Taft Angela J, Hooker Leesa, Humphreys Cathy, Hegarty Kelsey, Walter Ruby, Adams Catina, Agius Paul, Small Rhonda
Judith Lumley Centre, La Trobe University, Melbourne, Australia.
School of Social Work, University of Melbourne, Melbourne, Australia.
BMC Med. 2015 Jun 25;13:150. doi: 10.1186/s12916-015-0375-7.
Mothers are at risk of domestic violence (DV) and its harmful consequences postpartum. There is no evidence to date for sustainability of DV screening in primary care settings. We aimed to test whether a theory-informed, maternal and child health (MCH) nurse-designed model increased and sustained DV screening, disclosure, safety planning and referrals compared with usual care.
Cluster randomised controlled trial of 12 month MCH DV screening and care intervention with 24 month follow-up. The study was set in community-based MCH nurse teams (91 centres, 163 nurses) in north-west Melbourne, Australia. Eight eligible teams were recruited. Team randomisation occurred at a public meeting using opaque envelopes. Teams were unable to be blinded. The intervention was informed by Normalisation Process Theory, the nurse-designed good practice model incorporated nurse mentors, strengthened relationships with DV services, nurse safety, a self-completion maternal health screening checklist at three or four month consultations and DV clinical guidelines. Usual care involved government mandated face-to-face DV screening at four weeks postpartum and follow-up as required. Primary outcomes were MCH team screening, disclosure, safety planning and referral rates from routine government data and a postal survey sent to 10,472 women with babies ≤ 12 months in study areas. Secondary outcomes included DV prevalence (Composite Abuse Scale, CAS) and harm measures (postal survey).
No significant differences were found in routine screening at four months (IG 2,330/6,381 consultations (36.5 %) versus CG 1,792/7,638 consultations (23.5 %), RR = 1.56 CI 0.96-2.52) but data from maternal health checklists (n = 2,771) at three month IG consultations showed average screening rates of 63.1 %. Two years post-intervention, IG safety planning rates had increased from three (RR 2.95, CI 1.11-7.82) to four times those of CG (RR 4.22 CI 1.64-10.9). Referrals remained low in both intervention groups (IGs) and comparison groups (CGs) (<1 %). 2,621/10,472 mothers (25 %) returned surveys. No difference was found between arms in preference or comfort with being asked about DV or feelings about self.
A nurse-designed screening and care model did not increase routine screening or referrals, but achieved significantly increased safety planning over 36 months among postpartum women. Self-completion DV screening was welcomed by nurses and women and contributed to sustainability.
Australian New Zealand Clinical Trials Registry, ACTRN12609000424202, 10/03/2009.
母亲在产后面临家庭暴力(DV)风险及其有害后果。目前尚无证据表明初级保健机构中家庭暴力筛查的可持续性。我们旨在测试一种基于理论、由母婴健康(MCH)护士设计的模式与常规护理相比,是否能增加并维持家庭暴力筛查、披露、安全计划制定及转诊。
进行为期12个月的母婴健康家庭暴力筛查与护理干预的整群随机对照试验,并进行24个月的随访。该研究在澳大利亚墨尔本西北部以社区为基础的母婴健康护士团队(91个中心,163名护士)中开展。招募了8个符合条件的团队。团队随机分组在一次公开会议上通过不透明信封进行。团队无法设盲。干预措施基于规范化过程理论,护士设计的良好实践模式纳入了护士导师、加强了与家庭暴力服务机构的关系、护士安全、在三或四个月的咨询中使用自我完成的孕产妇健康筛查清单以及家庭暴力临床指南。常规护理包括政府规定在产后四周进行面对面的家庭暴力筛查,并根据需要进行随访。主要结局指标是通过常规政府数据以及向研究区域内10472名婴儿≤12个月的妇女发送的邮政调查得出的母婴健康团队筛查、披露、安全计划制定及转诊率。次要结局指标包括家庭暴力患病率(综合虐待量表,CAS)和伤害测量指标(邮政调查)。
在四个月时的常规筛查中未发现显著差异(干预组2330/6381次咨询(36.5%),对照组1792/7638次咨询(23.5%),RR = 1.56,CI 0.96 - 2.52),但干预组三个月咨询时来自孕产妇健康检查清单(n = 2771)的数据显示平均筛查率为63.1%。干预两年后,干预组的安全计划制定率从三倍(RR 2.95,CI 1.11 - 7.82)提高到对照组的四倍(RR 4.22,CI 1.64 - 10.9)。两个干预组和对照组的转诊率均较低(<1%)。2621/10472名母亲(25%)回复了调查问卷。在被问及家庭暴力或自我感受时,两组在偏好或舒适度方面未发现差异。
护士设计的筛查与护理模式未增加常规筛查或转诊,但在36个月内使产后妇女的安全计划制定显著增加。自我完成的家庭暴力筛查受到护士和妇女的欢迎,并有助于可持续性。
澳大利亚新西兰临床试验注册中心,ACTRN12609000424202,2009年3月10日。