Abstract
BackgroundDomestic violence, which may be psychological, physical, sexual, financial or emotional, is a major public health problem due to the long-term health consequences for women who have experienced it and for their children who witness it. In populations of women attending general practice, the prevalence of physical or sexual abuse in the past year from a partner or ex-partner ranges from 6 to 23%, and lifetime prevalence from 21 to 55%. Domestic violence is particularly important in general practice because women have many contacts with primary care clinicians and because women experiencing abuse identify doctors and nurses as professionals from whom they would like to get support. Yet health professionals rarely ask about domestic violence and have little or no training in how to respond to disclosure of abuse.Methods/DesignThis protocol describes IRIS, a pragmatic cluster randomised controlled trial with the general practice as unit of randomisation. Our trial tests the effectiveness and cost-effectiveness of a training and support programme targeted at general practice teams. The primary outcome is referral of women to specialist domestic violence agencies. Forty-eight practices in two UK cities (Bristol and London) are randomly allocated, using minimisation, into intervention and control groups. The intervention, based on an adult learning model in an educational outreach framework, has been designed to address barriers to asking women about domestic violence and to encourage appropriate responses to disclosure and referral to specialist domestic violence agencies. Multidisciplinary training sessions are held with clinicians and administrative staff in each of the intervention practices, with periodic feedback of identification and referral data to practice teams. Intervention practices have a prompt to ask about abuse integrated in the electronic medical record system. Other components of the intervention include an IRIS champion in each practice and a direct referral pathway to a named domestic violence advocate.DiscussionThis is the first European randomised controlled trial of an intervention to improve the health care response to domestic violence. The findings will have the potential to inform training and service provision.Trial registrationISRCTN74012786
Highlights
Domestic violence, which may be psychological, physical, sexual, financial or emotional, is a major public health problem due to the long-term health consequences for women who have experienced it and for their children who witness it
This paper describes the protocol of a cluster randomised controlled trial of a domestic violence training and support programme targeted at general practice teams, comparing the outcomes for practices that receive the intervention to those that do not
The intervention is a collaboration between primary health care services and third sector agencies specialising in domestic violence, combining educational outreach training sessions in general practices with a referral pathway to a named advocate-educator who was part of the team delivering the training
Summary
The scale of the problem Domestic violence is threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are in the same family or who are (or have been) intimate partners. There is even less evidence that clinician training or organisational change results in better care or referral to specialist domestic violence services [38], and the only trial to date measuring women centred outcomes (reoccurrence of violence or quality of life) of a system level screening intervention found no significant differences between intervention and control arms [40]. In a 2009 Cochrane review confined to randomized controlled trials of domestic violence advocacy, Ramsay and colleagues concluded that there was equivocal evidence that advocacy for women recruited in domestic violence shelters (refuges) had a beneficial effect on their physical and psychosocial well-being, and were unable to draw any conclusions for women receiving advocacy in or referred from health care settings [41]. This paper describes the protocol of a cluster randomised controlled trial of a domestic violence training and support programme targeted at general practice teams, comparing the outcomes for practices that receive the intervention to those that do not
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