Researching domestic violence and abuse in healthcare settings: Challenges and issues

McGarry, Julie; Ali, Parveen

doi:10.1177/1744987116650923

Cited by 8 publications

(3 citation statements)

References 62 publications

(76 reference statements)

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“…Our finding on differing conceptualisations of VAW reflects previous research that reported a lack of consensus regarding the definition of VAW and terminology used by researchers, practitioners, and research participants [ 35 ]. In the context of global research, the differences in definitions of VAW used by HIC funders, LMIC researchers and REC members were rooted in country-specific socio-political contexts.…”

Section: Discussionsupporting

confidence: 81%

Ethical challenges in global research on health system responses to violence against women: a qualitative study of policy and professional perspectives

Lewis,

Kalichman,

Azeredo

et al. 2024

BMC Med Ethics

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Background Studying global health problems requires international multidisciplinary teams. Such multidisciplinarity and multiculturalism create challenges in adhering to a set of ethical principles across different country contexts. Our group on health system responses to violence against women (VAW) included two universities in a European high-income country (HIC) and four universities in low-and middle-income countries (LMICs). This study aimed to investigate professional and policy perspectives on the types, causes of, and solutions to ethical challenges specific to the ethics approval stage of the global research projects on health system responses to VAW. Methods We used the Network of Ethical Relationships model, framework method, and READ approach to analyse qualitative semi-structured interviews (n = 18) and policy documents (n = 27). In March-July 2021, we recruited a purposive sample of researchers and members of Research Ethics Committees (RECs) from the five partner countries. Interviewees signposted policies and guidelines on research ethics, including VAW. Results We developed three themes with eight subthemes summarising ethical challenges across three contextual factors. The global nature of the group contributed towards power and resource imbalance between HIC and LMICs and differing RECs’ rules. Location of the primary studies within health services highlighted differing rules between university RECs and health authorities. There were diverse conceptualisations of VAW and vulnerability of research participants between countries and limited methodological and topic expertise in some LMIC RECs. These factors threatened the timely delivery of studies and had a negative impact on researchers and their relationships with RECs and HIC funders. Most researchers felt frustrated and demotivated by the bureaucratised, uncoordinated, and lengthy approval process. Participants suggested redistributing power and resources between HICs and LMICs, involving LMIC representatives in developing funding agendas, better coordination between RECs and health authorities and capacity strengthening on ethics in VAW research. Conclusions The process of ethics approval for global research on health system responses to VAW should be more coordinated across partners, with equal power distribution between HICs and LMICs, researchers and RECs. While some of these objectives can be achieved through education for RECs and researchers, the power imbalance and differing rules should be addressed at the institutional, national, and international levels. Three of the authors were also research participants, which had potential to introduce bias into the findings. However, rigorous reflexivity practices mitigated against this. This insider perspective was also a strength, as it allowed us to access and contribute to more nuanced understandings to enhance the credibility of the findings. It also helped to mitigate against unequal power dynamics.

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Section: Discussionsupporting

confidence: 81%

Ethical challenges in global research on health system responses to violence against women: a qualitative study of policy and professional perspectives

Lewis,

Kalichman,

Azeredo

et al. 2024

BMC Med Ethics

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“…Strengths of PATH include: recruitment of a sizeable proportion of the eligible women experiencing abuse and seeking help [ 46 ]; successful collaboration with agencies in the DVA sector to deliver a psychological intervention with reasonable fidelity; relatively complete data collection from participants retained in the trial; outcome data from at least one time point after randomisation from 74% of participants; and a nested longitudinal qualitative study (see Evans et al, DOI: 10.1371/journal.pone.0193077 ). The main limitation threatening the internal validity of the trial is the 34% loss of participants 12 months post-intervention, requiring pre-specified imputation of the missing outcome data.…”

Section: Discussionmentioning

confidence: 99%

Psychological advocacy towards healing (PATH): A randomized controlled trial of a psychological intervention in a domestic violence service setting

et al. 2018

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BackgroundExperience of domestic violence and abuse (DVA) is associated with mental illness. Advocacy has little effect on mental health outcomes of female DVA survivors and there is uncertainty about the effectiveness of psychological interventions for this population.ObjectiveTo test effectiveness of a psychological intervention delivered by advocates to DVA survivors.Design, masking, setting, participantsPragmatic parallel group individually randomized controlled trial of normal DVA advocacy vs. advocacy + psychological intervention. Statistician and researchers blinded to group assignment. Setting: specialist DVA agencies; two UK cities. Participants: Women aged 16 years and older accessing DVA services.InterventionEight specialist psychological advocacy (SPA) sessions with two follow up sessions.MeasurementsPrimary outcomes at 12 months: depression symptoms (PHQ-9) and psychological distress (CORE-OM). Primary analysis: intention to treat linear (logistic) regression model for continuous (binary) outcomes.Results263 women recruited (78 in shelter/refuge, 185 in community), 2 withdrew (1 community, control group; 1 intervention, refuge group), 1 was excluded from the study for protocol violation (community, control group), 130 in intervention and 130 in control groups. Recruitment ended June 2013. 12-month follow up: 64%. At 12-month follow up greater improvement in mental health of women in the intervention group. Difference in average CORE-OM score between intervention and control groups: -3.3 points (95% CI -5.5 to -1.2). Difference in average PHQ-9 score between intervention and control group: -2.2 (95% CI -4.1 to -0.3). At 12 months, 35% of the intervention group and 55% of the control group were above the CORE-OM -2clinical threshold (OR 0.32, 95% CI 0.16 to 0.64); 29% of the intervention group and 46% of the control group were above the PHQ-9 clinical threshold (OR 0.41, 95% CI 0.21 to 0.81),Limitations64% retention at 12 monthsConclusionsAn eight-session psychological intervention delivered by DVA advocates produced clinically relevant improvement in mental health outcomes compared with normal advocacy care.Trial registrationISRCTN registry ISRCTN58561170Original Research3675/3750

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“…Despite these results, some researchers concluded that health professionals consider to have little information to deal with IPV 58 lack of training about the phenomena, resulting in lower clinical practices integrating IPV screening, difficulties in communicate with victims, and lack of knowledge about how to start the IPV conversation with their patients 59 Findings suggest, for example, that the implicit understanding of the dynamics of violent relationships and the behaviors of the perpetrator of domestic violence are essential components of health care provision to avoid inadvertent inappropriate interactions with women 60 .…”

Section: Prevalence Of Intimate Partner Violencementioning

confidence: 99%

Sleep and women intimate partner victimization: prevalence, effects and good practices in health care settings

Matos¹,

Gonçalves²

2019

Sleep Sci

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Intimate Partner Violence is a global health issue with higher prevalence worldwide, mostly in women, higher social and economic costs and devastating physical and mental health consequences for the victims. Sleep disturbances has been associated with other mental health issues, being an important symptom when diagnosing post-traumatic stress disorder, depression or anxiety. It can also constitute an important sign to help health professionals to identify potential victims of intimate partner violence. This review paper main objectives are to address the connection between intimate partner violence and sleep disruption, the role and barriers of health professionals in screening this type of violence when sleep problems are present, and to describe good practices in order to identify these victims and to provide support. It has been found that intimate partner victims commonly experience significant sleep disturbances that include truncated sleep, nightmares and less restful sleep. Health professionals are first-line professionals with a pivot role to screen and identify women victims. However, a set of personal (e.g., lack of knowledge and inadequate perceptions about violence, cultural issues) and organizational barriers (e.g., time constraints, lack of training, absence of institutional protocols) may limit the accurate reading of those symptoms. Accordingly, health professionals must be alert not only to physical health conditions associated with violence (acute physical injuries, chronic physical injuries, obstetric and genital injuries), but also psychological problems, like depression, anxiety, post-traumatic stress disorder, alcohol or drug misuse, sleep disturbances, insomnia and nightmares. In the presence of alert symptoms related to violence, health professionals become able to screen, identify and provide ongoing care for women, promoting a trusting relationship and assuming an attentive non-judgmental listening.

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Researching domestic violence and abuse in healthcare settings: Challenges and issues

Cited by 8 publications

References 62 publications

Ethical challenges in global research on health system responses to violence against women: a qualitative study of policy and professional perspectives

Ethical challenges in global research on health system responses to violence against women: a qualitative study of policy and professional perspectives

Psychological advocacy towards healing (PATH): A randomized controlled trial of a psychological intervention in a domestic violence service setting

Sleep and women intimate partner victimization: prevalence, effects and good practices in health care settings

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