General Practice and Primary Care - Research Publications
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ItemBarriers to Responding to Reproductive Coercion and Abuse in Australian Primary Care(BioMed Central, 2021-05-04)Background: Reproductive coercion and abuse is defined as any behaviour that seeks to control a woman’s reproductive autonomy. In Australia, women often access reproductive health care through a primary care clinician, however, little is known about clinicians’ experiences responding to reproductive coercion and abuse. This study aims to address this gap by exploring the barriers to responding to reproductive coercion and abuse in Australian primary care. Methods: Twenty-four primary care clinicians from diverse clinical settings in primary care across Australia were recruited to participate in a semi-structured interview. Data were analysed thematically. Results: Through analysis, three themes were developed: It’s not even in the frame, which centred around clinicians lack of awareness around the issue. There’s not much we can do and There’s no one to help us. Conclusions: Many clinicians felt ill-equipped to identify and respond to reproductive coercion and abuse. Some clinicians hadn’t received any formal training, others were trained but had nowhere to refer women. Further complicating responses was a lack of support from referral services. This study highlights the need for more training and a streamlined referral pathways for women who experience reproductive coercion and abuse, as well as better access to reproductive health services in rural areas.
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ItemHow do health practitioners in a large Australian public hospital identify and respond to reproductive abuse? A qualitative study(ELSEVIER SCIENCE INC, 2019-10)OBJECTIVE: Reproductive abuse is defined as a deliberate attempt to control or interfere with a woman's reproductive choices. It is associated with a range of negative health outcomes and presents a hidden challenge for health practitioners. There is a dearth of research on reproductive abuse, particularly qualitative research. This study aims to address this gap by exploring how health practitioners in a large Australian public hospital identify and respond to reproductive abuse. METHODS: We conducted semi-structured interviews with n=17 health practitioners working across multiple disciplines within a large metropolitan public hospital in Victoria. Data were analysed thematically. RESULTS: Three themes were developed: Figuring out that something is wrong; Creating a safe space to work out what she wants; and Everyone needs to do their part. CONCLUSIONS: Practitioners relied on intuition developed through experience to identify reproductive abuse. Once identified, most practitioners described a woman-led response promoting safety; however, there were inconsistencies in how this was enacted across different professions. Lack of clarity around the level of response required was also a barrier. Implications for public health: Our findings highlight the pressing need for evidence-based guidelines for health practitioners and a 'best practice' model specific to reproductive abuse.
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ItemBarriers to responding to reproductive coercion and abuse among women presenting to Australian primary care(BMC, 2021-05-04)BACKGROUND: Reproductive coercion and abuse is defined as any behaviour that seeks to control a woman's reproductive autonomy. In Australia, women often access reproductive health care through a primary care clinician, however, little is known about clinicians' experiences responding to reproductive coercion and abuse. This study aims to address this gap by exploring the barriers to responding to reproductive coercion and abuse in Australian primary care. METHODS: In this qualitative study, twenty-four primary care clinicians from diverse clinical settings in primary care across Australia were recruited to participate in a semi-structured interview. Data were analysed thematically. RESULTS: Through analysis, three themes were developed: It's not even in the frame; which centred around clinicians lack of awareness around the issue. There's not much we can do, where clinicians described a lack of confidence in responding correctly as well as a lack of services to refer on to. Lastly There's no one to help us, explaining the disconnect between referral services and primary care as well as the impacts of lack of abortion on women experiencing reproductive coercion and abuse. CONCLUSIONS: Clinicians expressed similar experiences of barriers to respond to reproductive coercion and abuse. Many clinicians felt ill-equipped to identify and respond to reproductive coercion and abuse. Some clinicians hadn't received any formal training, others were trained but had nowhere to refer women. Further complicating responses was a lack of support from referral services. This study highlights the need for more training and a streamlined referral pathways for women who experience reproductive coercion and abuse, as well as better access to reproductive health services in rural areas.
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ItemWomen's experiences and expectations after disclosure of intimate partner abuse to a healthcare provider: A qualitative meta-synthesis(BMJ PUBLISHING GROUP, 2020)OBJECTIVE: To identify and synthesise the experiences and expectations of women victim/survivors of intimate partner abuse (IPA) following disclosure to a healthcare provider (HCP). METHODS: The databases MEDLINE, Embase, CINAHL, PsychINFO, SocINDEX, ASSIA and the Cochrane Library were searched in February 2020. Included studies needed to focus on women's experiences with and expectations of HCPs after disclosure of IPA. We considered primary studies using qualitative methods for both data collection and analysis published since 2004. Studies conducted in any country, in any type of healthcare setting, were included. The quality of individual studies was assessed using an adaptation of the Critical Appraisal Skills Programme checklist for qualitative studies. The confidence in the overall evidence base was determined using Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-Confidence in the Evidence from Reviews of Qualitative Research methods. Thematic synthesis was used for analysis. RESULTS: Thirty-one papers describing 30 studies were included in the final review. These were conducted in a range of health settings, predominantly in the USA and other high-income countries. All studies were in English. Four main themes were developed through the analysis, describing women's experiences and expectations of HCPs: (1) connection through kindness and care; (2) see the evil, hear the evil, speak the evil; (3) do more than just listen; and (4) plant the right seed. If these key expectations were absent from care, it resulted in a range of negative emotional impacts for women. CONCLUSIONS: Our findings strongly align with the principles of woman-centred care, indicating that women value emotional connection, practical support through action and advocacy and an approach that recognises their autonomy and is tailored to their individual needs. Drawing on the evidence, we have developed a best practice model to guide practitioners in how to deliver woman-centred care. This review has critical implications for practice, highlighting the simplicity of what HCPs can do to support women experiencing IPA, although its applicability to low-income and-middle income settings remains to be explored.
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Item"A Huge, Hidden Problem": Australian Health Practitioners' Views and Understandings of Reproductive Coercion(SAGE PUBLICATIONS INC, 2019-08)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 framework of violence against women, to facilitate cross-disciplinary collaborative responses.