Identification and Referral to Improve Safety (IRIS) programme

Executive summary: Domestic violence and abuse (DVA) is recognised as a significant global public health issue (World Health Organisation (WHO) 2013). DVA is a serious, multifaceted societal issue with profound health and mental wellbeing consequences with the potential for longer term health care needs in supporting survivors. The Office for National Statistics (2015) crime survey for 2013-2014 estimates that at least 1.4 million women and 700,000 men aged between 16 and 59 experienced DVA in England and Wales equating to 8.5% of women and 4.5% of men reporting a DVA crime (ONS, 2015). Furthermore, new data reports that 85% of DVA victims sought help, on average five times from professionals, including healthcare professionals, in the year before they received effective help (Safe Lives 2015). The cost to public services of domestic abuse (uprated to 2013 prices) is £4.3 bn with the majority of costs attributed to the health service (£1.9 bn) (Walby 2004, 2009). In 2011 the findings from a cluster randomised controlled trial (RCT); funded by the Health Foundation, for the Identification and Referral to Improve Safety (IRIS) programme was published in The Lancet (Feder et al., 2011). The trial was based on two urban primary care Trusts; Bristol and Hackney in London with a total of 48 general practices involved in the study from 2007 - 2010. The IRIS intervention programme comprises of a structured approach to support and management of DVA by providing training to clinical and non-clinical staff located within GP surgeries, ongoing consultancy to the practice team, a prompt within the patient’s medical records and a defined referral pathway to an advocate educator (AE) working locally. In November 2010 the IRIS National Steering group was formed. The current membership of this group comprises Donna Covey (Chair) – CEO, AVA, Professor Gene Feder – University of Bristol, Carol Metters – CEO, Next Link, Karen Ingala-Smith – CEO, nia, Val Lunn – CEO, WAIS, Dr. Roxane Agnew Davis – DVTraining Ltd. The IRIS DVA intervention model has received national recognition and strategic relevance in over seven key UK documents on domestic violence and abuse. This independent review of the national IRIS intervention is based on national and local data that is widely available since the publication of the IRIS RCT study (Feder et al., 2011). This report has been conducted independently of the national IRIS steering group but in consultation as part of the review process to compile this report for the Department of Health (DOH) 3 year funding criteria (2013 – 2016). The review is solely based on the literature available at the time of submitting this report (June 2016) and includes the annual IRIS data reports (2013, 2014, 2015) published peer review articles (Feder et al., 2011, Devine et al., 2012), local IRIS service evaluations (5 independent reports) from commissioned IRIS sites and an evaluation of the IRIS train the trainers report

From Silence to Voice: A collaborative international partnership to develop a digital resource for use in clinical and education settings about sexual violence from perspectives of students, educators and survivors.

Gender based violence (GBV) – which includes sexual violence - is a significant global public health and societal problem, recognised as a global human rights issue by the World Health Organisation (WHO, 2017). Global estimates indicate that 1 in 3 women experience physical/sexual violence in their lifetime (WHO, 2017). GBV/SV exerts a detrimental impact not only on the lives and health of women, but also those who witness abuse and has been identified as a large scale problem in South Africa with recorded estimates that a woman is raped every seventeen seconds. The impact of GBV/SV on the physical and psychological wellbeing of those who experience abuse is wide ranging. It includes the immediate physical effects for example, physical injury as well as longer term chronic ill health as a result, acute and enduring psychological trauma, mental ill-health, alongside secondary physiological health issues such as gynaecological and sexual health (Feder et al. 2011). It is well evidenced however that healthcare professionals across the spectrum do not respond effectively often due to a lack of knowledge or professional confidence and their own values and assumptions surrounding GBV/SV (McGarry et al. 2015). Education is pivotal, and a proven means to tackle a growing global problem. This includes pre-qualifying healthcare students who are often not exposed to education about GBV/SV within their current curricula. Working with our project partners and key stakeholders in South Africa during 2019, including women who have experienced GBV/SV, the aim of this research was to engage stakeholders in the co-production of a digital e-learning resource to use across multiple healthcare disciplines on GBV/SV. Our aim is to describe the process of an international collaboration, provide the context using survey data and present the digital resource and the evaluations conducted on the application and use within education and clinical settings. References: Feder G, Davies R, Baird K, Dunne D, Eldridge S, Griffiths C, Gregory A, Howell A, Johnson, M., Ramsay J, Garcia-Moreno, C., Armin, A. (2016) The sustainable development goals, violence and women’s and children’s health (WHO) http://www.who.int/bulletin/volumes/94/5/16-172205/en/ (accessed 7.7.18) McGarry J., Baker C., Wilson C., Felton A., Banerjee A, (2015). Preparation for safeguarding in UK pre-registration graduate nurse education. Journal of Adult Protection. 17(6), 371-379 World Health Organisation (2017) Violence against women http://www.who.int/news-room/fact-sheets/detail/violence-against-women (accessed 7.7.18

An exploration of infant feeding experiences of women in Lincolnshire in the early postnatal period

Executive Summary Breastfeeding initiation and maintenance rates within Lincolnshire remain lower than the average for the East Midlands and England. Rates of initiation of breastfeeding at birth in 2010/2011 were 72% in Lincolnshire, compared to an initiation rate in England of 74%. The percentage of babies still being either partially or exclusively breastfed at 6 – 8 weeks dropped to 39% in Lincolnshire in comparison to 46% in England (NHS Lincolnshire, 2011). The purpose of this qualitative research was to gain an understanding of primigravid women‟s breastfeeding experience in the first 6 – 8 week postpartum period. Whilst valuable audit data is held on infant feeding methods in Lincolnshire, this research focuses on offering insights into the experiences of new mothers in order to better understand their feeding experiences and decisions, with a view to understanding differences in rates. The objectives of the study were: PRIMARY OBJECTIVE To describe women‟s experiences of breastfeeding SECONDARY OBJECTIVES To determine women‟s perceptions of breastfeeding To identify the factors that influence breastfeeding duration and cessation. The study used phenomenological principles to understand the lived experiences of the women. The study focused on women who were living in the county of Lincolnshire. Ethical approval was granted by the University of Nottingham and the National Research Ethics Committee. Two methods of data collection were used: Personal diaries 48 primigravid women over 34 weeks gestation were invited to complete detailed daily diaries of their infant feeding experiences in the 6 to 8 week postnatal period. 22 diaries were completed, a response rate of 46%. In-depth interviews A sub-sample of 13 women participated in a face-to-face interview which explored their infant feeding experiences and factors that affected their decision to continue or to discontinue breastfeeding. Data analysis utilised phenomenological principles that proceeded from coding to category development to themes

The COVID-19 Pandemic in UK Care Homes - Revealing the Cracks in the System

open access articleThere are around 420,000 residents living in UK care homes. The majority are over 85, have multiple health conditions, live with frailty and are nearing the end of their lives. Up to 80% of residents live with dementia. Care homes are not part of the National Health Service (NHS). Care home places are funded through a complex mix of self-funding, means-tested support from local authorities, and continuous healthcare funding from the NHS. They are run by independent organisations. A third of providers are large for-profit chains, the remainder comprising not-for-profit third-sector organisations, or small private companies with only a small number of homes. The level of government reimbursement for long-term care homes in the UK is low by international standards, an issue highlighted by multiple public commissions3,4 but which has gone unaddressed by successive UK governments. Medical care to UK care homes is highly variable. In some areas, the NHS Care Home Vanguards have established dedicated General Practitioners with responsibility for each home and direct access to specialist multidisciplinary teams, with evidence that such approaches may minimise unnecessary admission to hospital5. But often, care is based on residents’ individual relationships with family doctors, with the result that access to medical care is variable and uncoordinated6. As the COVID -19 pandemic started, arrangements for medical care in English care homes were in the early stages of being standardised as part of the NHS England Enhanced Health in Care Homes project. There is a social dread surrounding care homes, perceived as places to avoid because of concerns about care quality and resistance to having to pay for social care when health care is free. Most of the coverage of care homes in mainstream media prior to COVID was negative, focussing on isolated scandalous cases of negligence or abuse, and rarely reporting on the exceptional work done by the sector daily. The workforce is not valued. There is no national accreditation for care home staff, opportunities for career progression are limited, staff are poorly paid and positions in care homes are often referred to as unskilled work

Silent voices: exploring narratives of women's experiences of health care professional responses to domestic violence and abuse

The impact of domestic violence and abuse (DVA) is far reaching not least in terms of both the immediate and longer term physical and mental wellbeing of those who have experienced abuse. DVA also exerts a considerable detrimental impact on the wider family including children. While professional perspectives of working with DVA survivors is increasingly well documented, there remains a paucity of accounts of encounters with healthcare services and/or healthcare professionals from survivors of DVA themselves. A central aim of this study was the exploration of women’s experiences of healthcare encounters told purely as personal narrative rather than framed in more traditional research terms. The focus of this paper therefore is unedited personal stories of encounters with healthcare professionals. The position of narrative as research method and the presentation of narratives in this particular instance are also considered

Healthcare professionals’ knowledge, attitudes, and experiences of FGM in sub-Saharan Africa: a systematic scoping review

Background Female Genital Mutilation (FGM) remains a challenge as evidence indicates that healthcare professionals (HCPs) who are required to play a role in the elimination of FGM, support the practice. The reasons some HCPs in Sub Saharan Africa still perpetuate FGM is unclear. Thus, this review aims to provide an overview of the existing evidence surrounding HCPs knowledge, attitudes, and experiences of FGM in order to determine the factors that may influence support for the continuation of FGM. Methods A search was conducted utilising six databases (CINHAL, PubMed, Embase, MEDLINE, PsycINFO and ASSIA) and using key terms such as female genital mutilation, FGM, knowledge, attitudes, experiences, practices, and healthcare professionals. At the end of the search, 12 studies were identified. The 12 studies were situated in sub-Saharan African countries (SSA) and they examined HCPs knowledge, attitudes, and experiences of FGM. Findings This review revealed three overarching themes: (1) Knowledge of FGM (2) attitudes towards the practice of FGM and (3) experiences of FGM. The review revealed that HCPs have limited knowledge of FGM and its health implications. Furthermore, some HCPs openly disapprove the practice of FGM, but may undermine abandonment messages and perform FGM in secret due to cultural affiliations and financial rewards. This is indicative of HCPs moving towards medicalising FGM by upholding cultural beliefs and practices rather than adhering to professional policies, codes of conduct and the legal position. This review identifies determinants for the preservation of FGM among some HCPs in SSA countries to include pervading cultural beliefs, poor design of professional trainings in the field of FGM and limited knowledge by HCP

Healthcare professionals’ knowledge, attitudes, and experiences of FGM in sub-Saharan Africa: a systematic scoping review

Open access articleBackground: Female Genital Mutilation (FGM) remains a challenge as evidence indicates that healthcare professionals (HCPs) who are required to play a role in the elimination of FGM, support the practice. The reasons some HCPs in Sub Saharan Africa still perpetuate FGM is unclear. Thus, this review aims to provide an overview of the existing evidence surrounding HCPs knowledge, attitudes, and experiences of FGM in order to determine the factors that may influence support for the continuation of FGM. Methods: A search was conducted utilising six databases (CINHAL, PubMed, Embase, MEDLINE, PsycINFO and ASSIA) and using key terms such as female genital mutilation, FGM, knowledge, attitudes, experiences, practices, and healthcare professionals. At the end of the search, 12 studies were identified. The 12 studies were situated in sub-Saharan African countries (SSA) and they examined HCPs knowledge, attitudes, and experiences of FGM. Findings: This review revealed three overarching themes: (1) Knowledge of FGM (2) attitudes towards the practice of FGM and (3) experiences of FGM. The review revealed that HCPs have limited knowledge of FGM and its health implications. Furthermore, some HCPs openly disapprove the practice of FGM, but may undermine abandonment messages and perform FGM in secret due to cultural affiliations and financial rewards. This is indicative of HCPs moving towards medicalising FGM by upholding cultural beliefs and practices rather than adhering to professional policies, codes of conducts and the legal position. This review identifies determinants for the preservation of FGM among some HCPs in SSA countries to include pervading cultural beliefs, poor design of professional trainings in the field of FGM and limited knowledge by HCPs

Exploring the impacts of organisational structure, policy and practice on the health inequalities of marginalised communities: illustrative cases from the UK healthcare system

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.This paper explores how organisational structure, policies and practices in healthcare can inadvertently disadvantage marginalised populations (e.g. individuals from ethnic minority backgrounds) and reinforce health inequalities. We draw upon three diverse UK healthcare settings (long term care institutions, high security hospitals and community pharmacies) to illustrate how systemic injustices negatively impact on access to care, treatment and health outcomes. The first case study considers the care of older people within nursing homes; specifically the disempowering effects of this service structure and impacts of choice reduction upon health and their access to health provision. The second case study explores the impact of security restrictions upon patients within high security hospitals, focusing particularly on the maintenance of relationships and support networks outside of the hospital. The third and final case study, draws upon the national community pharmacy medicine management service to illustrate ways in which policies and guidelines inadvertently obstruct patients' engagement with the service within a community setting. We draw upon these settings to highlight inequalities within different contexts and to illustrate the ways in which well intended services can inadvertently disadvantage marginalised communities in multiple ways

How to win friends and influence people: the value of the cohort in a doctoral research training programme

open access articleThis article is not about retention and attrition rates, or about successful outcomes, or about supervision, even though these are at the nub of most research on the doctoral experience. This article concerns the experiences of doctoral students undertaking educational research methods training, as opposed to the experiences of the PhD itself. The specific phenomenon identified in this small group study is the value of peer interaction within the cohort. Three strands of this relationship, namely peer support, cultural mix and bonding/ad-hoc social gatherings have been investigated. Our findings illustrate the importance and unexpected value of the ‘cohort’ on the participants in this study as they journey towards academia