Table 1

IRIS ADViSE adaptive pilot study: how site 1 informed site 2?

Site 1How site 1 informed site 2?Site 2
Clinical training sessions: Two open to staff attending on the day.Informal feedback to AE and qualitative interview revealed staff that had had no IRIS training.
Tried to improve access to training for all clinicians working in the service.		Additional abridged training sessions held for those unable to attend the main training sessions.
Electronic records’ adaptation: Six HARKCS questions on DVA, within a template, inserted into pro forma. Each question required a ‘yes’ or ‘no’ answer, alongside free text boxes:
H—Humiliate?
A—Afraid?
R—Rape?
K—Kick?
C—Children?
S—Safety?		Electronic quantitative results showed that

  • HARKCS template regularly completed incorrectly, for example, queries about children and safety made, even when no DVA identified.

  • Potential for clinicians to just read out questions in a tick box manner.

  • Reflective discussion at site 2 led to decision to use

  • HARKCS image, reminding clinicians to ask about the multiple dimensions of DVA, including emotional, sexual, physical abuse and coercive control, related to being afraid.

  • Fewer initial questions

  • Prompts to enquire about children and safety only appearing if there was a DVA disclosure.

HARKCS image added to pro forma.
Two DVA questions inserted into pro forma:
1. Have you asked about DVA? Y/N
2. Has DVA been disclosed? Y/N
If DVA disclosed, two more questions appear:
1. Immediate safety at risk?
2. Patient has children?
With free text box for recording of referral details.
HARKCS questions did not have to be filled in but could be skipped.Site 1: Enquiry rate 10%, identification rate 4%, referral rate 50%.
Tried to improve these rates by making it mandatory to indicate whether DVA had been asked about.		Mandatory for staff to indicate whether they had asked about DVA (‘yes’ or ‘no’) before they could complete the electronic notes.
Site 2: Enquiry rate 61%, identification rate 7%, referral rate 10%.
Evaluation: Pretraining and post-training sessions’ questionnaires used—low rates of return; given out to staff not delivering care at female wal in service—inappropriate to evaluate.Tried to improve return of questionnaires—their completion aligned closely to receiving a certificate of continuing professional development (CPD) and attendance.Pretraining and post-training sessions’ questionnaires when completed exchanged for a certificate confirming attendance at CPD session.
Evaluation showed average self-rated knowledge on DVA health consequences, enquiry, response and how to make advocacy referrals increased by 40%.
Four qualitative interviews, with staff; initial pilot interview carried out by academic GP. Other interviews by independent qualitative researcher.Topic guide for qualitative interview first constructed by academic GP. Revised and improved by independent qualitative researchers at site 1 and later at site 2, where it was used for a more comprehensive qualitative study. Results published separately.17 qualitative interviews by independent qualitative researcher.

  • AE, advocate-educator; DVA, domestic violence and abuse; GP, general practitioner; IRIR ADViSE, Identification and Referral to Improve Safety while Assessing Domestic Violence in Sexual Health Environments; HARKCS, template questions for asking about domestic violence and abuse—please see details in second row of table.