title: Training on domestic violence and child safeguarding in general practice: a mixed method evaluation of a pilot intervention.
abstract: Children's exposure to domestic violence is a type of child maltreatment, yet many general practice clinicians remain uncertain of their child safeguarding responsibilities in the context of domestic violence. We developed an evidence-based pilot training on domestic violence and child safeguarding for general practice teams. The aim of this study was to test and evaluate its feasibility, acceptability and the direction of change in short-term outcome measures.
  
  
  
  We used a mixed method design which included a pre-post questionnaire survey, qualitative analysis of free-text comments, training observations, and post-training interviews with trainers and participants. The questionnaire survey used a validated scale to measure participants' knowledge, confidence/ self-efficacy, and beliefs/ attitudes towards domestic violence and child safeguarding in the context of domestic violence.
  
  
  
  Eleven UK general practices were recruited (response rate 55%) and 88 clinicians attended the pilot training. Thirty-seven participants (42%) completed all pre-post questionnaires and nine were interviewed. All training sessions were observed. All six trainers were interviewed. General practice clinicians valued the training materials and teaching styles, opportunities for reflection and delivery by local trainers from both health and children's social services. The training elicited positive changes in total outcome score and knowledge and confidence/ self-efficacy sub scores which remained at 3-month follow up. However, the mean sub score of beliefs and attitudes did not change and the qualitative results were mixed. Two interviewees described changes in their clinical practice. Participants' suggestions for improving the training included incorporating more ethnic and class diversity in the material, using cases with multiple socio economic disadvantages, and addressing multi-agency collaboration in the context of changing and under-resourced services for children.
  
  
  
  The pilot training for general practice on child safeguarding in the context of domestic violence was feasible and acceptable. It elicited positive changes in clinicians' knowledge and confidence/ self-esteem. The extent to which clinical behaviour changed is unclear, but there are indications of changes in practice by some clinicians. The pilot training requires further refinement and evaluation before implementation.
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK. Nat.Lewis@bristol.ac.uk.
authors.forename: Natalia V
authors.initials: NV
authors.lastname: Lewis
authors.affiliation: School of Social Work, Care and Community, University of Central Lancashire, Harrington Building, Preston, PR1 2HE, UK.
authors.forename: Cath
authors.initials: C
authors.lastname: Larkins
authors.affiliation: School of Social Work, Care and Community, University of Central Lancashire, Harrington Building, Preston, PR1 2HE, UK.
authors.forename: Nicky
authors.initials: N
authors.lastname: Stanley
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
authors.forename: Eszter
authors.initials: E
authors.lastname: Szilassy
authors.affiliation: School for Policy Studies, University of Bristol, Social Science Complex, 8 Priory Road, Bristol, BS8 1TZ, UK.
authors.forename: William
authors.initials: W
authors.lastname: Turner
authors.affiliation: Leeds Institute of Health Sciences, Charles Thackrah Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Drinkwater
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
authors.forename: Gene S
authors.initials: GS
authors.lastname: Feder
mesh_terms: D000328:Adult; D002648:Child; D002649:Child Abuse; D002983:Clinical Competence; D017579:Domestic Violence; D000069581:Exposure to Violence; D005240:Feasibility Studies; D005260:Female; D058006:General Practice; D058005:General Practitioners / Q000193:education*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D010865:Pilot Projects; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D006113:United Kingdom; D055815:Young Adult
keywords: Child protection; Child safeguarding; Domestic violence; Evaluation report; Family practice; General practice; Pilot projects; Pre-post-tests; Qualitative evaluation; Quantitative evaluation