Adapting an evidence-based domestic violence intervention for general practice for behaviour change in community pharmacist consultations
Domestic violence and abuse (DVA) is a public health problem with devastating consequences for women’s health. A local health commissioner’s enquiry and scoping review suggest that women experiencing DVA may use more emergency contraceptives (EC) than other women. As community pharmacists provide sexual health services including supply of nearly 50% of all emergency hormonal contraceptives, they may be the first point of contact for patients experiencing DVA. Therefore, pharmacists should be involved in the primary health-care response to this public health problem. Identification and Referral to Improve Safety (IRIS) is an evidence-based intervention for behaviour change in general practitioner consultations with patients presenting with indicators of DVA. This study aimed to adapt IRIS for behaviour change in community pharmacist consultations on sexual health.
We followed the MRC framework for the development of complex interventions and the framework for the co-production of public health interventions. We used the COM-B Behaviour Change Wheel framework to ensure that the adapted intervention is grounded in established techniques to change behaviour. The adaptation work was carried out in two stages:1) an evidence synthesis from systematic review and case-control study in Clinical Practice Research Datalink (CPRD) on the association between DVA and EC use, literature review of DVA interventions in pharmacies and thematic analysis of qualitative interviews with pharmacists about the feasibility and acceptability of an adapted IRIS (n=20);2) co-production of the adapted IRIS with pharmacy stakeholders (n=13).During stage 2, we established an intervention development group consisting of members of the research team, IRIS developers and an academic pharmacist.
The systematic review and CPRD study found a positive association between DVA and EC use (OR between 1.5; 95% CI 1.1-2.0 and 6.5; 95% CI 4.2-10.2). We did not find studies of DVA interventions in community pharmacies. The qualitative study found that pharmacists were confident in providing public health services but lacked skills and confidence in identifying and responding to DVA. Pharmacists welcomed training on DVA, alongside organisation and system-level support, and raising public awareness on the role of pharmacies in multi-sector response to DVA. Pharmacists suggested adapting IRIS to the sexual health consultations (i.e., EC, chlamydia screening). Informed by the evidence from stage 1, the intervention development group drafted an IRIS adaptation, ran two stakeholder workshops, and mapped findings from stage 1 and workshops on the COM-B framework. The combined findings informed a programme theory and logic model for the adapted IRIS.
The adapted IRIS intervention will be tested in a feasibility study. Our systematic, theory driven adaptation of IRIS to a new setting and professional group has the potential to increase intervention acceptability, feasibility, and behaviour change in a transferable way, which may be applicable to other health-care settings.