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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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Arishaba A, Kiduuma W, Night G, Arinaitwe I, Niyonzima V, Mubangizi V. Predictors and Factors Associated with Counseling Seeking Behavior Against Intimate Partner Violence Among HIV-Positive Women in Southwestern Uganda. HIV AIDS (Auckl) 2022; 14:275-283. [PMID: 35711852 PMCID: PMC9196276 DOI: 10.2147/hiv.s362398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Adella Arishaba
- Department of Nursing, Faculty of Medicine Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Wilson Kiduuma
- Department of Nursing, Faculty of Medicine Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Grace Night
- Department of Physiotherapy, Faculty of Medicine Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Innocent Arinaitwe
- Department of Internal Medicine, Faculty of Medicine Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Vallence Niyonzima
- Department of Nursing, Faculty of Medicine Mbarara University of Science and Technology, Mbarara City, Uganda
- Correspondence: Vallence Niyonzima, Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara city, Uganda, Tel +256777842830, Email
| | - Vincent Mubangizi
- Department of Nursing, Faculty of Medicine Mbarara University of Science and Technology, Mbarara City, Uganda
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Alves-Costa F, Lane R, Gribble R, Taylor A, Fear NT, MacManus D. Help-seeking for Intimate Partner Violence and Abuse: Experiences of Civilian Partners of UK Military Personnel. JOURNAL OF FAMILY VIOLENCE 2022; 38:509-525. [PMID: 35399200 PMCID: PMC8982908 DOI: 10.1007/s10896-022-00382-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 05/10/2023]
Abstract
There is evidence that Intimate Partner Violence and Abuse (IPVA) is more prevalent among military populations compared with civilian populations. However, there has been limited research into the help-seeking experiences of civilian victim-survivors who have experienced IPVA within relationships with military personnel. This qualitative study aimed to explore the experiences of, and barriers to, help-seeking for IPVA victimisation among civilian partners of military personnel in order to identify strategies to improve the management of IPVA both within the military and civilian sectors. The study adopted a descriptive cross-sectional study design and used qualitative research methods. One-to-one telephone interviews were conducted with civilian victim-survivors (n = 25) between January and August 2018. Interview transcripts were analysed using thematic analysis. Three superordinate themes were derived: (1) Drivers to help-seeking; (2) Barriers to help-seeking; and (3) Experiences of services. The findings indicate difficulties in help-seeking for IPVA among civilian partners of military personnel due to stigma, fear, dependency, poor understanding of IPVA, lack of appropriate and timely support, and a perceived lack of victim support. Difficulties in help-seeking were perceived by participants to be amplified by military culture, public perceptions of the military, military protection of personnel and the lack of coordination between civilian and military judicial services. This study reinforces the need for a military specific Domestic Abuse strategy, identifies vulnerable groups and highlights a need for both increased awareness and understanding of IPVA within civilian and military services in order to provide adequate victim protection.
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Affiliation(s)
- Filipa Alves-Costa
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, Camberwell, London, SE5 8AB UK
| | - Rebecca Lane
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, Camberwell, London, SE5 8AB UK
| | - Rachael Gribble
- King‘s Centre for Military Health Research, King‘s College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ UK
| | - Anna Taylor
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Nicola T Fear
- King‘s Centre for Military Health Research, King‘s College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ UK
| | - Deirdre MacManus
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, Camberwell, London, SE5 8AB UK
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Adams C, Hooker L, Taft A. Threads of Practice: Enhanced Maternal and Child Health Nurses Working With Women Experiencing Family Violence. Glob Qual Nurs Res 2021; 8:23333936211051703. [PMID: 34692921 PMCID: PMC8532206 DOI: 10.1177/23333936211051703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 11/21/2022] Open
Abstract
Family violence is a serious public health issue with significant health consequences for women and children. Enhanced Maternal and Child Health nurses (EMCH) in Victoria, Australia, work with women experiencing family violence; however, scholarly examination of the clinical work of nurses has not occurred. This qualitative study explored how EMCH nurses work with women experiencing abuse, describing the personal and professional challenges for nurses undertaking family violence work. Twenty-five nurses participated in semi-structured interviews. Using interpretive description methodology has enabled an insight into nurses' family violence work. Threads of practice identified included (1) Validating/Reframing; (2) Non-judgmental support/Safeguarding and (3) Following/Leading. The nurses highlighted the diversity of experience for women experiencing abuse and nurses' roles in family violence nurse practice. The research contributes to understanding how EMCH nurses traverse threads of practice to support women experiencing family violence.
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Affiliation(s)
- Catina Adams
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
| | - Leesa Hooker
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia.,Rural Department of Nursing and Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Angela Taft
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
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Szilassy E, Roy J, Williamson E, Pitt K, Man MS, Feder G. Reaching everyone in general practice? Feasibility of an integrated domestic violence training and support intervention in primary care. BMC FAMILY PRACTICE 2021; 22:19. [PMID: 33435891 PMCID: PMC7802315 DOI: 10.1186/s12875-020-01297-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 10/25/2020] [Indexed: 12/16/2022]
Abstract
Background Primary care needs to respond effectively to patients experiencing or perpetrating domestic violence and abuse (DVA) and their children, but there is uncertainty about the value of integrated programmes. The aim of the study was to develop and test the feasibility of an integrated primary care system-level training and support intervention, called IRIS+ (Enhanced Identification and Referral to Improve Safety), for all patients affected by DVA. IRIS+ was an adaptation of the original IRIS (Identification and Referral to Improve Safety) model designed to reach female survivors of DVA. Methods Observation of training; pre/post intervention questionnaires with clinicians and patients; data extracted from medical records and DVA agency; semi-structured interviews with clinicians, service providers and referred adults and children. Data collection took place between May 2017 and April 2018. Mixed method analysis was undertaken to triangulate data from various sources to assess the feasibility and acceptability of the intervention. Results Clinicians and service providers believed that the IRIS+ intervention had filled a service gap and was a valuable resource in identifying and referring women, men and children affected by DVA. Despite increased levels of preparedness reported by clinicians after training in managing the complexity of DVA in their practice, the intervention proved to be insufficient to catalyse identification and specialist referral of men and direct identification and referral (without their non-abusive parents) of children and young people. The study also revealed that reports provided to general practice by other agencies are important sources of information about adult and children patients affected by DVA. However, in the absence of guidance about how to use this information in patient care, there are uncertainties and variation in practice. Conclusions The study demonstrates that the IRIS+ intervention is not feasible in the form and timeframe we evaluated. Further adaptation is required to achieve identification and referral of men and children in primary care: an enhanced focus on engagement with men, direct engagement with children, and improved guidance and training on responding to reports of DVA received from other agencies. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01297-5.
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Affiliation(s)
- Eszter Szilassy
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - 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, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Mei-See Man
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Gene Feder
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Souza MARD, Peres AM, Fumincelli L, Lopes VJ, Mercês NNAD, Wall ML. Percepção das mulheres em situação de violência sobre o apoio formal: Scoping review. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo Examinar e mapear as evidências científicas acerca das percepções das mulheres em situação de violência quanto aos serviços de apoio social formal. Método Scoping Review, conforme Joanna Briggs Institute e a questão norteadora: “Qual a percepção das mulheres em situação de violência ao buscar atendimento profissional nos serviços de apoio?”. Inclusos estudos nacionais, internacionais, primários, abordagens qualitativas, quantitativas, métodos mistos, idiomas inglês, português e espanhol, no espaço temporal de 2014 a 2019. Realizadas buscas em sete bases de dados, encontrados 1557 artigos e selecionados 16 como amostra final. Resultados Os atendimentos evidenciaram a escuta ativa, criação de vínculo e articulação dos serviços. Como também a falta de acolhimento; sentimento de insegurança, medo e humilhação. O processo de capacitação foi estabelecido pelos artigos como ferramenta aos profissionais, na promoção de abordagem direcionada e individualizada. Conclusões e considerações para a prática O acolhimento e vínculo propiciado por alguns serviços de apoio resultou em propostas de mudanças e suscitou nas mulheres reflexão, confiança e busca para saída do ciclo da violência. O contrário gerou afastamento dos serviços e consequente permanência junto ao agressor.
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Tarzia L, Bohren MA, Cameron J, Garcia-Moreno C, O'Doherty L, Fiolet R, Hooker L, Wellington M, Parker R, Koziol-McLain J, Feder G, Hegarty K. Women's experiences and expectations after disclosure of intimate partner abuse to a healthcare provider: A qualitative meta-synthesis. BMJ Open 2020; 10:e041339. [PMID: 33247027 PMCID: PMC7703445 DOI: 10.1136/bmjopen-2020-041339] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/16/2020] [Accepted: 11/18/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To identify and synthesise the experiences and expectations of women victim/survivors of intimate partner abuse (IPA) following disclosure to a healthcare provider (HCP). METHODS The databases MEDLINE, Embase, CINAHL, PsychINFO, SocINDEX, ASSIA and the Cochrane Library were searched in February 2020. Included studies needed to focus on women's experiences with and expectations of HCPs after disclosure of IPA. We considered primary studies using qualitative methods for both data collection and analysis published since 2004. Studies conducted in any country, in any type of healthcare setting, were included. The quality of individual studies was assessed using an adaptation of the Critical Appraisal Skills Programme checklist for qualitative studies. The confidence in the overall evidence base was determined using Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-Confidence in the Evidence from Reviews of Qualitative Research methods. Thematic synthesis was used for analysis. RESULTS Thirty-one papers describing 30 studies were included in the final review. These were conducted in a range of health settings, predominantly in the USA and other high-income countries. All studies were in English. Four main themes were developed through the analysis, describing women's experiences and expectations of HCPs: (1) connection through kindness and care; (2) see the evil, hear the evil, speak the evil; (3) do more than just listen; and (4) plant the right seed. If these key expectations were absent from care, it resulted in a range of negative emotional impacts for women. CONCLUSIONS Our findings strongly align with the principles of woman-centred care, indicating that women value emotional connection, practical support through action and advocacy and an approach that recognises their autonomy and is tailored to their individual needs. Drawing on the evidence, we have developed a best practice model to guide practitioners in how to deliver woman-centred care. This review has critical implications for practice, highlighting the simplicity of what HCPs can do to support women experiencing IPA, although its applicability to low-income and-middle income settings remains to be explored.
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Affiliation(s)
- Laura Tarzia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Family Violence Prevention, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Meghan A Bohren
- Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jacqui Cameron
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Lorna O'Doherty
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Research in Psychology, Behaviour and Achievement, Coventry University, Coventry, UK
| | - Renee Fiolet
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leesa Hooker
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Molly Wellington
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rhian Parker
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Koziol-McLain
- Centre for Interdisciplinary Trauma Research, Auckland University of Technology, Auckland, New Zealand
| | - Gene Feder
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Family Violence Prevention, The Royal Women's Hospital, Parkville, Victoria, Australia
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9
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Sparrow K, Alves-Costa F, Alves A, Greenberg N, Howard LM, Fear NT, MacManus D. The experience of health and welfare workers in identifying and responding to domestic abuse among military personnel in the UK. BMC Health Serv Res 2020; 20:947. [PMID: 33059688 PMCID: PMC7559780 DOI: 10.1186/s12913-020-05672-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/20/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Awareness of domestic violence and abuse (DVA) as a problem among military personnel (serving and veterans) has grown in recent years, and there is a need for research to inform improvements in the identification of and response to DVA in this population. This study aimed to explore the experience of health and welfare professionals in identifying and responding to DVA among the UK military population (serving personnel and veterans). METHODS Thirty-five semi-structured telephone interviews were conducted with health and welfare staff who work with serving UK military personnel and veterans. Interviews were analysed using thematic analysis. RESULTS Three superordinate themes were identified: i) patterns of DVA observed by health and welfare workers (perceived gender differences in DVA experiences and role of mental health and alcohol); (ii) barriers to identification of and response to DVA (attitudinal/knowledge-based barriers and practical barriers), and iii) resource issues (training needs and access to services). Participants discussed how factors such as a culture of hypermasculinity, under-reporting of DVA, the perception of DVA as a "private matter" among military personnel, and lack of knowledge and awareness of emotional abuse and coercive controlling behaviour as abuse constitute barriers to identification and management of DVA. Healthcare providers highlighted the need for more integrated working between civilian and military services, to increase access to support and provide effective care to both victims and perpetrators. Furthermore, healthcare and welfare staff reflected on their training needs in the screening and management of DVA to improve practice. CONCLUSIONS There is a need for increased awareness of DVA, particularly of non-physical forms of abuse, and of male victimisation in the military. Standardised protocols for DVA management and systematic training are required to promote a consistent and appropriate response to DVA. There is a particular training need among healthcare and first-line welfare staff, who are largely relied upon to identify cases of DVA in the military. Employing DVA advocates within military and civilian healthcare settings may be useful in improving DVA awareness, management and access to specialist support.
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Affiliation(s)
- Katherine Sparrow
- Forensic and Neurodevelopmental Science Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Filipa Alves-Costa
- Forensic and Neurodevelopmental Science Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.
- Barnet Enfield and Haringey Mental Health NHS Trust, London, UK.
| | - Ana Alves
- Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Neil Greenberg
- King's Centre for Military Health Research (KCMHR) Academic Department of Military Mental Health (ADMMH), King's College London, London, UK
| | - Louise M Howard
- Section of Women's Mental Health, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research (KCMHR) Academic Department of Military Mental Health (ADMMH), King's College London, London, UK
| | - Deirdre MacManus
- Forensic and Neurodevelopmental Science Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
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Coulthard P, Hutchison I, Bell JA, Coulthard ID, Kennedy H. COVID-19, domestic violence and abuse, and urgent dental and oral and maxillofacial surgery care. Br Dent J 2020; 228:923-926. [PMID: 32591703 PMCID: PMC7319221 DOI: 10.1038/s41415-020-1709-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Household isolation measures to reduce coronavirus transmission during the COVID-19 pandemic have resulted in increased risk of domestic violence and abuse (DVA). DVA physical injury most frequently involves the face. Dentists, dental care professionals, oral surgeons and oral and maxillofacial surgeons all have a critical part to play in identifying patients experiencing DVA, who present with dental and facial injury, and in making referrals to specialist agencies. This paper describes how to ask questions about DVA sensitively and how to make an appropriate referral. Early intervention and referral to a DVA advocate can prevent an abusive situation becoming worse with more intense violence. It can save lives.
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Affiliation(s)
- Paul Coulthard
- Dean & Director, Professor of Oral & Maxillofacial Surgery, Institute of Dentistry, Consultant in Oral Surgery, Bart's Health NHS Trust, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Turner Street, London, E1 2AD, UK.
| | - Iain Hutchison
- Professor of Oral & Maxillofacial Surgery, Queen Mary University of London, Director, The National Facial Oral and Oculoplastic Research Centre (NFORC), Chief Executive Saving Faces - The Facial Surgery Research Foundation, UK
| | - Joseph A Bell
- Dental Core Trainee, Oral and Maxillofacial Surgery, Bradford Teaching Hospital NHS Foundation Trust, UK
| | - Imogen D Coulthard
- RISE Charity DVA Ambassador Brighton, Biomedical Science Student, University of Brighton, UK
| | - Helena Kennedy
- Doughty Street Chambers, Director of the International Bar Association's Institute of Human Rights, UK
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11
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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.
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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
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12
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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.
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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
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13
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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.
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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
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14
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McGinn T, McColgan M, Daly M, Taylor B. Participants' Views About the Survivor Contact Element of IPV Perpetrator Programs: A Preliminary Study. VIOLENCE AND VICTIMS 2019; 34:889-909. [PMID: 31836642 DOI: 10.1891/0886-6708.vv-d-17-00150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Advocacy services, for victims and survivors, are at the core of our response to Intimate Partner Violence (IPV). The survivor contact element of IPV perpetrator programs is recognized as a necessary safety measure for their operation. Within the context of equivocal evaluations of these programs, and the impetus to find opportunities to enhance their effectiveness, this study report explores the service user perspective on survivor contact work. In-depth semi-structured interviews were completed with 18 perpetrators and 18 survivors involved in three Irish-based programs, and findings were analyzed using grounded theory principles. Almost without exception, survivors were positive about their engagement with an outreach service. There was evidence to suggest that perpetrator program outreach services do reach survivors who may not ordinarily make contact with an advocacy service. In general terms, survivors felt validated as survivors, they felt supported, they learned about abusive behaviors and some saw the service as a monitor of what their partner was saying during group work. However, some survivors described their fear that any reports of ongoing abuse, which they offered, would attract reprisals from their partner or the attentions of child protection services. More determined application of criminal justice measures, and enhanced resourcing of the survivor contact element of these programs, should be considered.
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Affiliation(s)
- Tony McGinn
- School of Sociology and Applied Social Studies, Ulster University, Magee Campus, Derry/Londonderry, Northern Ireland
| | - Mary McColgan
- School of Sociology and Applied Social Studies, Ulster University
| | - Margaret Daly
- Adapt Domestic Abuse Services, Limerick, Republic of Ireland
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15
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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.
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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
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16
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Exposure to domestic violence and abuse and consultations for emergency contraception: nested case-control study in a UK primary care dataset. Br J Gen Pract 2018; 69:e199-e207. [PMID: 30510095 PMCID: PMC6400602 DOI: 10.3399/bjgp18x700277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/20/2018] [Indexed: 01/24/2023] Open
Abstract
Background Evidence of an association between exposure to domestic violence and abuse (DVA) and use of emergency contraception (EC) is lacking in the UK. Aim To quantify the association between exposure to DVA and consultations for EC in general practice. Design and setting Nested case-control study in UK general practice. Method Using the Clinical Practice Research Datalink, the authors identified all women all women aged 15–49 years registered with a GP between 1 January 2011 and 31 December 2016. Cases with consultations for EC (n = 43 570) were each matched on age and GP against four controls with no consultations for EC (n = 174 280). The authors calculated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between exposure to DVA in the previous year and consultations for EC. Covariates included age, ethnicity, socioeconomic status, pregnancy, children, alcohol misuse, and depression. Results Women exposed to DVA were 2.06 times more likely to have a consultation for EC than unexposed women (95% CI = 1.64 to 2.61). Women aged 25–39 years with exposure to DVA were 2.8 times more likely to have a consultation for EC, compared with unexposed women (95% CI = 2.08 to 3.75). The authors found some evidence of an independent effect of exposure to DVA on the number of consultations for EC (OR 1.48, 95% CI = 0.99 to 2.21). Conclusion A request for EC in general practice can indicate possible exposure to DVA. Primary care consultation for EC is a relevant context for identifying and responding to DVA as recommended by the World Health Organization and National Institute for Health and Care Excellence guidelines. DVA training for providers of EC should include this new evidence.
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17
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Sohal AH, Feder G, Barbosa E, Beresford L, Dowrick A, El-Shogri F, Howell A, Lewis N, Johnson M, Nightingale C, Boomla K, Morris S, Eldridge S, Griffiths C. Improving the healthcare response to domestic violence and abuse in primary care: protocol for a mixed method evaluation of the implementation of a complex intervention. BMC Public Health 2018; 18:971. [PMID: 30075711 PMCID: PMC6091071 DOI: 10.1186/s12889-018-5865-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/19/2018] [Indexed: 11/28/2022] Open
Abstract
Background Domestic violence and abuse remains a major health concern. It is unknown whether the improved healthcare response to domestic violence and abuse demonstrated in a cluster randomised controlled trial of IRIS (Identification and Referral to Improve Safety), a complex intervention, including general practice based training, support and referral programme, can be achieved outside a trial setting. Aim: To evaluate the impact over four years of a system wide implementation of IRIS, sequentially into multiple areas, outside the setting of a trial. Methods An interrupted time series analysis of referrals received by domestic violence and abuse workers from 201 general practices, in five northeast London boroughs; alongside a mixed methods process evaluation and qualitative analysis. Segmented regression interrupted time series analysis to estimate impact of the IRIS intervention over a 53-month period. A secondary analysis compares the segmented regression analysis in each of the four implementation boroughs, with a fifth comparator borough. Discussion This is the first interrupted time series analysis of an intervention to improve the health care response to domestic violence. The findings will characterise the impact of IRIS implementation outside a trial setting and its suitability for national implementation in the United Kingdom. Electronic supplementary material The online version of this article (10.1186/s12889-018-5865-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alex Hardip Sohal
- Queen Mary University of London, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, England.
| | - Gene Feder
- School of Social and Community Medicine, University of Bristol, Bristol, England
| | - Estela Barbosa
- Department of Applied Health Research, University College London, London, England
| | - Lee Beresford
- Queen Mary University of London, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, England
| | - Anna Dowrick
- Queen Mary University of London, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, England
| | - Farah El-Shogri
- Queen Mary University of London, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, England
| | | | - Natalia Lewis
- Queen Mary University of London, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, England
| | | | - Claire Nightingale
- Queen Mary University of London, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, England
| | - Kambiz Boomla
- Queen Mary University of London, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, England
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, England
| | - Sandra Eldridge
- Queen Mary University of London, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, England
| | - Chris Griffiths
- Queen Mary University of London, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, England
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18
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Sprague S, McKay P, Madden K, Scott T, Tikasz D, Slobogean GP, Bhandari M. Outcome Measures for Evaluating Intimate Partner Violence Programs Within Clinical Settings: A Systematic Review of the Literature. TRAUMA, VIOLENCE & ABUSE 2017; 18:508-522. [PMID: 27053103 DOI: 10.1177/1524838016641667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Multiple intimate partner violence (IPV) identification and assistance programs have been implemented across clinical settings. The results of these studies are inconclusive and frequently conflicting, resulting in clinical uncertainty and controversy regarding the merits of IPV identification and assistance programs. We aimed to describe the choice of outcome measures used in previously published randomized trials of IPV identification and assistance programs. METHOD A comprehensive literature search was conducted in the Medline, Embase, PyscInfo, and CENTRAL databases. The outcomes assessed in each included study were extracted and categorized, and the methodological quality of each eligible study was assessed using the Cochrane Risk of Bias tool. RESULTS Of 20 eligible studies, 6 evaluated IPV identification programs and 14 studies examined IPV assistance programs. The included studies used 48 different outcomes that we classified into 10 categories. For identification studies, the most commonly used outcome categories were IPV disclosure (66.7%) and resource use (66.7%). The most commonly used outcome categories for the IPV assistance studies included IPV recurrence and severity (64.3%) and health outcomes (50%). The included studies demonstrated a number of methodological limitations as identified by the Cochrane Risk of Bias instrument. CONCLUSIONS IPV identification and assistance programs are evaluated using many different outcome measures. Although this diversity enriches the IPV literature, it makes it challenging to compare studies. The results of this review highlight the challenges of conducting research in the field of IPV and the complexity of selecting, measuring, and interpreting outcomes.
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Affiliation(s)
- Sheila Sprague
- 1 Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- 2 Department of Clinical Epidemiology & Biostatics, McMaster University, Hamilton, Ontario, Canada
| | - Paula McKay
- 2 Department of Clinical Epidemiology & Biostatics, McMaster University, Hamilton, Ontario, Canada
| | - Kim Madden
- 2 Department of Clinical Epidemiology & Biostatics, McMaster University, Hamilton, Ontario, Canada
| | - Taryn Scott
- 2 Department of Clinical Epidemiology & Biostatics, McMaster University, Hamilton, Ontario, Canada
| | - Diana Tikasz
- 3 Sexual Assault/Domestic Violence Care Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Gerard P Slobogean
- 1 Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- 4 Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mohit Bhandari
- 1 Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- 2 Department of Clinical Epidemiology & Biostatics, McMaster University, Hamilton, Ontario, Canada
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Sohal AH, Pathak N, Blake S, Apea V, Berry J, Bailey J, Griffiths C, Feder G. Improving the healthcare response to domestic violence and abuse in sexual health clinics: feasibility study of a training, support and referral intervention. Sex Transm Infect 2017; 94:83-87. [PMID: 28724743 PMCID: PMC5870455 DOI: 10.1136/sextrans-2016-052866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 02/27/2017] [Accepted: 03/16/2017] [Indexed: 11/23/2022] Open
Abstract
Objectives Sexual health and gynaecological problems are the most consistent and largest physical health differences between abused and non-abused female populations. Sexual health services are well placed to identify and support patients experiencing domestic violence and abuse (DVA). Most sexual health professionals have had minimal DVA training despite English National Institute for Health and Care Excellence recommendations. We sought to determine the feasibility of an evidence-based complex DVA training intervention in female sexual health walk-in services (IRIS ADViSE: Identification and Referral to Improve Safety whilst Assessing Domestic Violence in Sexual Health Environments). Methods An adaptive mixed method pilot study in the female walk-in service of two sexual health clinics. Following implementation and evaluation at site 1, the intervention was refined before implementation at site 2. The intervention comprised electronic prompts, multidisciplinary training sessions, clinic materials and simple referral pathways to IRIS ADViSE advocate-educators (AEs). The pilot lasted 7 weeks at site 1 and 12 weeks at site 2. Feasibility outcomes were to assign a supportive DVA clinical lead, an IRIS ADViSE AE employed by a local DVA service provider, adapt electronic records, develop local referral pathways, assess whether enquiry, identification and referral rates were measurable. Results Both sites achieved all feasibility outcomes: appointing a supportive DVA clinical lead and IRIS ADViSE AE, establishing links with a local DVA provider, adapting electronic records, developing local referral pathways and rates of enquiry, identification and referral were found to be measurable. Site 1: 10% enquiry rate (n=267), 4% identification rate (n=16) and eight AE referrals. Site 2: 61% enquiry rate (n=1090), a 7% identification rate (n=79) and eight AE referrals. Conclusions IRIS ADViSE can be successfully developed and implemented in sexual health clinics. It fulfils the unmet need for DVA training. Longer-term evaluation is recommended.
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Affiliation(s)
- Alex Hardip Sohal
- Queen Mary University of London, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, UK
| | - Neha Pathak
- Women's Health Research Unit, Queen Mary University of London, University of Bristol School of Social and Community Medicine, Bristol, UK
| | - Sarah Blake
- University of Bristol, School of Social and Community Medicine, Bristol, UK
| | - Vanessa Apea
- Barts Health NHS Trust, Sexual Health, London, UK
| | - Judith Berry
- University Hospitals Bristol NHS Foundation Trust, Bristol Sexual Health Centre, Bristol, UK
| | - Jayne Bailey
- University Hospitals Bristol NHS Foundation Trust, Bristol Sexual Health Centre, Bristol, UK.,University of Bristol, School of Social and Community Medicine, Bristol, UK
| | - Chris Griffiths
- Queen Mary University of London, Centre for Primary Care and Public Health, London, UK
| | - Gene Feder
- University of Bristol, Centre for Academic Primary Care, Bristol, UK
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20
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Zijlstra E, van de Laar R, Moors ML, Lo Fo Wong S, Lagro-Janssen A. Tensions and Ambivalent Feelings: Opinions of Emergency Department Employees About the Identification and Management of Intimate Partner Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2017; 32:1044-1067. [PMID: 26002876 DOI: 10.1177/0886260515587663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The objective of this study was to examine factors facilitating and constraining the identification and management of intimate partner violence (IPV) at an emergency department (ED). Semi-structured interviews were conducted with 18 ED employees of a university hospital in the Netherlands. All interviews were audiotaped, transcribed verbatim, and analyzed by using qualitative content analysis in Atlas.ti. Constraining factors were lack of knowledge, awareness, and resources at the ED. ED employees felt many barriers to bringing up IPV. Facilitating factors were good cooperation among staff, the involvement of one team member in producing an IPV protocol, having received training on child abuse, and private consulting rooms. The ED setting and the ED employees' task perception and attitude contained both constraining and facilitating factors: ED employees saw it as their task and responsibility to help IPV victims, but their priorities were to secure a high turnover and treat acute physical problems. Although ED employees expressed openness and willingness to help, they also took the view that victims had a considerable responsibility of their own in disclosing and managing IPV, which led to ambivalent feelings. In conclusion, ED employees faced tensions in IPV identification and management caused by lack of awareness, knowledge and resources, conflicting priorities at the ED, and ambivalent feelings. Improvements can be made by supporting ED employees with guidelines in the form of a protocol and with training that also addresses the tensions ED employees face.
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Affiliation(s)
- Elza Zijlstra
- 1 Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Rik van de Laar
- 1 Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Sylvie Lo Fo Wong
- 1 Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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21
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Lewis NV, Larkins C, Stanley N, Szilassy E, Turner W, Drinkwater J, Feder GS. Training on domestic violence and child safeguarding in general practice: a mixed method evaluation of a pilot intervention. BMC FAMILY PRACTICE 2017; 18:33. [PMID: 28259143 PMCID: PMC5336644 DOI: 10.1186/s12875-017-0603-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 02/21/2017] [Indexed: 11/17/2022]
Abstract
Background Children’s exposure to domestic violence is a type of child maltreatment, yet many general practice clinicians remain uncertain of their child safeguarding responsibilities in the context of domestic violence. We developed an evidence-based pilot training on domestic violence and child safeguarding for general practice teams. The aim of this study was to test and evaluate its feasibility, acceptability and the direction of change in short-term outcome measures. Methods We used a mixed method design which included a pre-post questionnaire survey, qualitative analysis of free-text comments, training observations, and post-training interviews with trainers and participants. The questionnaire survey used a validated scale to measure participants’ knowledge, confidence/ self-efficacy, and beliefs/ attitudes towards domestic violence and child safeguarding in the context of domestic violence. Results Eleven UK general practices were recruited (response rate 55%) and 88 clinicians attended the pilot training. Thirty-seven participants (42%) completed all pre-post questionnaires and nine were interviewed. All training sessions were observed. All six trainers were interviewed. General practice clinicians valued the training materials and teaching styles, opportunities for reflection and delivery by local trainers from both health and children’s social services. The training elicited positive changes in total outcome score and knowledge and confidence/ self-efficacy sub scores which remained at 3-month follow up. However, the mean sub score of beliefs and attitudes did not change and the qualitative results were mixed. Two interviewees described changes in their clinical practice. Participants’ suggestions for improving the training included incorporating more ethnic and class diversity in the material, using cases with multiple socio economic disadvantages, and addressing multi-agency collaboration in the context of changing and under-resourced services for children. Conclusions The pilot training for general practice on child safeguarding in the context of domestic violence was feasible and acceptable. It elicited positive changes in clinicians’ knowledge and confidence/ self-esteem. The extent to which clinical behaviour changed is unclear, but there are indications of changes in practice by some clinicians. The pilot training requires further refinement and evaluation before implementation. Electronic supplementary material The online version of this article (doi:10.1186/s12875-017-0603-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Natalia V Lewis
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Cath Larkins
- School of Social Work, Care and Community, University of Central Lancashire, Harrington Building, Preston, PR1 2HE, UK
| | - Nicky Stanley
- School of Social Work, Care and Community, University of Central Lancashire, Harrington Building, Preston, PR1 2HE, UK
| | - Eszter Szilassy
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - William Turner
- School for Policy Studies, University of Bristol, Social Science Complex, 8 Priory Road, Bristol, BS8 1TZ, UK
| | - Jessica Drinkwater
- Leeds Institute of Health Sciences, Charles Thackrah Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK
| | - Gene S Feder
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Pallitto C, García-Moreno C, Stöeckl H, Hatcher A, MacPhail C, Mokoatle K, Woollett N. Testing a counselling intervention in antenatal care for women experiencing partner violence: a study protocol for a randomized controlled trial in Johannesburg, South Africa. BMC Health Serv Res 2016; 16:630. [PMID: 27814706 PMCID: PMC5097399 DOI: 10.1186/s12913-016-1872-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 10/21/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) during or before pregnancy is associated with many adverse health outcomes. Pregnancy-related complications or poor infant health outcomes can arise from direct trauma as well as physiological effects of stress, both of which impact maternal health and fetal growth and development. Antenatal care can be a key entry point within the health system for many women, particularly in low-resource settings. Interventions to identify violence during pregnancy and offer women support and counselling may reduce the occurrence of violence and mitigate its consequences. METHODS Following a formative research phase, a randomized controlled trial will be conducted to test a nurse-led empowerment counselling intervention, originally developed for high-income settings and adapted for urban South Africa. The primary outcome is reduction of partner violence, and secondary outcomes include improvement in women's mental health, safety and self-efficacy. The study aims to recruit 504 pregnant women from three antenatal clinics in Johannesburg who will be randomized to the nurse-led empowerment arm (two 30-min counselling sessions) or enhanced control condition (a referral list) to determine whether participants in the intervention arm have better outcomes as compared to the those in the control arm. DISCUSSION This research will provide much needed evidence on whether a short counselling intervention delivered by nurses is efficacious and feasible in low resource settings that have high prevalence of IPV and HIV. TRIAL REGISTRATION The study was registered in the South African Clinical Trials Registry (DOH-27-0414-4720) on 11 August 2014 and in the ISRCTN Registry ( ISRCTN35969343 ) on 23 May 2016).
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Affiliation(s)
- Christina Pallitto
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Claudia García-Moreno
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Heidi Stöeckl
- Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SE UK
| | - Abigail Hatcher
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, 22 Esselen Street, Hillbrow, 2001 South Africa
| | - Catherine MacPhail
- School of Health, University of New England, Armidale, 2351 NSW Australia
| | - Keneoue Mokoatle
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, 22 Esselen Street, Hillbrow, 2001 South Africa
| | - Nataly Woollett
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, 22 Esselen Street, Hillbrow, 2001 South Africa
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23
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Snyder BL. Women's experience of being interviewed about abuse: a qualitative systematic review. J Psychiatr Ment Health Nurs 2016; 23:605-613. [PMID: 27860081 DOI: 10.1111/jpm.12353] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: There is disagreement about the costs and benefits of asking women about their abuse experiences in practice and research settings. No known meta-syntheses have been conducted to evaluate the qualitative data that exist on the experiences of women being asked about their abuse. WHAT THIS PAPER ADDS TO THE EXISTING KNOWLEDGE?: This review adds robust qualitative evidence that interviewing women about their abuse experiences can be a beneficial and healing experience for them. Mental health nurses are in an ideal position to create a therapeutic environment to interview women about their abuse experiences. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses are strongly encouraged to ask about and document abuse in all of their interviews and assessments, as well as act as advocates and discuss reported abuse within their interdisciplinary teams, to provide individualized, trauma-informed care. The mental health nurse should listen attentively, avoid judgement, offer reassurance, make appropriate referrals and provide resources for women, including those with both past and current abuse histories. Nurses are strongly encouraged to ask about abuse in all settings in which they encounter women, including in psychiatric and mental health settings. ABSTRACT Introduction Collections of quantitative data exist outlining the costs and benefits of asking female research participants about their abuse experiences; however, no known meta-syntheses have been conducted to evaluate the qualitative data that exist on the experiences of women being asked about their abuse. Aim/Question The purpose of this qualitative systematic review was to analyse and interpret qualitative findings regarding asking women about their abuse experiences with the intention of understanding risks and benefits. Method The sample (N = 11) was derived from an expansive search of peer-reviewed literature using multidisciplinary electronic databases. Qualitative findings were extracted, coded and categorized. Reflective memos were developed, and themes emerged. Results While initially distressing, being interviewed about abuse is more beneficial than harmful for women, due to the therapeutic process of talking about abuse. Discussion To maximize the therapeutic impact of discussing abuse, women must maintain autonomy and feel they are in a safe and confidential environment. Within this supportive atmosphere, very few women report any regret after discussing abuse and are able to identify positive outcomes. Implications for practice Findings from this review support the need for mental health nurses and other clinicians to create an optimal environment for discussing abuse and offer relevant practice recommendations. Researchers are encouraged to include women in studies that involve asking about abuse experiences.
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Affiliation(s)
- B L Snyder
- The University of Missouri - Columbia, Sinclair School of Nursing, Columbia, MO, USA
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24
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Zijlstra E, LoFoWong S, Hutschemaekers G, Lagro-Janssen A. Improving care for victims: a study protocol of the evaluation of a centre for sexual and family violence. BMJ Open 2016; 6:e011545. [PMID: 27619828 PMCID: PMC5030555 DOI: 10.1136/bmjopen-2016-011545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Worldwide, sexual and family violence are highly prevalent problems. Victims of sexual and family violence often do not seek formal help in the acute phase. When they do seek help, they encounter a system of scattered care. For this reason, a centre for sexual and family violence was launched in Nijmegen, the Netherlands. The centre provides multidisciplinary care for victims of acute sexual and/or family violence. With the study described in this study protocol, we want to evaluate the implementation process and the reach of the Center for Sexual and Family Violence Nijmegen (CSFVN). METHODS AND ANALYSIS We will conduct a mixed-methods study including quantitative and qualitative methods of data collection and analysis. Data about the implementation process will be obtained via semistructured interviews and focus group discussions. Content analysis will be done in software program Atlas.ti. Analysis of file data will be undertaken to assess the reach of the CSFVN (patient characteristics and characteristics of the care they received). The data will be analysed in SPSS. ETHICS AND DISSEMINATION The Medical Ethics Committee of the Radboud University Nijmegen Medical Center approved the study protocol under file number 2012-1218. Dissemination will be done by submitting scientific articles to academic peer-reviewed journals. We will present the results at relevant international, national and local conferences and meetings. We will send press releases to relevant media. We will share the results with the network of assault centres in the Netherlands.
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Affiliation(s)
- E Zijlstra
- Department of Primary and Community Care, Gender & Women's Health, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - S LoFoWong
- Department of Primary and Community Care, Gender & Women's Health, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - G Hutschemaekers
- Department of Clinical Psychology, Behavioural Science Institute Radboud University Nijmegen, Nijmegen, The Netherlands
| | - A Lagro-Janssen
- Department of Primary and Community Care, Gender & Women's Health, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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Malpass A, Sales K, Feder G. Reducing symbolic-violence in the research encounter: collaborating with a survivor of domestic abuse in a qualitative study in UK primary care. SOCIOLOGY OF HEALTH & ILLNESS 2016; 38:442-458. [PMID: 26403218 DOI: 10.1111/1467-9566.12352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper explores ideas of symbolic violence inherent in the research encounter (Bourdieu 1999). After defining symbolic violence and how the concept enters into domestic violence and abuse (DVA) research, we discuss the challenges arising from a (DVA) survivor taking on the role of interviewer in a qualitative study nested within a UK primary care based trial: IRIS (Identification and Referral to Improve Safety). KS, a survivor of DVA, conducted interviews with 12 women who had been referred to a domestic violence agency by primary care clinicians taking part in the IRIS trial in two UK cities (Bristol and east London) during 2009. Field notes were kept during all of the research meetings with KS and these were included in analysis. Our analysis maps the research pathway of 'non-violent communication' and discusses the role of social symmetry and proximity in the research encounter. We conclude that while a welcoming disposition, empathy and active listening are all generic skills to qualitative research; if a researcher can enter fieldwork with a claim of social proximity and symmetry, their use of these generic skills is enhanced through a process of shared objectification and empowerment talk. We explore the limitations of social proximity, its relationship to feminist and anthropological theories of 'insider' research and its relevance to primary care research.
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Affiliation(s)
- Alice Malpass
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, UK
| | | | - Gene Feder
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, UK
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26
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RCGP Research Paper of the Year 2014: partnership with patients is an important theme in primary care research. Br J Gen Pract 2015; 65:595. [PMID: 26500307 DOI: 10.3399/bjgp15x687469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Evans MA, Feder GS. Help-seeking amongst women survivors of domestic violence: a qualitative study of pathways towards formal and informal support. Health Expect 2015; 19:62-73. [PMID: 25556776 DOI: 10.1111/hex.12330] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Informal and formal support for women experiencing domestic violence and abuse (DVA) can improve safety and health outcomes. There has been little qualitative work on the role of both pathways to support and women's experiences of disclosing their experience of DVA in different contexts. OBJECTIVE AND STUDY DESIGN This qualitative study used repeat interviews with women survivors of DVA to explore their pathways to support and their experiences of barriers and facilitators to disclosure and help-seeking. SETTING AND PARTICIPANTS Thirty-one women seeking help from specialist DVA agencies in the UK were interviewed twice over 5 months. RESULTS Women recounted long journeys of ambivalence, often only disclosing abuse after leaving the perpetrator. Access to specialist support rarely came via general practitioners, despite high levels of consulting for anxious and depressed feelings, and was more often facilitated by police or housing agencies following a crisis such as assault. Informal disclosure only led to specialist help if the family member or friend themselves had experience or knowledge of DVA. DISCUSSION AND CONCLUSIONS Women experiencing DVA need earlier access to specialized DVA services. Many women needed an 'enabler' to facilitate access, but once this contact was made, disclosure to other professionals or to family and friends was legitimized in the eyes of the women. Safely accessible publicity about DVA services and an appropriate response from social and health-care professionals should be promoted, including support for women disclosing DVA to take action on the information they receive about services.
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Affiliation(s)
- Maggie A Evans
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Gene S Feder
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
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Manchester IRIS Project Service Review. Br J Gen Pract 2014; 64:391. [DOI: 10.3399/bjgp14x680917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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