Abstract
BackgroundIn Victoria, Australia, Maternal and Child Health (MCH) services deliver primary health care to families with children 0–6 years, focusing on health promotion, parenting support and early intervention. Family violence (FV) has been identified as a major public health concern, with increased prevalence in the child-bearing years. Victorian Government policy recommends routine FV screening of all women attending MCH services. Using Normalization Process Theory (NPT), we aimed to understand the barriers and facilitators of implementing an enhanced screening model into MCH nurse clinical practice.MethodsNPT informed the process evaluation of a pragmatic, cluster randomised controlled trial in eight MCH nurse teams in metropolitan Melbourne, Victoria, Australia. Using mixed methods (surveys and interviews), we explored the views of MCH nurses, MCH nurse team leaders, FV liaison workers and FV managers on implementation of the model. Quantitative data were analysed by comparing proportionate group differences and change within trial arm over time between interim and impact nurse surveys. Qualitative data were inductively coded, thematically analysed and mapped to NPT constructs (coherence, cognitive participation, collective action and reflexive monitoring) to enhance our understanding of the outcome evaluation.ResultsMCH nurse participation rates for interim and impact surveys were 79% (127/160) and 71% (114/160), respectively. Twenty-three key stakeholder interviews were completed. FV screening work was meaningful and valued by participants; however, the implementation coincided with a significant (government directed) change in clinical practice which impacted on full engagement with the model (coherence and cognitive participation). The use of MCH nurse-designed FV screening/management tools in focussed women’s health consultations and links with FV services enhanced the participants’ work (collective action). Monitoring of FV work (reflexive monitoring) was limited.ConclusionsThe use of theory-based process evaluation helped identify both what inhibited and enhanced intervention effectiveness. Successful implementation of an enhanced FV screening model for MCH nurses occurred in the context of focussed women’s health consultations, with the use of a maternal health and wellbeing checklist and greater collaboration with FV services. Improving links with these services and the ongoing appraisal of nurse work would overcome the barriers identified in this study.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0230-4) contains supplementary material, which is available to authorized users.
Highlights
In Victoria, Australia, Maternal and Child Health (MCH) services deliver primary health care to families with children 0–6 years, focusing on health promotion, parenting support and early intervention
Whilst Intimate partner violence (IPV) is the most common form of violence towards women, the Australian government uses the term family violence (FV) to encompass IPV when referring to a range of violent behaviours within families [6]
The aim of this paper is to present the findings of a mixed methods process evaluation of the MOVE cluster randomised trial (Taft et al, forthcoming)
Summary
In Victoria, Australia, Maternal and Child Health (MCH) services deliver primary health care to families with children 0–6 years, focusing on health promotion, parenting support and early intervention. Violence (FV) has been identified as a major public health concern, with increased prevalence in the child-bearing years. Intimate partner violence (IPV) is a human rights issue and contributes to serious health, economic and social problems for individual women, children and communities [1,2,3]. In Australia, 17% of women have experienced IPV in their life time especially in the child bearing years [4,5]. Whilst IPV is the most common form of violence towards women, the Australian government uses the term family violence (FV) to encompass IPV when referring to a range of violent behaviours within families [6]. As women are predominantly the victims of FV [1], we will refer to men as perpetrators and women and children as victims
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