Intimate partner violence (IPV) is an important contributor to the burden of disease in South Africa. Evidence-based approaches to IPV in primary care are lacking. This study evaluated a project that implemented a South African protocol for screening and managing IPV. This article reports primarily on the benefits of this intervention from the perspective of women IPV survivors.
This was a project evaluation involving two urban and three rural primary care facilities. Over 4–8 weeks primary care providers screened adult women for a history of IPV within the previous 24 months and offered referral to the study nurse. The study nurse assessed and managed the women according to the protocol. Researchers interviewed the participants 1 month later to ascertain adherence to their care plan and their views on the intervention.
In total, 168 women were assisted and 124 (73.8%) returned for follow-up. Emotional (139, 82.7%), physical (115, 68.5%), sexual (72, 42.9%) and financial abuse (72, 42.9%) was common and 114 (67.9%) were at high/severe risk of harm. Adherence to the management plan ranged from testing for syphilis 10/25 (40.0%) to consulting a psychiatric nurse 28/58 (48.3%) to obtaining a protection order 28/28 (100.0%). Over 75% perceived all aspects of their care as helpful, except for legal advice from a non-profit organisation. Women reported significant benefits to their mental health, reduced alcohol abuse, improved relationships, increased self-efficacy and reduced abusive behaviour. Two characteristics seemed particularly important: the style of interaction with the nurse and the comprehensive nature of the assessment.
Female IPV survivors in primary care experience benefit from an empathic, comprehensive approach to assessing and assisting with the clinical, mental, social and legal aspects. Primary care managers should find ways to integrate this into primary care services and evaluate it further.
Did women experiencing IPV find assessment and management in primary care beneficial?
What aspects of their care plan did they adhere to?
What aspects of their care plan did they find most helpful?
Women diagnosed with IPV in primary care perceive benefit from an intervention characterised by both empathic, non-judgemental and a comprehensive approach to the clinical, mental, social and legal aspects.
Women reported benefits to their mental health, alcohol use, relationships and experience of abusive behaviour.
IPV survivors were most proactive about securing protection orders, laying criminal charges and testing for pregnancy post-intervention.
Strengths and limitations of this study
A comprehensive biopsychosocial and forensic intervention in primary care was tested, securing follow-up that revealed its value.
The study was conducted under usual working conditions and resource availability making the findings applicable to the primary care context.
Although the study only involved five purposely selected facilities, the rural/urban mix makes it likely that these are fairly typical.
Obsequiousness bias was reduced by different researchers conducting the follow-up interviews.
Follow-up after 1 month is too short to predict the longer-term consequences of the intervention.
The study measured the effect of the intervention on the abuse indirectly via participant self-reports.