Knowledge and practices of regional and rural general practitioners in the identification and management of intimate partner and family violence: a mixed methods study in Western Australia.

Abstract

Background: General Practitioners (GPs) are well placed to identify and assist patients experiencing intimate partner violence (IPV) and family violence (FV). However, patients experiencing IPV/FV can be under-detected or inadequately assisted when GPs do not have the necessary confidence, knowledge, attitudes or skills for this. Given the high rates of IPV/FV in the Australian regional setting where this study was conducted, this investigation explored the confidence, knowledge, attitudes and practices of local GPs in identifying and managing patients who are experiencing IPV/FV.

Methods: This mixed methods study utilised a survey tool adapted from a review of existing instruments. The adapted tool included questions on provider confidence, knowledge, attitudes and practices for quantitative analysis, as well as open-response questions that were analysed thematically. All GPs (n = 58) working within the area at the time of the study were invited to participate via emails and written letters distributed through practices and at pre-existing meetings, with 25 completing the survey (43% response rate).

Results: Participants lacked knowledge around GP-facilitated disclosure of abuse, many believing the patient to be the main reason for non-disclosure. Half or fewer respondents indicated confidence in creating safety plans with patients, in making appropriate referrals and in identifying IPV/FV by history, signs and symptoms. There were mostly favourable attitudes towards asking about and assisting with IPV/FV, although only one quarter of respondents believed that individuals experiencing IPV/FV can make appropriate choices about how to handle their situation. In terms of practice, only one third agreed that they could match interventions to patient readiness to change. Other key concerns included difficulties in accessing timely support, with improved coordination of local services and systematic changes in the GP environment being the most common recommendations made by respondents.

Conclusions: This study demonstrated that the responding GPs in a regional area with high rates of IPV/FV have generally favourable attitudes towards identifying and assisting with IPV/FV but lack knowledge and confidence in the practical elements of enquiry. Surprisingly for a regional area, there was poor understanding of local support provision. The findings have the potential to meaningfully inform regional and rural primary care experiences, including desired educational opportunities and enhancing the relationship between health professionals and relevant community organisations. The results support the need for upstream changes in the general practice environment to improve the ability of regional and rural GPs to build relationships with patients over time and enhance overall health outcomes for those affected by abuse.