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Bacchus LJ, Colombini M, Pearson I, Gevers A, Stöckl H, Guedes AC. Interventions that prevent or respond to intimate partner violence against women and violence against children: a systematic review. Lancet Public Health 2024; 9:e326-e338. [PMID: 38702097 DOI: 10.1016/s2468-2667(24)00048-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 05/06/2024]
Abstract
Efforts to prevent or respond to intimate partner violence (IPV) and violence against children (VAC) are still disparate worldwide, despite increasing evidence of intersections across these forms of violence. We conducted a systematic review to explore interventions that prevent or respond to IPV and VAC by parents or caregivers, aiming to identify common intervention components and mechanisms that lead to a reduction in IPV and VAC. 30 unique interventions from 16 countries were identified, with 20 targeting both IPV and VAC. Key mechanisms for reducing IPV and VAC in primary prevention interventions included improved communication, conflict resolution, reflection on harmful gender norms, and awareness of the adverse consequences of IPV and VAC on children. Therapeutic programmes for women and children who were exposed to IPV facilitated engagement with IPV-related trauma, increased awareness of the effects of IPV, and promoted avoidance of unhealthy relationships. Evidence gaps in low-income and middle-income countries involved adolescent interventions, post-abuse interventions for women and children, and interventions addressing both prevention and response to IPV and VAC. Our findings strengthen evidence in support of efforts to address IPV and VAC through coordinated prevention and response programmes. However, response interventions for both IPV and VAC are rare and predominantly implemented in high-income countries. Although therapeutic programmes for parents, caregivers, and children in high-income countries are promising, their feasibility in low-income and middle-income countries remains uncertain. Despite this uncertainty, there is potential to improve the use of health services to address IPV and VAC together.
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Affiliation(s)
- Loraine J Bacchus
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Manuela Colombini
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Isabelle Pearson
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Anik Gevers
- Sexual Violence Research Initiative, Cape Town, South Africa
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians University of Munich, Munich, Germany
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Szilassy E, Coope C, Emsley E, Williamson E, Barbosa EC, Johnson M, Dowrick A, Feder G. Feasibility of a reconfigured domestic violence and abuse training and support intervention responding to affected women, men, children and young people through primary care. BMC PRIMARY CARE 2024; 25:38. [PMID: 38273231 PMCID: PMC10811857 DOI: 10.1186/s12875-023-02249-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Identification in UK general practice of women affected by domestic violence and abuse (DVA) is increasing, but men and children/young people (CYP) are rarely identified and referred for specialist support. To address this gap, we collaborated with IRISi (UK social enterprise) to strengthen elements of the IRIS + intervention which included the identification of men, direct engagement with CYP, and improved guidance on responding to information received from other agencies. IRIS + was an adaptation of the national IRIS (Identification and Referral to Improve Safety) model focused on the needs of women victim-survivors of DVA. Without diminishing the responses to women, IRIS + also responded to the needs of men experiencing or perpetrating DVA, and CYP living with DVA and/or experiencing it in their own relationships. Our study tested the feasibility of the adapted IRIS + intervention in England and Wales between 2019-21. METHODS We used mixed method analysis to triangulate data from various sources (pre/post intervention questionnaires with primary care clinicians; data extracted from medical records and DVA agencies; semi-structured interviews with clinicians, service providers and referred adults and children) to assess the feasibility and acceptability of the IRIS + intervention. RESULTS The rate of referral for women doubled (21.6/year/practice) from the rate (9.29/year/practice) in the original IRIS trial. The intervention also enabled identification and direct referral of CYP (15% of total referrals) and men (mostly survivors, 10% of total referrals). Despite an increase in self-reported clinician preparedness to respond to all patient groups, the intervention generated a low number of men perpetrator referrals (2% of all referrals). GPs were the principal patient referrers. Over two-thirds of referred women and CYP and almost half of all referred men were directly supported by the service. Many CYP also received IRIS + support indirectly, via the referred parents. Men and CYP supported by IRIS + reported improved physical and mental health, wellbeing, and confidence. CONCLUSIONS Although the study showed acceptability and feasibility, there remains uncertainty about the effectiveness, cost-effectiveness, and scalability of IRIS + . Building on the success of this feasibility study, the next step should be trialling the effectiveness of IRIS + implementation to inform service implementation decisions.
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Affiliation(s)
- Eszter Szilassy
- Centre for Academic Primary Care, Bristol Medical School (Population Health Sciences), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Caroline Coope
- Centre for Academic Primary Care, Bristol Medical School (Population Health Sciences), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Elizabeth Emsley
- Bristol Medical School (Population Health Sciences), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | | | - Estela Capelas Barbosa
- Centre for Academic Primary Care, Bristol Medical School (Population Health Sciences), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | | | - Anna Dowrick
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gene Feder
- Centre for Academic Primary Care, Bristol Medical School (Population Health Sciences), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Downes L, Barbosa EC. COVID-19 adaptations to a training and support programme to improve primary care response to domestic abuse: a mixed methods rapid study. BMC PRIMARY CARE 2024; 25:21. [PMID: 38200413 PMCID: PMC10777646 DOI: 10.1186/s12875-023-02203-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 11/07/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Increased incidence and/or reporting of domestic abuse (DA) accompanied the COVID-19 pandemic. National lockdowns and enforced social isolation necessitated new ways of supporting victims of DA remotely. Identification and Referral to Improve Safety (IRIS) is a programme to improve the response to domestic abuse in general practice, providing training for general practice teams and support for patients affected by DA, which has previously been proven effective and cost-effective [1-3]. The COVID-19 pandemic required the adaptation of the programme to online training and remote support. METHODS This study is mixed methods rapid research, which aimed to gather evidence around the relevance, desirability and acceptability of IRIS operating remotely. Quantitative IRIS referral data were triangulated with data from four surveys and 15 interviews. Participants were local IRIS teams, IRIS-trained clinicians, and victim-survivors supported by IRIS services. The study was designed using the Lean Impact approach, allowing quick evaluation of innovation and the impact of social interventions. We carried out a framework analysis of the interviews, which is a qualitative methodology widely used in policy and applied research that enables research teams to move from descriptive accounts to a conceptual explanation of findings [4, 5]. RESULTS We found that the adaptation to online training and support of IRIS was acceptable and desirable. Most clinicians felt confident addressing DA over the phone and online, although most were more confident face-to-face. While referrals to IRIS services initially declined in March 2020, numbers of referrals increased to pre-pandemic levels by July 2020. Patients felt well supported remotely, although patients who had previously experienced face-to-face support preferred it. Technology was the most frequently mentioned barrier to the change from face-to-face training and support to online training and remote support. CONCLUSIONS This study contributes to practice by asserting the desirability and acceptability of training clinicians to be able to identify, ask about DA and refer to the IRIS programme during telephone/online consultations. This is of relevance to health and public health commissioners when making commissioning decisions to improve the general practice response to domestic abuse.
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Cochrane M, Szilassy E, Coope C, Emsley E, Johnson M, Feder G, Barbosa EC. Primary care system-level training and support programme for the secondary prevention of domestic violence and abuse: a cost-effectiveness feasibility model. BMJ Open 2024; 14:e071300. [PMID: 38184310 PMCID: PMC10773355 DOI: 10.1136/bmjopen-2022-071300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 11/15/2023] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVES This study aimed to evaluate the prospective cost-effectiveness of the Identification and Referral to Improve Safety plus (IRIS+) intervention compared with usual care using feasibility data derived from seven UK general practice sites. METHOD A cost-utility analysis was conducted to assess the potential cost-effectiveness of IRIS+, an enhanced model of the UK's usual care. IRIS+ assisted primary care staff in identifying, documenting and referring not only women, but also men and children who may have experienced domestic violence/abuse as victims, perpetrators or both. A perpetrator group programme was not part of the intervention per se but was linked to the IRIS+ intervention via a referral pathway and signposting. A Markov model was constructed from a societal perspective to estimate mean incremental costs and quality-adjusted life years (QALYs) of IRIS+ compared with to usual care over a 10-year time horizon. RESULTS The IRIS+ intervention saved £92 per patient and produced QALY gains of 0.003. The incremental net monetary benefit was positive (£145) and the IRIS+ intervention was cost-effective in 55% of simulations at a cost-effectiveness threshold of £20 000 per QALY. CONCLUSION The IRIS+ intervention could be cost-effective or even cost saving from a societal perspective in the UK, though there are large uncertainties, reflected in the confidence intervals and simulation results.
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Affiliation(s)
| | - Eszter Szilassy
- Population health Sciences, University of Bristol, Bristol, UK
| | - Caroline Coope
- Population health Sciences, University of Bristol, Bristol, UK
| | | | | | - Gene Feder
- Population health Sciences, University of Bristol, Bristol, UK
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Emsley E, Coope C, Williamson E, Barbosa EC, Feder G, Szilassy E. General practice as a place to receive help for domestic abuse during the COVID-19 pandemic: a qualitative interview study in England and Wales. Br J Gen Pract 2023; 73:e769-e777. [PMID: 37722856 PMCID: PMC10523333 DOI: 10.3399/bjgp.2022.0528] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 06/26/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND General practice is an important place for patients experiencing or perpetrating domestic violence and abuse (DVA), and for their children to seek and receive help. While the incidence of DVA may have increased during the COVID- 19 pandemic, there has been a reduction in DVA identifications and referrals to specialist services from general practice. Concurrently there has been the imposition of lockdown measures and a shift to remote care in general practices in the UK. AIM To understand the patient perspective of seeking and receiving help for DVA in general practice during the COVID-19 pandemic. This was then compared with experiences of general practice healthcare professionals. DESIGN AND SETTING A qualitative interview study in seven urban general practices in England and Wales, as part of a feasibility study of IRIS+, an integrated primary care DVA system-level training and support intervention. METHOD Semi-structured interviews with 21 patients affected by DVA and 13 general practice healthcare professionals who had received IRIS+ training. Analysis involved a Framework approach. RESULTS Patients recounted positive experiences of seeking help for DVA in general practice during the pandemic. However, there have been perceived problems with the availability of general practice and a strong preference for face-to-face consultations, over remote consultations, for the opportunities of non- verbal communication. There were also concerns from healthcare professionals regarding the invisibility of children affected by DVA. CONCLUSION Perspectives of patients and their families affected by DVA should be prioritised in general practice service planning, including during periods of transition and change.
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Affiliation(s)
| | | | | | | | - Gene Feder
- Bristol Medical School, University of Bristol, Bristol
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Fomenko E, Keygnaert I, Van Poel E, Collins C, Gómez Bravo R, Korhonen P, Laine MK, Murauskiene L, Tatsioni A, Willems S. Screening for and Disclosure of Domestic Violence during the COVID-19 Pandemic: Results of the PRICOV-19 Cross-Sectional Study in 33 Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3519. [PMID: 36834213 PMCID: PMC9964689 DOI: 10.3390/ijerph20043519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic left no one untouched, and reports of domestic violence (DV) increased during the crisis. DV victims rarely seek professional help, yet when they do so, they often disclose it to their general practitioner (GP), with whom they have a trusting relationship. GPs rarely screen and hence rarely take the initiative to discuss DV with patients, although victims indicate that offering this opportunity would facilitate their disclosure. This paper aims to describe the frequency of screening for DV by GPs and disclosure of DV by patients to the GP during the COVID-19 pandemic, and to identify key elements that could potentially explain differences in screening for and disclosure of DV. The PRICOV-19 data of 4295 GP practices from 33 countries were included in the analyses, with practices nested in countries. Two stepwise forward clustered ordinal logistic regressions were performed. Only 11% of the GPs reported (much) more disclosure of DV by patients during COVID-19, and 12% reported having screened for DV (much). Most significant associations with screening for and disclosure of DV concerned general (pro)active communication. However, (pro)active communication was performed less frequently for DV than for health conditions, which might indicate that GPs are insufficiently aware of the general magnitude of DV and its impact on patients and society, and its approach/management. Thus, professional education and training for GPs about DV seems highly and urgently needed.
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Affiliation(s)
- Elizaveta Fomenko
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Ines Keygnaert
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Claire Collins
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
| | - Raquel Gómez Bravo
- Centre Hospitalier Neuropsychiatrique, Rehaklinik, L-9002 Ettelbruck, Luxembourg
- Research Group Self-Regulation and Health, Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, Faculty of Humanities, Education and Social Sciences, University of Luxembourg, L-4366 Esch-sur-Alzette, Luxembourg
| | - Päivi Korhonen
- Department of General Practice, University of Turku and Turku University Hospital, 20521 Turku, Finland
| | - Merja K. Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland
- Folkhälsan Research Center, 00280 Helsinki, Finland
| | - Liubove Murauskiene
- Public Health Department, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania
| | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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Bregulla JL, Hanisch M, Pfleiderer B. Dentists' Competence and Knowledge on Domestic Violence and How to Improve It-A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074361. [PMID: 35410043 PMCID: PMC8998579 DOI: 10.3390/ijerph19074361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022]
Abstract
Domestic violence (DV) is an important public health topic with a high prevalence in society. Dentists are also frontline responders to DV, as they not only treat victims of DV with dental injuries, but they can also screen for the presence of DV because they see patients for regular check-ups. Using the WHO definition, which describes domestic violence as intimate partner violence, 17 papers could be included in our analyses. The results of this review clearly indicated that although dentists, as members of the health care sector, are important frontline responders to DV, they are neither trained adequately at medical school nor do most feel competent enough to ask victims about DV or support them as needed. DV is often not taught at dentistry schools at all. The aims of this review were to provide an overview of existing literature on dentists' knowledge and beliefs regarding DV, whether and how DV is taught in medical education and to give recommendations on how to improve the education of dentists on this topic. Based on our findings, we recommend that DV education should be mandatory at dentistry schools and in further training for dentists with a focus on communication with victims, how DV can be identified and how to support victims well.
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Affiliation(s)
- Jana Lauren Bregulla
- Department for Prosthodontics and Biomaterials, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W 30, 48149 Muenster, Germany;
- Clinic for Radiology, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building A 16, Medical Faculty University of Muenster, 48129 Muenster, Germany
| | - Marcel Hanisch
- Research Unit Rare Diseases with Orofacial Manifestations, Department of Cranio-Maxillofacial Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W 30, 48149 Muenster, Germany;
| | - Bettina Pfleiderer
- Clinic for Radiology, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building A 16, Medical Faculty University of Muenster, 48129 Muenster, Germany
- Correspondence:
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Roy J, Williamson E, Pitt K, Stanley N, Man MS, Feder G, Szilassy E. 'It felt like there was always someone there for us': Supporting children affected by domestic violence and abuse who are identified by general practice. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:165-174. [PMID: 33963618 DOI: 10.1111/hsc.13385] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 02/22/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
One in five children in the UK are affected by domestic violence and abuse. However, primary care clinicians (GPs and nurses) struggle to effectively identify and support children and young people living in homes where it is present. The IRIS+ (Enhanced Identification and Referral to Improve Safety) training and advocacy support intervention aimed to improve how clinicians respond to children and young people affected by domestic violence and abuse. IRIS+ training was delivered as part of a feasibility study to four general practices in an urban area in England (UK). Our mixed method design included interviews and questionnaires about the IRIS+ intervention with general practice patients, including children and young people as well as with clinicians and advocacy service providers. We collected the number of identifications and referrals by clinicians of children experiencing domestic violence and abuse through a retrospective search of medical and agency records 10 months after the intervention. Forty-nine children exposed to domestic violence and abuse were recorded in medical records. Thirty-five children were referred to a specialist domestic violence and abuse support service over a period of 10 months. Of these, 22 received direct or indirect support. The qualitative findings indicated that children benefitted from being referred by clinicians to the service. However, several barriers at the patient and professional level prevented children and young people from being identified and supported. Some of these barriers can be addressed through modifications to professional training and guidance, but others require systematic and structural changes to the way health and social care services work with children affected by domestic violence and abuse.
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Affiliation(s)
- Jessica Roy
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Emma Williamson
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Katherine Pitt
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Nicky Stanley
- School of Social Work, Care and Community, University of Central Lancashire, Preston, UK
| | - Mei-See Man
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Gene Feder
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Eszter Szilassy
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
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