Women's evaluation of abuse and violence care in general practice: a cluster randomised controlled trial (weave) (original) (raw)
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The Lancet, 2013
Background Evidence for a benefi t of interventions to help women who screen positive for intimate partner violence (IPV) in health-care settings is limited. We assessed whether brief counselling from family doctors trained to respond to women identifi ed through IPV screening would increase women's quality of life, safety planning and behaviour, and mental health. Methods In this cluster randomised controlled trial, we enrolled family doctors from clinics in Victoria, Australia, and their female patients (aged 16-50 years) who screened positive for fear of a partner in past 12 months in a health and lifestyle survey. The study intervention consisted of the following: training of doctors, notifi cation to doctors of women screening positive for fear of a partner, and invitation to women for one-to-six sessions of counselling for relationship and emotional issues. We used a computer-generated randomisation sequence to allocate doctors to control (standard care) or intervention, stratifi ed by location of each doctor's practice (urban vs rural), with random permuted block sizes of two and four within each stratum. Data were collected by postal survey at baseline and at 6 months and 12 months post-invitation (2008-11). Researchers were masked to treatment allocation, but women and doctors enrolled into the trial were not. Primary outcomes were quality of life (WHO Quality of Life-BREF), safety planning and behaviour, mental health (SF-12) at 12 months. Secondary outcomes included depression and anxiety (Hospital Anxiety and Depression Scale; cutoff ≥8); women's report of an inquiry from their doctor about the safety of them and their children; and comfort to discuss fear with their doctor (fi ve-point Likert scale). Analyses were by intention to treat, accounting for missing data, and estimates reported were adjusted for doctor location and outcome scores at baseline. This trial is registered with the Australian New Zealand Clinical Trial Registry, number ACTRN12608000032358. Findings We randomly allocated 52 doctors (and 272 women who were eligible for inclusion and returned their baseline survey) to either intervention (25 doctors, 137 women) or control (27 doctors, 135 women). 96 (70%) of 137 women in the intervention group (seeing 23 doctors) and 100 (74%) of 135 women in the control group (seeing 26 doctors) completed 12 month follow-up. We detected no diff erence in quality of life, safety planning and behaviour, or mental health SF-12 at 12 months. For secondary outcomes, we detected no between-group diff erence in anxiety at 12 months or comfort to discuss fear at 6 months, but depressiveness caseness at 12 months was improved in the intervention group compared with the control group (odds ratio 0•3, 0•1-0•7; p=0•005), as was doctor enquiry at 6 months about women's safety (5•1, 1•9-14•0; p=0•002) and children's safety (5•5, 1•6-19•0; p=0•008). We recorded no adverse events. Interpretation Our fi ndings can inform further research on brief counselling for women disclosing intimate partner violence in primary care settings, but do not lend support to the use of postal screening in the identifi cation of those patients. However, we suggest that family doctors should be trained to ask about the safety of women and children, and to provide supportive counselling for women experiencing abuse, because our fi ndings suggest that, although we detected no improvement in quality of life, counselling can reduce depressive symptoms.
BMJ Open, 2020
ObjectivesThis was a 2-year follow-up study of a primary care-based counselling intervention (weave) for women experiencing intimate partner violence (IPV). We aimed to assess whether differences in depression found at 12 months (lower depression for intervention than control participants) would be sustained at 24 months and differences in quality in life, general mental and physical health and IPV would emerge.DesignCluster randomised controlled trial. Researchers blinded to allocation. Unit of randomisation: family doctors.SettingFifty-two primary care clinics, Victoria, Australia.ParticipantsBaseline: 272 English-speaking, female patients (intervention n=137, doctors=35; control n=135, doctors=37), who screened positive for fear of partner in past 12 months. Twenty-four-month response rates: intervention 59% (81/137), control 63% (85/135).InterventionsIntervention doctors received training to deliver brief, woman-centred counselling. Intervention patients were invited to receive ...
Journal of Interpersonal Violence, 2013
Intimate partner violence (IPV) has major affects on women's wellbeing. There has been limited investigation of the association between type and severity of IPV and health outcomes. This article describes socio-demographic characteristics, experiences of abuse, health, safety, and use of services in women enrolled in the Women's Evaluation of Abuse and Violence Care (WEAVE) project. We explored associations between type and severity of abuse and women's health, quality of life, and help seeking. Women (aged 16-50 years) attending 52 Australian general practices, reporting fear of partners in last 12 months were mailed a survey between June 2008 and May 2010. Response rate was 70.5% (272/386). In the last 12 months, one third (33.0%) experienced Severe Combined Abuse, 26.2% Physical and Emotional Abuse, 26.6% Emotional Abuse and/or Harassment only, 2.7% Physical Abuse only and 12.4% scored negative on the Composite Abuse Scale. A total of 31.6% of participants reported poor or fair health and 67.9% poor social support. In the last year, one third had seen a psychologist (36.6%) or had 5 or more general practitioner visits (34.3%); 14.7% contacted IPV services; and 24.4% had made a safety plan. Compared to other abuse groups, women with Severe Combined Abuse had poor quality of life and mental health, despite using more medications, counseling, and IPV services and were more likely to have days out of role because of emotional issues. In summary, women who were fearful of partners in the last year, have poor mental health and quality of life, attend health care services frequently, and domestic violence services infrequently. Those women experiencing severe combined physical, emotional, and sexual abuse have poorer quality of life and mental health than women experiencing other abuse types. Health practitioners should take a history of type and severity of abuse for women with mental health issues to assist access to appropriate specialist support.
Social science & medicine (1982), 2016
Interventions in health settings for intimate partner violence (IPV) are being increasingly recognised as part of a response to addressing this global public health problem. However, interventions targeting this sensitive social phenomenon are complex and highly susceptible to context. This study aimed to elucidate factors involved in women's uptake of a counselling intervention delivered by family doctors in the weave primary care trial (Victoria, Australia). We analysed associations between women's and doctors' baseline characteristics and uptake of the intervention. We interviewed a random selection of 20 women from an intervention group women to explore cognitions relating to intervention uptake. Interviews were audio-recorded, transcribed, coded in NVivo 10 and analysed using the theory of planned behaviour (TPB). Abuse severity and socio-demographic characteristics (apart from current relationship status) were unrelated to uptake of counselling (67/137 attended ses...
Australian and New Zealand Journal of Public Health, 2002
Objective: To deter mine the prevalence and socio-demographic associations of physical, emotional and sexual abuse by a partner or ex-partner for women attending Australian general practices. Method: In 1996, women attending 20 randomly chosen Brisbane inner south region general practices were screened f or a history of partner abuse using a selfreport questionnaire. Multivariate analyses were conducted on the data, using presence of abuse or not adjusting for cluster effect to obtain prevalence rate ratios for socio-demographic background data and history of violence in the family of origin. Results: Thirty-seven per cent (CI 31.0-42.4) of the survey participants (n=1,836, response rate 78.5%) admitted to having ever experienced abuse in an adult intimate relationship. One in four women (23.3%) had ever exper ienced physical abuse, one in three (33.9%) emotional abuse and one in 10 (10.6%) sexual abuse. Abused women were 64.1 (CI 44.4-94.1) times more likely to have ever been afraid of any partner than non-abused women. Of women in current relationships (n=1,344), 8.0% self-reported physical or emotional or sexual abuse in the past 12 months and 1.5% all three types of abuse. Associations of abuse included being younger (<60 years), separated or divorced, having a history of child abuse or domestic violence between their parents. Conclusion: Partner abuse is ver y common in women attending general practices and clinicians need to be alert to possible indications of par tner abuse (age, marital status , past history of abuse).
BMC Family Practice, 2021
Background Primary care needs to respond effectively to patients experiencing or perpetrating domestic violence and abuse (DVA) and their children, but there is uncertainty about the value of integrated programmes. The aim of the study was to develop and test the feasibility of an integrated primary care system-level training and support intervention, called IRIS+ (Enhanced Identification and Referral to Improve Safety), for all patients affected by DVA. IRIS+ was an adaptation of the original IRIS (Identification and Referral to Improve Safety) model designed to reach female survivors of DVA. Methods Observation of training; pre/post intervention questionnaires with clinicians and patients; data extracted from medical records and DVA agency; semi-structured interviews with clinicians, service providers and referred adults and children. Data collection took place between May 2017 and April 2018. Mixed method analysis was undertaken to triangulate data from various sources to assess ...
The identification of intimate partner violence (IPV) against women as a public health problem has led to routine health care site-based screening and brief intervention policies. However, there is a lack of evidence supporting the usefulness and safety of such policies. Our objective was to ascertain the acceptability, usefulness, and harm of a brief health care site-based screening intervention. In this qualitative study, semistructured interviews were conducted with 36 women several weeks after a standardized screening intervention in either an emergency department (adult and paediatric) or primary health care setting. The majority of women (97%) welcomed the IPV screening intervention and perceived it as nonthreatening and safe. The women reported no increased risk of harm because of the screening. The responses showed that the intervention had a therapeutic and educational quality, and the attitude and approach of the person asking the intervention questions was critical to a positive outcome. Women without a history of violence cautioned that IPV screening may be offensive to those who are abused, whereas those who reported abuse thought IPV screening was essential "to stop it [from] happening." Our findings challenge concerns that IPV screening is offensive to women and increases their potential for danger. Participants were appreciative of the opportunity to tell their abuse stories in a safe and supportive context, and challenged the health care system to implement IPV screening, asking "What took you so long?" J Midwifery Womens Health 2008;53:504 -510
Journal of Midwifery & Womens Health, 2008
The identification of intimate partner violence (IPV) against women as a public health problem has led to routine health care site-based screening and brief intervention policies. However, there is a lack of evidence supporting the usefulness and safety of such policies. Our objective was to ascertain the acceptability, usefulness, and harm of a brief health care site-based screening intervention. In this qualitative study, semistructured interviews were conducted with 36 women several weeks after a standardized screening intervention in either an emergency department (adult and paediatric) or primary health care setting. The majority of women (97%) welcomed the IPV screening intervention and perceived it as nonthreatening and safe. The women reported no increased risk of harm because of the screening. The responses showed that the intervention had a therapeutic and educational quality, and the attitude and approach of the person asking the intervention questions was critical to a positive outcome. Women without a history of violence cautioned that IPV screening may be offensive to those who are abused, whereas those who reported abuse thought IPV screening was essential "to stop it [from] happening." Our findings challenge concerns that IPV screening is offensive to women and increases their potential for danger. Participants were appreciative of the opportunity to tell their abuse stories in a safe and supportive context, and challenged the health care system to implement IPV screening, asking "What took you so long?" J Midwifery Womens Health 2008;53:504 -510