Background Intimate partner violence (IPV) is a major public health problem with harmful conseque... more Background Intimate partner violence (IPV) is a major public health problem with harmful consequences. In Australia, there is no national standard screening tool and screening practice is variable across states. The objectives of this study were to assess in the antenatal healthcare setting: i) the validity of a new IPV brief screening tool and ii) women’s preference for screening response format, screening frequency and comfort level. Methods One thousand sixty-seven antenatal patients in a major metropolitan Victorian hospital in Australia completed a paper-based, self-administered survey. The survey included four screening items about whether they were Afraid/Controlled/Threatened/Slapped or physically hurt (ACTS) by a partner or ex-partner in the last 12 months; and the Composite Abuse Scale (reference standard). The ACTS screen was presented firstly with a binary yes/no response format and then with a five-point ordinal frequency format from ‘never’ (0) to ‘very frequently’ (4)...
Despite claims of “new” and “involved” fathers, research shows men’s actual fathering practices r... more Despite claims of “new” and “involved” fathers, research shows men’s actual fathering practices remain relatively unchanged. Increasing attention is being paid to the influence of child and family services on father engagement with calls from researchers and practitioners for a game change in parenting interventions. In this article, we draw on case study data to examine how gender impacts on maternal and child health services’ engagement with new fathers in respectful relationships programs. Our analysis shows that gender shapes men’s fathering and consequently their involvement in programs that seek to engage men as fathers. These gendered behaviors intersect with the practices, policies, and orientation of the Maternal and Child Health Service. The findings hold important implications for designing strategies to engage men in family services.
Reproductive coercion is understood as behavior interfering with a woman’s reproductive autonomy.... more Reproductive coercion is understood as behavior interfering with a woman’s reproductive autonomy. It is usually perpetrated by a male partner, and sometimes by other family members. Reproductive coercion encompasses violence, threats, or coercion to force a woman to become or remain pregnant, or to terminate a pregnancy. To date, few studies have focused on this topic, particularly using qualitative methods. In this article, we aim to explore how Australian health practitioners understand and perceive reproductive coercion. We conducted semistructured interviews with health practitioners from an Australian public hospital, and the resulting data were analyzed thematically. Overall, reproductive coercion was described as complex and hidden. There were diverse understandings around its parameters and scope, which were shaped by the participants’ disciplines and paradigms. Our findings point toward a need for greater clarity around reproductive coercion and how it sits within a broader...
Perpetrators of domestic violence are predominantly men, and victims/survivors are usually women ... more Perpetrators of domestic violence are predominantly men, and victims/survivors are usually women and children. Men who use violence in their relationships may present to general practice with relationship problems, mental health issues or substance abuse. Domestic violence has a significant negative impact on the health and wellbeing of the whole family. General practitioners (GPs) potentially play a pivotal role in identification, response and referral to men's behavioural change services. This article aims to describe how GPs can identify and respond to men who use violence in their relationships. It takes into account that male perpetrators are not a homogenous group, coming from all socioeconomic and cultural groups. GPs have a role in the identification, management and referral of men who use violence in their relationships. Great care needs to be taken when GPs are seeing the whole family, to ensure the safety of women and children.
Domestic violence is a global health issue. The World Health Organization (WHO) recommends traini... more Domestic violence is a global health issue. The World Health Organization (WHO) recommends training health professionals to respond appropriately to victims of domestic violence. Despite those who experience domestic violence attending general practice, general practitioners (GPs) receive little training in managing this issue. Helplines predominantly exist to support the general public and patients; however, few exist for GPs, and there are none regarding domestic violence. This article explores how helplines can support GPs in the management of patients who have experienced domestic violence. A scoping review of helplines targeting GPs was used in this study. Few helplines target health professionals and limited evaluations on these helplines have been undertaken. Health professional helplines cover broad specialist fields, and health professionals value access to specialists. Helplines are educational and increase the confidence of health professionals in providing quality patien...
Intimate partner violence (IPV) is common in patients attending health-care services and is assoc... more Intimate partner violence (IPV) is common in patients attending health-care services and is associated with a range of health problems. The majority of IPV perpetrators are men, and a substantial minority of men are victims, yet health-care professionals have little evidence or guidance on how to respond to male patients who perpetrate or experience violence in their intimate relationships. We conducted a systematic review to determine the effectiveness of interventions for male perpetrators or victims of IPV in health settings. Online databases, reference lists, Google Scholar, and gray literature were searched, and inclusion/exclusion criteria were applied. Narrative synthesis methods were used due to the heterogeneity of study types and outcome measures. Fourteen studies describing 10 interventions met our inclusion criteria: nine randomized controlled trials, four cohort studies, and one case-control study. Interventions were predominantly therapeutic in nature and many were con...
General practice nurses wishing to develop their careers in general practice are often unsupporte... more General practice nurses wishing to develop their careers in general practice are often unsupported, relying on the culture of individual practices. Given the structural diversity of Australian general practice, we qualitatively explored staff experiences of organisational governance, what supports are in place and can be used to assist nurses to advance. Semi-structured interviews with 28 staff (including nurses, GPs, receptions and practice managers) were undertaken across three practices, as part of a case-study approach. It was found that general practice staff know little of organisational governance and how it may be harnessed. Practical and flexible organisational governance were the most important factors in supporting general practice nurses to develop and utilise nursing skills, but advocacy from medical colleagues was necessary to support advancement. Barriers include funding structures, non-supportive cultures and inflexible organisational governance structures. Organisat...
The purpose of this study was to measure the prevalence of intimate partner and family violence a... more The purpose of this study was to measure the prevalence of intimate partner and family violence amongst a population of Australian female nurses, doctors and allied health professionals. We conducted a descriptive, cross-sectional survey in a large Australian tertiary maternity hospital with 471 participating female health professionals (45.0% response rate). The primary outcome measures were 12 month and lifetime prevalence of intimate partner violence (Composite Abuse Scale) and family violence. In the last 12 months, one in ten (43, 11.5%) participants reported intimate partner violence: 4.2% (16) combined physical, emotional and/or sexual abuse; 6.7% (25) emotional abuse and/or harassment; 5.1% (22) were afraid of their partner; and 1.7% (7) had been raped by their partner. Since the age of sixteen, one third (125, 29.7%) of participants reported intimate partner violence: 18.3% (77) had experienced combined physical, emotional and/or sexual abuse; 8.1% (34) emotional abuse and/...
Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists, Jan 26, 2018
Examine knowledge, opinions and practices of psychiatrists and trainees in responding to domestic... more Examine knowledge, opinions and practices of psychiatrists and trainees in responding to domestic violence (DV). Online survey including two sub-scales from PREMIS (Physician Readiness to Manage Intimate Partner Violence Survey): knowledge (10 items) and preparedness (10 items). Of psychiatrists completing the survey (216), 47% had received less than 2 hours of training in DV. PREMIS findings showed moderate knowledge of, and preparedness to deal with, DV. Participants with more clinical experience had significantly more knowledge and preparedness to deal with DV. Findings suggest more training in DV for psychiatrists is needed.
Intimate partner violence (IPV) is a common complex social and public health problem. Interventio... more Intimate partner violence (IPV) is a common complex social and public health problem. Interventions for IPV male perpetrators are an essential component of an early and effective response. Yet little is known about how to engage men in interventions for help-seeking. Using the theory of planned behavior (TPB), we explored men's perceptions of seeking help for an unhealthy relationship and how they could be supported to recognize their behavior and undertake change at an early stage. We recruited 23 men who were currently attending a men's behavior change program in Australia to take part in focus groups. These were recorded, transcribed, and thematically analyzed. The TPB concepts of behavioral beliefs, perceived control, and subjective norms were found throughout the data. Behavioral beliefs covered four subthemes: self-awareness, self-reflection and agency, the influence of others to change, and needing the right message in the right place. Perceived control was connected ...
Intimate partner violence (IPV) considerably harms the health, safety and well-being of women. In... more Intimate partner violence (IPV) considerably harms the health, safety and well-being of women. In response, public health systems around the globe have been gradually implementing strategies. In particular, low-income and middle-income countries (LMIC) have been developing innovative interventions in primary healthcare (PHC) addressing the problem. This paper describes a protocol for a systematic review of studies addressing the impacts and outcomes of PHC centre interventions addressing IPV against women from LMIC. A systematic search for studies will be conducted in African Index Medicus, Africa Portal Digital Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Index Medicus for the Southeast Asia Region, IndMed, Latin American and Caribbean Health Science Literature Database (LILACS), Medecins Sans Frontieres, MEDLINE, Minority Health and Health Equity Archive, ProQuest, PsycINFO, Scientific Electronic Library Online, (SciELO) and Social Policy and...
Australian and New Zealand journal of public health, Jan 22, 2017
An innovative health-justice partnership was established to deliver legal assistance to women exp... more An innovative health-justice partnership was established to deliver legal assistance to women experiencing family violence who attended an Australian hospital. This paper reports on a multifaceted response to build capacity and willingness of health professionals to identify signs of family violence and engage with referral pathways to on-site legal assistance. A Realistic Evaluation analysed health professionals' knowledge and attitudes towards identification, response and referral for family violence before and after training; and use of referral pathways. Of 123 health professionals participating in training, 67 completed baseline and follow-up surveys. Training improved health professionals' self-reported knowledge of, and confidence in, responding to family violence and understanding of lawyers' roles in hospitals. Belief that patients should be referred to on-site legal services increased. Training did not correspond to actual increased referrals to legal assistanc...
Australian and New Zealand journal of public health, 2017
To develop a scale to assess the perceived readiness of general practitioners (GPs) to identify a... more To develop a scale to assess the perceived readiness of general practitioners (GPs) to identify and respond to intimate partner abuse (IPA) and to examine its psychometric properties. A qualitative study of GPs' perceived readiness and a literature review were used to generate items for the General Practitioners' Perceived Readiness to identify and respond to Intimate Partner Abuse Scale (GRIPS). Responses of 287 Australian GPs and GP registrars were analysed to provide psychometric evaluation of the GRIPS. Principal components analysis generated a three-factor scale comprising 30 items with good internal consistency, (Cronbach's alpha from 0.67 to 0.88). The three distinct and reliable subscales consisting of 7 to 13 items are: Self-Efficacy; Motivational Readiness; and Emotional Readiness. The subscales were closely correlated with relevant theoretical constructs and demonstrated a unique relationship with IPA training and clinical experience. The GRIPS, a new scale wi...
There are few existing studies which have investigated the meanings of 'readiness' and &#... more There are few existing studies which have investigated the meanings of 'readiness' and 'preparedness' among family doctors working with female patients who experience intimate partner abuse (IPA). We aimed to explore how doctors perceived the concepts of readiness and preparedness to identify and respond to IPA against female patients. We adopted purposive sampling and conducted individual semi-structured interviews with 19 doctors (11 females and 8 males) practising in primary care. Thematic analysis identified dominant and associated themes, and the coding framework was transformed into a thematic map. We further applied cross-coding and code-confirming procedures in analysing the transcripts. Participants described differences in the meanings of readiness and preparedness when responding to IPA, though they considered that these two concepts were inter-related. The findings revealed four themes of doctors' perceived 'readiness' to identify and respond ...
Australian and New Zealand journal of public health, 2017
Sexual violence (SV) against adult women is prevalent and associated with a range of mental healt... more Sexual violence (SV) against adult women is prevalent and associated with a range of mental health issues. General practitioners could potentially have a role in responding, however, there is little information to help guide them. Data around prevalence of all forms of adult SV (not just rape) is inconsistent, particularly in clinical samples, and the links between other forms of SV and mental health issues are not well supported. This study aimed to address these gaps in the knowledge base. A descriptive, cross-sectional study was conducted in Australian general practice clinics. Two hundred and thirty adult women completed an anonymous iPad survey while waiting to see the doctor. More than half the sample had experienced at least one incident of adult SV. Most commonly, women reported public harassment or flashing, unwanted groping and being coerced into sex. Women who had experienced adult SV were more likely to experience anxiety than women who had not, even after controlling fo...
Background Intimate partner violence (IPV) is a major public health problem with harmful conseque... more Background Intimate partner violence (IPV) is a major public health problem with harmful consequences. In Australia, there is no national standard screening tool and screening practice is variable across states. The objectives of this study were to assess in the antenatal healthcare setting: i) the validity of a new IPV brief screening tool and ii) women’s preference for screening response format, screening frequency and comfort level. Methods One thousand sixty-seven antenatal patients in a major metropolitan Victorian hospital in Australia completed a paper-based, self-administered survey. The survey included four screening items about whether they were Afraid/Controlled/Threatened/Slapped or physically hurt (ACTS) by a partner or ex-partner in the last 12 months; and the Composite Abuse Scale (reference standard). The ACTS screen was presented firstly with a binary yes/no response format and then with a five-point ordinal frequency format from ‘never’ (0) to ‘very frequently’ (4)...
Despite claims of “new” and “involved” fathers, research shows men’s actual fathering practices r... more Despite claims of “new” and “involved” fathers, research shows men’s actual fathering practices remain relatively unchanged. Increasing attention is being paid to the influence of child and family services on father engagement with calls from researchers and practitioners for a game change in parenting interventions. In this article, we draw on case study data to examine how gender impacts on maternal and child health services’ engagement with new fathers in respectful relationships programs. Our analysis shows that gender shapes men’s fathering and consequently their involvement in programs that seek to engage men as fathers. These gendered behaviors intersect with the practices, policies, and orientation of the Maternal and Child Health Service. The findings hold important implications for designing strategies to engage men in family services.
Reproductive coercion is understood as behavior interfering with a woman’s reproductive autonomy.... more Reproductive coercion is understood as behavior interfering with a woman’s reproductive autonomy. It is usually perpetrated by a male partner, and sometimes by other family members. Reproductive coercion encompasses violence, threats, or coercion to force a woman to become or remain pregnant, or to terminate a pregnancy. To date, few studies have focused on this topic, particularly using qualitative methods. In this article, we aim to explore how Australian health practitioners understand and perceive reproductive coercion. We conducted semistructured interviews with health practitioners from an Australian public hospital, and the resulting data were analyzed thematically. Overall, reproductive coercion was described as complex and hidden. There were diverse understandings around its parameters and scope, which were shaped by the participants’ disciplines and paradigms. Our findings point toward a need for greater clarity around reproductive coercion and how it sits within a broader...
Perpetrators of domestic violence are predominantly men, and victims/survivors are usually women ... more Perpetrators of domestic violence are predominantly men, and victims/survivors are usually women and children. Men who use violence in their relationships may present to general practice with relationship problems, mental health issues or substance abuse. Domestic violence has a significant negative impact on the health and wellbeing of the whole family. General practitioners (GPs) potentially play a pivotal role in identification, response and referral to men's behavioural change services. This article aims to describe how GPs can identify and respond to men who use violence in their relationships. It takes into account that male perpetrators are not a homogenous group, coming from all socioeconomic and cultural groups. GPs have a role in the identification, management and referral of men who use violence in their relationships. Great care needs to be taken when GPs are seeing the whole family, to ensure the safety of women and children.
Domestic violence is a global health issue. The World Health Organization (WHO) recommends traini... more Domestic violence is a global health issue. The World Health Organization (WHO) recommends training health professionals to respond appropriately to victims of domestic violence. Despite those who experience domestic violence attending general practice, general practitioners (GPs) receive little training in managing this issue. Helplines predominantly exist to support the general public and patients; however, few exist for GPs, and there are none regarding domestic violence. This article explores how helplines can support GPs in the management of patients who have experienced domestic violence. A scoping review of helplines targeting GPs was used in this study. Few helplines target health professionals and limited evaluations on these helplines have been undertaken. Health professional helplines cover broad specialist fields, and health professionals value access to specialists. Helplines are educational and increase the confidence of health professionals in providing quality patien...
Intimate partner violence (IPV) is common in patients attending health-care services and is assoc... more Intimate partner violence (IPV) is common in patients attending health-care services and is associated with a range of health problems. The majority of IPV perpetrators are men, and a substantial minority of men are victims, yet health-care professionals have little evidence or guidance on how to respond to male patients who perpetrate or experience violence in their intimate relationships. We conducted a systematic review to determine the effectiveness of interventions for male perpetrators or victims of IPV in health settings. Online databases, reference lists, Google Scholar, and gray literature were searched, and inclusion/exclusion criteria were applied. Narrative synthesis methods were used due to the heterogeneity of study types and outcome measures. Fourteen studies describing 10 interventions met our inclusion criteria: nine randomized controlled trials, four cohort studies, and one case-control study. Interventions were predominantly therapeutic in nature and many were con...
General practice nurses wishing to develop their careers in general practice are often unsupporte... more General practice nurses wishing to develop their careers in general practice are often unsupported, relying on the culture of individual practices. Given the structural diversity of Australian general practice, we qualitatively explored staff experiences of organisational governance, what supports are in place and can be used to assist nurses to advance. Semi-structured interviews with 28 staff (including nurses, GPs, receptions and practice managers) were undertaken across three practices, as part of a case-study approach. It was found that general practice staff know little of organisational governance and how it may be harnessed. Practical and flexible organisational governance were the most important factors in supporting general practice nurses to develop and utilise nursing skills, but advocacy from medical colleagues was necessary to support advancement. Barriers include funding structures, non-supportive cultures and inflexible organisational governance structures. Organisat...
The purpose of this study was to measure the prevalence of intimate partner and family violence a... more The purpose of this study was to measure the prevalence of intimate partner and family violence amongst a population of Australian female nurses, doctors and allied health professionals. We conducted a descriptive, cross-sectional survey in a large Australian tertiary maternity hospital with 471 participating female health professionals (45.0% response rate). The primary outcome measures were 12 month and lifetime prevalence of intimate partner violence (Composite Abuse Scale) and family violence. In the last 12 months, one in ten (43, 11.5%) participants reported intimate partner violence: 4.2% (16) combined physical, emotional and/or sexual abuse; 6.7% (25) emotional abuse and/or harassment; 5.1% (22) were afraid of their partner; and 1.7% (7) had been raped by their partner. Since the age of sixteen, one third (125, 29.7%) of participants reported intimate partner violence: 18.3% (77) had experienced combined physical, emotional and/or sexual abuse; 8.1% (34) emotional abuse and/...
Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists, Jan 26, 2018
Examine knowledge, opinions and practices of psychiatrists and trainees in responding to domestic... more Examine knowledge, opinions and practices of psychiatrists and trainees in responding to domestic violence (DV). Online survey including two sub-scales from PREMIS (Physician Readiness to Manage Intimate Partner Violence Survey): knowledge (10 items) and preparedness (10 items). Of psychiatrists completing the survey (216), 47% had received less than 2 hours of training in DV. PREMIS findings showed moderate knowledge of, and preparedness to deal with, DV. Participants with more clinical experience had significantly more knowledge and preparedness to deal with DV. Findings suggest more training in DV for psychiatrists is needed.
Intimate partner violence (IPV) is a common complex social and public health problem. Interventio... more Intimate partner violence (IPV) is a common complex social and public health problem. Interventions for IPV male perpetrators are an essential component of an early and effective response. Yet little is known about how to engage men in interventions for help-seeking. Using the theory of planned behavior (TPB), we explored men's perceptions of seeking help for an unhealthy relationship and how they could be supported to recognize their behavior and undertake change at an early stage. We recruited 23 men who were currently attending a men's behavior change program in Australia to take part in focus groups. These were recorded, transcribed, and thematically analyzed. The TPB concepts of behavioral beliefs, perceived control, and subjective norms were found throughout the data. Behavioral beliefs covered four subthemes: self-awareness, self-reflection and agency, the influence of others to change, and needing the right message in the right place. Perceived control was connected ...
Intimate partner violence (IPV) considerably harms the health, safety and well-being of women. In... more Intimate partner violence (IPV) considerably harms the health, safety and well-being of women. In response, public health systems around the globe have been gradually implementing strategies. In particular, low-income and middle-income countries (LMIC) have been developing innovative interventions in primary healthcare (PHC) addressing the problem. This paper describes a protocol for a systematic review of studies addressing the impacts and outcomes of PHC centre interventions addressing IPV against women from LMIC. A systematic search for studies will be conducted in African Index Medicus, Africa Portal Digital Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Index Medicus for the Southeast Asia Region, IndMed, Latin American and Caribbean Health Science Literature Database (LILACS), Medecins Sans Frontieres, MEDLINE, Minority Health and Health Equity Archive, ProQuest, PsycINFO, Scientific Electronic Library Online, (SciELO) and Social Policy and...
Australian and New Zealand journal of public health, Jan 22, 2017
An innovative health-justice partnership was established to deliver legal assistance to women exp... more An innovative health-justice partnership was established to deliver legal assistance to women experiencing family violence who attended an Australian hospital. This paper reports on a multifaceted response to build capacity and willingness of health professionals to identify signs of family violence and engage with referral pathways to on-site legal assistance. A Realistic Evaluation analysed health professionals' knowledge and attitudes towards identification, response and referral for family violence before and after training; and use of referral pathways. Of 123 health professionals participating in training, 67 completed baseline and follow-up surveys. Training improved health professionals' self-reported knowledge of, and confidence in, responding to family violence and understanding of lawyers' roles in hospitals. Belief that patients should be referred to on-site legal services increased. Training did not correspond to actual increased referrals to legal assistanc...
Australian and New Zealand journal of public health, 2017
To develop a scale to assess the perceived readiness of general practitioners (GPs) to identify a... more To develop a scale to assess the perceived readiness of general practitioners (GPs) to identify and respond to intimate partner abuse (IPA) and to examine its psychometric properties. A qualitative study of GPs' perceived readiness and a literature review were used to generate items for the General Practitioners' Perceived Readiness to identify and respond to Intimate Partner Abuse Scale (GRIPS). Responses of 287 Australian GPs and GP registrars were analysed to provide psychometric evaluation of the GRIPS. Principal components analysis generated a three-factor scale comprising 30 items with good internal consistency, (Cronbach's alpha from 0.67 to 0.88). The three distinct and reliable subscales consisting of 7 to 13 items are: Self-Efficacy; Motivational Readiness; and Emotional Readiness. The subscales were closely correlated with relevant theoretical constructs and demonstrated a unique relationship with IPA training and clinical experience. The GRIPS, a new scale wi...
There are few existing studies which have investigated the meanings of 'readiness' and &#... more There are few existing studies which have investigated the meanings of 'readiness' and 'preparedness' among family doctors working with female patients who experience intimate partner abuse (IPA). We aimed to explore how doctors perceived the concepts of readiness and preparedness to identify and respond to IPA against female patients. We adopted purposive sampling and conducted individual semi-structured interviews with 19 doctors (11 females and 8 males) practising in primary care. Thematic analysis identified dominant and associated themes, and the coding framework was transformed into a thematic map. We further applied cross-coding and code-confirming procedures in analysing the transcripts. Participants described differences in the meanings of readiness and preparedness when responding to IPA, though they considered that these two concepts were inter-related. The findings revealed four themes of doctors' perceived 'readiness' to identify and respond ...
Australian and New Zealand journal of public health, 2017
Sexual violence (SV) against adult women is prevalent and associated with a range of mental healt... more Sexual violence (SV) against adult women is prevalent and associated with a range of mental health issues. General practitioners could potentially have a role in responding, however, there is little information to help guide them. Data around prevalence of all forms of adult SV (not just rape) is inconsistent, particularly in clinical samples, and the links between other forms of SV and mental health issues are not well supported. This study aimed to address these gaps in the knowledge base. A descriptive, cross-sectional study was conducted in Australian general practice clinics. Two hundred and thirty adult women completed an anonymous iPad survey while waiting to see the doctor. More than half the sample had experienced at least one incident of adult SV. Most commonly, women reported public harassment or flashing, unwanted groping and being coerced into sex. Women who had experienced adult SV were more likely to experience anxiety than women who had not, even after controlling fo...
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