Title: REPROVIDE (Reaching Everyone Programme of Research On Violence in diverse Domestic Environments)
Funder: Department of Health and Social Care

Abstract: REPROVIDE aim: To increase the safety and well-being of victims of domestic violence and abuse (DVA) and their children Workstream 1 Aim: To improve identification and referral from general practice of female and male patients experiencing or perpetrating DVA and their children. Objectives Study 1: assess the evidence for interventions for men experiencing DVA Study 2: develop integrated training, support, referral and advocacy intervention (IRIS+); including specification of outcome data for men and children exposed to DVA Study 3: evaluate acceptability and utility of IRIS+ intervention to clinicians Study 4: determine effectiveness and cost-effectiveness of IRIS+ vs. current IRIS programme Study 5: understand the perceptions and experiences of IRIS+ trainers and practitioners and the perceived impact of IRIS+ on patients Workstream 2 Aim: To improve outcomes for partners or ex-partners and children of perpetrators of DVA through a primary-care linked domestic violence perpetrator programme (DDVP) Objectives Study 6: Synthesize evidence to identify the DVPP with the greatest likelihood of effectiveness and inform our choice of outcome measures for the trial Study 7: Determine the acceptability and feasibility of the DVPP and trial design Study 8: Determine effectiveness and cost effectiveness of the DVPP Study 9: To understand the perceptions and experiences of participants experiences of the intervention and its context Background and rationale Domestic violence and abuse (DVA) is a major public health and clinical challenge to health services. Previous research has demonstrated that training and support programmes can improve the response of clinicians to women patients experiencing abuse. Training around the needs of men experiencing or perpetrating DVA and exposed children has been piloted, but the DVA advocacy response to male victims needs further development. Primary care-based training for an effective and safe response to all family members experiencing or perpetrating DVA needs to be integrated into one programme and rigorously evaluated. There remains uncertainty about teffectiveness of interventions for patients who disclose perpetration,d espite the ubiquity of perpetrator programmes in the UK, Europe and north America. Research plan Workstream I Study 1: Systematic review of interventions in all settings for male victims of DVA and mapping study of UK programmes Method: systematic review of (a) studies relating to interventions for male victims of DVA (b) reports in grey literature in any UK-based setting; analysis: (a) Narrative review of quantitative studies; qualitative meta-analysis of qualitative studies. (b) mapping and thematic analysis Study 2: Development and data specification of IRIS+ Method: two stage Delphi consensus method with action learning and wider stakeholder group to configure IRIS+; specification of data collection for trial Study 3: Feasibility study of IRIS+ Method: delivery of IRIS+ in four general practices and measurement of clinician attendance, referral and PIMS questionnaire; analysis: feasibility will be judged by attendance, referral and change in PIMS score Study 4: Trial of IRIS+ Method: Cluster randomised trial of 48 general practices randomised to IRIS vs IRIS+. Primary outcomes: number of men having contact with specialist DVA services and number of children identified as exposed to DVA Analysis: Poisson regression model; for cost-effectiveness -Markov model extrapolating from exposure to advocacy to safety and wellbeing outcomes for men, women and children. Study 5: Nested qualitative study of programme implementation Method: focused ethnography; analysis: thematic Workstream II Study 6: Evidence synthesis and intervention development Method: realist review synthesising previous systematic reviews and new studies with views of PPI groups; modified two-stage Delphi to inform adaption of DDVP and choice of outcome measures and nature of the control arm for trial Study 7: Pilot study of primary care-based perpetrator programme Method: recruitment of 24 perpetrators and partners or ex-partners randomising to intervention and control arms, delivery of intervention, 12-month follow up; analysis: pre-specified progression criteria for main trial Study 8: Parallel group pragmatic individually randomised controlled trial Method: 360 men identified as perpetrators of DVA and their partners or ex-partners randomised to the perpetrator programme intervention or a control arm. Follow-up: 12 months. Outcome measures will include violence, psychological distress, mental health and quality of life. Primary comparative analysis will compare the primary outcome(s) using an intention-to-treat regression model. Economic analysis: cost consequences framework comparing cost from health care and societal perspectives with outcomes Study 9: Nested qualitative study Method: focused ethnography including observation and interviews with trial participants and programme facilitators; analysis: thematic Projected outputs & dissemination plans Academic papers reporting systematic review and evidence synthesis and cost-effectiveness and process and contextual interpretation findings of the two trials. Comprehensive knowledge mobilisation strategy to implement findings through service implementation and commissioning Benefits to patients and the NHS Given the prevalence of DVA, if the IRIS+ and/or the DDVP prove effective and cost effective, implementation would improve the safety, well-being and health of victims of DVA and their children. There would also be a downstream economic benefit to the NHS and society at large.

Lay abstract: Domestic violence and abuse (DVA) is a serious public and clinical health problem. This research plans to improve how healthcare professionals respond to all adult patients who experience or perpetrate DVA and to their children. The two workstreams will examine the value of 1) training general practice staff about the needs of children exposed to DVA, and men experiencing or perpetrating DVA and linking them to specialist services; 2) a group programme for men who perpetrate DVA to help them stop being abusive. 1. Testing training and referral to expert agencies for women, men and children affected by DVA We will expand our preivous research showing that general practice staff can respond appropriately to women experiencing DVA and engage practices in addressing the needs of children exposed to DVA and to men and women experiencing or perpetrating it. Training will include access to an expert (an advocate) who specialises in male victims and perpetrators. The training and advocate role will be tried out initially in 4 practices and then in a large experimental study (trial) testing whether the programme works and is value for money. 2. Testing a group programme for men perpetrating DVA Programmes for men who perpetrate DVA exist, but we don t know enough about whether they work for the men or victims/survivors of DVA. The researchers and a group of experts will consult on which is the most promising programme and this will be adapted and tested first in a small group of men who have perpetrated DVA and their partners or ex-partners and, if this looks promising, test it in a large experimental study (trial) based in primary care. Men who have perpetrated DVA and their partners/ex-partners will be recruited so that we can measure the extent to which safety has increased and whether abuse has stopped/decreased. This work emerged from extensive consultation with established and new public and patient involvement (PPI) groups and we will continue to work with (in separate consultations) DVA survivors and perpetrators to inform both workstreams in this programme of work. In addition, we will consider the needs of minority groups who are often not included in service developments. This includes migrants, black and ethnic minority communities and people in gay or lesbian relationships. We are focusing on male perpetrators who have relationships with women because these men form the largest group of perpetrators. However, alongside the trial we will use interviews to explore the needs of other groups of perpetrators such as gay men. Our results will be heard by relevant academic and non-academic audiences, including service commissioners to put our findings into practice, which will be discussed throughout the programme with a systematic strategy in the final year.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH