Reaching everyone in general practice with the IRIS+ domestic violence training and support programme: Challenges and opportunities
While knowledge of the impact of domestic violence and abuse (DVA) on health is increasing, there is considerable scope to address system barriers to DVA identification within the general practice setting and enhance clinicians’ ability to respond appropriately to affected families. The IRIS+ intervention aimed to increase the safety and wellbeing of victims of DVA by improving that response. This paper presents some of the key findings of the feasibility study and will explore clinician and patient engagement, issues around feasibility, acceptability, implementation, as well as future research directions.
The IRIS+ feasibility study builds on the successful IRIS model and is part of the REPROVIDE programme of research on healthcare responses to DVA. The original IRIS model was focused on the needs of women survivors of DVA. Tested in a randomised controlled trial, IRIS has been implemented nationally in the UK in 35 areas. The objective of the IRIS+ intervention was to improve the identification and management of DVA in general practice by facilitating disclosure, referral, documentation and follow-up care of female and male patients who may have experienced DVA as victims or perpetrators and their children. The aim of the IRIS+ study was to develop and deliver the intervention (training and referral to specialist DVA advocacy support programme) and evaluate its feasibility, acceptability and utility with a mixed method design. Like the original IRIS model, IRIS+ was based on a close partnership with a specialist DVA agency.IRIS+ provides an example of an evidence-based multi-component intervention that has been developed with multi-professional input and has been evaluated for feasibility using mixed methods: secondary data extraction, semi-structured interviews, questionnaires.
Our process evaluation led to an understanding of practice level and contextual factors enhancing and blocking the implementation of the IRIS+ intervention, also revealing potential new mechanisms for strengthening direct identification and referral of children exposed to DVA and men experiencing or perpetrating DVA, particularly extensive 3rd party reports of DVA in the medical record. The pilot of IRIS+ found that delivery of the intervention was feasible and proved acceptable to general practices and to those patients who were identified as experiencing DVA and referred to the IRIS+ hub. Moreover, it was feasible to measure outcomes in this vulnerable population in the IRIS+ hub setting. Identification and referral of children exposed to DVA is a breakthrough in the general practice setting. However, we did not demonstrate the feasibility of identifying and referring men exposed to or perpetrating DVA.
Implications of these findings for the next phase of research and for wider implementation will be discussed.