Search

Copyright of Huisarts En Wetenschap is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVE: The aim of this study was to discover the ways in which a training program on intimate partner abuse affected a doctor's daily practice. METHODS: Eighteen family doctors who participated in a training program on partner abuse were interviewed. RESULTS: The interviewees evaluated the training program to be useful in raising their awareness and suspect criteria on partner abuse. Any questions and frustrations they had concerning the subject were resolved. They felt more confident and equipped to discuss and aid abused patients after the training. CONCLUSION: In order to improve doctors' awareness of partner abuse in daily practice, they must need first realize the scale of the problem and then become more comfortable in their own attitude and finally more confident in their ability to aid these patients. PRACTICE IMPLICATIONS: Training on partner abuse should be specifically tailored to change awareness, attitudes and consultation skills. [ABSTRACT FROM AUTHOR]

Abstract Background Intimate partner violence is highly prevalent and mostly affects women with negative consequences for their physical and mental health. Children often witness the violence which has negative consequences for their well-being too. Care offered by family physicians is often rejected because abused women experience a too high threshold. Mentor mother support, a low threshold intervention for abused mothers in family practice, proved to be feasible and effective in Rotterdam, the Netherlands. The primary aim of this study is to investigate which factors facilitate or hinder the implementation of mentor mother support in family practice. Besides we evaluate the effect of mentor mother support in a different region. Methods/Design An observational study with pre- and posttests will be performed. Mothers with home living children or pregnant women who are victims of intimate partner violence will be offered mentor mother support by the participating family physicians. The implementation process evaluation consists of focus groups, interviews and questionnaires. In the effect evaluation intimate partner violence, the general health of the abused mother, the mother-child relationship, social support, and acceptance of professional help will be measured twice (t = 0 and t = 6 months) by questionnaires, reporting forms, medical records and interviews with the abused mothers. Qualitative coding will be used to analyze the data from the reporting forms, medical records, focus groups, interviews, and questionnaires. Quantitative data will be analyzed with descriptive statistics, chi square test and t-test matched pairs. Discussion While other intervention studies only evaluate the feasibility and effectiveness of the intervention, our primary aim is to evaluate the implementation process and thereby investigate which factors facilitate or hinder implementation of mentor mother support in family practice.

Objective: To examen the short-term and long-term responses of sexual assault victims who attended a sexual assault centre., Methods: Semi-structured interviews were held with twelve victims of sexual assault who received help from a sexual assault centre. Analyses were done in Atlas.ti. via a process of open, axial and selective coding., Results: Shortly after assault, the victims' response was to strike a balance between denial and acknowledgement that the violence was real and not their fault. In the ling term most victims experienced a dynamic recovery process with fluctuating responses. Their social support network played a crucial role in reaching out for professional care., Conclusion: Shortly after assault sexual violence victims need the violence to be acknowledged by skilful, empathic care providers. In the long term, victims experience vitims experience a dynamic recovery process with fluctuating responses in which continuity of care is of the utmost importance., (© 2019 Nordic College of Caring Science.)

Background: Sexual and family violence are problems that affect many women and men, and the negative health consequences of violence are numerous. As adequate acute interprofessional care can prevent negative health consequences and improve forensic medical examination, a Centre for Sexual and Family Violence was set up., Aim: We aimed to improve our understanding of the challenges in interprofessional collaboration in a newly set-up centre for sexual and family violence., Methods: We conducted a qualitative study with semi-structured interviews about the experiences with interprofessional collaboration of 16 stakeholders involved in the Centre for Sexual and Family Violence Nijmegen. Participants were selected by purposive sampling., Results: Participants found that the interprofessional collaboration had improved communication and competences. However, there were challenges too. Firstly, the interprofessional collaboration had brought parties closer together, but the collaboration also forced professionals to strongly define their boundaries. Mutual trust and understanding needed to be built up. Secondly, a balance had to be struck between pursuing the shared vision - which was to improve quality of care for victims - and giving space to organizations' and professionals' own interest. Thirdly, care for victims of sexual and family violence could be demanding on healthcare providers in an emotional sense, which might jeopardize professional's initial motivation for joining the Centre for Sexual and Family Violence Nijmegen., Conclusion: The interprofessional collaboration in an assault centre improves quality of care for victims, but there are also challenges. The tasks of an assault centre are to create opportunities to discuss professional roles and professional interests, to build up good interpersonal relations in which trust and understanding can grow, to formulate a strong and shared victim-centred vision and to support care providers with training, feedback and supervision., (© 2017 Nordic College of Caring Science.)

Background: Adolescents and young adults (AYAs) are of special interest in a group of children exposed to family violence (FV). Past-year prevalence of exposure to FV is known to be highest in AYAs and has severe consequences. Peer support is an effective approach to behavior change and the Internet is considered suitable as a mode of delivery., Objective: The study aimed to evaluate both effectiveness and feasibility of a randomized controlled trial (RCT) and feasibility study of the Internet-based self-support method "Feel the ViBe" (FtV) using mixed-methods approach to fully understand the strengths and weaknesses of a new intervention., Methods: AYAs aged 12-25 years and exposed to FV were randomized in an intervention group (access to FtV + usual care) and a control group (minimally enhanced usual care) after they self-registered themselves. From June 2012 to July 2014, participants completed the Impact of Event Scale (IES) and Depression (DEP) and Anxiety (ANX) subscales of the Symptom CheckList-90-R (SCL-90) every 6 weeks. The Web Evaluation Questionnaire was completed after 12 weeks. Quantitative usage data were collected using Google analytics and content management system (CMS) logs and data files. A univariate analysis of variance (UNIANOVA) and mixed model analysis (intention-to-treat [ITT], complete case) were used to compare groups. Pre-post t tests were used to find within-group effects. Feasibility measures structurally address the findings. The CONsolidated Standards Of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth (CONSORT-EHEALTH) checklist was closely followed., Results: In total, 31 out of 46 participants in the intervention group and 26 out of 47 participants in the control group started FtV. Seventeen participants (intervention: n=8, control: n=9) completed all questionnaires. Mixed model analysis showed significant differences between groups on the SCL-90 DEP (P=.04) and ANX (P=.049) subscales between 6 and 12 weeks after participation started. UNIANOVA showed no significant differences. Pre-post paired sample t tests showed significant improvements after 12 weeks for the SCL-90 DEP (P=.03) and ANX (P=.046) subscales. Reported mean Web-based time per week was 2.83 with a session time of 36 min. FtV was rated a mean 7.47 (1-10 Likert scale) with a helpfulness score of 3.16 (1-5 Likert scale). All participants felt safe. Two-thirds of the intervention participants started regular health care., Conclusions: No changes on the IES were found. SCL-90 DEP and ANX showed promising results; however, the calculated sample size was not reached (n=18). FtV functions best as a first step for adolescents and young adults in an early stage of change. FtV can be easily implemented without extensive resources and fits best in the field of public health care or national governmental care., Trial Registration: Netherlands National Trial Register (NTR): NTR3692; http://www.trialregister.nl/trialreg/admin/ rctview.asp?TC=3692 (Archived by WebCite at http://www.webcitation.org/6qIeKyjA4)., (©Karin van Rosmalen-Nooijens, Sylvie Lo Fo Wong, Judith Prins, Toine Lagro-Janssen. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 12.06.2017.)

The objective of this study was to examine factors facilitating and constraining the identification and management of intimate partner violence (IPV) at an emergency department (ED). Semi-structured interviews were conducted with 18 ED employees of a university hospital in the Netherlands. All interviews were audiotaped, transcribed verbatim, and analyzed by using qualitative content analysis in Atlas.ti. Constraining factors were lack of knowledge, awareness, and resources at the ED. ED employees felt many barriers to bringing up IPV. Facilitating factors were good cooperation among staff, the involvement of one team member in producing an IPV protocol, having received training on child abuse, and private consulting rooms. The ED setting and the ED employees' task perception and attitude contained both constraining and facilitating factors: ED employees saw it as their task and responsibility to help IPV victims, but their priorities were to secure a high turnover and treat acute physical problems. Although ED employees expressed openness and willingness to help, they also took the view that victims had a considerable responsibility of their own in disclosing and managing IPV, which led to ambivalent feelings. In conclusion, ED employees faced tensions in IPV identification and management caused by lack of awareness, knowledge and resources, conflicting priorities at the ED, and ambivalent feelings. Improvements can be made by supporting ED employees with guidelines in the form of a protocol and with training that also addresses the tensions ED employees face.

Women who have experienced intimate partner violence use health care services more often than non-abused women, but it is unclear what they expect from physicians in relation to their intimate partner violence experience. In this study the authors explored whether women in Serbia expect physicians to help them after having experienced intimate partner violence, what kind of help the women expected, and if none, why none is expected. The authors of this study conducted structured interviews with 120 women who visited six primary healthcare centres. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed applying content analyses. The majority of women (81.7%) expected healthcare professionals to help them in the event of intimate partner violence, mainly through giving advice, information, contacting other institutions, services, and providing understanding and support. Fewer women expected help in the form of documenting violence and contacting police. Only a minority (8.3%) did not expect help, noting that intimate partner violence is beyond the scope of healthcare professionals' interest or competencies, and/or that violence was a private problem, while 10% were unsure about the role of physicians in the case of intimate partner violence. The majority of women in this study expected help with intimate partner violence. Physicians should be aware of these expectations and how to provide support to women experiencing intimate partner violence.

Intimate partner violence (IPV) is a highly prevalent problem among women. Our aim was to investigate the prevalence of IPV among patients of an out-patient clinic obstetrics-gynecology, association with level of education, and women's opinion on asking about IPV by physicians. We conducted a survey among women between 18 and 60 years in a waiting room of an out-patient clinic obstetrics-gynecology. We used the Composite Abuse Scale to measure type and severity of IPV. Two hundred women of whom 82 (41%) were pregnant, were included in the study (response 57%). Twenty-three percent of the women ever experienced IPV and 9% currently. IPV is more prevalent among women with a lower educated partner. Four of the pregnant women (5%) experienced current IPV. Seventy-eight percent of the respondents find it important for physicians to ask about IPV. IPV proved to be a highly prevalent problem in an out-patient clinic obstetrics-gynecology with almost one-quarter of the patients ever having been victim of various forms of IPV, and almost one in 10 currently. Awareness of the possibility of IPV and early recognition by physicians might reduce mental and physical sequels and strengthen women's feeling of being supported.

Objective: We aimed to explore what women valued most in disclosing partner abuse to their doctor and whether disclosure played a role in handling their abuse situation., Methods: A qualitative method was used to understand abused women's views and experiences with disclosure to their family doctor. Thirty-six women were interviewed within 4 weeks after disclosure to their family doctor., Results: Most women went to see the doctor for some medical complaint, and only three women planned to disclose the abuse. Twenty-five women valued most their doctor's communicative approach with empathy or empowering and nine women valued most the instrumental approach. Eight women of the latter group wanted this combined with a communicative approach. After disclosure to the family doctor, a group of women (n=20) perceived a real change in their possibilities to handle their situation. They appeared to be in a position we named: 'in transition', a state in which they started or continued a process of change. Another group of women (n=13) appeared to be in a 'locked-up' position, a state without any prospect on change, feeling out of control and fearing the abuser. Three women reacted reserved towards change., Conclusion: A communicative approach, providing empathy and empowerment, is important to women in disclosing partner abuse. More than half of the women perceived possibilities for a change., Practice Implications: Talking about abuse is an important step in a woman's process of change. Doctors should acknowledge the advantage of their position as a professional confidant and ask women about abuse.

Background: Female patients, abused by their partner, are heavy users of medical services. To date, valid indicators of partner abuse of women are lacking., Aim: To outline the healthcare utilisation in family practice of women who have suffered abuse, and compare this to the average female population in family practice., Design of Study: As part of a primary study on the role of family doctors in recognising and managing partner abuse a retrospective study was performed. Anonymised data from the electronic medical records of women who have suffered abuse were collected over the period January 2001-July 2004. These data were compared to those from the average female population of the Second Dutch National Survey in General Practice 2001 (DNSGP-2)., Setting: Family practices in Rotterdam and surrounding areas in 2004., Method: The numbers of consultations and prescriptions for pain medication, tranquillisers and antidepressants of women who have suffered abuse (n = 92) were compared to those of the female population of the DNSGP-2 (n = 210 071). The presented health problems and referrals of the studied group were examined., Results: Pain, in all its manifestations, appeared to be the most frequently presented health problem. Compared to the female population of the DNSGP-2, in all age categories, women who have suffered abuse consult their family doctor almost twice as often and receive three to seven times more pain medication., Conclusion: A doubled consultation frequency, chronic pain and an excessively high number of prescriptions for pain medication are characteristics of healthcare utilisation of women have been abused in this study. These findings contribute to the development of the concept of the 'symptomatic' female patient.

Background: Intimate partner abuse is very common among female patients in family practice. In general, doctors overlook the possibility of partner abuse., Aim: To investigate whether awareness of intimate partner abuse, as well as active questioning, increase after attending focus group and training, or focus group only., Design of Study: Randomised controlled trial in a stratified sample., Setting: Family practices in Rotterdam and surrounding areas., Method: A full-training group (n = 23), a group attending focus group discussions alone (n = 14), and a control group (n = 17) were formed. Data were collected with incident reporting of every female patient (aged >18 years) that was suspected of, or presented, partner abuse during a period of 6 months. The primary outcome measure was the number of reported patients; the secondary outcome measure was the number of patients with whom the GP had non-obvious reasons to suspect/discuss abuse., Results: Comparison of the full-training group (n = 87 patients) versus the control group (n = 14 patients) resulted in a rate ratio of 4.54 (95% confidence interval [CI] = 2.55 to 8.09, P <0.001); the focus group only group (n = 30 cases) versus control group: rate ratio of 2.2 (95% CI = 1.14 to 4.26, P = 0.019); full-training versus the focus group only group: rate ratio of 2.19 (95% CI = 1.36 to 3.52, P = 0.001). Comparison of the fulltraining group with the untrained groups for awareness of partner abuse in case of non-obvious signs resulted in: odds ratio 5.92 (95% CI = 2.25 to 15.62, P <0.01) all corrected for sex, district, practice setting, working part/full-time, experience, and age of the doctor., Conclusions: Training was the most significant determinant to improve awareness and identification of intimate partner abuse. Active questioning increased, especially where there were non-obvious signs. The focus group on its own doubled the awareness of partner abuse.

Intimate partner abuse is world-wide much more prevalent than often suspected. Three female patients consulted their family doctor with a variety of complaints. A 53-year-old woman, mother of three grown-up children, and divorced a year ago, sought help after four days, for a large infected wound of her right hand. A 32-year-old single mother of a 2-year-old girl asked the practice assistant for an iteration of a tranquillizer because of tension headache. A 36-year-old divorced mother of three sons was sent by her company doctor to ask for a referral to a psychiatrist because of chronic fatigue. All three women appeared to have been severely abused by their partners, recently or in the past, and were reluctant to disclose the abuse. Two women were regular visitors of doctor's offices with diverse unspecific complaints. The third woman was a victim of sexual abuse as a child and was severely depressed. Active asking about experiences of intimate partner abuse helped these women to disclose the real nature of their problem. Important effect is that abused women can accept help and experience support to improve their situation. Doctors should suspect intimate partner abuse more often in patients who are heavy medical consumers, depressed or victims of sexual abuse in childhood. Single and divorced mothers can hide a history of abuse. Doctors should ask clear and specific questions about relationships and listen without passing judgement so as to help women to disclose abuse.

Objective: To determine whether consultation behaviour of Turkish, Surinam and Moroccan children (0-14 years old) with a GP differs from that of a comparable group of Dutch children., Design: Cohort study with comparison of matched groups., Setting: 103 general practices in the Netherlands., Methods: Data on 63.753 children collected in the Dutch National Survey were used. 161 GPs registered all contacts between patient and practice during 1 year (in 4 parts of each 3 months). Sociodemographic characteristics of all 103 practice populations were gathered. For each Turkish, Surinam and Moroccan child a Dutch child was selected with similar age, gender, socio-economic status, degree of urbanisation, season of registration and sickness insurance coverage. Consult frequency, number of encounters per episode of care, morbidity presented, duration of encounter and percentages of encounters during evening, night and weekend were registered., Results: There were no significant differences in consult frequency between the three ethnic groups and their Dutch reference group, nor were there any differences in number of encounters during an episode of care. The morbidity presented did vary compared with Dutch children. Turkish children consulted the GP more often for gastrointestinal problems (relative risk (RR): 1,81) and respiratory problems (RR: 1,27), but less often for ear problems (RR: 0,54). Surinam children consulted the GP less often for musculoskeletal problems (RR: 0,65), but more often for respiratory problems (RR: 1,20). Moroccan children consulted the GP less often for ear problems (RR: 0,51). For a larger percentage of ethnic children the duration of encounter was less than ten minutes., Conclusion: Turkish, Surinam and Moroccan children do not consult a GP more often than a comparable group of Dutch children. The morbidity presented differed.