Exploring primary care responses to domestic violence and abuse (DVA): operationalisation of a national initiative

Julie Mcgarry,Basharat Hussain,Kim Watts

doi:10.1108/jap-10-2018-0025

Abstract

PurposeIn the UK, the Identification and Referral to Improve Safety (IRIS) initiative has been developed for use within primary care to support women survivors of domestic violence and abuse (DVA). However, while evaluated nationally, less is known regarding impact of implementation at a local level. The purpose of this paper is to explore the effectiveness of IRIS within one locality in the UK.Design/methodology/approachA qualitative study using interviews/focus groups with primary care teams and women who had experienced DVA in one primary care setting in the UK. Interviews with 18 participants from five professional categories including: general practitioners, practice nurses, practice managers, assistant practice managers and practice receptionists. Focus group discussion/interview with seven women who had accessed IRIS. Data were collected between November 2016 and March 2017.FindingsFive main themes were identified for professionals: Team role approach to training, Professional confidence, Clear pathway for referral and support, Focussed support, Somewhere to meet that is a “safe haven”. For women the following themes were identified: Longevity of DVA; Lifeline; Face to face talking to someone; Support and understood where I was coming from; A place of safety.Practical implicationsIRIS played a significant role in helping primary care professionals to respond effectively. For women IRIS was more proactive and holistic than traditional approaches.Originality/valueThis study was designed to assess the impact that a local level implementation of the national IRIS initiative had on both providers and users of the service simultaneously. The study identifies that a “whole team approach” in the primary care setting is critical to the effectiveness of DVA initiatives.

Highlights

AND BACKGROUNDIntimate partner violence (IPV), referred to in the United Kingdom (UK) as domestic violence and abuse (DVA) (Home Office, 2013) is recognised as a significant global public health, societal and human rights issue (World Health Organisation (WHO), 2018)
The study identifies that a ‘whole team approach’ in the primary care setting is critical to the effectiveness of DVA initiatives
In the present study participants described the way in which the IRIS training, as a collective experience, was understood by the practice staff to be of central importance in terms of engendering a whole team approach to DVA: I think it was about a couple of years ago [IRIS training], and we undertook whole practice training on two separate occasions and did it as a team

Summary

Introduction

AND BACKGROUNDIntimate partner violence (IPV), referred to in the United Kingdom (UK) as domestic violence and abuse (DVA) (Home Office, 2013) is recognised as a significant global public health, societal and human rights issue (World Health Organisation (WHO), 2018). Global estimates on DVA indicate 35% (1 in 3) of women experience physical and/or sexual violence in their lifetime (WHO, 2017). In the UK it is estimated that 1.3 million women each year have experienced DVA (Office for National Statistics (ONS), 2016). The impact of DVA on the physical and psychological wellbeing of those who experience abuse is wide ranging. This includes the immediate physical effects of DVA including physical injury as well as longer term chronic ill health (Bosch et al 2017). The negative health consequences of DVA are not just immediate but may continue in the longer term (Lacey et al 2013, McGarry et al 2011)

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