Sexual health professionals feel that it is appropriate and valuable to ask their patients about domestic violence and abuse, NIHR-funded research at the University of Bristol and Queen Mary University of London has found. But time, workload and finding the right moment during consultations can be barriers to doing so.
The risk of gynaecological and sexual health problems is three times higher in women who have suffered domestic abuse. Forty-seven per cent of women attending sexual health services will have experienced domestic abuse at some point in their lives.
Sexual health services can be the first point of contact for women who have experienced domestic abuse. The National Institute for Health and Care Excellence (NICE) list them as a setting in which patients should be asked about it. However, most sexual health professionals have had minimal training in identifying and responding to it.
The researchers talked to front line sexual health staff and domestic violence and abuse advocate workers about their experience of using an evidence-based training package, IRIS ADViSE.
GP surgeries in 34 areas of England and Wales have implemented the IRIS (Identification and Referral to Improve Safety) programme, following a successful randomised controlled trial and development of a commissioning model. IRIS helps GPs to identify and respond to women who are experiencing domestic abuse, and refer them on to specialist services. In the areas using IRIS, there have been significant increases in women being referred to domestic violence agencies and the recording of domestic abuse in patients’ medical records.
Following on from this success in primary care, the IRIS ADViSE (Assessing for Domestic Violence in Sexual Health Environments) pilot looked at using the IRIS approach in a sexual health setting. It provides IRIS-based training to the sexual health workforce, with the aim of increasing professional awareness and improving their responses to patients experiencing domestic abuse.
The research team interviewed 17 sexual health clinic staff and domestic violence and abuse advocate workers who had been involved in the IRIS ADViSE pilot in Bristol. All the people interviewed felt that asking about domestic abuse and referring women on to specialist services was appropriate and valuable in a sexual health setting.
The staff described feeling confident and prepared after the training. They were able to tailor how they asked about domestic abuse to suit the patient. Some staff did describe initial challenges ensuring a ‘comfortable’ consultation when first asking about domestic abuse. Managing the time pressure as a result of a patient disclosing that they’d been abused could also be difficult.
The staff reported that some disclosures were considered relatively simple and easy to handle, where patients can be easily referred to the partner domestic violence and abuse organisation or provided with information.
However, cases with an immediate risk of harm to the patient or their children were more complex in terms of managing the patient’s wishes and navigating existing safeguarding procedures. This added to staff’s already limited time and busy workloads.
Dr Jeremy Horwood, lead researcher from the Centre for Academic Primary Care at University of Bristol and NIHR CLAHRC West, said:
“Sexual health staff are definitely supportive of asking their patients about domestic violence and abuse. But it’s crucial that they have support to do so, as these patients must be dealt with sensitively and referred on appropriately.
“At the policy and commissioning level, stronger recognition of the issues around domestic violence and abuse referrals, and resources to support them, are needed. Commissioners and local NHS trusts need to engage and commit to support domestic violence and abuse training, and to support programmes such as IRIS ADViSE.”
A companion study published in Sexually Transmitted Infections in July looked at referral data in two sexual health clinics, one in Bristol and another in east London, where staff had been trained using IRIS ADViSE.
The qualitative research was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West and the Wellcome Trust.
‘Assessing for Domestic Violence in Sexual Health Environments: a qualitative study’: Jeremy Horwood, Andrew Morden, Jayne E Bailey, Neha Pathak, Gene Feder. Published in Sexually Transmitted Infections