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Assessing for domestic violence in sexual health environments: a qualitative study
  1. Jeremy Horwood1,2,
  2. Andrew Morden1,2,
  3. Jayne E Bailey2,
  4. Neha Pathak2,3,
  5. Gene Feder2
  1. 1 The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  2. 2 School of Social and Community Medicine,University of Bristol, Bristol, UK
  3. 3 Women’s Health Research Unit,Queen Mary University of London, London, UK
  1. Correspondence to Dr Jeremy Horwood, NIHR CLAHRC West, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK; j.horwood{at}


Objectives Domestic violence and abuse (DVA) is a major clinical challenge and public health issue. Sexual health services are an important potential site of DVA intervention. The Assessing for Domestic Violence in Sexual Health Environments (ADViSE) intervention aimed to improve identification and management of DVA in sexual healthcare settings and is a modified version of the Identification and Referral to Improve Safety (IRIS) general practice programme. Our qualitative evaluation aimed to explore the experiences of staff participating in an IRIS ADViSE pilot.

Methods Interviews were conducted with 17 sexual health clinic staff and DVA advocate workers. Interviews were audio recorded, transcribed, anonymised and analysed thematically.

Results Staff prioritised enquiring about DVA and tailored their style of enquiry to the perceived characteristics of patients, current workload and individual clinical judgements. Responding to disclosures of abuse was divided between perceived low-risk cases (with quick onwards referral) and high-risk cases (requiring deployment of institution safeguarding procedures), which were viewed as time consuming and could create tensions with patients. Ongoing training and feedback, commissioner recognition, adequate service-level agreements and reimbursements are required to ensure sustainability and wider implementation of IRIS ADViSE.

Conclusions Challenges of delivering and sustaining IRIS ADViSE included the varied styles of enquiry, as well as tensions and additional time pressure arising from disclosure of abuse. These can be overcome by modifying initial training, providing regular updates and stronger recognition (and resources) at policy and commissioning levels.

  • Clinical Care (general)
  • Compex Interventions
  • Qualitative Research
  • Sexual Abuse

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Handling editor Jackie A Cassell

  • Contributors JEB, JH, GF, NP and AM were responsible for developing the study design. AM conducted the interviews. JEB, JH, GF and AM contributed to primary data analysis. All authors contributed to the interpretation of results, commented on draft manuscripts and have given their approval for publication.

  • Funding The research is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West) at University Hospitals Bristol NHS Foundation Trust. The IRIS ADVISE intervention was funded by the Wellcome Trust Strategic Award and the Elizabeth Blackwell institute.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Welcome Trust, the Elizabeth Blackwell Institute or the Department of Health.

  • Competing interests NP was funded by the Wellcome Trust during the intervention and was funded by an NIHR academic clinical fellowship during the preparation of this manuscripts.

  • Ethics approval University of Bristol Faculty of Medicine and Dentistry Research Ethics Committee (FREC 19022).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All enquires should be directed to the corresponding author.

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