title: A comprehensive model for intimate partner violence in South African primary care: action research.
abstract: BACKGROUND
  Despite extensive evidence on the magnitude of intimate partner violence (IPV) as a public health problem worldwide, insubstantial progress has been made in the development and implementation of sufficiently comprehensive health services. This study aimed to implement, evaluate and adapt a published protocol for the screening and management of IPV and to recommend a model of care that could be taken to scale in our underdeveloped South African primary health care system.
  
  
  METHODS
  Professional action research utilised a co-operative inquiry group that consisted of four nurses, one doctor and a qualitative researcher. The inquiry group implemented the protocol in two urban and three rural primary care facilities. Over a period of 14 months the group reflected on their experience, modified the protocol and developed recommendations on a practical but comprehensive model of care.
  
  
  RESULTS
  The original protocol had to be adapted in terms of its expectations of the primary care providers, overly forensic orientation, lack of depth in terms of mental health, validity of the danger assessment and safety planning process, and need for ongoing empowerment and support. A three-tier model resulted: case finding and clinical care provision by primary care providers; psychological, social and legal assistance by 'IPV champions' followed by a group empowerment process; and then ongoing community-based support groups.
  
  
  CONCLUSIONS
  The inquiry process led to a model of comprehensive and intersectoral care that is integrated at the facility level and which is now being piloted in the Western Cape, South Africa.
authors.affiliation: Nursing Division, Faculty of Medicine and Health Sciences, Stellenbosch University, P O Box 19063, Tygerberg 7505, South Africa. kjoy@sun.ac.za
authors.forename: Kate
authors.initials: K
authors.lastname: Joyner
authors.forename: Bob
authors.initials: B
authors.lastname: Mash
mesh_terms: D017579:Domestic Violence; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D011320:Primary Health Care; D036301:Qualitative Research; D012657:Self-Help Groups; D013019:South Africa; D013179:Spouse Abuse / Q000175:diagnosis*