Transforming health settings to address gender‐based violence in Australia

Women's Experiences Accessing Mental Health Care in Australia After Sexual Violence in Adulthood

In Australia, at least one in every five women has experienced sexual violence since age 15. Research consistently links sexual violence with poor mental health, persisting long after the crisis period. Trauma-informed mental health support is therefore critical. This article draws on interviews with 29 women who had experienced sexual violence to understand their experiences accessing mental health services in Australia. Our findings suggest that, constrained by a biomedical model of care, mental health practitioners' understanding of trauma generally, and sexual violence particularly, may be lacking. Further, women struggle to navigate a "maze" of services.

Readiness of Exercise Physiologists, Physiotherapists and Other Allied Health Professionals to Respond to Gender-Based Violence: A Mixed-Methods Study

Experiencing gender-based violence (GBV) is associated with health conditions that are common indications for referral to exercise physiologists, physiotherapists and other allied health professionals (AHPs). The readiness of AHPs to identify and respond to GBV is currently unknown. This study aimed to determine the readiness of AHPs to respond to a person who had experienced GBV. Participants completed the modified Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) and/or an interview. The AHPs felt underprepared, had low perceived knowledge and lacked confidence to respond to and support people who have experienced GBV, despite recognition of the importance and agreement of the relevance to AHPs' practice.

'Atawhai': a primary care provider-led response to family violence in Aotearoa New Zealand

BACKGROUND

As a key determinant of ill-health, family violence is inadequately responded to within Aotearoa New Zealand health policy and practice. Without adequate system support, health professionals can often be unsure of what to do, or how to help. Developed in response to this system gap, 'Atawhai' aims to make it easier for primary care professionals to respond to family violence.

METHODS

Underpinned by indigenous Māori customs, Atawhai combines complexity theory and participatory research methodologies to be responsive to the complexity involved in family violence. We worked with 14 primary care professionals across ten whakawhitiwhiti kōrero wānanga (meetings for deliberate dialogue) to identify and develop primary care system pathways and tools for responding to family violence. This paper focuses on the development of Atawhai through wānanga and observation methods. Methods used to capture change will be reported separately.

FINDINGS

Atawhai is a relational response to family violence, focused on developing a network of trusted relationships between health and social care professionals to support safe responses to those accessing care. This study identified four key health system pathways to responsiveness and developed associated tools to support health care responsiveness to family violence. We found the quality of relationships, both among professionals and with those accessing care, coupled with critical reflection on the systems and structures that shape policy and practice are essential in generating change within primary care settings.

CONCLUSIONS

Atawhai is a unique health care response to family violence evidenced on empirical knowledge of primary care professionals. Our theoretical lens calls attention to parts of the system often obscured by current health care responses to family violence. Atawhai presents an opportunity to develop a grassroots-informed, long-term response to family violence that evolves in response to needs.

Help-Seeking After Intimate Partner or Sexual Violence: Exploring the Experiences of International Student Women in Australia

Research suggests that many international students experience intimate partner violence (IPV) or sexual violence (SV) whilst attending tertiary institutions. Yet, little is known about how they engage in help-seeking and what types of support they need following IPV/SV. In this paper, we present findings from a qualitative analysis of 30 in-depth interviews with international student women who experienced SV/IPV while studying in Australia. The findings highlight how isolation and structural factors can create significant barriers to help-seeking for international student women. Yet, the findings also highlight the agency and resourcefulness of international student women in overcoming challenges. The provision of culturally and linguistically appropriate and tailored support for international students is crucial in order to help reduce the harms of SV/IPV.

Protocol for a randomised controlled trial of a healthy relationship tool for men who use intimate partner violence (BETTER MAN)

BACKGROUND

Intimate partner violence (IPV) is common globally, but there is a lack of research on how to intervene early with men who might be using IPV. Building on evidence supporting the benefits of online interventions for women victim/survivors, this study aims to test whether a healthy relationship website (BETTER MAN) is effective at improving men's help seeking, their recognition of behaviours as IPV and their readiness to change their behaviours.

METHODS/DESIGN

In this two-group, pragmatic randomised controlled trial, men aged 18-50 years residing in Australia who have been in an adult intimate relationship (female, male or non-binary partner) in the past 12 months are eligible. Men who report being worried about their behaviour or have had others express concerns about their behaviour towards a partner in the past 12 months will be randomised with a 1:1 allocation ratio to receive the BETTER MAN website or a comparator website (basic healthy relationships information). The BETTER MAN intervention includes self-directed, interactive reflection activities spread across three modules: Better Relationships, Better Values and Better Communication, with a final "action plan" of strategies and resources. Using an intention to treat approach, the primary analysis will estimate between-group difference in the proportion of men who report undertaking help-seeking behaviours for relationship issues in the last 6 months, at 6 months post-baseline. Analysis of secondary outcomes will estimate between-group differences in: (i) mean score of awareness of behaviours in relationships as abusive immediately post-use of website; (ii) mean score on readiness to change immediately post-use of website and 3 months after baseline; and (iii) cost-effectiveness.

DISCUSSION

This trial will evaluate the effectiveness of an online healthy relationship tool for men who may use IPV. BETTER MAN could be incorporated into practice in community and health settings, providing an evidence-informed website to assist men to seek help to promote healthy relationships and reduce use of IPV.

TRIAL REGISTRATION

ACTRN12622000786796 with the Australian New Zealand Clinical Trials Registry: 2 June 2022. Version: 1 (28 September 2023).

Identifying and responding to family adversity in Australian community and primary health settings: a multi-site cross sectional study

Background

Unaddressed family adversity has potentially modifiable, negative biopsychosocial impacts across the life course. Little is known about how Australian health and social practitioners identify and respond to family adversity in community and primary health settings.

Objective

To describe, in two Australian community health services: (1) the number of adversities experienced by caregivers, (2) practitioner identification of caregivers experiencing adversity, (3) practitioner response to caregivers experiencing adversity, and (4) caregiver uptake of referrals.

Methods

Survey of caregivers of children aged 0-8 years attending community health services in Victoria and New South Wales (NSW). Analysis described frequencies of caregiver self-reported: (1) experiences of adversity, (2) practitioner identification of adversity, (3) practitioner response to adversity, and (4) referral uptake. Analyses were sub-grouped by three adversity domains and site.

Results

349 caregivers (Victoria: n = 234; NSW: n = 115) completed the survey of whom 88% reported experiencing one or more family adversities. The median number of adversities was 4 (2-6). Only 43% of participants were directly asked about or discussed an adversity with a practitioner in the previous 6 months (Victoria: 30%; NSW: 68%). Among caregivers experiencing adversity, 30% received direct support (Victoria: 23%; NSW: 43%), and 14% received a referral (Victoria: 10%; NSW: 22%) for at least one adversity. Overall, 74% of caregivers accepted referrals when extended.

Conclusion

The needs of Australian families experiencing high rates of adversity are not systematically identified nor responded to in community health services. This leaves significant scope for reform and enhancement of service responses to families experiencing adversity.

Variations in Author Gender in Obstetrics Disease Prevalence Literature: A Systematic Review

This systematic review aims to evaluate gender differences in authorship of prevalence literature concerning intimate partner violence (IPV) during pregnancy and gestational diabetes mellitus (GDM). GDM studies were matched for publication year and study country as a gender-neutral obstetric disease with similar morbidity to IPV. Relevant studies were captured without language restrictions via online searches of PubMed, Scopus and Web of Science from database inception to January 2022. Proportion of female authors and gender of the first and corresponding author were outcome measures. Multivariable regression models were built to examine if female authors featured more or less often in IPV during pregnancy and GDM literature adjusting by the influence of type of study, country's human development index (HDI), year of publication and journal's impact factor. 137 IPV-GDM studies pairs were included. Female authors in IPV studies were slightly lower than in GDM [59.7%, 95% CI 54.7-64.7, vs. 54.9%, 95% CI 50.7-59.1, p = 0.204]. Studies published in high-income countries were more likely to be signed by a woman as first and corresponding author (Odds Ratio 2.22, 95% CI 1.20; 4.11, p = 0.011 and Odds Ratio 2.24, CI 1.22; 4.10, p = 0.009 respectively) and proportion of women as corresponding authors decreased as the journal impact factor increased (β = 0.62, 95% CI 0.37, 1.05, p = 0.075). There is a gender gap in the field of prevalence research in IPV during pregnancy with variations according to the level of development. International programs aimed at eradicating these inequalities are needed.