Title: Dentistry Responding In Domestic Violence and Abuse (DRIDVA): Feasibility Study For Cluster Randomised Trial of a Practice-Based Intervention
Funder: Department of Health and Social Care

Abstract: Background Domestic Violence and Abuse (DVA) is a violation of human rights with short and long term damage to physical and mental health. It takes place between individuals in intimate relationships and family members, and may manifest as physical violence, emotional abuse, financial abuse, psychological abuse, and/or controlling behaviour. Although there are dental injuries resulting from domestic violence and abuse, available research shows that dentists and dental care professionals are not actively supporting their patients who present with injuries that might have resulted from DVA. The NICE domestic violence and abuse guidelines recommendation that all healthcare professionals be involved in identifying, supporting and referring to specialist advocacy services people experiencing DVA, have not been implemented in dental services, reflecting the absence of DVA training and referral pathways. Aims The overarching aim of this research is to explore the feasibility of using an evidence-based, cost-effective, and practice-level intervention in improving health and social care outcomes of adult patients with lived experience of domestic violence and abuse utilising primary care dental practices. This study has two aims, which are to: To assess the feasibility of using an adapted practice-based (Identification and Referral to Improve Safety [IRIS]) intervention to aid recognition, appropriate support, and referral of adults utilising primary care dental services presenting with injuries that might have resulted from domestic violence and abuse. To explore the feasibility of a cluster-randomised trial design to evaluate the adapted IRIS intervention in primary care dental services. There are a number of areas of uncertainty relating to achieving the aims of the study. Hence, we will collect information on the following : appropriateness and acceptability of IRIS intervention delivery within primary care dental services recruitment and retention rates, and examine reasons for non-participation and attrition document the types of dental injuries observed as resulting from domestic violence and abuse Plan of Investigation This is a cluster-randomised feasibility study, with a nested qualitative study. General Dental Practices will be the unit of analysis. It is proposed that the duration of the feasibility study will be 24 months. Over a four month period, we will hold series of workshops with key stakeholders to facilitate the development of a dentistry-specific IRIS care pathway. Following the development of the dentistry-specific IRIS care pathway, six general dental practices will be recruited through Greater Manchester Dental Professional Network and randomly allocated to trial arms to explore the feasibility of trialling the adapted IRIS pathway. Three general dental practices will be randomly allocated to the usual practice arm and three general dental practices to the intervention arm. The intervention will involve training staff in general dental practices, installing software in the electronic medical system of dental practices, and establishing a referral pathway to a designated advocate-educator from the collaborating agency (Manchester Women s Aid). A nested qualitative study will also be conducted to explore the acceptability of IRIS intervention within primary care dental practices. Data will also be collected from the electronic medical records of participating practices, referral data from the collaborating agency, and health economics data. Potential benefits to patients/NHS There are approximately 15.4 million incidents of domestic violence and abuse annually in Britain. The total annual monetary cost of DVA in England for the government, the individual (human and emotional suffering), NHS, employers and the criminal justice system is around &pound;23 billion, with an estimated &pound;1.7 billion cost to the NHS. Existing evidence suggests IRIS is an effective care pathway for supporting victims and survivors of DVA within general medical practice. Hence, an adapted IRIS care pathway for dental workforce may be beneficial for dental patients presenting with injuries resulting from DVA.

Lay abstract: Domestic violence and abuse (DVA) is a global public health problem and major risk for serious injury and even death. Healthcare professionals are in a good position to help victims and survivors, however, available research shows that dentists and dental care professionals do not actively support their patients who present with injuries that might have resulted from DVA, unlike general medical practices (GMPs) and Accident & Emergency units. This research will deliver an intervention (Identification and Referral to Improve Support [IRIS]) to improve how dentists and dental care professionals respond to adult patients presenting with injuries that might have resulted from DVA. The IRIS care pathway has been widely used within GMPs to identify and support female patients experiencing DVA, and has been shown to improve identification and referral of victims and survivors to appropriate specialist support agencies. However, this care pathway has never been used within general dental practices (GDPs). IRIS cannot be directly translated to GDPs due to major differences between dentistry and general medicine, the environments in which they operate and the types of patient seen by dentists. We therefore need to assess whether setting up an IRIS care pathway in dentistry is feasible. This research has two main aims: (1) to assess the feasibility of using an adapted IRIS intervention in GMPs; (2) to evaluate the adapted IRIS in dental practices. Firstly, we will ask dental teams, victims and survivors of DVA and support agencies how we can adapt the IRIS pathway to dental practices. Next, we will train dental staff to use the adapted pathway and then ask stakeholders about its usefulness in dental practice. We feel these are necessary steps towards a wider future trial to determine whether the IRIS care pathway is effective in supporting adult victims of DVA using GDPs.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: DISPUTED AETIOLOGY AND OTHER;ORAL AND GASTROINTESTINAL