Title: Improving the health care response to domestic violence
Funder: Department of Health (England)

Abstract: Aim: To improve the response of the NHS to domestic violence (DV) through effective care for people experiencing abuse and perpetrators Main objectives: 1. measure prevalence of DV among men attending primary care 2. pilot a general practice intervention to improve care for men experiencing or perpetrating DV 3 & 4 evaluate a psychological intervention delivered by DV advocates to women 5. estimate prevalence of DV in people with mental health disorders, and articulate their health care needs in relation to DV 6. measure prevalence of DV in men who have sex with men (MSM) attending sexual health clinics and its association with sexually transmitted infection 7. articulate experiences of DV and perpetration among MSM and training needs of sexual health clinic staff 8. pilot a sexual health clinic intervention to improve care for MSM experiencing or perpetrating DV 9. model cost-effectiveness of interventions in studies 2 & 8 with value of information analysis 10. synthesize qualitative data across all studies to explore barriers/facilitators to enquiry about & response to DV Background Domestic violence (DV) is threatening behaviour, violence or abuse between adults who are or have been intimate partners, regardless of gender or sexuality. Population life-time prevalence is 28% for women, 18% for men, and higher in clinical populations. Annual cost to the UK economy is £23 billion. DV causes long term damage to physical, reproductive and mental health. It is often invisible to clinicians and poorly managed, although its health consequences are a major burden on the NHS. There is virtually no research on men as victims or perpetrators of DV in the context of health services; we do not even have reliable estimates of prevalence in clinical populations. There is some evidence for effectiveness of interventions such as advocacy for women who have experienced DV, but the effects are modest, particularly for mental health outcomes. We have little evidence to guide health care policy for DV in MSM, even in services designed for this population. Research plans Workstream I MALE PERPETRATORS AND VICTIMS ATTENDING PRIMARY CARE Study 1: Cross-sectional survey of prevalence in general practice and association with demographic characteristics and mental health status Study 2: pilot of educational and support intervention targeted at primary care clinicians to promote enquiry about men’s experience or perpetration of DV and improved management after disclosure. Workstream II MENTAL HEALTH Study 3: Randomised controlled trial of a psychological intervention delivered by specialist DV advocates (Psychological Advocacy Towards Healing: PATH) Study 4: Nested qualitative study in PATH to explore perceptions of advocates and clients Study 5: Systematic review of studies measuring DV prevalence of populations of people with mental health disorders; systematic review of interview or focus group studies of people with mental health disorders who have experienced DV Workstream III MEN WHO HAVE SEX WITH MEN (MSM) ATTENDING SEXUAL HEALTH CLINICS Study 6: cross sectional survey of prevalence in sexual health clinics and association with sexually transmitted infections Study 7: qualitative study to explore experience of victimisation and perpetration of DV with MSM attending sexual health clinics and to identify clinician knowledge and skills deficit in relation to supporting MSM affected by DV Study 8: pilot of educational and support intervention targeted at sexual health clinicians and advisors to promote enquiry about MSM’s DV experience or perpetration and improved management after disclosure. Workstream IV SYNTHESIS Study 9: cost-effectiveness models with data from studies 1,2,6 & 8 followed by value of information analysis Study 10: meta-synthesis of qualitative data from studies 2, 4, 7 and 8 Research team: Leading DV, applied health care research researchers in the UK and internationally, collaborating with service providers and users. Experience of synthesising and translating research findings into clinical guidance and policy recommendations. Research environment: 5* departments in research led institutions. Close collaboration with SW and London PCRNs and MHRNs. Outputs: 2 systematic reviews, RCT result, 3 cost-effectiveness models and value of information analysis, qualitative meta-synthesis and commissioning guidance Outcomes: improved management in primary care and sexual health setting of men experiencing or perpetrating DV; improved mental health for women experiencing DV Impact: high prevalence of DV and its health consequences means that our findings, if implemented, will have a substantial population impact within 3-5 years of end of the programme Public involvement: Survivors of DV, users of DV advocacy services and 2 organisations representing users are involved in design of programme, will have oversight of the workstreams and will collaborate in interpretation and dissemination of findings. .


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL;7.3 MANAGEMENT AND DECISION MAKING
Health categories: MENTAL HEALTH;DISPUTED AETIOLOGY AND OTHER