General Practice and Primary Care - Research Publications

Permanent URI for this collection

Search Results

Now showing 1 - 10 of 81
  • Item
    Thumbnail Image
    Identifying the barriers faced by obstetricians and registrars in screening or enquiry of intimate partner violence in pregnancy: A systematic review of the primary evidence.
    Lu, C ; Georgousopoulou, E ; Baloch, S ; Walton-Sonda, D ; Hegarty, K ; Sethna, F ; Brown, NAT (Wiley, 2024-02)
    INTRODUCTION: Intimate partner violence (IPV) disproportionally affects women compared to men. The impact of IPV is amplified during pregnancy. Screening or enquiry in the antenatal outpatient setting regarding IPV has been fraught with barriers that prevent recognition and the ability to intervene. AIMS: The aim of this systematic review was to determine the barriers that face obstetricians/gynaecologists regarding enquiry of IPV in antenatal outpatient settings. The secondary objective was to determine facilitators. METHODS: Primary evidence was searched using Ovid MEDLINE, Ovid Maternity and Infant Care, PubMed and Proquest from 1993 to May 2023. The included studies comprised empirical studies published in English language targeting a population of doctors providing antenatal outpatient care. The review was PROSPERO-registered (CRD42020188994). Independent screening and review was performed by two authors. The findings were analysed thematically. RESULTS: Nine studies addressing barriers and two studies addressing facilitators were included: three focus-group or semi-structured interviews, six surveys and two randomised controlled trials. Barriers for providers centred at the system level (time, training), provider level (personal beliefs, cultural bias, experience) and provider-perceived patient level (fear of offending, patient readiness to disclose). Increased experience and the use of validated tools were strong facilitators. CONCLUSION: Barriers to screening reflect multi-level obstruction to the identification of women exposed to IPV. Although the antenatal outpatient clinic setting addresses a particular population vulnerable to IPV, the barriers for obstetricians are not unique. The use of validated cueing tools provides an evidence-based method to facilitate enquiry of IPV among antenatal women, assisting in identification by clinicians. Together with education and human resources, such aids build capacity in women and obstetric providers.
  • Item
    No Preview Available
    Social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples in Aboriginal controlled social housing
    Brown, A ; Haregu, T ; Gee, G ; Mensah, F ; Waters, L ; Brown, SJ ; Nicholson, JM ; Hegarty, K ; Smith, D ; D'Amico, S ; Ritte, R ; Paradies, Y ; Armstrong, G (BMC, 2023-10-06)
    BACKGROUND: Little is known about the wellbeing and aspirations of Aboriginal and Torres Strait Islander peoples living in social housing. Aboriginal and Torres Strait Islander peoples living in social housing face common social housing challenges of low income, higher incidence of mental health issues and poorer health along with specific challenges due to the impacts of colonisation and its ongoing manifestations in racism and inequity. A greater understanding of social and emotional wellbeing needs and aspirations is essential in informing the provision of appropriate support. METHODS: Surveys of social and emotional wellbeing (SEWB) were completed by 95 Aboriginal people aged 16 years and older living in Aboriginal Housing Victoria social housing in 2021. The survey addressed a range of domains reflecting social and emotional wellbeing, as defined by Aboriginal and Torres Strait Islander peoples. RESULTS: Most respondents demonstrated a strong sense of identity and connection to family however 26% reported having 6 or more health conditions. Ill health and disability were reported to be employment barriers for almost a third of people (32%). Improving health and wellbeing (78%) was the most cited aspiration. Experiences of racism and ill health influenced engagement with organisations and correspondingly education and employment. CONCLUSION: Strong connections to identity, family and culture in Aboriginal peoples living in social housing coexist along with disrupted connections to mind, body and community. Culturally safe and appropriate pathways to community services and facilities can enhance these connections. Research aimed at evaluating the impact of strengths-based interventions that focus on existing strong connections will be important in understanding whether this approach is effective in improving SEWB in this population. TRIAL REGISTRATION: This trial was retrospectively registered with the ISRCTN Register on the 12/7/21 with the study ID:ISRCTN33665735.
  • Item
    No Preview Available
    Visualising Patterns in Women's Experiences of Intimate Partner Violence in the First 10 years of Motherhood
    FitzPatrick, KM ; Brown, S ; Hegarty, K ; Mensah, F ; Gartland, D (SAGE PUBLICATIONS INC, 2023-02)
    Intimate partner violence (IPV) can involve patterns of physical, sexual and emotional abuse. Women typically experience physical IPV in combination with emotional IPV, while emotional IPV is often experienced in the absence of other types of IPV. There is very little known about women's experiences of these different types of IPV over time. The primary aim of this paper is to describe patterns in women's individual experiences of physical and/or emotional IPV across the first 10 years of motherhood. Data were drawn from a prospective pregnancy cohort of 1507 first-time mothers in Melbourne, Australia. Emotional, physical, and combined physical and emotional IPV were reported in the first, fourth and tenth year of motherhood using the Composite Abuse Scale. The overall prevalence of each type of IPV remained consistent across the three time-points, with emotional IPV alone being the most prevalent. There was substantial variability in women's experiences of IPV over time and there was no common progression from one type of IPV to another. Women were more likely to report IPV at more than one time-point if they experienced combined physical and emotional IPV, while for women who reported emotional or physical IPV alone this was more likely to be at a single time-point. A number of socio-demographic characteristics in early pregnancy were associated with a higher risk of reporting IPV at all three time-points, including being unemployed (RRR = 3.6; 95% CI: 2.1, 6.2) and being aged 18-24 years (RRR = 3.1; 95% CI: 1.8, 5.4). Knowledge of the variability and persistence of IPV in the first 10 years of motherhood, and factors associated with these experiences, can help tailor effective health and social service responses.
  • Item
    Thumbnail Image
    Trajectories of intimate partner violence (IPV) in a primary care cohort of women with depressive symptoms
    Hegarty, K ; Densley, K ; Gilchrist, G ; Elliott, P ; Gunn, J (Bristol University Press, 2023-02)
    Aims: To assess trajectories of women’s experience of intimate partner violence (IPV) over time, and baseline risk factors and associated four-year outcomes for different trajectories. Design: A cohort study of 548 women with depressive symptoms, attending primary care appointments, were surveyed annually for four years. Secondary analysis was undertaken using growth mixture modelling to generate IPV trajectories. Analyses of associations of these generated classes of IPV with hypothesised baseline and four-year measures were undertaken. Results: At baseline, 42% (231) women experienced IPV in past 12 months. Five-class IPV trajectory model showed five groups over time: consistently ‘high IPV’ (5%, n=28), ‘some IPV’ (14%, n=77), ‘minimal IPV’ (9%, n=52), ‘decreasing IPV’ (11%, n=62), and ‘no IPV’ (60%, n=329). Baseline differences showed women in ‘high’ and ‘some’ group had more childhood abuse, low income and poor mental health compared to ‘minimal’ or ‘no IPV’ groups. At four years, ‘decreasing IPV’ group was aligned with ‘minimal/no IPV’ groups on mental health, quality of life and social support measures. Conclusion: Women exhibited different trajectories of IPV over time with high burden of mental health problems, except for when IPV decreases. Clinical identification of IPV and tailoring of responses to decrease exposure to IPV is warranted to reduce disease burden.
  • Item
    Thumbnail Image
    Translation and cross-cultural adaptation of the Composite Abuse Scale into Brazilian Portuguese.
    Rocha, RWGD ; Oliveira, DCD ; Liebel, VA ; Pallu, PHR ; Hegarty, KL ; Signorelli, MC (Universidade de Sao Paulo, Agencia USP de Gestao da Informacao Academica (AGUIA), 2022)
    OBJECTIVE: To perform the translation and cross-cultural adaptation from English into Brazilian Portuguese of the Composite Abuse Scale, an instrument that identifies and quantifies intimate partner violence. METHODS: This study is based on the strict implementation of its previously published protocol, which consists of ten steps: (a) conceptual analysis; (b) double-blind translation; (c) comparison and first reconciled version of the two translations; (d) back-translation; (e) review of the back-translation by the developer and second reconciled version; (f) expert committee review (n = 6); (g) comparison of expert reviews and third reconciled version; (h) cognitive interviews with women from the Casa da Mulher Brasileira in Curitiba (n = 15); (i) assessments of user perceptions and final reconciliation; and (j) submission of the final version of the questionnaire to the developer. RESULTS: The implementation of the 10 steps of the protocol allowed the idiomatic, semantic, conceptual and experiential equivalences of the Composite Abuse Scale, incorporating suggestions and criticisms from the different participants of the process. Participants included the developer, professional translators, researchers specialized on the subject, women in situation of intimate partner violence, and professionals who provide care to them. Experts and cognitive interviews with women were instrumental in ensuring equivalence, and facilitating the understanding, including: (1) adaptation of the term "intimate relation" to "affective or conjugal relation"; (2) substitution of enclisis for proclisis cases in 20 items; (3) adoption of gender-neutral language, allowing its use in heterosexual, bisexual, and same-sex relations; (4) materialization of an instrument of scientific rigor and self-applicable, which may help women to visualize the situations of abuse in their relations. CONCLUSIONS: The translation and cross-cultural adaptation process of the Composite Abuse Scale resulted in the Composite Abuse Scale Brazilian Portuguese Version, a 30-item self-applicable instrument, capable to identify and quantify intimate partner violence, its frequency, severity and typologies (physical, emotional, harassment and severe combined violence).
  • Item
    No Preview Available
    Timing of Physical and Emotional Intimate Partner Violence Exposure and Women's Health in an Australian Longitudinal Cohort Study.
    FitzPatrick, KM ; Brown, SJ ; Hegarty, K ; Mensah, F ; Gartland, D (SAGE Publications, 2023-02-07)
    Drawing on data from a prospective pregnancy cohort (N = 1,507), this study examines the relationship between exposure to physical and emotional intimate partner violence (IPV) across the first 10 years of motherhood and women's mental and physical health. A measure of IPV (Composite Abuse Scale) was included at 1, 4, and 10 years postpartum. Past year and prior experiences of IPV were associated with mental and physical health issues at 10 years, both for mothers who had experienced combined IPV and emotional IPV alone. Awareness of the health issues associated with different types of IPV can assist in tailoring responses for women who experience IPV.
  • Item
    Thumbnail Image
    Transforming health settings to address gender-based violence in Australia
    Hegarty, KL ; Andrews, S ; Tarzia, L (WILEY, 2022-08-01)
    Gender-based violence includes intimate partner violence, sexual violence and other harmful acts directed at people based on their gender. It is common in Australia and causes great ill health, especially for women victims/survivors, with Indigenous women particularly affected. Health services are an opportune place for early intervention for victims/survivors of gender-based violence as they attend frequently. Interventions that are evidence-based and respond to consensus from victim/survivor voices include universal education, screening in antenatal care, first line supportive care, and referral for advocacy and psychological interventions, including mother-child work. Health care staff require training, protocols, scripts, referral pathways, understanding of cultural safety and antiracist practice in service delivery, and leadership support to undertake this sensitive work, including support, if needed, for their own experiences of gender-based violence. Using a trauma-, violence- and gender-informed approach across health systems, taking into account structural inequities, is essential to sustain the gender-based violence work in health services. Gender-based violence experienced by Indigenous women is distinct and of urgent concern as rates rapidly increase. Inequities across the health system are pronounced for Indigenous women.
  • Item
    Thumbnail Image
    Healthcare Students' and Educators' Views on the Integration of Gender-Based Violence Education into the Curriculum: a Qualitative Inquiry in Three Countries
    Sammut, D ; Ferrer, L ; Gorham, E ; Hegarty, K ; Kuruppu, J ; Lopez Salvo, F ; Bradbury-Jones, C (SPRINGER/PLENUM PUBLISHERS, 2023-10)
    Abstract Purpose Health and social care professionals are ideally placed to identify and address gender-based violence (GBV), yet research continues to demonstrate that the subject is being poorly covered at undergraduate level. This qualitative study explored health and social care students’ and educators’ views on GBV education, with a view to identifying ‘best practice’. We aimed to capture students’ and educators’ experiences and perceptions of GBV education across participating countries; how participants thought GBV should be taught/learned within their curricula; and their views on how GBV education might be ‘optimized’. Methods We conducted nine focus group discussions and one semi-structured interview with 23 students and 21 academic staff across the UK, Australia and Chile. Results Thematic analysis yielded three themes: (1) GBV addressed in all but name, (2) Introduce sooner, explore later and (3) A qualitative approach to learning. Educators and students indicated that GBV is largely being overlooked or incompletely addressed within curricula. Many participants expressed a wish for the subject to be introduced early and revisited throughout their study, with content evolving as cohorts mature. Lastly, our findings indicate that GBV education could benefit from adopting a ‘qualitative’ approach, prioritizing survivor narratives and incorporating dialogue to facilitate student engagement. Conclusion Though time constraints and competing demands within undergraduate curricula are frequently cited as barriers to moving away from traditional didactic methods, our findings suggest that teacher-centered strategies are insufficient and, in some regards, inappropriate for GBV education. The need for a paradigm shift in GBV education is discussed.
  • Item
    Thumbnail Image
    "You can't swim well if there is a weight dragging you down": cross-sectional study of intimate partner violence, sexual assault and child abuse prevalence against Australian nurses, midwives and carers
    McLindon, E ; Diemer, K ; Kuruppu, J ; Spiteri-Staines, A ; Hegarty, K (BMC, 2022-09-12)
    BACKGROUND: Domestic and family violence (DFV), including intimate partner violence (IPV), sexual assault and child abuse are prevalent health and social issues, often precipitating contact with health services. Nurses, midwives and carers are frontline responders to women and children who have experienced violence, with some research suggesting that health professionals themselves may report a higher incidence of IPV in their personal lives compared to the community. This paper reports the largest study of DFV against health professionals to date. METHOD: An online descriptive, cross-sectional survey of 10,674 women and 772 men members of the Australian Nursing and Midwifery Federation (ANMF) (Victorian Branch). The primary outcome measures were 12-month and adult lifetime IPV prevalence (Composite Abuse Scale); secondary outcomes included sexual assault and child abuse (Australian Bureau of Statistics Personal Safety Survey) and prevalence of IPV perpetration (bespoke). RESULTS: Response rate was 15.2% of women/11.2% of men who were sent an invitation email, and 38.4% of women/28.3% of men who opened the email. In the last 12-months, 22.1% of women and 24.0% of men had experienced IPV, while across the adult lifetime, 45.1% of women and 35.0% of men had experienced IPV. These figures are higher than an Australian community sample. Non-partner sexual assault had been experienced by 18.6% of women and 7.1% of men, which was similar to national community sample. IPV survivors were 2-3 times more likely to have experienced physical, sexual or emotional abuse in childhood compared to those without a history of IPV (women OR 2.7, 95% CI 2.4 to 2.9; men OR 2.8, 95% CI 2.0 to 4.1). Since the age of sixteen, 11.7% of men and 1.7% of women had behaved in a way that had made a partner or ex-partner feel afraid of them. CONCLUSIONS: The high prevalence of intimate partner violence and child abuse in this group of nurses, midwives and carers suggests the need for workplace support programs. The findings support the theory that childhood adversity may be related to entering the nursing profession and has implications for the training and support of this group.
  • Item
    Thumbnail Image
    Women's experiences and expectations of intimate partner abuse identification in healthcare settings: a qualitative evidence synthesis
    Korab-Chandler, E ; Kyei-Onanjiri, M ; Cameron, J ; Hegarty, K ; Tarzia, L (BMJ PUBLISHING GROUP, 2022-07)
    OBJECTIVES: To explore women's experiences and expectations of intimate partner abuse (IPA) disclosure and identification in healthcare settings, focusing on the process of disclosure/identification rather than the healthcare responses that come afterwards. DESIGN: Systematic review and meta-synthesis of qualitative studies DATA SOURCES: Relevant studies were sourced by using keywords to search the databases MEDLINE, EMBASE, CINAHL, PsychINFO, SocINDEX and ASSIA in September 2021. ELIGIBILITY CRITERIA: Studies needed to focus on women's views about IPA disclosure and identification in healthcare settings, use qualitative methods and have been published in the last 5 years. DATA EXTRACTION AND SYNTHESIS: Relevant data were extracted into a customised template. The Critical Appraisal Skills Programme checklist for qualitative research was used to assess the methodological quality of included studies. A thematic synthesis approach was applied to the data, and confidence in the findings was appraised using The Confidence in the Evidence from Reviews of Qualitative research methods. RESULTS: Thirty-four studies were included from a range of healthcare settings and countries. Three key themes were generated through analysing their data: (1) Provide universal education, (2) Create a safe and supportive environment for disclosure and (3) It is about how you ask. Included papers were rated overall as being of moderate quality, and moderate-high confidence was placed in the review findings. CONCLUSIONS: Women in the included studies articulated a desire to routinely receive information about IPA, lending support to a universal education approach that equips all women with an understanding of IPA and options for assistance, regardless of disclosure. Women's suggestions for how to promote an environment conducive to disclosure and how to enquire about IPA have clear implications for clinical practice.PROSPERO registration numberCRD42018091523.