Exploration of barriers to screening for domestic violence in the perinatal period using an ecological framework

Abstract

Aims: To explore Australian healthcare providers' perspectives on factors that influence disclosure and domestic violence screening through the lens of Heise's (1998) integrated ecological framework.Design: This paper reports the findings that were part of a sequential mixed methods study with survey data informing interview questions. Participants for interviews were recruited after expressing an interest after completing surveys, as well as via snowball sampling.Methods: Semi-structured interviews were undertaken in 2017 with 12 practicing healthcare providers delivering care to women in the perinatal period in Greater Western Sydney, NSW, Australia. Data were analysed using Braun and Clarke's ( 2006) six-step thematic approach. Findings:The findings were framed within Heise's integrated ecological framework under four main themes. The main themes were 'Ontogenic: Factors preventing women from disclosing'; 'Microsystem: Factors preventing healthcare providers from asking'; 'Exosystem: Organizational structures not conducive to screening'; and 'Macrosystem: Cultural attitudes and socioeconomic influences affecting screening'. Conclusion:Organizational policies are needed for better systems of reminding healthcare providers to enquire for domestic and family violence and mandating this within their practices. Mandatory domestic and family violence education and training that is suitable for the time constraints and learning needs of the healthcare provider is recommended for all healthcare providers caring for perinatal women. Further research is needed in addressing culturally specific barriers for healthcare providers to enquire about domestic and family violence in a culturally appropriate way.

Domestic violence against women has increased during the COVID‐19 pandemic: A perspective paper about the need for change to current and future practice

“…Proactive screening is a key strategy for identifying DV and related mental health issues and front-line clinical staff are very well positioned to do this. However, there are barriers and issues that can impede effective screening, and these include a range of factors on the part of clinical staff including uncertainty of what to do if a disclosure is made, lack of confidence in responding appropriately, time constraints and a lack of resources (Usanov et al, 2023). These authors go on to highlight the importance of ensuring that frontline health clinical staff are provided education and support to build their knowledge and confidence in this area, to better support women through proactive screening.…”

“…Women of any age can experience DV; however, during pregnancy is a known time of high risk (Adams et al, 2022; Usanov et al, 2023) and this is a time where most women are in some sort of contact with health services. Pregnant women were at greater physical and psychological risk during COVID‐19 because of their conditions and the prevalence of other stressors such as DV, made their situation worse.…”