title: Women's experiences of referral to a domestic violence advocate in UK primary care settings: a service-user collaborative study.
abstract: BACKGROUND
  Women experiencing domestic violence and abuse (DVA) are more likely to be in touch with health services than any other agency, yet doctors and nurses rarely ask about abuse, often failing to identify signs of DVA in their patients.
  
  
  OBJECTIVE
  To understand women's experience of disclosure of DVA in primary care settings and subsequent referral to a DVA advocate in the context of a DVA training and support programme for primary care clinicians: Identification and Referral to Improve Safety (IRIS).
  
  
  METHODS
  A service-user collaborative study using a qualitative study design. Recruitment was from across IRIS trial settings in Bristol and Hackney, London.
  
  
  METHODS
  Twelve women who had been referred to one of two specialist DVA advocates (based at specialist DVA agencies) were recruited by a GP taking part in IRIS. Women were interviewed by a survivor of DVA and interviews were recorded and transcribed verbatim. Analysis was thematic using constant comparison.
  
  
  RESULTS
  GPs and nurses can play an important role in identifying women experiencing DVA and referring them to DVA specialist agencies. GPs may also have an important role to play in helping women maintain any changes they make as a result of referral to an advocate, by asking about DVA in subsequent consultations.
  
  
  CONCLUSIONS
  A short time interval between a primary care referral and initial contact with an advocate was valued by some women. For the initial contact with an advocate to happen as soon as possible after a primary care referral has been made, a close working relationship between primary care and the third sector needs to be cultivated.
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol.
authors.forename: Alice
authors.initials: A
authors.lastname: Malpass
authors.forename: Kim
authors.initials: K
authors.lastname: Sales
authors.forename: Medina
authors.initials: M
authors.lastname: Johnson
authors.forename: Annie
authors.initials: A
authors.lastname: Howell
authors.forename: Roxane
authors.initials: R
authors.lastname: Agnew-Davies
authors.forename: Gene
authors.initials: G
authors.lastname: Feder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003299:Cooperative Behavior; D017579:Domestic Violence / Q000517:prevention & control* / Q000523:psychology; D004502:Education, Medical, Continuing; D005260:Female; D058006:General Practice / Q000458:organization & administration; D006801:Humans; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010344:Patient Advocacy; D011320:Primary Health Care; D036301:Qualitative Research; D012017:Referral and Consultation / Q000458:organization & administration*; D014342:Truth Disclosure; D006113:United Kingdom; D014754:Violence / Q000517:prevention & control* / Q000523:psychology; D016387:Women's Health
keywords: advocate; domestic abuse and violence; general practice; referral; service user; women’s health