Training clinicians to proactively ask patients about domestic violence and abuse (DVA) is feasible for sexual health clinics to implement and could increase referrals to specialist services, according to a joint CLAHRC North Thames/CLAHRC West study led by researchers at Queen Mary University of London (QMUL) and the University of Bristol involving over 4,300 women.
The risk of gynaecological and sexual health problems (including sexually transmitted infections, painful sex, vaginal bleeding and recurrent urinary tract infections) is three-fold higher in women who have suffered DVA. Meanwhile, 47 per cent of women attending sexual health services will have experienced DVA at some point in their lives.
Sexual health services can be the first point of contact for women who have experienced DVA, and were listed by the National Institute for Health and Care Excellence (NICE) as a setting in which all patients should be asked about DVA. However, most sexual health professionals have had minimal training in identifying and responding to DVA.
The study looked at the feasibility of sexual health clinics adopting a programme called IRIS (Identification and Referral to Improve Safety) – a DVA training and referral programme endorsed by NICE, the Royal College of GPs and Department of Health, originally aimed at encouraging GPs to ask patients whether they are experiencing DVA and to make referrals to specialist domestic violence services.
The team tested the intervention in two female walk-in sexual health services; an east London clinic serving an inner-city multi-ethnic population, and a Bristol clinic serving an urban population.
In the east London clinic over seven weeks, 267 out of 2,568 women attending were asked about DVA, with 16 of those (4 per cent) saying that they were affected by abuse. Overall, eight of the women affected by abuse (50 per cent) were referred to specialist services.
In the Bristol clinic over twelve weeks, 1,090 out of 1,775 women attending were asked about DVA, with 79 of those (7 per cent) saying they were affected by abuse. Overall, eight of the women affected by abuse (10 per cent), were referred to the specialist services.
Lead CLAHRC North Thames researcher Dr Alex Sohal (pictured left) said:
“Women attend sexual health clinics for care of their sexual health but little thought is given to whether the relationship with the person that a woman has sex with directly harms her health. Without training, system level changes and senior managerial support, clinicians end up ignoring DVA in consultations or have an arbitrary approach that fails many women affected by DVA.
Not only is this a feasible intervention for a sexual health clinic setting, but we also found that clinical leads and busy local DVA service providers were incredibly supportive, with many people understanding the importance of making this work.”
Read the full paper:
Improving the healthcare response to domestic violence and abuse in sexual health clinics: feasibility study of a training, support and referral intervention
Sohal AH, Pathak N, Blake S, et al. Sex Transm Infect Published Online First: doi:10.1136/ sextrans-2016-052866
Research Assistant Moïse Roche enjoyed success at the recent prestigious Health Services Research UK conference in Nottingham.
A poster outlining Moise’s work, as part of our Improving care of people with memory problems in Black African and Caribbean groups study won the People’s Poster Prize at the event – as voted by attendees.
Congratulations to Moïse!
A project under our mental health theme focuses on improving the care of Black African and Caribbean people with memory problems, which can be an early warning sign for dementia. We know that Black African and Caribbean elders develop dementia earlier, and seek help later than their white peers.
This delay can greatly impact access to care and support, and reduce the independence of dementia patients prematurely.
We have carried out extensive engagement work within this community – running focus groups and conducting interviews to find out the perceptions and beliefs that prevent people visiting their GP when memory problems first arise.
As well as disseminating our findings we have concentrated all the learning from the project into a new leaflet “Getting help for forgetfulness“.
We co-designed this leaflet with patients and the public and it aims to encourage health-seeking behaviour among elders encountering memory problems.
It answers questions about symptoms, sets out what help is available and why you should visit your GP, and provides useful information and contacts.
We trialled the leaflet in patients without a diagnosis of dementia in several GP practices and they liked it.
We can provide printed copies to the NHS, community and voluntary groups and charities – just contact us with your needs.
Email Moïse Roche to order copies of the leaflet – email@example.com
School-based interventions to increase health and wellbeing
The health and wellbeing of school children is a pressing concern in England, with a growing prevalence of obesity and diabetes in childhood. It is also widely recognised that a child’s emotional health and wellbeing influences their cognitive development and learning, as well as their physical and social health and mental wellbeing in adulthood.
These increased concerns, aligned with a better recognition of the emotional and mental health needs of children, led the Greater London Authority (GLA) to develop and co-ordinate a school based health programme to improve health and wellbeing for all pupils in London.
The result was the development of the GLA’s Healthy Schools London programme (HSL) launched in April 2013 and co-ordinated by the Greater London Authority (GLA). The programme encourages schools to adopt a whole school approach to combat the specific health and wellbeing needs of their pupils by developing their policies and procedures. HSL recognises and rewards the schools’ endeavours through a system of awards: Bronze, Silver, and Gold.
A CLAHRC North Thames project recently completed a two-year evaluation of the programme. The aim of the evaluation was to assess the contribution of the programme to improving educational attainment, and health and well-being, among schoolchildren in London. It was funded jointly by the GLA and the CLAHRC, and was conducted between 2014 and 2016 by Dr Harry Rutter and Dr Andrew Barnfield from the London School of Hygiene and Tropical Medicine (LSHTM).
We conducted literature reviews, focus groups in 20 schools, interviews with 6 directors of public health and directors of children’s services, focus groups with borough leads, interviews with the GLA core team and borough leads, and two assessment visits to special schools. We also conducted an online survey across all participating schools, with a total of over 450 responses.
Was HSL effective in its aims?
- Assessed the potential for the HSL programme to influence educational achievement, promote healthy lifestyle behaviours, and reduce health inequalities in London
- Investigated the extent to which becoming a Healthy School is associated with changes in school-level policies, and activities.
- Assessed the nature and level of engagement with the HSL programme by schools, including any differential uptake by socio-economic factors, and to understand the drivers and barriers to becoming a Healthy School
- Provided recommendations to inform the ongoing development of the HSL programme
The evaluation concluded that HSL provides a valuable mechanism to encourage change at school level. Among a suite of recommendations, the evaluation suggested that:
- HSL would be strengthened by encouraging schools to work more closely together.
- A mentoring programme could help to spread best practice between schools,
- There is scope for stronger links between school sand local communities.
- The implementation of a programme to enhance health and wellbeing provision in early year’s settings could provide an additional mechanism for health improvement, and promote school preparedness among the capital’s children.
Harry Rutter is a public health physician. He is a senior clinical research fellow at the London School of Hygiene and Tropical Medicine; senior strategic adviser on obesity to Public Health England; an adjunct professor of public health at University College Cork; and an honorary senior clinical lecturer at the University of Oxford. He was the founder director of the National Obesity Observatory for England 2007-2011, led the development of the English National Child Measurement Programme childhood obesity surveillance system, chaired the NICE Programme Development Group (PDG) for guidance on promoting walking and cycling, was a member of the NICE PDG on preventing obesity and the Department of Health Expert Panel on obesity, sat on the management group of the Foresight Obesity project, and has helped to lead the development of the WHO Europe Health Economic Assessment Tool (WHO HEAT). He is currently involved in research assessing the role of social and environmental factors on both obesity and physical activity, and the research and policy implications of intervening in complex system.
Professor Feder’s expertise includes Cardiovascular health – in particular the diagnosis and management of angina and using cardiovascular risk as a basis of treatment decisions. He was was a co-applicant on our successful bid to secure funding for the Identification and Referral to Improve Safety (IRIS): Improving the response to domestic violence and abuse project and is working with us from his base at the University of Bristol.
Anna is an NIHR funded PhD student evaluating the implementation of a primary care domestic violence training programme. Anna’s work relates to our Identification and Referral to Improve Safety (IRIS): Improving the response to domestic violence and abuse project.
She has an interest in translational research, qualitative methods, gender, health inequalities and participatory approaches to research.