Women’s experiences of referral to a domestic violence advocate in UK primary care settings: a service-user collaborative study

Abstract

INTRODUCTIONIdentification and Referral to Improve Safety (IRIS) is a training and support programme for general practice that aims to improve the response to women experiencing domestic violence and abuse (DVA). The programme trains clinicians in identification, initial response or validation, referral to specialist DVA advocacy, and continuing support.In a cluster randomised trial the IRIS intervention had a substantial effect on identification of women experiencing DVA and on referral to DVA advocacy.1 A meta-analysis of qualitative studies found women survivors of DVA see healthcare professionals as potential sources of support.2 However, there is still uncertainty about effective responses from clinicians, 3 including those working in general practice, 4 and about how women experience programmes such as IRIS that are designed to improve clinician engagement with DVA.The aims of this study were to understand women's experiences of disclosure of DVA in general practice settings in the context of the IRIS programme, focusing on women's subsequent referral by their GP or practice nurse to a DVA advocate. The study set out to explore women's experience of the initial contact with an advocate after the GP referral and their views on how important this initial meeting and contact was to any changes that they subsequently reported in attitude and behaviour that improved their sense of safety. It also aimed to investigate whether it mattered to the women that they had been referred to a DVA advocate by a healthcare professional and what impact, if any, their subsequent contact with their GP or nurse had on any changes they made after seeing the DVA advocate. METHOD Study designA service-user collaborative study using a qualitative study design was conducted. A multidisciplinary team of two DVA advocates, one social scientist, and one DVA specialist clinical psychologist supported a survivor of DVA (KS) to design and deliver a piece of service-user research (service user in this case refers to previous use of domestic violence agencies and services). SamplingWomen were recruited who had been referred to a domestic violence agency by general practice professionals taking part in a randomised controlled trial testing the IRIS programme. Recruitment took place across the trial sites in Bristol and Hackney. A purposive sampling strategy was adopted to maximise heterogeneity in terms of age, ethnicity, length of DVA, and whether or not women were still with the perpetrator. Twenty women were approached initially in each site by a specialist advocate and told about the study. Thirty-five women

Reducing symbolic‐violence in the research encounter: collaborating with a survivor of domestic abuse in a qualitative study in UK primary care

“…A separate thematic analysis of this data set exploring women's experience of the role of advocates in GP referral is reported elsewhere (Malpass et al . ).…”

“…The findings of that study are reported elsewhere (Malpass et al . ). This paper explores our intention to reduce as much as possible the ‘symbolic violence’ inherent in the research encounter (Bourdieu , ).…”

Help‐seeking amongst women survivors of domestic violence: a qualitative study of pathways towards formal and informal support

“…Women often lack confidence that their primary care doctor or general practitioner (GP) can offer help, but those who do disclose abuse value the empathetic communication, validation of their situation and referral for additional help that may follow . However, disclosure without appropriate referral may leave women vulnerable and a major trial showed that GPs, to identify abuse, need both dedicated training and a clear referral pathway to specialist advocacy . Little is known about the part played by health professionals in women's overall help‐seeking strategies.…”

Testing a counselling intervention in antenatal care for women experiencing partner violence: a study protocol for a randomized controlled trial in Johannesburg, South Africa

“…This, combined with discussions about safety planning and options for ending violence can be a valuable and empowering means of problem-solving and building self-efficacy in this context [21–23, 25, 26]. Some studies have found that having a focal person at the health centre who is specially trained on violence and dedicated to the issue can be an important element in responding to violence [27]; others identified support groups as a potentially positive intervention option [28]. In general, research has confirmed the value of interventions to address partner violence in antenatal care settings and suggests that even a single counselling session can result in improved safety behaviours and reduced levels of intimate partner violence [21, 22].…”