Responding to Domestic Violence in Clinical Practice: Are we Equipped Enough?

Abstract

Dear Editor, Domestic violence is a major social and public health problem. Its impact on the physical and mental health of women and their social functioning is pernicious.[1] The World Health Organization's (WHO) multicountry study on domestic violence estimated that the lifetime prevalence of physical intimate-partner violence varied from 13 to 61%.[2] The National Family Health Survey (2005-06) in India, documented that almost two out of five ever-married women, in India, experience spousal violence.[3] Among the abused women in India, only one in four ever spoke to anyone about the domestic violence.[3] Primary care physicians could play a major role in identifying and providing support to the victims of domestic violence, as the abused women are more likely to be in contact with the health system than any other machinery.[45] A systematic review of qualitative studies revealed that the survivors of domestic violence wanted to be asked by their doctors about the domestic violence.[5] Many primary care physicians are not well equipped to handle the issue of domestic violence among their patients.[145] The objective of the current study was to assess the beliefs, attitudes, and practice of healthcare practitioners from a rural secondary care hospital, regarding the identification and management of domestic violence among their patients. The study was done among doctors and nurses of a secondary care rural hospital at Oddanchatram. It is a 299-bedded hospital, with an average daily attendance of 1,500 patients in the Outpatient Department. Data was collected using an unlinked, anonymous, structured questionnaire. The results have been documented for 85 completely filled questionnaires. Among them 71 (83.5%) health personnel felt that domestic violence was common among their patients. Six (7.1%) used to always ask their patients about domestic violence and 12 (14.1%) never asked about it. Of the doctors and nurses interviewed, 56 (65.8%) had identified a domestic violence victim at least once in the past one year. 39 (45.9%) of the health personnel reported that they were not comfortable in enquiring about domestic violence and 16 (18.8%) stated they were not confident at all in asking about domestic violence. The felt barriers while asking about domestic violence were, lack of time spent with each patient 26 (30.6%), afraid of offending the patient 22 (25.9%), and ignorance about how to ask 12 (14.1%). For the question on strategies to handle a victim of domestic violence, 52 (61.1%) of the doctors and nurses felt they had minimal or no strategies to help patients who approached them with domestic violence, and only two (2.4%) perceived themselves as efficient in the management of domestic violence. Despite their potentially important role, most health personnel have not received any training and are currently not well-prepared to provide an effective response to domestic violence. The present medical curriculum does not contain adequate inputs or practical skill development to prepare the doctors to cope with the issues of domestic violence. Physicians need to be aware of the possibility of violence in the lives of their patients and to offer support and information about agencies that can provide help. Domestic violence interventions should take into account the clinical roles and unique barriers encountered by general practitioners. Mechanisms are needed to enable the creation and strengthening of linkages between healthcare providers and support services.