“From taboo to routine”: a qualitative evaluation of a hospital-based advocacy intervention for domestic violence and abuse

Abstract

Background: Health services are often the first point of professional contact for people who have experienced domestic violence and abuse. We report on the evaluation of a multi-site, hospital-based advocacy intervention for survivors of domestic violence and abuse. Independent Domestic Violence Advisors (IDVAs), who provide survivors with support around safety, criminal justice, and health and wellbeing, were located in five hospitals in England between 2012 and 2015 in emergency departments and maternity services. We present views about IDVAs' approaches to tackling domestic violence and abuse, how the IDVA service worked in practice, and factors that hindered and facilitated engagement with survivors. Methods: We adopted a convenience sampling approach and invited participation from all who offered to take part within the study timeframe. Sixty-four healthcare professionals, IDVAs, IDVA service managers, and commissioners at all sites were interviewed. Interviews were analysed using a thematic approach: familiarising ourselves with the data through repeated readings and noting initial ideas; generating initial codes through double coding notable features of the data across the dataset; collating codes into potential themes; and reviewing themes to ensure they captured the essence of the data. Results: Two key themes emerged. The first was Hospital-based IDVAs fulfil several crucial roles. This theme highlighted that healthcare professionals thought the hospital-based IDVA service was valuable because it enhanced their skills, knowledge, and confidence in asking about domestic violence and abuse. It enabled them to immediately refer and provide support to patients who might have otherwise been lost along a referral pathway. It also reached survivors who might otherwise have remained hidden. The second theme was Success hinges on a range of structural factors. This theme illustrated the importance of ongoing domestic violence and abuse training for staff, the IDVA having private and dedicated space, and the service being embedded in hospital infrastructure (e.g. featuring it in hospital-wide policies and enabling IDVAs access to medical records). Conclusion: Hospital-based IDVAs offer a unique and valued way to respond to domestic violence and abuse in a healthcare setting. Further work must now be done to explore how to implement the service sustainably.

A Hospital-Based Independent Domestic Violence Advisor Service: Demand and Response During the COVID-19 Pandemic

“…[10] Furthermore, abuse often remains hidden, even when victims access healthcare, for example, victims often present seeking help for associated conditions, such as mental health problems, or physical injuries, caused by DVA, without disclosing it. [3,7,11,12] The factors in uencing non-disclosure are complex and include shame and embarrassment among victims, in addition to: lack of time, awareness, con dence, and skills/training amongst healthcare professionals. [3,7,11,12] Thus, there is a need to improve rates of identi cation of DVA, in healthcare, as well as the response when it is disclosed.…”

“…[3,7,11,12] The factors in uencing non-disclosure are complex and include shame and embarrassment among victims, in addition to: lack of time, awareness, con dence, and skills/training amongst healthcare professionals. [3,7,11,12] Thus, there is a need to improve rates of identi cation of DVA, in healthcare, as well as the response when it is disclosed.…”

“…One development aimed at improving specialist DVA support in hospitals has been the establishment of hospital-based IDVA services; IDVAs have worked from A&E, minor injuries, maternity and sexual health departments [11,[13][14][15][16]. Evaluations have found several bene ts to delivering DVA support in this waythe addition of specialist DVA support and a referral route -within the hospital.…”

“…Evaluations have found several bene ts to delivering DVA support in this waythe addition of specialist DVA support and a referral route -within the hospital. [11,14]. Staff reported high satisfaction levels [15], increased con dence and skills in asking about and responding to DVA.…”

Domestic abuse among female doctors: thematic analysis of qualitative interviews in the UK

“…An evaluation of an Independent Domestic Violence Advisor (IDVA) hospital programme found that staff sought advice for themselves personally even though the IDVA was there to support patients. 11 Evaluation of DA training for healthcare professionals (HPs) found ‘ an unintended consequence was the disclosure of DA among staff’ , highlighting a need for support mechanisms for staff. 12 It is important to understand doctors’ experience of DA to help employers, colleagues, and HPs respond positively, and to understand how aspects of working as a doctor may increase the risk of becoming a victim-survivor.…”