Kelsey Hegarty, Rhian Parker, Jacqui Cameron, Gail Gilchrist, Angela Taft, Margot Scott (Assoc.), Ms Virginia Geddes (Assoc.) and Mel Irenyi (Project Worker)
Department of General Practice, University of Melbourne
Mothers' and Child Health Research, La Trobe University
Domestic Violence Incest and Resource Centre
beyondblue Victorian Centre of Excellence
Project completion year
WEAVE aimed to explore women’s views and experiences of how general practitioners (GPs) should manage partner abuse for the whole family. Despite the high association of mental health issues with partner abuse, there is limited information on how GPs should manage partner abuse. GPs are often the first source of potential help for women as they frequently attend for themselves or their children. As GPs are family doctors, they also see the male perpetrator in the family. Guidelines for GPs to manage all members of the family when there is partner abuse happening became available in draft form mid 2005 and this project sought abused women’s opinions on these guidelines from a sample drawn from general practice. In addition, women’s views on their own experiences of pathways to recovery were gathered. In particular, what made them resilient in the face of partner abuse and whether GPs had played any role during their lifetime in assisting their pathway to recovery.
Women who have ever been afraid of their partner and who were attending selected GPs (nine doctors) were asked by telephone either to participate in a focus group study evaluating the guidelines (15 women) or an interview study exploring their pathways to recovery and resiliency (18 women). Focus groups and interviews were digitally recorded and transcribed verbatim then a thematic analysis was conducted. All interview participants piloted a survey exploring women’s abuse and depression histories and their experience of general practice care.
Main outcomes/key project findings
Management by General Practitioners
Several themes emerged around the issues of GPs managing women experiencing partner abuse (from both the focus groups and the interviews). Barriers to GP care that emerged included internal (denial of abuse, loyalty and religious beliefs) and external (GPs don’t have enough time, perception of GPs dealing with physical complaints only, difficulty accessing care because of lack of availability in rural areas and cost). Generally women’s expectations of what GPs could do were low as they did not see them as being trained or able to deal with emotional issues. Despite this perception, the women wanted GPs to have good communication skills, ask about abuse and have appropriate resources and referral base. All the women thought training of all clinic staff, protocols around confidentiality and safety within the practice, pamphlets and posters available and computer alerts were a good idea.
Most of the focus group participants were unsure of the role GPs should take directly with men because of confidentiality and safety issues and that men were unlikely to take responsibility for their violence. Most of them thought that GPs should not be asking men directly about their use of violence and many had no direct experience of men’s services. One woman had a positive experience with her husband going to an anger management group through a referral from a mother baby unit.
With regard to the GPs role with children, all focus group participants endorsed mandatory reporting, and a role with adolescent children, but all of them thought that caution was needed in any direct role with young children. There were mixed feelings about addressing parenting issues with women. This highlighted the dilemma that while women often stay for a long time because of the children, the long term impact on the children is very harmful.
Pathway to recovery
Analysis of the interview data shows that there were diverse pathways to recovery for the participants with some still feeling that they had not healed. Further, these women did not see their general practitioner as a major source of help as they attempted to recover from abuse and violence. The idea of a woman reclaiming a sense of self – in either a reflexive ‘internal’ sense or external social context appears to be a key feature in the pathway to recovery. Some women described strong female role models (usually their mothers) as important whilst other women described significant moments or turning points in the recovery process.
The questionnaire was piloted with 13 women, who all found it acceptable in terms of time taken to complete, the instructions on how to complete it and the presentation of the survey. An adapted version will be utilised in the NHMRC funded randomised controlled trial to start in July 2007.
Implications for policy and practice
GPs need to promote their availability to help women who have experienced intimate partner violence as they are currently not perceived as a potential source of help. Further, practice nurses, similar to GPs are seen as being involved in medical care rather than meeting emotional health needs.
Women made suggestions for improvements in care that included GPs asking women with symptoms suggestive of abuse, brochures and posters, training of all staff, and accessible, affordable counsellors available in the practice to refer to. The recent policy changes with the Better Access program may in part fulfil this latter recommendation.
However, education of health professionals in this area remains inconsistent and inadequate. Recent policy directions of practice nurses becoming involved in domestic violence counselling seem to be at odds with the current level of skills and training of such nurses and their time availability for such work within the practice.
Training of GPs to be able to discuss women’s own sense of self and strategies to build resiliency and self esteem might be of benefit. Suggestions around clinic improvements and training could be included in model practice accreditation and standards.