Objectives Sexual health and gynaecological problems are the most consistent and largest physical health differences between abused and non-abused female populations. Sexual health services are well placed to identify and support patients experiencing domestic violence and abuse (DVA). Most sexual health professionals have had minimal DVA training despite English National Institute for Health and Care Excellence recommendations. We sought to determine the feasibility of an evidence-based complex DVA training intervention in female sexual health walk-in services (IRIS ADViSE: Identification and Referral to Improve Safety whilst Assessing Domestic Violence in Sexual Health Environments).
Methods An adaptive mixed method pilot study in the female walk-in service of two sexual health clinics. Following implementation and evaluation at site 1, the intervention was refined before implementation at site 2. The intervention comprised electronic prompts, multidisciplinary training sessions, clinic materials and simple referral pathways to IRIS ADViSE advocate-educators (AEs). The pilot lasted 7 weeks at site 1 and 12 weeks at site 2. Feasibility outcomes were to assign a supportive DVA clinical lead, an IRIS ADViSE AE employed by a local DVA service provider, adapt electronic records, develop local referral pathways, assess whether enquiry, identification and referral rates were measurable.
Results Both sites achieved all feasibility outcomes: appointing a supportive DVA clinical lead and IRIS ADViSE AE, establishing links with a local DVA provider, adapting electronic records, developing local referral pathways and rates of enquiry, identification and referral were found to be measurable. Site 1: 10% enquiry rate (n=267), 4% identification rate (n=16) and eight AE referrals. Site 2: 61% enquiry rate (n=1090), a 7% identification rate (n=79) and eight AE referrals.
Conclusions IRIS ADViSE can be successfully developed and implemented in sexual health clinics. It fulfils the unmet need for DVA training. Longer-term evaluation is recommended.
- Complex interventions
- Evidence based medicine
- Public health
- Health serv research
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Contributors AHS designed the pilot evaluation in site 1 and was responsible for the study at that site. She drafted and revised the manuscript. NP designed the pilot evaluation in site 2 and was responsible for the study at that site. She contributed to manuscript revision and constructed the figures and tables. GF contributed to the design of the studies and contributed to manuscript revision. SB, VA, JB, JB and CG contributed to manuscript revision. SB was also an advocate educator at site 2. VA and JB were responsible for service delivery at sites 1 and 2, respectively, assisting in anonymous data collection.
Funding Should read: "AHS and NP were funded by the National Institute for Health Research (NIHR) for their academic clinical lectureship and academic clinical fellowship respectively, during the preparation of this manuscript. NP was funded by the Wellcome Trust during the implementation of the pilot. The research and AHS was supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at the Barts Health NHS Trust; and the West CLAHRC. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Tower Hamlets Public Health provided funding for work carried out at site 1. GF is a consultant for the IRIS programme for which the University of Bristol receives a fee. None of these funding organisations had any role in the design, implementation, and interpretation nor reporting of this work."
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Additional unpublished data are available from the corresponding author by contacting via email.
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