Identification and Referral to Improve Safety (IRIS) of women experiencing domestic violence with a primary care training and support programme: a cluster randomised controlled trial
Open accessAbstract
Background Most clinicians have no training about domestic violence, fail to identify patients experiencing abuse, and are uncertain about management after disclosure. We tested the effectiveness of a programme of training and support in primary health-care practices to increase identification of women experiencing domestic violence and their referral to specialist advocacy services.Methods In this cluster randomised controlled trial, we selected general practices in two urban primary care trusts, Hackney (London) and Bristol, UK. Practices in which investigators from this trial were employed or those who did not use electronic records were excluded. Practices were stratified by proportion of female doctors, postgraduate training status, number of patients registered, and percentage of practice population on low incomes. Within every primary care trust area, we randomised practices with a computer-minimisation programme with a random component to intervention or control groups. The intervention programme included practice-based training sessions, a prompt within the medical record to ask about abuse, and a referral pathway to a named domestic violence advocate, who also delivered the training and further consultancy. The primary outcome was recorded referral of patients to domestic violence advocacy services. The prespecified secondary outcome was recorded identification of domestic violence in the electronic medical records of the general practice. Poisson regression analyses accounting for clustering were done for all practices receiving the intervention. Practice staff and research associates were not masked and patients were not aware they were part of a study. This study is registered at Current Controlled Trials, ISRCTN74012786.Findings We randomised 51 (61%) of 84 eligible general practices in Hackney and Bristol. Of these, 24 received a training and support programme, 24 did not receive the programme, and three dropped out before the trial started. 1 year after the second training session, the 24 intervention practices recorded 223 referrals of patients to advocacy and the 24 control practices recorded 12 referrals (adjusted intervention rate ratio 22·1 [95% CI 11·5-42·4]). Intervention practices recorded 641 disclosures of domestic violence and control practices recorded 236 (adjusted intervention rate ratio 3·1 [95% CI 2·2-4·3). No adverse events were recorded.Interpretation A training and support programme targeted at primary care clinicians and administrative staff improved referral to specialist domestic violence agencies and recorded identification of women experiencing domestic violence. Our findings reduce the uncertainty about the benefit of training and support interventions in primary care settings for domestic violence and show that screening of women patients for domestic violence is not a necessary condition for improved identification and referral to advocacy services.Funding Health Foundation.
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A major trial showed that general practitioners, to identify abuse, need both dedicated training and a clear referral pathway to specialist advocacy.
“and a major trial showed that GPs, to identify abuse, need both dedicated training and a clear referral pathway to specialist advocacy.22”
From Help‐seeking amongst women survivors of domestic violence: a qualitative study of pathways towards formal and informal support (2016) · cites this paper as [22]
Nine out of 10 reviews of depression prevention trials in children and adolescents report significant reductions in depressive symptoms, generally with small effect sizes.
“Nine out of 10 reviews of these trials report significant reductions in depressive symptoms, 428-436 generally with small effect sizes.”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [429]
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- Authors
- Feder, G., Davies, R. A., Baird, K., Dunne, D., Eldridge, S., Griffiths, C., Gregory, A., Howell, A., Johnson, M., Ramsay, J., Rutterford, C., & Sharp, D.
- Affiliations
- University of Bristol (GB)
- University of the West of England (GB)
- University of London (GB)
- Corresponding author
- Feder, Gene
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2011-11
- Volume
- 378
- Issue
- 9805
- Pages
- 1788-1795
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2099573012
- Cited by
- 406
- References
- 34
- Citations by year
- 2026: 19 · 2025: 20 · 2024: 49 · 2023: 22 · 2022: 21 · 2021: 44 · 2020: 31 · 2019: 26 · 2018: 16 · 2017: 25 · 2016: 26 · 2015: 28 · 2014: 31 · 2013: 19 · 2012: 26
- FWCI
- 25.35
- Type
- journal article
- Language
- en
- Open access
- green
- eprints.uwe.ac.uk
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- UWE Research Repository (UWE Bristol) (submittedVersion, cc-by)
- Bristol Research (University of Bristol) (submittedVersion)
- Griffith Research Online (submittedVersion)
- Funders
- National Institute for Health and Care Research
- Fonds National de la Recherche Luxembourg
- National Institutes of Health
- National Institute on Aging
- Topics
- Social Sciences › Health › Intimate Partner and Family Violence
- Social Sciences › Demography › Elder Abuse and Neglect
- Social Sciences › Gender Studies › Sexual Assault and Victimization Studies
- Keywords
- domestic violence, women, primary care, clinician training, domestic violence screening, disclosure, general practice, electronic health records, iris, low-income populations, women's health services, health disparities, child abuse
- MeSH terms
- Education, Medical, Continuing, Female, United Kingdom, Humans, Outcome and Process Assessment, Health Care, Primary Health Care, Referral and Consultation, Cluster Analysis, Domestic Violence, General Practice
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