Influencing factors in the implementation and management of routine enquiry for intimate partner violence (IPV) in antenatal care setting in Ireland: A case study

Abstract

Referred to any form of violence by either partner within an intimate relationship, intimate partner violence (IPV), is recognised as a serious global public health problem. IPV results in poorer health and quality of life and loss of income for victims and their family. Additionally, IPV increases demands on health and social care resources. Disclosure and identification is problematic. IPV routine enquiry is one means to support IPV identification and disclosure. Healthcare professionals including midwives are well positioned to identify, provide immediate support, and refer women onto appropriate support agencies but can lack the necessary personal and institutional resources to effectively amd appropriately respond when required.

This study aimed to explore the factors that influence the implementation and management of routine enquiry for intimate partner violence (IPV) in antenatal care setting in Ireland, to inform policy and practitioners. The study involved two phases: phase one - an overview of reviews and phase two – a qualitative case study. The Social Ecological Model (SEM) provided the theoretical framework underpinning the study.

Twenty-two reviews were selected following a systematic database search and screening process. The overview represented a priori literature review for phase two – a qualitative intrinsic single case study. The case study involved semi-structured interviews with 70 participants (40 women accessing and 30 healthcare professional providing antenatal care) in antenatal care units in the Republic of Ireland. A review of supportive documentation and context descriptions were also conducated.

The factors found to influence the implementation and management of IPV routine enquiry in antenatal care were categorised and mapped using the SEM levels of intervention: individual, relationship, community, institutional and policy.

At individual level, the key factors identified to influence IPV routine enquiury included knowledge and discourse on IPV, expectations and acceptance of IPV routine enquiry, women’s perceptions of personal safety and their readiness to disclose and IPV screening being conducted as part of routine antenatal care.

Core attributes of the relationships between women and healthcare professionals, between the different healthcare professional disciplines and between healthcare professionals and IPV agencies were identified at relationship level included trust and confidence, continunity of care and the expertise and approach of healthcare proffessionals. At institutional level, having and detailing the essential components of an IPV protocol grounded in an integrated systems based approach was identified. This, it was recognised, needed to be implemented and managed using a culturally sensitive approach. Issues identified at policy cross cut all levels and included healthcare service and professional’s preparedness, commitment and provision of adequate resources, critical role of digital technology and the media.

A critical overall conclusion from the study was that enabling management of IPV routine enquiry in antenatal care demands healthcare system and healthcare professional preparedness supported by a systems based IPV routine enquiry protocol, as part of an integrated response to IPV. Furthermore, healthcare system and healthcare professional preparedness and women’s readiness enabled discussion and disclosure of IPV.

The study concluded with the design of a Social Ecological Model (SEM) of the Factors that Influence IPV Routine Enquiry in Antenatal Care, accompanied by a IPV Routine Enquiry Protocol Algorithm to inform policy and practitioners on the planning, implementation and management of IPV routine enquiry protocol for antenatal care. Additionally, a model: Enabling IPV Discussion and Disclosure Model, derived from the study findings, was presented.