General Practice and Primary Care - Research Publications
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ItemSexual violence associated with poor mental health in women attending Australian general practices(ELSEVIER SCIENCE INC, 2017-10)OBJECTIVE: 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. METHODS: 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. RESULTS: 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 for other factors. Women who had experienced adult SV were more likely to feel down, depressed or hopeless than women who had not; however, this association disappeared after controlling for childhood sexual abuse. CONCLUSIONS: The findings support the association between SV and poor mental health, even when 'lesser' incidents have occurred. Implications for public health: General practitioners should consider an experience of SV as a possible factor in otherwise unexplained anxiety and depressive symptoms in female patients.
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Item“Technology Doesn’t Judge You”: Young Australian Women’s Views on Using the Internet and Smartphones to Address Intimate Partner Violence(Taylor & Francis, 2017)Intimate partner violence (IPV) is a pervasive social issue. Younger women tend to experience the highest rates of violence, associated with a range of negative health outcomes. Although interventions in health settings have shown promise, younger women may be reluctant to access services or discuss relationships with a health professional. Delivering an IPV intervention online or via a smartphone has the potential to overcome some of these barriers. Little is known, however, about how young women might perceive such an intervention, or what factors might influence its uptake. Drawing on focus groups interviews, we explore the views of young Australian women on using a website or application to address IPV. Azjen’s Theory of Planned Behavior is used to help understand the beliefs and norms around technology and help-seeking for IPV. Findings highlight the potential for technological interventions to become a valuable addition to the resources available to young women.
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ItemAn online healthy relationship tool and safety decision aid for women experiencing intimate partner violence (I-DECIDE): a randomised controlled trial(ELSEVIER SCI LTD, 2019-06)BACKGROUND: Evidence for online interventions to help women experiencing intimate partner violence is scarce. We assessed whether an online interactive healthy relationship tool and safety decision aid (I-DECIDE) would increase women's self-efficacy and improve depressive symptoms compared with an intimate partner violence information website. METHODS: In this two-group pragmatic randomised controlled trial, we enrolled women who had screened positive for any form of intimate partner violence or fear of a partner in the 6 months before recruitment. Women aged 16-50 years currently residing in Australia, who had safe access to a computer and an internet connection, and who answered positively to one of the screening questions in English were eligible for inclusion. Participants were randomly assigned (1:1) by computer to receive either the intervention or control website. The intervention website consisted of modules on healthy relationships, abuse and safety, and relationship priority setting, and a tailored action plan. The control website was a static intimate partner violence information website. As the initial portion of the website containing the baseline questions was identical for both groups, there was no way for women to tell which group they had been allocated to, and the research team were also masked to participant allocation until after analysis of the 12-month data. Data were collected at baseline, immediately after completion of the website, at 6 months, and 12 months. Primary outcomes were mean general self-efficacy score (immediately after website completion, and at 6 months and 12 months) and mean depression score (at 6 months and 12 months). Data analyses were done according to intention-to-treat principles, accounting for missing data, and adjusted for outcome baseline scores. This trial was registered with the Australian New Zealand Clinical Trials Registry, ACTRN 12614001306606. FINDINGS: Between Jan 16, and Aug 28, 2015, 584 patients registered for the study and were assessed for eligibility. 422 eligible participants were randomly allocated to the intervention group (227 patients) or control group (195 patients). 179 (79%) participants in the intervention group and 156 (80%) participants in the control group completed 12-month follow-up. Mean self-efficacy at 6 months and 12 months was lower for participants in the intervention group than for participants in the control group, although this did not meet the prespecified mean difference (6 months: 27·5 [SD 5·1] vs 28·1 [4·4], imputed mean difference 1·3 [95% CI 0·3 to 2·3]; 12 months: 27·8 [SD 5·4] vs 29·0 [5·0], imputed mean difference 1·6 [95% CI 0·5 to 2·7]). We found no difference between groups in depressive symptoms at 6 months or 12 months (6 months: 22·5 [SD 17·1] vs 24·2 [17·2], imputed mean difference -0·3 [95% CI -3·5 to 3·0]; 12 months: 21·9 [SD 19·3] vs 21·5 [19·3], imputed mean difference -1·9 [95% CI -5·6 to 1·7]). Qualitative findings indicated that participants found the intervention supportive and a motivation for action. INTERPRETATION: Our findings highlight the need for further research, development, and refinement of online interventions for women experiencing intimate partner violence, particularly into the duration needed for interventions. Although we detected no meaningful differences between groups, our qualitative results indicated that some women find an online tool a helpful source of motivation and support. FUNDING: Australian Research Council.
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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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ItemHealth professionals' experiences of providing care for women survivors of sexual violence in psychiatric inpatient units(BMC, 2019-11-14)BACKGROUND: Survivors of sexual violence, who are predominantly women, commonly access mental health services. Psychiatric inpatient units in Australia are predominately mixed gender and may further retraumatise these women. Sexual violence is under-recognised by mental health professionals and there is a lack of adequate policy or direction for mental health service services. To date, only a small amount of research has focused on health professionals' experiences of providing trauma-informed care to women in psychiatric settings, with most studies focused on specific practices or interventions. Qualitative data is particularly lacking on this topic. This is a critical gap in the knowledge given that health professionals are key to detecting and addressing victimisation. The aim of this study was to gain an in-depth understanding of healthcare professionals' experiences and perceptions in providing care to women who are survivors of sexual violence in psychiatric inpatient units. METHODS: This qualitative study utilised semi-structured interviews with 40 health professionals recruited from four psychiatric inpatient units within a large Australian public mental health organisation. Data were examined using thematic analysis. RESULTS: Three main typologies were developed to describe participants' experiences of the care provided to women; 1) Dismissing and denying; 2) Acknowledging but unprepared; 3) Empathising but despairing. DISCUSSION: Gender, professional training, adherence to the biomedical model, and level of experience influenced health professionals' experiences. CONCLUSIONS: Health professionals in this study held varying attitudes towards female consumers and responses to sexual violence. Our findings suggest the need to address individual staff perception and promote trauma-informed and gender-sensitive care across all disciplines, genders, and levels of experience.
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ItemHealth professionals' perceptions of how gender sensitive care is enacted across acute psychiatric inpatient units for women who are survivors of sexual violence(BMC, 2019-12-23)BACKGROUND: Sexual violence is a global public health issue. It is a form of gender-based violence commonly experienced by women accessing mental health services. The biomedical model has been the dominant model of care in acute psychiatric units, however, there has been a global movement towards more gender-sensitive and trauma-informed models. To date, only a small amount of research has focused on evaluating these models of care and health professionals' experiences of providing this care. The aim of this study is to gain an in-depth understanding of healthcare professionals' perceptions of how Gender Sensitive Care (GSC) is enacted across acute psychiatric inpatient units for women who are survivors of sexual violence. METHODS: This study used case study methodology and the Normalisation Process Theory (NPT) conceptual framework. NPT is a practical framework that can be used to evaluate the implementation of complex models of care in health settings. It included semi-structured interviews with 40 health professionals, document and policy reviews, and observations from four psychiatric inpatient units within a large Australian public mental health organisation. Data were examined using thematic and content analysis. RESULTS: Themes were developed under the four NPT core constructs; 1) Understanding GSC in acute psychiatric units: "Without the corridors there's not a lot we can do", 2) Engagement and Commitment to GSC in acute psychiatric units: "There are a few of us who have that gender sensitive lens", 3) Organising, relating and involvement in GSC: "It's band aid stuff", 4) Monitoring and Evaluation of GSC in acute psychiatric units: "We are not perfect, we have to receive that feedback". DISCUSSION: Many health professionals held a simplistic understanding of GSC and avoided the responsibility of implementing it. Additionally, the competing demands of the biomedical model and a lack of appraisal has resulted in an inconsistent enactment of GSC. CONCLUSIONS: Health professionals in this study enacted GSC to varying levels. Our findings suggest the need to address each NPT construct comprehensively to adequately implement GSC.
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ItemExploring the relationships between sexual violence, mental health and perpetrator identity: a cross-sectional Australian primary care study(BMC, 2018-12-27)BACKGROUND: Research supports the association between adult sexual violence (SV) and poor mental health. However, most studies focus on rape and physical sexual assault. Little is known about how more subtle forms of SV affect women's well-being. Furthermore, evidence for the impact of the perpetrator's identity is mixed. There is also little data from clinical populations to help health practitioners identify SV. This paper addresses these gaps by exploring the associations between different types of adult SV, perpetrator identity, and women's mental health in the Australian primary care setting. METHODS: We conducted a descriptive, cross-sectional study in general practice clinics. Adult women completed an anonymous survey while waiting for the doctor. Measures included PHQ-9 (depression), GAD-7 (anxiety) and PCL-C (post-traumatic stress disorder). SV was measured using items from the National Intimate Partner and Sexual Violence Survey and categorised into three groups (rape/sexual assault; coercive behaviours and/or reproductive control; and unwanted sexual contact). RESULTS: We found significant associations between rape/sexual assault and poor mental health, and between coercion and/or reproductive control and higher PTSD and anxiety scores, compared to women with no SV experiences. SV perpetrated by an intimate partner was associated with significantly higher mean PTSD scores than SV perpetrated by a stranger, and significantly higher depression scores than SV perpetrated by another known person. CONCLUSION: Findings suggest that associations between SV and mental health are mediated by type of SV and perpetrator identity. Health practitioners should enquire about different types of SV beyond stranger rape as a cause of poor mental health, and about perpetrator identity to inform them about the likelihood of ongoing symptoms.
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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.
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ItemWomen’s Experiences Receiving Support Online for Intimate Partner Violence: How Does it Compare to Face-to-Face Support from a Health Professional?(Oxford University Press (OUP), 2018)There is a growing need for novel approaches in supporting victims of intimate partner violence (IPV), particularly as the demand placed on formal services increases. Online interventions in this space have shown a great deal of theoretical promise. However, currently little is known about how women perceive this form of support, and how their experiences of receiving support online might differ from face-to-face approaches. This study aims to address this gap through qualitative interviews with n = 16 women who had experienced IPV. Eight of the women had received support via an interactive online intervention, and eight had received a counselling intervention delivered by their general practitioner (GP) (family doctor). The findings suggest that many elements of face-to-face support can also be delivered effectively online, leading to greater control over the help-seeking process. On the other hand, a trusting relationship with the GP can also be extremely helpful to women seeking to disclose, and is difficult to replicate online. Which method of delivery is preferred may depend on whether a woman values trust or control in her help-seeking journey. Both online and face-to-face interventions for IPV should focus on providing individualized support that raises awareness, lessens isolation and considers women’s own unique needs and circumstances.
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ItemMethodological and Ethical Challenges in a Web-Based Randomized Controlled Trial of a Domestic Violence Intervention(JMIR PUBLICATIONS, INC, 2017-03)The use of Web-based methods to deliver and evaluate interventions is growing in popularity, particularly in a health care context. They have shown particular promise in responding to sensitive or stigmatized issues such as mental health and sexually transmitted infections. In the field of domestic violence (DV), however, the idea of delivering and evaluating interventions via the Web is still relatively new. Little is known about how to successfully navigate several challenges encountered by the researchers while working in this area. This paper uses the case study of I-DECIDE, a Web-based healthy relationship tool and safety decision aid for women experiencing DV, developed in Australia. The I-DECIDE website has recently been evaluated through a randomized controlled trial, and we outline some of the methodological and ethical challenges encountered during recruitment, retention, and evaluation. We suggest that with careful consideration of these issues, randomized controlled trials can be safely conducted via the Web in this sensitive area.