Elsevier

Social Science & Medicine

Volume 160, July 2016, Pages 35-42
Social Science & Medicine

Receiving care for intimate partner violence in primary care: Barriers and enablers for women participating in the weave randomised controlled trial

https://doi.org/10.1016/j.socscimed.2016.05.017Get rights and content

Highlights

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    Women exposed to intimate partner violence (IPV) are open to help in primary care.

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    Implementation strategies need to fit with the complex characteristics of the target group.

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    Doctor communication is a key factor influencing the uptake of doctor-delivered IPV interventions.

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    Research context has a strong potential to interact with implementation and outcomes.

Abstract

Background

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).

Methods

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).

Results

Abuse severity and socio-demographic characteristics (apart from current relationship status) were unrelated to uptake of counselling (67/137 attended sessions). Favourable doctor communication was strongly associated with attendance. Eight themes emerged, including four sets of beliefs that influenced attitudes to uptake: (i) awareness of the abuse and readiness for help; (ii) weave as an avenue to help; (iii) doctor’s communication; and (iv) role in providing care for IPV; and four sets of beliefs regarding women’s control over uptake: (v) emotional health, (vi) doctors’ time, (vii) managing the disclosure process and (viii) viewing primary care as a safe option.

Conclusions

This study has identified factors that can promote the implementation and evaluation of primary care-based IPV interventions, which are relevant across health research settings, for example, ensuring fit between implementation strategies and characteristics of the target group (such as range in readiness for intervention). On practice implications, providers’ communication remains a key issue for engaging women. A key message arising from this work concerns the critical role of primary care and health services more broadly in reaching victims of domestic violence, and providing immediate and ongoing support (depending on the healthcare context).

Section snippets

Background

Intimate partner violence (IPV) is a global public health problem that predominately affects women and their children (WHO, 2013a). Women exposed to IPV are frequent users of a diverse range of health services, and there is an urgent need to expand and improve the quality of evidence for interventions that could be offered to those identified through contact with health services (Garcia-Moreno et al., 2015, National Institute of Health and Care Excellence, 2014, O’Doherty et al., 2015, Wathen

Methods

The primary source of data for this study was derived from semi-structured interviews with a selection of women who had completed their participation in the weave trial (Hegarty et al., 2013). We examined quantitative metrics related to the patterns of uptake to provide additional contextual information. Originally, 137 women were invited to counselling; 67 (49%) of these women received a dose (one to six sessions). We compared characteristics (assessed at recruitment/baseline) of women who

Results

The women who took up counselling as part of the weave programme did not differ from those who did not in terms of baseline characteristics. However, the attenders were less likely to be in a current relationship (Table 1), and they rated their doctors’ communication skills (GPAQ; Mead et al., 2008) more favourably (Table 2).

Compared to the intervention group overall, the 20 selected women may have been less open to help from a doctor for IPV (55% vs. 73%) and they less often regarded the weave

Discussion

With increasing focus on the need for more evidence on health-based interventions to tackle IPV (National Institute of Health and Care Excellence, 2014, Wathen and MacMillan, 2012, World Health Organization, 2013b), this study, a process evaluation of the weave trial (Hegarty et al., 2013), identified factors that influenced survivors of IPV to take up a counselling intervention in primary care. Context has important implications for implementation and outcomes (Moore et al., 2015) particularly

Concluding remarks

The study identifies specific factors of note in implementing and evaluating primary care-based IPV interventions. There is a need to ensure a fit between characteristics and capabilities of the intervention setting and the target group’s cognitive appraisals and readiness for intervention. We support embedding theory-informed, mixed-methods process analyses into trials to identify early potential difficulties in recruitment, retention, intervention delivery and uptake. We also urge greater

Acknowledgements

We acknowledge the major contribution of all women in the weave trial, and in particular, the twenty women who were interviewed for this sub-study. Funding for this work was provided by the National Health and Medical Research Council (Australia; NHMRC ID APP1007687).

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