Branigan, 2004;
Green, 2014; Postmus et al., 2012; Stylianou et al., 2013).
Men’s VAW is a universal problem, existing in all levels,
arenas, and
social classes in society. Nevertheless, as critics of a
universalistic approach
have argued, women are differently positioned or situated, in
relation to
structures such as class, ethnicity, sexuality, and so on and
therefore have
both varied experiences of abuse and diverse needs of help and
support
(Crenshaw, 1993; Kandaswamy, 2010; Sokoloff & Dupont,
2010; Weis et al,
2005). Applying intersectionality as a theoretical perspective
means that we
have analyzed financial abuse and financial dimensions of VAW
as a com-
plex social and political problem, not only based on gender

inequality but
also linked to other forms of oppression and vulnerabilities that
intersect with
gender and sexism (Chronister, 2007; Sokoloff & Dupont,
2010).
Theoretically, this brings to the fore a need to reflect on
universality in
relation to intersectionality and to move toward a “multiple
gender” theory
that recognizes differences both between genders and within
genders
(Connell, 1987; Crenshaw, 1993; Sokoloff & Dupont, 2010).
As earlier research has shown, our results suggests that
financial abuse con-
tinues not only across time but also across space—from the
private sphere into
the public. For example there is research showing how state
bureaucracies and
their institutional practices and procedures mimic and support
the perpetuation
of men’s financial abuse—although often unconsciously
(Branigan, 2004;
Ulmestig & Eriksson, 2016). Survivors of VAW are also
confronted with a lack
of respect from social services, including “mind games,”
extreme rudeness,
and caseworkers “talking down” to them (Laakso & Drevdahl,
2006). We argue
that the concept of continuum of violence can also be applied to
these findings

to highlight how women’s experiences of financial abuse in
intimate relation-
ships, in the private sphere, are inextricably intertwined with
aspects of finan-
cial abuse they experience in the public sphere, when
confronting state
bureaucracies. Analyses of financial abuse showing that the
dichotomy between
the public and private spheres is false (Branigan, 2004) further
strengthen our
suggestion to apply the concept of continuum of violence. As
our model dem-
onstrates (Figure 1), a continuum perspective on financial abuse
can help us
understand how different forms of financial abuse and different
types of vio-
lence intersect and are intertwined in women’s experiences of
VAW, how finan-
cial abuse has a continuum across time—and does not end with
separation.
Finally, we show how women’s experiences of financial abuse
also are charac-
terized by continuity across space, and work as a continuum
between private
and public spheres, different arenas and practices.
The study has its limitations, especially due to its limited
numbers of inter-
views. However, the quality or impact of qualitative research
should not be
judged by its numbers but on the quality of the data and the
analysis.
Generalizing results, building on 19 interviews and from a
specific context,
is of course difficult but the study still adds cumulatively and
theoretically to

our understanding of women’s experiences on financial abuse
and VAW. To
deepen that knowledge, and to enable comparative analyses,
there is a need
for more research, for example qualitative analyses of financial
abuse, how
social welfare institutions handle it, and how women survivors
of VAW in
different welfare contexts experience it.
The women in our study live in a country with, by international
standards, a
generous welfare state, a high level of formal gender equality,
and relatively
strong legal protection for victims of VAW. Regardless of
whether the women
interviewed have separated from their abusive partner or not,
the financial abuse
they have experienced most likely continues. To stop financial
abuse—and other
forms of VAW—and find sustainable solutions to the problem
we argue that a
more comprehensive understanding of VAW and financial abuse
is necessary.
Our results make financial abuse visible also in generous
welfare states and help
researchers as well as social workers to see and act on the
abuse. By unveiling
the complexity in women’s experiences of financial abuse, we
think that the
distinction between financial abuse and nonabuse can be

questioned and policy
makers can be offered a tool to understand that financial abuse
is a distinct form
of abuse, but not separated from women’s experiences of other
forms of abuse.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research,
authorship, and/or publication of this article.
Figure 1. A model for a more comprehensive theoretical
understanding of
how different forms of financial abuse are intertwined in
women’s lives, together
with other forms of VAW, and how it continues across time and
across different
spheres/institutions.
Note. VAW = violence against women.
Funding
The author(s) disclosed receipt of the following financial
support for the research,
authorship, and/or publication of this article: The research
project has been
funded by the Swedish Crime Victim Compensation and Support
Authority
[Brottsoffermyndigheten] (Grant number 47210012).
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Author Biographies
Marie Eriksson is a senior lecturer in social work at Linnaeus
University, Sweden. She
has a PhD in history, and her thesis is about marital discord and
men’s violence against
women in 19th-century Sweden. Her main research interest
revolves around gender and
violence—both in present and past times. At present, she is
involved in a research project
on financial abuse in the context of men’s violence against
women. Together with
Richard Ulmestig, she has recently published an article
“Financial Consequences of
Leaving Violent Men: Women Survivors of Domestic Violence
and the Social Assistance
System in Sweden” in European Journal of Social Work. In
another research project, she
is studying different forms of women’s violence in the 19th-
and 20th-century Sweden.
Rickard Ulmestig is a senior lecturer in social work at Linnaeus
University, Sweden.
His main research interest is in policy change and
organizational change within the
welfare state. He has published several studies within labor
market policy, social
assistance, and the specific welfare policy in the Nordic
countries. He has, together
with Ivan Harslöf, edited Changing Social Risks and Social
Policy Responses in the
Nordic Welfare States (Palgrave). He has lately started to study
financial aspects on
domestic violence and how these are handled by survivors of
domestic violence and
by the welfare state.

/WW_full%20report_color.pdf
/WW_full%20report_color.pdf
Journal of Interpersonal Violence
2020, Vol. 35(15-16) 3011 –3033
© The Author(s) 2017
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/0886260517706761
journals.sagepub.com/home/jiv
Article
Developing and
Validating the Scale of
Economic Self-Efficacy
Gretchen L. Hoge, PhD, MSW,1
Amanda M. Stylianou, PhD, LCSW,2
Andrea Hetling, PhD,1
and Judy L. Postmus, PhD, ACSW1
Abstract
Experiencing intimate partner violence (IPV) and financial
hardship are
often intertwined. The dynamics of an abusive relationship may

include
economic abuse tactics that compromise a survivor’s ability to
work, pursue
education, have access to financial resources, and establish
financial skills,
knowledge, and security. An increasingly common goal among
programs
serving IPV survivors is increasing financial empowerment
through financial
literacy. However, providing financial education alone may not
be enough
to improve financial behaviors. Psychological factors also play
a role when
individuals make financial choices. Economic self-efficacy
focuses on the
individual’s perceived ability to perform economic or financial
tasks, and
may be considered a primary influence on one’s ability to
improve financial
decisions and behaviors. The current study tests the reliability
and validity of
a Scale of Economic Self-Efficacy with a sample of female
survivors of IPV. This
study uses a calibration and validation analysis model including
full and split-
sample exploratory and confirmatory factor analyses, assesses
for internal
consistency, and examines correlation coefficients between
economic self-
efficacy, economic self-sufficiency, financial strain, and
difficulty living with
income. Findings indicate that the 10-item, unidimensional
Scale of Economic
1Rutgers University, New Brunswick, NJ, USA
2Safe Horizon, New York, NY, USA

Corresponding Author:
Gretchen L. Hoge, Center on Violence Against Women &
Children, School of Social Work,
Rutgers University, 390 George St., New Brunswick, NJ 08901,
USA.
Email: [email protected]
706761 JIVXXX10.1177/0886260517706761Journal of
Interpersonal ViolenceHoge et al.
research-article2017
https://us.sagepub.com/en-us/journals-permissions
https://journals.sagepub.com/home/jiv
mailto:[email protected]
http://crossmark.crossref.org/dialog/?doi=10.1177%2F08862605
17706761&domain=pdf&date_stamp=2017-05-03
3012 Journal of Interpersonal Violence 35(15-16)
Self-Efficacy demonstrates strong reliability and validity among
this sample of
IPV survivors. An ability to understand economic self-efficacy
could facilitate
individualized service approaches and allow practitioners to
better support
IPV survivors on their journey toward financial empowerment.
Given
the increase in programs focused on assets, financial
empowerment, and
economic well-being, the Scale of Economic Self-Efficacy has
potential as a
very timely and relevant tool in the design, implementation, and
evaluation
of such programs, and specifically for programs created for IPV
survivors.

Keywords
economic self-efficacy, financial knowledge, intimate partner
violence,
domestic violence, women, personal finance, financial
management
Introduction
Experiencing intimate partner violence (IPV) and financial
hardship are often
intertwined. The dynamics of an abusive relationship may
include economic
abuse tactics that compromise a survivor’s ability to work,
pursue education,
have access to financial resources, and establish financial skills,
knowledge,
and security (Adams, Sullivan, Bybee, & Greeson, 2008). Thus,
an increas-
ingly common goal among programs serving IPV survivors is
increasing
financial empowerment through financial literacy.
Financial educators and behavioral economists have recognized
the role
psychological factors play when individuals make financial
choices (The
Social Research Centre, 2011) and, hence, have deduced that
providing
financial education alone may not be enough to improve
financial behaviors
(Gilovich, Griffin, & Kahneman, 2002; Rothwell, Khan, &
Cherney, 2015;
Schuchardt et al., 2009; Sherraden, 2013; Thaler & Sunstein,
2008; Zweig,
2007). Self-efficacy, an individual’s confidence in her or his

perceived ability
to perform a specific task or behavior, is also needed to change
one’s behav-
ior (Fishbein & Ajzen, 2010). Researchers have found that
higher levels of
economic self-efficacy (ESE), or the perceived ability to
perform economic
or financial tasks, have translated into positive financial
behavior (Danes,
Huddleston-Casas, & Boyce, 1999; Vitt et al., 2000). An
understanding of an
individual’s sense of ESE can aid educators in strengthening
approaches to
building financial empowerment.
Although a validated and widely used scale is available to
measure gen-
eral self-efficacy, there is no comprehensive measure of ESE
that has been
tested in the field of IPV. Hence, the aim of this research was to
test the reli-
ability and validity of the Scale of Economic Self-Efficacy, a
measure that
Hoge et al. 3013
focuses on perceived confidence in one’s ability to complete
specific finan-
cial tasks, among a sample of female IPV survivors.
Background
IPV, Economic Self-Efficacy, and Financial Empowerment

An estimated two million women per year are victims of IPV in
the United
States (Tjaden & Thoennes, 2000). IPV includes threatened,
attempted, or
completed physical, psychological, sexual, and economic
abusive tactics
used by the perpetrator to gain power and control over the
survivor. In situa-
tions where economic abuse is present, perpetrators use tactics
to control a
survivor’s access to financial resources, to prevent her from
improving her
financial situation, and to exploit her financial resources
(Adams et al., 2008;
Postmus, Plummer, & Stylianou, 2016; Sanders, 2015).
Survivors report that
financial dependency on an abusive partner is a primary reason
they stay in
or return to abusive relationships (Anderson & Saunders, 2003;
Barnett,
2000; Kim & Gray, 2008).
While IPV occurs among all socioeconomic backgrounds, low -
income
women are more often subject to abuse than middle or upper -
income women
(Meier, 1997; Tolman & Raphael, 2000). According to the 2010
National
Intimate Partner and Sexual Violence Survey, 9.7% of women
with annual
household incomes less than US$25,000 had experienced IPV in
the past 12
months compared with 2.8% of women in the highest income
category of
US$75,000 or more (Breiding, Chen, & Black, 2014). Although
women are

more likely than men to be victims of IPV, they are also more
likely than men
to live longer, have shorter work tenures, and to earn less
money putting
women at higher risk than men for having financial difficulties
(Weir &
Willis, 2000). In addition, while research documents low levels
of financial
literacy across the gender divide, financial illiteracy is more
prevalent among
women than men (Lusardi & Mitchell, 2008).
When applying the concept of ESE and self-efficacy judgments
(Bandura,
1977) in the context of IPV, and in particular with low -income
women expe-
riencing IPV, a survivor’s determination of her capacity to
manage financial
resources is based on various experiences. This will be affected
by whether
she has had previous experience in managing household
finances or whether
she has observed successful financial management by others.
Her feelings
will also be influenced by whether she has received
encouragement from
significant others to manage the household’s finances, as well
as her somatic
experiences while engaging in financial behaviors. It is also
important to con-
sider how these experiences may vary in different cultural
contexts, where

cultural norms or language proficiency may influence a
survivor’s involve-
ment in financial management.
In an economically abusive relationship, a survivor’s perception
of her
ESE may be limited in a number of ways in relation to the
influences described
above. For example, a survivor is often restricted from
accessing financial
resources (Brewster, 2003; VonDeLinde, 2002; Wettersten et
al., 2004),
which limits her experience in performing financial behaviors.
The perpetra-
tor may also manage finances without input or agreement from
the survivor
(Anderson et al., 2003; Brewster, 2003), which limits her
vicarious experi-
ence of financial management behaviors. In addition, the
perpetrator may
utilize psychological abuse tactics to verbally undermine the
survivor’s con-
fidence in managing household finances. Finally, a survivor’s
somatic expe-
riences, including anxiety, depression, and posttraumatic stress
symptoms,
may create a negative emotional response to financial
discussions or
behaviors.
Advocates in the IPV field might increase a survivor’s ESE by
providing
financial knowledge and experiences in which the survivor can
practice
engaging in and observing financial behaviors in a supportive

environment
(Christy-McMullin, 2003; Correia, 2000; Sanders & Schnabel,
2006). In
doing so, advocates can support survivors in learning financial
management
skills to empower survivors and increase survivors’ sense of
confidence
about their ability to manage their own finances (Sanders,
2007). A compre-
hensive measure of ESE would serve IPV advocates and others
to identify
survivors who need support specifically in the area of
improving financial
knowledge and behavior to move toward financial
independence.
Measuring Economic Self-Efficacy
According to social cognitive theory (Bandura, 1997), self-
efficacy, or an
individual’s perceived ability to complete a task, is the prime
factor for influ-
encing behavior. Self-efficacy has a powerful impact on
behavior because
self-efficacy is a strong conviction of competence based on the
individual’s
evaluation of various sources of information about her abilities
(Bandura,
1986). Self-efficacy literature focuses on two types of self-
efficacy: global
and task specific. Global self-efficacy is conceptualized as a
general sense of
self-efficacy that refers to a broad and stable sense of personal
competence to
deal effectively with a variety of situations (Schwarzer &
Jerusalem, 1995).

In contrast, task specific self-efficacy focuses on a specific
behavior and the
individual’s sense of competency in carrying out that specific
behavior.
Bandura (1997) advocates for a behavior-specific approach to
the study of
self-efficacy, arguing that a measure of general self-efficacy is
inadequate for
Hoge et al. 3015
tapping an individual’s efficacy in managing tasks associated
with a specific
behavior. Therefore, to understand an individual’s perceived
competence in
managing her financial resources and addressing financial
challenges, a mea-
sure of ESE must focus specifically on tasks related to financial
management
behaviors.
Studies on financial literacy and empowerment programs have
utilized a
number of measures of ESE. These have included combinations
of various
scales with limited questions (Dietz, Carrozza, & Ritchey, 2003;
Dulebohn &
Murray, 2007), indexes comprised of limited questions related
to financial
confidence (Loke, Choi, & Libby, 2015), as well as a single
scale including
questions related to both general and ESE (Lown, 2011). There
have been
few studies published specifically on the measurement of ESE.

The first
study that aimed to create a measure of ESE (Lown, 2011)
created and vali-
dated a measure of Financial Self-Efficacy (FSE) to help
educators and coun-
selors better understand, guide, and motivate their students and
clients. The
developed instrument was based on the 10-item General Self-
Efficacy Scale
(GSES: Schwarzer & Jerusalem, 1995). The GSES was modified
by incorpo-
rating specific references to financial manageme nt in six out of
the original
10 statements. The scale was then validated among employees
of a large state
university as part of a larger study on financial planning.
Among this sample,
the principal components factor analysis resulted in two distinct
factors. The
first factor consisted of the six FSE items while the second
factor consisted of
the four general self-efficacy items. The final scale included the
six items
from the FSE subscale (e.g. progress toward my financial goals,
stick to
spending plan, lack confidence in managing finances), and
demonstrated
strong internal reliability in the study. However, the four items
from the
GSES that were not modified to include financial specific
behavior language
were dropped from the scale. This separation of FSE items from
general self-
efficacy items supported Bandura’s (1997) argument that
general self-effi-
cacy items do not measure the same construct as behavior-

specific items.
However, it was undetermined as to whether those four items
would have
remained in the scale if they had also been modified to target
specific finan-
cial tasks.
The second study (Weaver, Sanders, Campbell, & Schnabel,
2009) created
and validated the Domestic Violence–Financial Issues Scale
(DV-FI). The
DV-FI is an assessment of the financial issues facing female
survivors of IPV.
The DV-FI includes a subscale measuring ESE with items
related to confi-
dence in achieving financial goals (e.g., I am confident I can
meet my goals
for becoming financially secure, I am confident I can meet my
goals for elim-
inating credit card debt). Although this scale provides important
information
on assessing a survivor’s confidence with specific financial
domains, such as
managing credit and obtaining employment and educational
opportunities, it
is not a comprehensive measure of ESE. Indeed, in one study
with IPV survi-
vors from lower socioeconomic status, this subscale poorly
captured ESE
since survivors reported being “confident in eliminating credit
card debt” as

they did not have credit cards to incur any debt (Postmus &
Plummer, 2010).
A comprehensive measure of ESE must be specific enough that
it can accu-
rately measure the survivor’s confidence in engaging in
financial behaviors,
but cannot be so specific that the behaviors are not applicable to
all IPV sur-
vivors. For example, not all survivors are focused on gaining
employment or
educational opportunities. Similarly, questions cannot be too
general that par-
ticipants are answering items based on general notions of self-
efficacy rather
than ESE.
A third study developed and validated a measure of FSE for the
purposes
of examining gender-related attitudes toward financial
management among
female entrepreneurs (Amatucci & Crawley, 2011). The authors
built their
FSE construct by combining items capturing “managing money”
in anentre-
preneurial self-efficacy scale (Wilson, Kickul & Marlino, 2007)
and “imple-
menting financial” items from another entrepreneurial self-
efficacy scale
(McGee, Peterson, Mueller & Sequeira, 2009) (i.e., How would
you rate your
skills in financial management? How confident do you feel
about your skills
in financial management? How confident do you feel about your
abilities to
undertake the successful financial management of your
company?) The use

of this measure of ESE is limited in scope due to issues of both
specificity
and generalization in item construction. The third item limits
the use of this
measure to business owners, while the first and second items are
broad in
nature and may be interpreted differently by different
respondents. In addi-
tion, the first item measures perceived skills, whereas the
second and third
items measure perceived confidence. Furthermore, the sample
that was used
in creating this measure was comprised of female business
owners who were
primarily aged above 40 years and mostly had a college degree,
with about
one-third holding a graduate degree. This is a demographic that
may enjoy a
more stable financial reality than those starting out financially,
or those who
experience extreme financial challenges. As such, this measure
of ESE does
not prove generalizable for broader samples.
The aim of the present study was to evaluate the reliability and
validity of
a fully modified version of the GSES (Schwarzer & Jerusalem,
1995) with a
sample of female survivors of IPV. The research questions for
this study
included the following:
Research Question 1: What are the psychometric properties of
the Scale
of ESE among a culturally diverse group of female survivors of
IPV?

Hoge et al. 3017
Research Question 2: How strongly does the Scale of ESE
correlate with
other financial measures including economic self-sufficiency,
financial
strain, and difficulty with income?
Method
This current study is part of a larger study that included
longitudinal, random-
ized control methods to evaluate the impact of the “Moving
Ahead Through
Financial Management” economic empowerment program
designed for sur-
vivors of IPV. The Allstate Foundation in partnership with the
National
Network to End Domestic Violence (NNEDV) created the
curriculum to help
survivors identify the signs of economic abuse and its impact in
their lives, to
increase their financial knowledge and ability to manage their
finances, and
to aid them in securing the confidence necessary to rebuild their
financial
foundation (www.clicktoempower.org).
This larger study recruited 457 participants from 14 agencies
serving sur-
vivors of IPV in seven states across the Northwest, Midwest,
and Texas
regions of the United States and the territory of Puerto Rico.

The agencies
were located in urban and suburban locations of varied
socioeconomic levels,
and served both English-speaking and Spanish-speaking
survivors. Staff
advertised the study within their agencies and conducted initial
eligibility
screenings of potential participants prior to scheduling their
first interview. A
participant needed to be a woman who (a) had experienced some
form of IPV
in the 12 months leading up to the screening, (b) was 18 years
of age or older
at the time of the screening, (c) had not attended a financial
literacy class in
the 2 years prior to the screening, (d) was committed to attend
the curriculum
group if randomly selected to participate, and (e) was
committed to partici-
pate in study interviews whether or not they were randomly
selected to par-
ticipate in the curriculum group. Women who met the eligibility
criteria and
expressed interest to the advocate in participating in the study
completed a
contact sheet that requested personal information, including
safe phone num-
bers and email addresses they identified as safe. Once
completed, the contact
sheets were collected by the advocates in each domestic
violence agency and
sent to the research team. One of the research team members
then contacted
the women to set up the face-to-face interview dates.
Each member of the research team had experience working with

IPV survi-
vors and was trained on the research protocol. Precautions were
taken to ensure
that both phone and in-person contact with survivors was
conducted in a safe
and sensitive manner. The initial pretest interview was
conducted in person at
the agency from which the participant was recruited, and lasted
approximately 1
hr. The survey instrument covered a wide range of measures
related to economic
www.clicktoempower.org
and emotional well-being, as well as demographic variables of
interest. The sur-
vey was read aloud by the researcher and then participant
answers were entered
directly into an online version of the survey through SNAP©, a
web-based sur-
vey tool. Paper and pencil surveys were used in situations where
Internet access
was unavailable, and data were then entered into the web-based
format immedi-
ately following survey administration. Institutional Review
Board approval was
obtained prior to all interaction with study participants, and all
participants com-
pleted the informed consent process prior to participation.
Participants received
a US$20 VISA gift card for their participation in the pretest
survey.

Analytic Sample
This current study uses data from the pretest (Time 1)
interviews with the full
sample of 457 survivors of IPV. Data from the pretest were
selected for this
analysis, as this study focuses solely on scale creation and does
not examine
the impact of the financial empowerment intervention. Little’s
Missing
Completely at Random (Little, 1988) was run to assess for
missing data for
each individual item in the Scale of ESE. This test indicated
that missing data
on these items was missing completely at random, χ2(72) =
74.965, p > .1.
Listwise deletion was thus used to remove any case with
missing data on
items in this scale, resulting in an analytic sample of 447
participants, out of
the original 457 sample members.
Table 1 demonstrates the percentages, means and standard
deviations of
the demographic variables for the total analytic sample of 447,
as well as for
the randomly split sample halves used in analysis. For the
overall sample,
mean age was 36 years (SD = 9.14). The sample consisted
primarily of
women of color with 54.3% of the sample identifying as
Latina/Hispanic;
20.2% as Black or African American, non-Hispanic women;
17.5% as White,
non-Hispanic women; and 8.0% as “Other.” Approximately half
(51.7%) of

the respondents were born in the United States. Almost half
(48.1%) reported
an annual income under US$10,000. Just over 45% of the
participants were
employed either part or full-time. Just over 20% of the
respondents reported
currently being involved in an abusive relationship. About 81%
of the women
reported being financially responsible for children under the age
of 18 years.
No statistically significant differences were found between the
randomly
split sample halves on any of these demographic variables.
Measures
The survey instrument was comprised of several validated or
revised scales.
The survey was available in both English and Spanish. A
member of the
Hoge et al. 3019
Table 1. Descriptive Statistics for Total and Randomly Split
Analytic Sample.
Variable
% or M (SD)
Total Analytic
Sample (n = 447)
Calibration

Sample (n = 230)
Validation
Sample (n = 217)
Age, M (SD) 36.3 (9.14) 36.7 (9.29) 35.9 (8.98)
Time obtaining services
Less than 3 months 48.0 46.6 49.5
3 months-6 months 34.7 36.4 32.9
More than 6 months 17.3 17.0 17.6
Services received (%)
Emergency/short-term
housing
14.1 14.3 13.8
Individual counseling 59.1 59.6 58.5
Legal advocacy 28.9 26.5 31.3
Support groups 58.8 55.7 62.2
Services for children 32.0 30.4 33.6
Advocacy/case-
management
26.6 28.7 24.4
Marital status
Married/civil union 17.9 19.2 16.6
Separated/divorced 45.3 43.6 47.0
Single 35.9 35.4 36.4
Currently in abusive
relationship
20.1 22.8 17.2
Race/ethnicity
White, non-Hispanic 17.5 19.7 15.2

Black or African
American, non-Hispanic
20.2 19.7 20.7
Latina or Hispanic 54.3 52.4 56.2
Other 8.0 8.2 7.9
Born in the United States 51.7 51.8 51.6
Employed (full- or part-
time)
45.1 41.1 49.6
Financially responsible for
children
80.7 77.3 84.3
Has health insurance 55.3 55.9 54.6
Receiving social services 71.4 68.7 74.2
Annual income less than
US$10,000
48.1 45.8 50.5
research team who was a native Spanish-speaker with English
fluency trans-
lated the survey from English to Spanish. Various members of
the research
team who were native English speakers with Spanish fluency
then reviewed
the Spanish survey for accuracy. Any discrepancies or

clarifications in trans-
lation were discussed between these members of the research
team and a final
Spanish version was decided upon for use with Spanish-
speaking partici-
pants. For this article, the Scale of ESE, the Scale of Economic
Self-
Sufficiency, the Financial Strain Survey, and an item measuring
difficulty
living on annual income were examined.
Economic self-efficacy. Based on Bandura’s (1997)
recommendation of utiliz-
ing task specific measures of self-efficacy, all 10 items of the
GSES (Schwar-
zer & Jerusalem, 1995) were modified to focus specifically on
financial
behaviors. Each item was altered to include economic language.
For exam-
ple, the first item of the GSES states, “I can always manage to
solve difficult
problems if I try hard enough.” The item was rephrased to
measure ESE by
changing the item to state, “I can always manage to solve
difficult financial
problems if I try hard enough.” Response options ranged from 1
(strongly
disagree) to 5 (strong agree) on a 5-point Likert-type scale. The
authors
aimed to revise the GSES to design a comprehensive measure of
ESE that
would be specific enough to accurately measure a survivor’s
confidence in
engaging in financial behaviors, but not so specific that the
financial behav-
iors would not be applicable to all IPV survivors.

The GSES (Schwarzer & Jerusalem, 1995) has shown to be a
reliable and
valid scale when measuring self-efficacy and has been used with
many differ-
ent sample groups such as teachers and college students
(Brafford & Beck,
1991; Gibson & Dembo, 1984). It has also been used in
different languages
including German, Spanish, and Chinese (Schwarzer, Basler,
Kwiatek,
Schroder, & Zhang, 2008). Among this sample, the scale
demonstrated ade-
quate internal reliability with a Cronbach’s alpha of .88. Table
2 provides
means and standard deviations for individual items and the
overall scale for
the analytic sample.
Economic self-sufficiency. Economic self-sufficiency (Gowdy
& Pearlmutter,
1993) was included to measure respondents’ ability to
accomplish specific
financial tasks in the past month. Participants rated the
frequency with which
they had accomplished these tasks over the past month by using
a 5-point
scale with answers ranging from 1 (no, not at all) to 5 (yes, all
of the time).
An exploratory factor analysis (EFA) was run with this sample
and the num-
ber of items was reduced from 15 to 14, including three
subscales: Ability to
Manage Daily/Immediate Financial Needs (seven questions, α =
.80), Ability

Hoge et al. 3021
to Have Discretionary Funds (three questions, α = .74), and
Ability to Main-
tain Independent Living (four questions, α = .64). This revised
scale was
renamed Scale of Economic Self-Sufficiency-14 (SESS-14)
(Hetling, Hoge
& Postmus, 2016).
Financial strain. The Financial Strain Survey (Aldana &
Liljenquist, 1998;
Hetling, Stylianou & Postmus, 2015) is an18-item scale that
measures five
areas of financial strain including Poor Financial Education
(three items),
Poor Relationships (four items), Physical Symptoms (four
items), Poor Credit
Card Use (three items), and Unable to Meet Financial
Obligations (four
items). Participants were asked to indicate how often the items
applied to
them over the past 12 months. Participants indicated such
frequency using a
5-point scale with answers ranging from 1 (never) to 5 (always).
Items 1, 2,
3, and 15 were recoded as they were negatively worded items.
In this sample
Table 2. Descriptive Statistics for Scale of Economic Self-
Efficacy Items (N = 447).
Item M (SD)

I can solve most financial problems if I invest the
necessary effort.
3.67 (.90)
I can always manage to solve difficult financial problems if
I try hard enough.
3.51 (1.1)
If I am in financial trouble, I can usually think of something
to do.
3.50 (.94)
If I have a financial problem, I can find ways to get what I
need.
3.43 (1.05)
When I am confronted with a financial problem, I can
usually find several solutions.
3.19 (1.01)
No matter what financial problem comes my way, I’m
usually able to handle it.
3.17 (.99)
Thanks to my resourcefulness, I know how to handle
unforeseen financial situations.
3.15 (1.07)
I can remain calm when facing financial difficulties because

I can rely on my financial abilities.
2.91 (1.08)
I am confident that I could deal efficiently with
unexpected financial events.
2.83 (1.05)
It is easy for me to stick to and accomplish my financial
goals.
2.77 (1.07)
Note. Scale of 1-5: 1 = strongly disagree, 2 = disagree, 3 =
neutral, 4 = agree, or 5 = strongly
agree.
Participants were asked, “Please choose the answer that best
represents your experience in
the last month.”
of female survivors of IPV, the overall scale (Financial Strain, α
= .84) and
most subscales demonstrated high internal reliability (Poor
Financial Educa-
tion, α = .81, Poor Relationships, α = .80, Physical Symptoms, α
= .87, Poor
Credit Card Use, α = .54, and Unable to Meet Financial
Obligations, α = .82).
Difficulty living on income. To measure the participant’s
perceived difficulty

living on annual household income, participants were asked,
“Over the past
12 months, how difficult was it for you to live on your annual
household
income?” Response options ranged from 1 (not at all difficult)
to 5 (extremely
difficult).
Data Analysis
A four-part process was used to explore and confirm the factor
structure of
the Scale of ESE among survivors of IPV and to test the
reliability and con-
current validity of the scale.
First, EFA, using Principal Axis Factoring extraction and Direct
Oblimin
rotation, was used to examine the factor structure of the Scale
of ESE for the
total analytic sample of 447 participants using SPSS 21.0 data
analysis pack-
age. Oblique rotation was utilized based on the assumption that
the factors
would be highly correlated (Worthington & Whittaker, 2006).
Second, the overall sample was randomly split for the purposes
of further
validation of the factor structure of the Scale of ESE. This
random split resulted
in a subsample of 230 participants used for the purposes of
calibration of the
factor structure through repeat EFA, and a subsample of 217
participants used
for factor structure validation through confirmatory factor
analysis (CFA).

Similar to the EFA run on the total analytic sample, Principal
Axis Factoring
extraction and Direct Oblimin rotation were used to examine the
factor struc-
ture of the ESE scale with the calibration sample. CFA was then
run on the vali-
dation subsample using structural equation modeling in AMOS
Graphics.
Third, the internal consistency of the ESE scale was examined.
This was
assessed by examining the Cronbach’s alpha coefficient for the
overall scale
among the total analytic sample (n = 447).
Fourth, concurrent validity was tested for the total analytic
sample through
correlation analyses between the Scale of ESE, the SESS-14, the
Financial
Strain Survey, and the item measuring participants’ difficulty
with income.
These scales and items were chosen based on their conceptual
similarity with
the Scale of ESE. The correlation between the Scale of ESE and
the SESS-14
was hypothesized to be positive, whereas negative correlations
were the
expected result among the Scale of ESE and the Financial Strain
Survey and
the item measuring participants’ difficulty with income.
Hoge et al. 3023
Results

Phase 1: EFA With the Overall Sample
The EFA resulted in a one-factor solution, utilizing all of the
original 10
items, Kaiser-Mayer-Olkin (KMO) = .906; χ2(45) = 859.940, p
< .001,
which accounted for 49.12% of the total variance. The oblique
rotated
factor matrix indicated that all items loaded moderate to high,
ranging
from .577 to .747. Table 3 presents the factor matrix loadings of
the
items.
Table 3. Factor Matrix Factor Loadings.
Item
Factor Loading
Total Sample
(n = 447)
Calibration
Subsample (n = 230)
1. I can always manage to solve difficult
financial problems if I try hard enough.
.602 .583
2. If I have a financial problem, I can find
ways to get what I need.
.577 .590

3. It is easy for me to stick to and
accomplish my financial goals.
.591 .584
4. I am confident that I could deal
efficiently with unexpected financial
events.
.708 .722
5. Thanks to my resourcefulness, I know
how to handle unforeseen financial
situations.
.711 .709
6. I can solve most financial problems if I
invest the necessary effort.
.628 .620
7. I can remain calm when facing financial
difficulties because I can rely on my
financial abilities.
.671 .630
8. When I am confronted with a financial
problem, I can usually find several
solutions.
.705 .694
9. If I am in financial trouble, I can usually

think of something to do.
.639 .626
10. No matter what financial problem
comes my way, I’m usually able to
handle it.
.747 .708
% of total variance explained 49.12 47.79
Phase 2: EFA and CFA With Randomly Split Sample
Calibration: EFA. The EFA of the calibration subsample (n =
230) resulted in
a one factor solution in the split-sample calibration analysis,
including all of
the original 10 items, KMO = .904, χ2(45) = 1778.95, p < .001.
This factor
structure accounted for 47.79% of the total variance. The
oblique rotated fac-
tor matrix for this analysis indicated that all items loaded
moderate to high,
with factor loadings ranging from .583 to .722, similar to the
result of the
analysis run on the total analytic sample. The factor matrix
loadings of indi-
vidual items from this analysis are also presented in Table 3.
Validation: CFA. A CFA was run to further validate the factor
structure of the

Scale of ESE using the validation subsample (n = 217). The
unidimensional,
10-item factor structure accepted in the process of calibration
through EFA
was tested. The initial model showed a modestly good fit to the
data, χ2 =
125.203, comparative fit index (CFI) = .902, goodness-of-fit
index (GFI) =
.899, root mean square error of approximation (RMSEA) = .109,
Tucker–
Lewis index (TLI) = .874. However, upon review of
modification indices, it
was found that error terms for Items 1 and 2, Items 4 and 5, and
Items 8 and
9 were correlated. It was determined that these error
correlations also had
substantive validity. As such, post hoc analysis was run to
determine whether
a model including these error term correlations would result in a
statistically
significant improvement in model fit. Since these models were
nested, Δχ2
was evaluated to determine whether the modified model was a
statistically
significantly different from the initial model. As Table 4 shows,
the one-fac-
tor model including modifications based on post hoc analysis
provides a sta-
tistically significantly improved fit to the data (χ2 = 74.775,
CFI = .954,
GFI = .938, RMSEA = .079, TLI = .935, Δχ2(3) = 50.428, p <
.001).
Phase 3: Reliability
The internal consistency of the Scale of ESE among this sample

was assessed
by examining the Cronbach’s alpha coefficient. The overall
Scale of ESE
demonstrated a good level of internal consistency, with a
Cronbach’s reli-
ability coefficient of .88.
Phase 4: Concurrent Validity
Correlations were used to examine the concurrent validity of the
Scale of ESE.
Table 5 depicts the correlations among the Scale of ESE, the
overall scale and
three subscales of the SESS-14, the overall scale and five
subscales of the
Financial Strain Survey, and the item measuring perceived
difficulty living on
Hoge et al. 3025
annual income. The Scale of ESE was negatively correlated with
the overall
Financial Strain Survey and all five of its subscales (Financial
Strain, r = −.500,
p < .01; Physical Subscale, r = −.370, p < .01; Poor Education
Subscale, r =
−.376, p < .01; Poor Relationships Subscale, r = −.255, p < .01;
Poor Credit Card
Use Subscale, r = −.114, p < .05; and Unable to Meet
Obligations Subscale, r =
−.401, p < .01). The Scale of ESE was also negatively
correlated with the diffi-
culty with income item (r = −.285, p < .01). The Scale of ESE
was positively

correlated with the overall SESS-14 scale and all three of its
subscales (SESS-14
scale, r = .497, p < .01; Ability to Manage Immediate Financial
Needs Subscale,
r = .553, p < .01; Ability to Have Discretionary Funds Subscale,
r = .392, p <
.01; Ability to Maintain Independent Living, r = .224, p < .01).
Discussion
This study indicates that the Scale of ESE is an appropriate tool
for under-
standing and measuring ESE among IPV survivors. Examination
of the Scale
of ESE using the full sample EFA, as well as through EFA
calibration and
Table 4. Overall Fit Statistics for Economic Self-Efficacy
Confirmatory Factor
Analyses (N = 217).
Measures of Fit
Models
One-Factor Modified One-Factor
ESE ESE
Discrepancy χ2 125.203 74.775
df 35 32
p value .000 .000
Discrepancy / df 3.577 2.337
GFI .899 .938
AGFI .842 .894
TLI .874 .935

CFI .902 .954
RMSEA (CI) .109 [.089, .130] .079 [.056, .102]
ECVI (CI) .765 [.624, .941] .559 [.460, .694]
BIC 167.349 198.512
AIC model 165.203 120.775
AIC saturated 110.000 110.000
Note. ESE = Economic Self-Efficacy Scale; GFI = goodness-of-
fit index; AGFI = adjusted
goodness-of-fit index; TLI = Tucker–Lewis index; CFI =
comparative fit index; RMSEA = root
mean square error of approximation; CI = confidence interval;
ECVI = expected cross-
validation index; BIC = Bayesian information criterion; AIC =
Akaike information criterion.
3026
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Hoge et al. 3027

CFA validation using randomly split samples produced the same
10-item uni-
dimensional scale, indicating strong validity with this sample of
IPV survi-
vors. Examination of the Cronbach’s alpha coefficient for
internal consistency
indicated strong reliability of this scale. Correlation of the
overall ESE scale
with other relevant economic concepts also produced results
indicating a
strong level of concurrent validity for this scale. In examining
correlations of
conceptually related concepts, results show that ESE is
correlated with other
key financial variables that may be indicators of one’s ability to
move for-
ward financially.
Our results are tempered by study limitations related to external
validity.
First, sampling procedures limit the generalizability of the
findings to all IPV
survivors. Study participants were currently receiving services
from a domes-
tic violence agency and self-selected to participate in the
research project.
These characteristics indicate an ability to seek out resources
that may differ
from survivors who are not connected to services or from
survivors who
chose not to participate in the study. Volunteering to participate
in the study
may also signal that study participants may have a stronger
interest in improv-
ing financial behaviors in comparison to survivors who were not

interested in
the study.
Second, descriptive statistics of the sample illustrated that the
sample was
primarily low-income women of color. Over half the women in
the sample
(54.3%) identified as Latina or Hispanic, and over 20.2%
identified as Black
or African American. In addition, close to half of the
participants were for-
eign-born (48.3%). On one hand, this suggests that the concepts
being stud-
ied may have cultural relevance for diverse groups. On the other
hand,
although these demographics are reflective of domestic violence
agency cli-
ents, further research is needed to test the measure among more
diverse
sociodemographic samples. Given the number of participants
who identified
as Latina or foreign-born, level of acculturation or cultural
factors such as
English language literacy, cultural beliefs and practices
regarding gender and
finances, or previous access to and use of financial institutions
in one’s coun-
try of origin could also have had an impact on ESE. However, it
should also
be taken into consideration that there might be notable
differences in these
areas among the cultural groups classified as Latina or
Hispanic. Furthermore,
almost half (48.1%) of study participants reported earning less
than
US$10,000 annually, and 71.4% reported receiving some form

of social ser-
vices. Although, this may indicate relevance of these financial
concepts for
those experiencing financial hardship, it does limit the ability to
generalize to
varied financial backgrounds. Further research is needed to test
the reliability
and validity of the Scale of ESE with different ethnic,
socioeconomic, and
community samples of IPV survivors, as well as with non-IPV
samples, and
those with greater resources to better understand how the scale
functions in
diverse populations. Since the current study used data from the
pretest period
of the longitudinal study, further testing of the scale across later
time periods
is needed to confirm the reliability and validity of the scale
over time.
Conclusion and Use of Scale
Despite study limitations and the need for further research, the
strong validity
of the Scale of ESE in our study suggests that it should be used
in practice set-
tings to understand ESE. For practitioners working with IPV
survivors, an
ability to understand ESE could facilitate more individualized
approaches to
financial empowerment. This might involve financial counseling

or specific
activities aimed at increasing confidence in managing finances
and other
financial tasks. Practitioners might also facilitate discussion of
any psycho-
logical distress that a survivor may have experienced related to
finances that
could have affected their confidence in this area. By
incorporating an under-
standing of ESE along with a measure of financial literacy or
knowledge,
practitioners and advocates would be in a better position to
gauge a survivor’s
capacity for financial management and support them on their
journey toward
financial empowerment. Moreover, given the increase in
programs focused on
assets, financial empowerment, and financial well-being for
other popula-
tions, the Scale of ESE has potential as a very timely and
relevant tool in the
design and implementation of financial literacy programs in
general, particu-
larly those developed for women.
The study findings also support the use of the Scale of ESE for
research
and evaluation concerning policy and programming aimed at
improving
micro-level financial outcomes. Evaluations of new and existing
programs
could use the Scale of ESE to measure impact. In both the
research and policy
communities, we see an increased focus on behavioral change
and a growing
understanding that behavioral change is affected by more than

just knowl-
edge. Future evaluations need validated measures on individual
outcomes
beyond the acquisition of new financial knowledge. The Scale
of ESE pro-
vides a robust measure of one critical aspect of improving
financial behav-
iors: a task specific measure of self-efficacy. Thus, by including
the Scale of
ESE in future evaluations and research, we expand our
understanding of pro-
grams’ ability to instill new knowledge on related topics, as
well as increase
ESE and potentially change financial behaviors.
Authors’ Note
Points of view in this document are those of the authors and do
not necessarily repre-
sent the official position or policies of The Allstate Foundation.
Hoge et al. 3029
Acknowledgments
The authors would like to acknowledge the support of all the
survivors, agencies,
advocates, and members of the research team who made this
study possible.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research,

authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial
support for the research,
authorship, and/or publication of this article: This project was
supported by The
Allstate Foundation, Economics Against Abuse Program.
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