Reviewer’ s report
Title: Improving the Response of Primary Care Providers to Rural First Nation Women who
Experience Intimate Partner Violence: A Qualitative Study
Version: 0Date: 25 Feb 2020
Reviewer: Nancy Glass
Reviewer's report:
The investigators should be congratulated for their work to improve the health care response to
survivors of IPV in rural and often underserved and marginalized communities, in this case ruralFirst Nation communities in Northern Ontario. Although an important topic, there are manylimitations that should be addressed prior to publication. The paper would be strengthened bycontextualizing the background - perhaps using the Ecological Framework (see Heise, Lori) and/orframework already designed with First Nation communities to guide public health and health careprograms. Identifying the multiple and complex individual, family, community and society factorsthat increase risk for IPV in First Nation communities, including colonization, but additionalfactors such as social and gender norms that normalize the use of violence by male partners,discrimination in education, employment and access to services that impact economic security,behaviors (alcohol/drug use) to manage/cope with trauma and absence of quality mental healthcare, etc. It would also important to provide more detail on the communities being studies -perhaps demographics of the rural community and what is known about the IPV in the studycommunities and the existing protocols and provision of primary care to IPV survivors (do thesecommunities have screening and counseling protocols, existing referral pathways, partnerorganization), this will help readers understand if the recommendation are feasible within the
context. The framework should guide the rationale for the study. Why focus on primary care
providers vs. other challenges in health and referral services in rural areas and First Nations,perhaps noting the negative health impact of IPV , reproductive and sexual health, mental health,chronic diseases, infectious diseases, etc., that often make the health care provider a front-lineresponse to survivors and a setting that could provide trauma informed care and warm referrals toproviders. There is much newer work on validated screening measure (what women want - directquestions, confidentiality, compassion and competency) and need to link your findings specificallywith the existing reach from multiple studies published by nurses and other providers in Canadaand beyond. I would encourage you taking a look at Dr. Colleen Varcoe's work with First Nationsurvivors, as well as Marilyn Ford Giboe (Western Ontario), Susan Jack (McMasters, PatO'Campo (Toronto). There is so much work that has been done in the health care settings. Thestudy work as presented adds very little to what is currently known about the health care responseto IPV for diverse populations. The themes as presented are basic and are not linked to a guidingframework or existing evidence. The table detailing the participants is not necessary, especiallygiven the community, 2 clinics and small sample of providers. Also, it is important toacknowledge that given the sample of primarily women providers and some First Nation,participants may have also experienced IPV in their relationship. It is important to includeevidence on how being a survivor may influence clinical practice, how comfortable one is at
asking patients to disclose IPV?
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
NoDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
NoAre you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
Not relevant to this manuscriptQuality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
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