title: Primary care identification and referral to improve safety of women experiencing domestic violence (IRIS): protocol for a pragmatic cluster randomised controlled trial.
abstract: BACKGROUND
  Domestic violence, which may be psychological, physical, sexual, financial or emotional, is a major public health problem due to the long-term health consequences for women who have experienced it and for their children who witness it. In populations of women attending general practice, the prevalence of physical or sexual abuse in the past year from a partner or ex-partner ranges from 6 to 23%, and lifetime prevalence from 21 to 55%. Domestic violence is particularly important in general practice because women have many contacts with primary care clinicians and because women experiencing abuse identify doctors and nurses as professionals from whom they would like to get support. Yet health professionals rarely ask about domestic violence and have little or no training in how to respond to disclosure of abuse.
  
  
  METHODS
  This protocol describes IRIS, a pragmatic cluster randomised controlled trial with the general practice as unit of randomisation. Our trial tests the effectiveness and cost-effectiveness of a training and support programme targeted at general practice teams. The primary outcome is referral of women to specialist domestic violence agencies. Forty-eight practices in two UK cities (Bristol and London) are randomly allocated, using minimisation, into intervention and control groups. The intervention, based on an adult learning model in an educational outreach framework, has been designed to address barriers to asking women about domestic violence and to encourage appropriate responses to disclosure and referral to specialist domestic violence agencies. Multidisciplinary training sessions are held with clinicians and administrative staff in each of the intervention practices, with periodic feedback of identification and referral data to practice teams. Intervention practices have a prompt to ask about abuse integrated in the electronic medical record system. Other components of the intervention include an IRIS champion in each practice and a direct referral pathway to a named domestic violence advocate.
  
  
  CONCLUSIONS
  This is the first European randomised controlled trial of an intervention to improve the health care response to domestic violence. The findings will have the potential to inform training and service provision.
  
  
  BACKGROUND
  ISRCTN74012786.
authors.affiliation: Academic Unit of Primary Health Care, University of Bristol, 25-27 Belgrave Road, Clifton, Bristol, BS8 2AA, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Gregory
authors.forename: Jean
authors.initials: J
authors.lastname: Ramsay
authors.forename: Roxane
authors.initials: R
authors.lastname: Agnew-Davies
authors.forename: Kathleen
authors.initials: K
authors.lastname: Baird
authors.forename: Angela
authors.initials: A
authors.lastname: Devine
authors.forename: Danielle
authors.initials: D
authors.lastname: Dunne
authors.forename: Sandra
authors.initials: S
authors.lastname: Eldridge
authors.forename: Annie
authors.initials: A
authors.lastname: Howell
authors.forename: Medina
authors.initials: M
authors.lastname: Johnson
authors.forename: Clare
authors.initials: C
authors.lastname: Rutterford
authors.forename: Debbie
authors.initials: D
authors.lastname: Sharp
authors.forename: Gene
authors.initials: G
authors.lastname: Feder
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D017579:Domestic Violence / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007318:Inservice Training / Q000191:economics; D011320:Primary Health Care; D016730:Program Development; D012017:Referral and Consultation; D012107:Research Design; D006113:United Kingdom; D016387:Women's Health