Identifying intimate partner violence in different ethnic groups in primary care - a systematic review and secondary data analysis

PhDBackground Intimate partner violence (IPV), including physical, sexual and emotional violence, causes short and long term ill-health. Brief questions that can identify women from different ethnic groups experiencing IPV who present in clinical settings are a prerequisite for an appropriate response from health services to this substantial public health problem. Aim: To examine the evidence for the validity of questions trying to identify IPV in different ethnic groups and to determine whether their validity varies between ethnic groups. Methods Design: A systematic review and the secondary data analysis of a cross-sectional survey of four questions (HARK) identifying IPV in a primary care sample. Main outcome measures: Systematic review - for each set of index questions identified, diagnostic accuracy indices, correlation coefficients, reliability measures, validity evidence based on response processes and test content were analysed and interpreted. Secondary data analysis - diagnostic indices for IPV and its dimensions in three ethnic groups were calculated for the four HARK questions combined and for the individual HARK questions. 4 Results Systematic review – there is no evidence of questions valid for identifying IPV in specific ethnic groups, including white groups. Secondary data analysis - the optimal HARK cut off score of ≥ 1 was unaffected by the participants‟ ethnicity. The diagnostic indices generated using the HARK cut off of ≥ 1 remained at a high level, in all three ethnic groups. There were no significant ethnic differences in the diagnostic indices of the four combined and individual HARK questions‟ ability at identifying either IPV or its dimensions. Conclusion From the systematic review and secondary data analysis, there is no evidence that questions‟ validity for identifying IPV varies significantly between different ethnic groups. The secondary data analysis does provide evidence that four questions (the HARK) can identify IPV in self-classified UK census categories of African- Caribbean, south Asian, and white groups

Disruption of a primary health care domestic violence and abuse service in two London boroughs: interrupted time series evaluation

Background: Domestic violence and abuse (DVA) is experienced by about 1/3 of women globally and remains a major health concern worldwide. IRIS (Identification and Referral to Improve Safety of women affected by DVA) is a complex, system-level, training and support programme, designed to improve the primary healthcare response to DVA. Following a successful trial in England, since 2011 IRIS has been implemented in eleven London boroughs. In two boroughs the service was disrupted temporarily. This study evaluates the impact of that service disruption. Methods: We used anonymised data on daily referrals received by DVA service providers from general practices in two IRIS implementation boroughs that had service disruption for a period of time (six and three months). In line with previous work we refer to these as boroughs B and C. The primary outcome was the number of daily referrals received by the DVA service provider across each borough over 48 months (March 2013–April 2017) in borough B and 42 months (October 2013–April 2017) in borough C. The data were analysed using interrupted-time series, non-linear regression with sensitivity analyses exploring different regression models. Incidence Rate Ratio (IRR), 95% confidence intervals and p-values associated with the disruption were reported for each borough. Results: A mixed-effects negative binomial regression was the best fit model to the data. In borough B, the disruption, lasted for about six months, reducing the referral rate significantly (p = 0.006) by about 70% (95%CI = (23,87%)). In borough C, the three-month service disruption, also significantly (p = 0.005), reduced the referral rate by about 49% (95% CI = (18,68%)). Conclusions: Disrupting the IRIS service substantially reduced the rate of referrals to DVA service providers. Our findings are evidence in favour of continuous funding and staffing of IRIS as a system level programme

The sensitivity and specificity of four questions (HARK) to identify intimate partner violence: a diagnostic accuracy study in general practice

<p>Abstract</p> <p>Background</p> <p>Intimate partner violence (IPV) including physical, sexual and emotional violence, causes short and long term ill-health. Brief questions that reliably identify women experiencing IPV who present in clinical settings are a pre-requisite for an appropriate response from health services to this substantial public health problem. We estimated the sensitivity and specificity of four questions (HARK) developed from the Abuse Assessment screen, compared to a 30-item abuse questionnaire, the Composite Abuse Scale (CAS).</p> <p>Methods</p> <p>We administered the four HARK questions and the CAS to women approached by two researchers in general practice waiting rooms in Newham, east London. Inclusions: women aged more than 17 years waiting to see a doctor or nurse, who had been in an intimate relationship in the last year. Exclusions: women who were accompanied by children over four years of age or another adult, too unwell to complete the questionnaires, unable to understand English or unable to give informed consent.</p> <p>Results</p> <p>Two hundred and thirty two women were recruited. The response rate was 54%. The prevalence of current intimate partner violence, within the last 12 months, using the CAS cut off score of ≥3, was 23% (95% C.I. 17% to 28%) with pre-test odds of 0.3 (95% C.I. 0.2 to 0.4). The receiver operator characteristic curve demonstrated that a HARK cut off score of ≥1 maximises the true positives whilst minimising the false positives. The sensitivity of the optimal HARK cut-off score of ≥1 was 81% (95% C.I. 69% to 90%), specificity 95% (95% C.I. 91% to 98%), positive predictive value 83% (95% C.I. 70% to 91%), negative predictive value 94% (95% C.I. 90% to 97%), likelihood ratio 16 (95% C.I. 8 to 31) and post-test odds 5.</p> <p>Conclusion</p> <p>The four HARK questions accurately identify women experiencing IPV in the past year and may help women disclose abuse in general practice. The HARK questions could be incorporated into the electronic medical record in primary care to prompt clinicians to ask about recent partner violence and to encourage disclosure by patients. Future research should test the effectiveness of HARK in clinical consultations.</p

The 'Growth Monitoring Teaching Aid' rapidly improves mothers' understanding of growth curves

Most growth monitoring programmes in developing countries have not been successful in reducing malnutrition. This is due, at least in part, to the exclusion of mothers from the process of growth monitoring. An essential requisite for greater participation is for mothers to understand the meaning of a growth chart. The 'Growth Monitoring Teaching Aid' (GMTA) is an educational game which attempts to expedite the process of understanding growth curves by simulating the growth curve of a child using water added to a bucket suspended below the direct recording scales. Thirty mothers were divided into an experimental group who used the GMTA for 2-4 h and a control group who did not use it. Six questions were used to test each subject's understanding of growth curves. Paired t tests revealed that the experimental group significantly increased their understanding of growth, whereas the control group did not. The mean score for the experimental group prior to playing the game was 1.43; this increased to 5.27 after playing the game (P<0.0001). The GMTA by rapidly improving the present poor level of understanding of growth curves, may allow greater maternal participation in growth monitoring.3 page(s

Improving the healthcare response to domestic violence and abuse in sexual health clinics: feasibility study of a training, support and referral intervention

Should read: "AHS and NP were funded by the National Institute for Health Research (NIHR) for their academic clinical lectureship and academic clinical fellowship respectively, during the preparation of this manuscript. NP was funded by the Wellcome Trust during the implementation of the pilot. The research and AHS was supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at the Barts Health NHS Trust; and the West CLAHRC. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Tower Hamlets Public Health provided funding for work carried out at site 1. GF is a consultant for the IRIS programme for which the University of Bristol receives a fee. None of these funding organisations had any role in the design, implementation, and interpretation nor reporting of this work.

Improving the healthcare response to domestic violence and abuse in primary care: protocol for a mixed method evaluation of the implementation of a complex intervention.

BACKGROUND: Domestic violence and abuse remains a major health concern. It is unknown whether the improved healthcare response to domestic violence and abuse demonstrated in a cluster randomised controlled trial of IRIS (Identification and Referral to Improve Safety), a complex intervention, including general practice based training, support and referral programme, can be achieved outside a trial setting. AIM: To evaluate the impact over four years of a system wide implementation of IRIS, sequentially into multiple areas, outside the setting of a trial. METHODS: An interrupted time series analysis of referrals received by domestic violence and abuse workers from 201 general practices, in five northeast London boroughs; alongside a mixed methods process evaluation and qualitative analysis. Segmented regression interrupted time series analysis to estimate impact of the IRIS intervention over a 53-month period. A secondary analysis compares the segmented regression analysis in each of the four implementation boroughs, with a fifth comparator borough. DISCUSSION: This is the first interrupted time series analysis of an intervention to improve the health care response to domestic violence. The findings will characterise the impact of IRIS implementation outside a trial setting and its suitability for national implementation in the United Kingdom.National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North Thames at Bart’s Health NHS Trust (NIHR CLAHRC North Thames)