1
|
Saberi E, Hurley J, Hutchinson M. The role of champions in leading domestic violence and abuse practice improvement in healthcare: a scoping review. J Nurs Manag 2021; 30:1658-1666. [PMID: 34798682 DOI: 10.1111/jonm.13514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/31/2021] [Accepted: 11/14/2021] [Indexed: 11/29/2022]
Abstract
AIM To describe and synthesize evidence for champions of domestic violence practice improvement in healthcare and highlight implications for leadership and nurse management. BACKGROUND Globally, healthcare leaders have been tasked with improving service responses to domestic violence. Evidencing the role of champions, and how managers may harness champions in improving responses to domestic violence, is an important factor in successfully leading change in this field. EVALUATION A scoping review was conducted using four electronic databases (Proquest, PubMed, Medline and PsycINFO). KEY ISSUES Eleven studies were included. Champion characteristics, roles, and factors influencing their impact were distilled. Barriers to the success of champions were identified as were four aspects of the champion role: mentor and expert advice; communication and engagement; strategic advocacy, coordination and project leadership; personal and emotional support. CONCLUSIONS The review highlighted that champions involved in domestic violence project implementation have unique aspect to their role, along with characteristics reported in the broader champion literature. As an emerging field, there is evidence that domestic violence champions play an important role in mentoring and supporting healthcare workers to effectively change their practice. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers and leaders need to understand the champion construct and the roles that champions enact to generate domestic violence and abuse system and practice change. Further research is required to provide guidance.
Collapse
Affiliation(s)
- Elham Saberi
- Southern Cross University, School of Health and Human Sciences, Lismore, NSW
| | - John Hurley
- Southern Cross University, School of Health and Human Sciences, Coffs Harbour, NSW
| | - Marie Hutchinson
- Southern Cross University, School of Health and Human Sciences, Coffs Harbour, NSW
| |
Collapse
|
2
|
Sikder SS, Ghoshal R, Bhate-Deosthali P, Jaishwal C, Roy N. Mapping the health systems response to violence against women: key learnings from five LMIC settings (2015-2020). BMC WOMENS HEALTH 2021; 21:360. [PMID: 34629077 PMCID: PMC8504083 DOI: 10.1186/s12905-021-01499-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022]
Abstract
Background Violence against women (VAW) is a global challenge, and the health sector is a key entry point for survivors to receive care. The World Health Organization adopted an earlier framework for health systems response to survivors. However, documentation on the programmatic rollout of health system response to violence against women is lacking in low and middle-income countries. This paper studies the programmatic roll out of the health systems response across select five low- and middle-income countries (LMIC) and identifies key learnings. Methods We selected five LMIC settings with recent or active programming on national-level health system response to VAW from 2015 to 2020. We synthesized publicly available data and program reports according to the components of the WHO Health Systems Framework. The countries selected are Bangladesh, Brazil, Nepal, Rwanda, and Sri Lanka. Results One-stop centers were found to be the dominant model of care located in hospitals in four countries. Each setting has implemented in-service training as key to addressing provider knowledge, attitudes and practice; however, significant gaps remain in addressing frequent staff turnover, provision of training at scale, and documentation of the impact of training. The health system protocols for VAW address sexual violence but do not uniformly include clinical and health policy responses for emotional or economic violence. Providing privacy to survivors within health facilities was a universal challenge. Conclusion Significant efforts have been made to address provider attitudes towards provision of care and to protocolize delivery of care to survivors, primarily through one-stop centers. Further improvements can be made in data collection on training impact on provider attitudes and practices, in provider identification of VAW survivors, and in prioritization of VAW within health system budgeting, staffing, and political priorities. Primary health facilities need to provide first-line support for survivors to avoid delays in response to all forms of VAW as well as for secondary prevention. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01499-8.
Collapse
Affiliation(s)
| | - Rakhi Ghoshal
- CARE India, No.14, Patliputra Colony, Patna, Bihar, 800013, India.,WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
| | | | - Chandni Jaishwal
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA, 30322, USA
| | - Nobhojit Roy
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden. .,The George Institute for Global Health, New Delhi, India.
| |
Collapse
|
3
|
Dowrick A, Feder G, Kelly M. Boundary-Work and the Distribution of Care for Survivors of Domestic Violence and Abuse in Primary Care Settings: Perspectives From U.K. Clinicians. QUALITATIVE HEALTH RESEARCH 2021; 31:1697-1709. [PMID: 33749389 PMCID: PMC8438775 DOI: 10.1177/1049732321998299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Health care encounters are opportunities for primary care practitioners to identify women experiencing domestic violence and abuse (DVA). Increasing DVA support in primary care is a global policy priority but discussion about DVA during consultations remains rare. This article explores how primary care teams in the United Kingdom negotiate the boundaries of their responsibilities for providing DVA support. In-depth interviews were undertaken with 13 general practitioners (GPs) in two urban areas of the United Kingdom. Interviews were analyzed thematically. Analysis focused on the boundary practices participants undertook to establish their professional remit regarding abuse. GPs maintained permeable boundaries with specialist DVA support services. This enabled ongoing negotiation of the role played by clinicians in identifying DVA. This permeability was achieved by limiting the boundaries of the GP role in the care of patients with DVA to identification, with the work of providing support distributed to local specialist DVA agencies.
Collapse
Affiliation(s)
- Anna Dowrick
- Queen Mary University of London, London, United Kingdom
| | - Gene Feder
- University of Bristol, Bristol, United Kingdom
| | - Moira Kelly
- Queen Mary University of London, London, United Kingdom
| |
Collapse
|
4
|
Szilassy E, Barbosa EC, Dixon S, Feder G, Griffiths C, Johnson M, De Simoni A, Wileman V, Panovska-Griffiths J, Dowrick A. PRimary care rEsponse to domestic violence and abuse in the COvid-19 panDEmic (PRECODE): protocol of a rapid mixed-methods study in the UK. BMC FAMILY PRACTICE 2021; 22:91. [PMID: 33980165 PMCID: PMC8115859 DOI: 10.1186/s12875-021-01447-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 04/28/2021] [Indexed: 11/10/2022]
Abstract
Background The implementation of lockdowns in the UK during the COVID-19 pandemic resulted in a system switch to remote primary care consulting at the same time as the incidence of domestic violence and abuse (DVA) increased. Lockdown-specific barriers to disclosure of DVA reduced the opportunity for DVA detection and referral. The PRECODE (PRimary care rEsponse to domestic violence and abuse in the COvid-19 panDEmic) study will comprise quantitative analysis of the impact of the pandemic on referrals from IRIS (Identification and Referral to Improve Safety) trained general practices to DVA agencies in the UK and qualitative analysis of the experiences of clinicians responding to patients affected by DVA and adaptations they have made transitioning to remote DVA training and patient support. Methods/Design Using a rapid mixed method design, PRECODE will explore and explain the dynamics of DVA referrals and support before and during the pandemic on a national scale using qualitative data and over four years of referrals time series data. We will undertake interrupted-time series and non-linear regression analysis, including sensitivity analyses, on time series of referrals to DVA services from routinely collected data to evaluate the impact of the pandemic and associated lockdowns on referrals to the IRIS Programme, and analyse key determinants associated with changes in referrals. We will also conduct an interview- and observation-based qualitative study to understand the variation, relevance and feasibility of primary care responses to DVA before and during the pandemic and its aftermath. The triangulation of quantitative and qualitative findings using rapid analysis and synthesis will enable the articulation of multiscale trends in primary care responses to DVA and complex mechanisms by which these responses have changed during the pandemic. Discussion Our findings will inform the implementation of remote primary care and DVA service responses as services re-configure. Understanding the adaptation of clinical and service responses to DVA during the pandemic is crucial for the development of evidence-based, effective remote support and referral beyond the pandemic. Trial registration PRECODE is an observational epidemiologic study, not an intervention evaluation or trial. We will not be reporting results of an intervention on human participants.
Collapse
Affiliation(s)
- Eszter Szilassy
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, BS8 2PS, Bristol, UK.
| | - Estela Capelas Barbosa
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, BS8 2PS, Bristol, UK.,IRISi, Bristol, UK
| | - Sharon Dixon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,Donnington Medical Partnership, Oxford, UK
| | - Gene Feder
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, BS8 2PS, Bristol, UK
| | - Chris Griffiths
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Anna De Simoni
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Vari Wileman
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jasmina Panovska-Griffiths
- Department of Applied Health Research, Institute of Epidemiology and Health Care, University College London, London, UK.,Wolfson Centre for Mathematical Biology and The Queen's College, University of Oxford, Oxford, UK
| | - Anna Dowrick
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
Panovska-Griffiths J, Sohal AH, Martin P, Capelas EB, Johnson M, Howell A, Lewis NV, Feder G, Griffiths C, Eldridge S. Disruption of a primary health care domestic violence and abuse service in two London boroughs: interrupted time series evaluation. BMC Health Serv Res 2020; 20:569. [PMID: 32571378 PMCID: PMC7309975 DOI: 10.1186/s12913-020-05397-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 06/03/2020] [Indexed: 12/02/2022] Open
Abstract
Background Domestic violence and abuse (DVA) is experienced by about 1/3 of women globally and remains a major health concern worldwide. IRIS (Identification and Referral to Improve Safety of women affected by DVA) is a complex, system-level, training and support programme, designed to improve the primary healthcare response to DVA. Following a successful trial in England, since 2011 IRIS has been implemented in eleven London boroughs. In two boroughs the service was disrupted temporarily. This study evaluates the impact of that service disruption. Methods We used anonymised data on daily referrals received by DVA service providers from general practices in two IRIS implementation boroughs that had service disruption for a period of time (six and three months). In line with previous work we refer to these as boroughs B and C. The primary outcome was the number of daily referrals received by the DVA service provider across each borough over 48 months (March 2013–April 2017) in borough B and 42 months (October 2013–April 2017) in borough C. The data were analysed using interrupted-time series, non-linear regression with sensitivity analyses exploring different regression models. Incidence Rate Ratio (IRR), 95% confidence intervals and p-values associated with the disruption were reported for each borough. Results A mixed-effects negative binomial regression was the best fit model to the data. In borough B, the disruption, lasted for about six months, reducing the referral rate significantly (p = 0.006) by about 70% (95%CI = (23,87%)). In borough C, the three-month service disruption, also significantly (p = 0.005), reduced the referral rate by about 49% (95% CI = (18,68%)). Conclusions Disrupting the IRIS service substantially reduced the rate of referrals to DVA service providers. Our findings are evidence in favour of continuous funding and staffing of IRIS as a system level programme.
Collapse
Affiliation(s)
- Jasmina Panovska-Griffiths
- Department of Applied Health, Institute of Epidemiology and Health Care, University College London, London, UK. .,Institute for Global Health, University College London, London, UK. .,The Queen's College, Oxford University, Oxford, UK.
| | - Alex Hardip Sohal
- Institute of Population Sciences, Queen Mary University London, London, UK
| | - Peter Martin
- Department of Applied Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Estela Barbosa Capelas
- IRISi, Bristol, UK.,Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Natalia V Lewis
- Institute of Population Sciences, Queen Mary University London, London, UK.,Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gene Feder
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chris Griffiths
- Institute of Population Sciences, Queen Mary University London, London, UK
| | - Sandra Eldridge
- Institute of Population Sciences, Queen Mary University London, London, UK
| |
Collapse
|
6
|
Sohal AH, Feder G, Boomla K, Dowrick A, Hooper R, Howell A, Johnson M, Lewis N, Robinson C, Eldridge S, Griffiths C. Improving the healthcare response to domestic violence and abuse in UK primary care: interrupted time series evaluation of a system-level training and support programme. BMC Med 2020; 18:48. [PMID: 32131828 PMCID: PMC7057596 DOI: 10.1186/s12916-020-1506-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 01/30/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND It is unknown whether interventions known to improve the healthcare response to domestic violence and abuse (DVA)-a global health concern-are effective outside of a trial. METHODS An observational interrupted time series study in general practice. All registered women aged 16 and above were eligible for inclusion. In four implementation boroughs' general practices, there was face-to-face, practice-based, clinically relevant DVA training, a prompt in the electronic medical record, reminding clinicians to consider DVA, a simple referral pathway to a named advocate, ensuring direct access for women to specialist services, overseen by a national, health-focused DVA organisation, fostering best practice. The fifth comparator borough had only a session delivered by a local DVA specialist agency at community venues conveying information to clinicians. The primary outcome was the daily number of referrals received by DVA workers per 1000 women registered in a general practice, from 205 general practices, in all five northeast London boroughs. The secondary outcome was recorded new DVA cases in the electronic medical record in two boroughs. Data was analysed using an interrupted time series with a mixed effects Poisson regression model. RESULTS In the 144 general practices in the four implementation boroughs, there was a significant increase in referrals received by DVA workers-global incidence rate ratio of 30.24 (95% CI 20.55 to 44.77, p < 0.001). There was no increase in the 61 general practices in the other comparator borough (incidence rate ratio of 0.95, 95% CI 0.13 to 6.84, p = 0.959). New DVA cases recorded significantly increased with an incident rate ratio of 1.27 (95% CI 1.09 to 1.48, p < 0.002) in the implementation borough but not in the comparator borough (incidence rate ratio of 1.05, 95% CI 0.82 to 1.34, p = 0.699). CONCLUSIONS Implementing integrated referral routes, training and system-level support, guided by a national health-focused DVA organisation, outside of a trial setting, was effective and sustainable at scale, over four years (2012 to 2017) increasing referrals to DVA workers and new DVA cases recorded in electronic medical records.
Collapse
Affiliation(s)
- Alex Hardip Sohal
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Gene Feder
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kambiz Boomla
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Anna Dowrick
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Richard Hooper
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | | | | | - Natalia Lewis
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Clare Robinson
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Chris Griffiths
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| |
Collapse
|
7
|
Dheensa S, Halliwell G, Daw J, Jones SK, Feder G. "From taboo to routine": a qualitative evaluation of a hospital-based advocacy intervention for domestic violence and abuse. BMC Health Serv Res 2020; 20:129. [PMID: 32085771 PMCID: PMC7035753 DOI: 10.1186/s12913-020-4924-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/21/2020] [Indexed: 11/24/2022] Open
Abstract
Background Health services are often the first point of professional contact for people who have experienced domestic violence and abuse. We report on the evaluation of a multi-site, hospital-based advocacy intervention for survivors of domestic violence and abuse. Independent Domestic Violence Advisors (IDVAs), who provide survivors with support around safety, criminal justice, and health and wellbeing, were located in five hospitals in England between 2012 and 2015 in emergency departments and maternity services. We present views about IDVAs’ approaches to tackling domestic violence and abuse, how the IDVA service worked in practice, and factors that hindered and facilitated engagement with survivors. Methods We adopted a convenience sampling approach and invited participation from all who offered to take part within the study timeframe. Sixty-four healthcare professionals, IDVAs, IDVA service managers, and commissioners at all sites were interviewed. Interviews were analysed using a thematic approach: familiarising ourselves with the data through repeated readings and noting initial ideas; generating initial codes through double coding notable features of the data across the dataset; collating codes into potential themes; and reviewing themes to ensure they captured the essence of the data. Results Two key themes emerged. The first was Hospital-based IDVAs fulfil several crucial roles. This theme highlighted that healthcare professionals thought the hospital-based IDVA service was valuable because it enhanced their skills, knowledge, and confidence in asking about domestic violence and abuse. It enabled them to immediately refer and provide support to patients who might have otherwise been lost along a referral pathway. It also reached survivors who might otherwise have remained hidden. The second theme was Success hinges on a range of structural factors. This theme illustrated the importance of ongoing domestic violence and abuse training for staff, the IDVA having private and dedicated space, and the service being embedded in hospital infrastructure (e.g. featuring it in hospital-wide policies and enabling IDVAs access to medical records). Conclusion Hospital-based IDVAs offer a unique and valued way to respond to domestic violence and abuse in a healthcare setting. Further work must now be done to explore how to implement the service sustainably.
Collapse
Affiliation(s)
- Sandi Dheensa
- Domestic Violence/Abuse and Health Research Group (DVAHG), Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Gemma Halliwell
- Domestic Violence/Abuse and Health Research Group (DVAHG), Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Jennifer Daw
- Safelives, Suite 2a, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK
| | - Sue K Jones
- Safelives, Suite 2a, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK
| | - Gene Feder
- Domestic Violence/Abuse and Health Research Group (DVAHG), Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| |
Collapse
|
8
|
Boundary spanners: Negotiating connections across primary care and domestic violence and abuse services. Soc Sci Med 2019; 245:112687. [PMID: 31759249 DOI: 10.1016/j.socscimed.2019.112687] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 11/23/2022]
Abstract
Improving access to support for people experiencing domestic violence and abuse requires better connections between healthcare services and specialist domestic violence and abuse (DVA) support agencies. We examined the work involved in restructuring the relationship between primary care and specialist DVA support services. This was part of a broader study of the implementation of a general practice DVA training and support programme (IRIS). We conducted an ethnography in two different UK areas where the IRIS programme was being delivered. We investigated the work done by specialist DVA workers (Advocate Educators) in the dual role of providing training to GPs and advocacy support to patients. Drawing on concepts of boundary actors and boundary objects, we examined how interactions between clinicians and patients changed after the introduction of the IRIS programme. The referral pathway emerged as a boundary object, meeting a shared ambition of general practitioners and patients to distribute responsibility for addressing DVA. However, maintaining this as a boundary object-in-use required significant, and often unseen, work on the part of the Advocate Educator as boundary spanner. Our study contributes to scholarship on boundary work by highlighting the role of marginal boundary actors in maintaining the use of boundary objects among disparate groups.
Collapse
|
9
|
Baloushah S, Maasoumi R, Farahani FK, Khadoura KJ, Elsous A. Intimate partner violence against Palestinian women in Gaza strip: Prevalence and correlates. J Family Med Prim Care 2019; 8:3621-3626. [PMID: 31803663 PMCID: PMC6881945 DOI: 10.4103/jfmpc.jfmpc_498_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/22/2019] [Accepted: 09/19/2019] [Indexed: 11/26/2022] Open
Abstract
Context: Intimate partner violence (IPV) affects gravely the victims and is resulting in negative physical and psychological consequences. Aims: This paper aimed to determine the prevalence of IPV against women in Gaza strip and associated factors. Moreover, to explore women's seeking behaviors to help. Settings and Design: Cross-sectional study. Methods and Materials: Community internet-based survey was conducted using the Heart Insult Threat Scout questionnaire and the reporting behavior of respondent to violence act. Statistical Analysis Used: A number of 517 ever married women responded and data were entered and analyzed using SPSS software version 23. Results: About 517 women participated. Of which, 23% (119/517) reported exposure to any types of IPV. Multivariate logistic regression showed factors associated with IPV were as follows: husbands who are drug user (OR = 27.577, CI95%: 5.153–147.591; P < 0.001), husband exposure to violence in childhood (OR = 9.174, CI95%: 4.753–7.727; P > 0.001), and family with a special needs child (OR = 2.956, CI95%: 1.131–8.607; P < 0.05). Approximately, two-thirds of the victims tended to keep silent toward violence and dealt with it as a private and family issue; hence, they hesitated to communicate with others or seek any help to protect themselves. Conclusions: About 23% from the study participants experience violence in their life time. Factors associated with IPV are husband's drug abuse, having a child with special needs, and husband's childhood experience of violence. Qualitative researches are needed to understand the women experience to violence and sociocultural barrier for disclosure.
Collapse
Affiliation(s)
- Suha Baloushah
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Science International Campus, Tehran, Iran
| | - Raziyeh Maasoumi
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Science, Tehran, Iran
| | - Farideh Khalajabadi Farahani
- Population Studies and Reproductive Health Department, National Population Studies Comprehensive Management Institute, Tehran, Iran
| | - Khalid Jamal Khadoura
- Department of Epidemiology, Public Health School, Tehran University of Medical Science, Tehran, Iran
| | - Aymen Elsous
- Assistant Professor, Faculty of Health Professions, Israa University, Gaza Strip, Palestine
| |
Collapse
|
10
|
Lewis NV, Dowrick A, Sohal A, Feder G, Griffiths C. Implementation of the Identification and Referral to Improve Safety programme for patients with experience of domestic violence and abuse: A theory-based mixed-method process evaluation. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e298-e312. [PMID: 30868711 PMCID: PMC6617800 DOI: 10.1111/hsc.12733] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/14/2019] [Accepted: 02/11/2019] [Indexed: 06/09/2023]
Abstract
Identification and Referral to Improve Safety (IRIS) is a training and support programme to improve the response to domestic violence and abuse (DVA) in general practice. Following a pragmatic cluster-randomised trial, IRIS has been implemented in over 30 administrative localities in the UK. The trial and local evaluations of the IRIS implementation showed an increase in referrals from general practice to third sector DVA services with a variation in the referral rates within and across practices. Using Normalisation Process Theory (NPT), we aimed to understand the reasons for such variability by identifying factors that influenced the implementation of IRIS in the National Health Service (NHS). We conducted a mixed-method process evaluation which included: (a) a case study (100 hr of participant observation, 19 interviews); (b) a survey (n = 118); (c) qualitative analysis of free-text comments from the survey; (d) qualitative interviews (n = 8); (e) document review (n = 44). Data were collected from NHS and third sector staff across five London boroughs from August 2015 to December 2017, analysed descriptively and thematically and triangulated using the NPT constructs coherence, cognitive participation, collection action and reflexive monitoring. The survey showed wide variation in the extent to which practice staff saw IRIS as a normal part of their daily work. Qualitative data and documents illuminated drivers of DVA work, implementation barriers and suggested solutions. The drivers were related to individual professional's characteristics and relationships. The barriers were linked to the differing sense-making and legitimisation of DVA work and differing contexts between the NHS and third sector. Solutions were adaptations to IRIS relative to these contextual differences. The suggested solutions can be used to update IRIS commissioning guidance, training for trainers and training for general practice. The updates should reflect the importance of ongoing support of IRIS from practice leads and commissioners, extended funding periods for IRIS and continuity of the IRIS team.
Collapse
Affiliation(s)
- Natalia V. Lewis
- Centre for Primary Care and Public HealthQueen Mary University of LondonLondonUK
- Centre for Academic Primary Care, Bristol Medical School, University of BristolBristolUK
| | - Anna Dowrick
- Centre for Primary Care and Public HealthQueen Mary University of LondonLondonUK
| | - Alex Sohal
- Centre for Primary Care and Public HealthQueen Mary University of LondonLondonUK
| | - Gene Feder
- Centre for Academic Primary Care, Bristol Medical School, University of BristolBristolUK
| | - Chris Griffiths
- Centre for Primary Care and Public HealthQueen Mary University of LondonLondonUK
| |
Collapse
|
11
|
Barbosa EC, Verhoef TI, Morris S, Solmi F, Johnson M, Sohal A, El-Shogri F, Dowrick S, Ronalds C, Griffiths C, Eldridge S, Lewis NV, Devine A, Spencer A, Feder G. Cost-effectiveness of a domestic violence and abuse training and support programme in primary care in the real world: updated modelling based on an MRC phase IV observational pragmatic implementation study. BMJ Open 2018; 8:e021256. [PMID: 30158224 PMCID: PMC6119435 DOI: 10.1136/bmjopen-2017-021256] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 07/03/2018] [Accepted: 07/31/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To evaluate the cost-effectiveness of the implementation of the Identification and Referral to Improve Safety (IRIS) programme using up-to-date real-world information on costs and effectiveness from routine clinical practice. A Markov model was constructed to estimate mean costs and quality-adjusted life-years (QALYs) of IRIS versus usual care per woman registered at a general practice from a societal and health service perspective with a 10-year time horizon. DESIGN AND SETTING Cost-utility analysis in UK general practices, including data from six sites which have been running IRIS for at least 2 years across England. PARTICIPANTS Based on the Markov model, which uses health states to represent possible outcomes of the intervention, we stipulated a hypothetical cohort of 10 000 women aged 16 years or older. INTERVENTIONS The IRIS trial was a randomised controlled trial that tested the effectiveness of a primary care training and support intervention to improve the response to women experiencing domestic violence and abuse, and found it to be cost-effective. As a result, the IRIS programme has been implemented across the UK, generating data on costs and effectiveness outside a trial context. RESULTS The IRIS programme saved £14 per woman aged 16 years or older registered in general practice (95% uncertainty interval -£151 to £37) and produced QALY gains of 0.001 per woman (95% uncertainty interval -0.005 to 0.006). The incremental net monetary benefit was positive both from a societal and National Health Service perspective (£42 and £22, respectively) and the IRIS programme was cost-effective in 61% of simulations using real-life data when the cost-effectiveness threshold was £20 000 per QALY gained as advised by National Institute for Health and Care Excellence. CONCLUSION The IRIS programme is likely to be cost-effective and cost-saving from a societal perspective in the UK and cost-effective from a health service perspective, although there is considerable uncertainty surrounding these results, reflected in the large uncertainty intervals.
Collapse
Affiliation(s)
| | | | - Steve Morris
- University College London, Department of Applied Health Research, London, UK
| | - Francesca Solmi
- Division of Psychiatry, University College London, London, UK
| | | | - Alex Sohal
- NIHR CLAHRC North Thames at Bart's Health NHS Trust, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Farah El-Shogri
- NIHR CLAHRC North Thames at Bart's Health NHS Trust, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Susanna Dowrick
- NIHR CLAHRC North Thames at Bart's Health NHS Trust, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Clare Ronalds
- Pankhurst Trust Incorporating, Manchester Women's Aid, Manchester, UK
| | - Chris Griffiths
- NIHR CLAHRC North Thames at Bart's Health NHS Trust, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- NIHR CLAHRC North Thames at Bart's Health NHS Trust, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Natalia V Lewis
- NIHR CLAHRC North Thames at Bart's Health NHS Trust, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Angela Devine
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Anne Spencer
- University of Exeter Medical School, Exeter, Devon, UK
| | - Gene Feder
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| |
Collapse
|