The University of Hong Kong, China.
Monash University, Clayton, Victoria, Australia.
J Interpers Violence. 2021 Oct;36(19-20):9623-9647. doi: 10.1177/0886260519869067. Epub 2019 Aug 17.
While primary care physicians (PCPs) have opportunities to recognize patients who encounter domestic violence (DV) by intimate partners, warning symptoms such as unexplained physical injury, bruising, anxiety, and depression are often missed during clinic visits. This study investigated the barriers of Hong Kong PCPs toward managing DV, including recognition, management, and referrals of these patients. Four focus group interviews were conducted to explore the in-depth opinions of PCPs on managing DV in Hong Kong. The themes identified were investigated in a questionnaire survey with data from 504 PCPs working in public and private sectors. Factor analysis of the survey data suggested four major barrier factors: (a) worries about the potential harms of intervening in patients' domestic affairs and DV issues, (b) lack of guidelines and support services, (c) limited skills and time in managing DV, and (d) patients' reluctance in disclosing DV issues. PCPs with more years of practice had more worries about intervening in domestic issues (Factor 1), while the younger PCPs tended to perceive limited skills and time in managing DV cases as barriers (Factor 3). PCPs working in the public setting were more likely to ask patients about DV ( = 5.4 vs. 2.9), suspected DV ( = 3.8 vs. 2.3), and managed DV ( = 1.7 vs. 1.0) in the past 5 years compared with the private PCPs. Some PCPs in the focus groups expressed the view that DV cases should be handled by social workers instead of doctors. Survey respondents who held such views about doctors' limited role in DV management also scored higher in all of the barrier factors. The findings suggest that there are boundaries between domestic and medical realms, especially in a Chinese context. Resolving PCPs' worries by training, provision of DV management guidelines, and referral pathway to social workers may be good starting points to bridge the gaps.
虽然初级保健医生（PCP）有机会识别遇到亲密伴侣家庭暴力（DV）的患者，但在就诊期间，常常会错过不明原因的身体伤害、瘀伤、焦虑和抑郁等警告症状。本研究调查了香港 PCP 管理 DV 的障碍，包括对这些患者的识别、管理和转介。进行了四次焦点小组访谈，以探讨 PCP 对管理香港 DV 的深入看法。对 504 名在公私部门工作的 PCP 进行问卷调查，以调查主题。调查数据的因子分析表明存在四个主要障碍因素：（a）担心干预患者家庭事务和 DV 问题可能带来的潜在危害；（b）缺乏指导方针和支持服务；（c）管理 DV 的技能和时间有限；（d）患者不愿透露 DV 问题。实践经验较多的 PCP 对干预家庭问题的担忧较多（因素 1），而年轻的 PCP 则倾向于认为管理 DV 案件的技能和时间有限是障碍（因素 3）。与私人 PCP 相比，在公共环境中工作的 PCP 更有可能在过去 5 年内询问患者关于 DV（=5.4 对 2.9）、疑似 DV（=3.8 对 2.3）和管理 DV（=1.7 对 1.0）的问题。一些焦点小组的 PCP 表示，DV 案件应由社会工作者而不是医生处理。对医生在 DV 管理中作用有限的观点持这种看法的调查受访者在所有障碍因素中的得分也更高。研究结果表明，在家庭和医疗领域之间存在界限，尤其是在中文语境中。通过培训、提供 DV 管理指南以及向社会工作者转介途径来解决 PCP 的担忧，可能是弥合差距的良好起点。
