Breaking the silence : the role of healthcare professionals in the prevention of intimate partner violence

Abstract

Evidence in the literature suggests that abused women before turning to the criminal justice or any other domestic violence services will very often present themselves with injuries to all levels of healthcare services including primary health care and accident and emergency. This qualitative study aims to explore the experiences and current practices of healthcare professionals in the identification and management of intimate partner violence (IPV). In addition, the barriers and facilitators to the identification and interventions in providing the appropriate care were also explored. Focus groups (n=6) made up of nurses and one to one semi-structured interviews (n=7) with physicians from the Primary Health Care Department (PHCD) and Emergency Department (ED) of the acute general hospital in Malta were carried out. All the interviews were recorded and transcribed. Thematic analysis was used to elicit themes from the data extracted. The findings provide new insight into the factors that facilitate and impede decisions to address the issue of IPV. Inadequate preparation both in training and in the lack of guidelines and protocols emerged as key barriers, together with other clinical pressures such as lack of time, work overload, lack of adequate environment to communicate with the victim, and lack human resources within the daily context of both the primary and emergency health care practices. The study suggests that targeting IPV in the healthcare settings requires a multidisciplinary approach together with policies and infrastructure changes that protect privacy and confidentiality of women; it necessitates ongoing training and support for staff; the development of protocols, guidelines and data collection systems. There also needs to be investment in strengthening the human resources of the institution. Finally it is important that monitoring and evaluation exercises are put in place to assess the quality service provision and benefits versus risks to women.