Mothers are at risk of domestic violence
(DV) and its harmful consequences postpartum. There is no evidence to
date for sustainability of DV screening in primary care settings. We
aimed to test whether a theory-informed, maternal and child health (MCH)
nurse-designed model increased and sustained DV screening, disclosure,
safety planning and referrals compared with usual care.
Cluster randomised controlled trial of 12 month MCH DV screening and care intervention with 24 month follow-up.
The study was set in community-based MCH nurse teams (91 centres, 163 nurses) in north-west Melbourne, Australia.
Eight eligible teams were recruited.
Team randomisation occurred at a public meeting using opaque envelopes.
Teams were unable to be blinded.
The intervention was informed by
Normalisation Process Theory, the nurse-designed good practice model
incorporated nurse mentors, strengthened relationships with DV services,
nurse safety, a self-completion maternal health screening checklist at
three or four month consultations and DV clinical guidelines. Usual care
involved government mandated face-to-face DV screening at four weeks
postpartum and follow-up as required.
Primary outcomes were MCH team
screening, disclosure, safety planning and referral rates from routine
government data and a postal survey sent to 10,472 women with babies ≤
12 months in study areas. Secondary outcomes included DV prevalence
(Composite Abuse Scale, CAS) and harm measures (postal survey).
No significant differences were found in
routine screening at four months (IG 2,330/6,381 consultations (36.5 %)
versus CG 1,792/7,638 consultations (23.5 %), RR = 1.56 CI 0.96–2.52)
but data from maternal health checklists (n = 2,771) at three month IG
consultations showed average screening rates of 63.1 %. Two years
post-intervention, IG safety planning rates had increased from three (RR
2.95, CI 1.11–7.82) to four times those of CG (RR 4.22 CI 1.64–10.9).
Referrals remained low in both intervention groups (IGs) and comparison
groups (CGs) (<1 %).
2,621/10,472 mothers (25 %) returned
surveys. No difference was found between arms in preference or comfort
with being asked about DV or feelings about self.
A nurse-designed screening and care
model did not increase routine screening or referrals, but achieved
significantly increased safety planning over 36 months among postpartum
women. Self-completion DV screening was welcomed by nurses and women and
contributed to sustainability.
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Researchers: Angela J Taft, Leesa Hooker, Cathy Humphreys, Kelsey L Hegarty, Ruby Walter, Catina Adams, Paul Agius and Rhonda Small