PRimary care rEsponse to domestic violence and abuse in the COvid-19 panDEmic (PRECODE): protocol of a rapid mixed-methods study in the UK

Abstract

Background The implementation of lockdowns in the UK during the COVID-19 pandemic resulted in a system switch to remote primary care consulting at the same time as the incidence of domestic violence and abuse (DVA) increased. Lockdown-specific barriers to disclosure of DVA reduced the opportunity for DVA detection and referral. The PRECODE (PRimary care rEsponse to domestic violence and abuse in the COvid-19 panDEmic) study will comprise quantitative analysis of the impact of the pandemic on referrals from IRIS (Identification and Referral to Improve Safety) trained general practices to DVA agencies in the UK and qualitative analysis of the experiences of clinicians responding to patients affected by DVA and adaptations they have made transitioning to remote DVA training and patient support. Methods/Design Using a rapid mixed method design, PRECODE will explore and explain the dynamics of DVA referrals and support before and during the pandemic on a national scale using qualitative data and over four years of referrals time series data. We will undertake interrupted-time series and non-linear regression analysis, including sensitivity analyses, on time series of referrals to DVA services from routinely collected data to evaluate the impact of the pandemic and associated lockdowns on referrals to the IRIS Programme, and analyse key determinants associated with changes in referrals. We will also conduct an interview- and observation-based qualitative study to understand the variation, relevance and feasibility of primary care responses to DVA before and during the pandemic and its aftermath. The triangulation of quantitative and qualitative findings using rapid analysis and synthesis will enable the articulation of multiscale trends in primary care responses to DVA and complex mechanisms by which these responses have changed during the pandemic. Discussion Our findings will inform the implementation of remote primary care and DVA service responses as services re-configure. Understanding the adaptation of clinical and service responses to DVA during the pandemic is crucial for the development of evidence-based, effective remote support and referral beyond the pandemic. Trial registration PRECODE is an observational epidemiologic study, not an intervention evaluation or trial. We will not be reporting results of an intervention on human participants.

A Hospital-Based Independent Domestic Violence Advisor Service: Demand and Response During the COVID-19 Pandemic

“…Indeed, concern was expressed that lockdown was particularly problematic for DVA victims con ned in close quarters with their perpetrators and therefore at greater risk, whilst also being less likely to leave home and seek help. These ndings echo others' concerns about DVA victims during lockdown [17], and evidence of decreased hospital admissions for DVA, despite social conditions that increase the risk of violence. [22] After the initial drop in referrals at the start of lockdown, both the quantitative and qualitative ndings showed a busy service with increased referrals; the IDVAs continued to provide a robust response, taking on and supporting all cases referred to them.…”

“…Concerns about DVA grew due to 'stay at home' orders, which meant households were largely con ned to their own homes. With victims and perpetrators kept in close proximity, with reduced opportunities for victims to seek help [17], it was widely suggested that DVA would increase. Indeed, police recorded crime data showed a rise in DVA since the start of the pandemic [18] and demand for DVA charity services increased.…”

Challenges of safeguarding via remote consulting during the COVID-19 pandemic: a qualitative interview study

“…Alongside changes in primary care, the COVID-19 pandemic response created further potential vulnerabilities, such as school closures, 14 lockdowns, and care home isolation. 15 There were reports of increased rates of domestic violence, 16 impacts on young carers, 17 reported increased rates of shaken baby syndrome 18 and serious neurosurgical trauma to children, 19 risks for those with learning disabilities, 20 concerns about resuscitation decisions, 21 and financial exploitation of vulnerable adults. 22…”

Impact of the first national COVID-19 lockdown on referral of women experiencing domestic violence and abuse in England and Wales

“…In this paper we present the results of the first analysis from the Primary Care Response to Domestic Violence and Abuse in the Covid-19 Pandemic (PRECODE) mixed study; the protocol for which has recently been published [ 29 ]. The aim of this paper is to evaluate the impact of large-scale systemic closures, in our case proxied by both national lockdowns or school closures, on the number of referrals of women from general practice to local IRIS DVA support programmes.…”