A cluster randomised controlled trial of a whole of general practice intervention to prevent and reduce domestic violence among migrant and refugee communities
In Australia, an estimated one in six women has experienced family violence over her life-time. Often the first professional an abused woman comes in contact with is her healthcare provider, offering a unique opportunity for support. Australia benefits from the increasing diversity of its migrant populations, of which South Asians are an emerging group, accounting for 2.1% of the Australian population in the 2011 census. Yet a culturally appropriate response to enhance the safety of South Asian and other immigrant and refugee women and their communities is currently lacking.
The Australian government has identified the crucial role of an effective primary care system to reduce the health damage caused by family violence. Yet, to date, there have been no intervention studies in health care settings that focus specifically on the needs of immigrant communities. Increasingly, Australia's healthcare system is enriched by bilingual South Asian GPs who may be immigrant doctors or born in immigrant families and educated here. Doctors are highly regarded authority figures in communities and if trained and adequately supported, can play an important role in supporting women who experience family violence, and enhancing their safety.
Harmony is a pragmatic cluster randomised controlled trial that aims to test the feasibility and effectiveness of a systems intervention to improve the capacity of primary care clinicians (GPs, nurses and others) to enquire about family violence, provide first line support, and offer confidential referral to culturally diverse women patients. The study, adapted from a successful UK model, is being trialled in 20 general practice sites in regions of high South Asian immigrant population in Melbourne's north west and south east suburbs.
The Harmony intervention
The intervention consists of 3 main strategies:
- Clinical and administrative staff training on identifying and responding in a culturally safe way to patients experiencing family violence, focusing on working with South-Asian migrant and refugee populations
- Twelve month advocate/case work support for women and for all clinic staff by a specialist bilingual South Asian case worker based at a family violence specialist agency for South-Asian migrant and refugee communities
- On-going contact between clinicians and the advocate/case worker for support and feedback on referrals for the twelve months
The feasibility and effectiveness of this intervention will be measured through process evaluations and outcome assessments. The rate of family violence identification, safety planning and referral as recorded in routine GP patient medical records and referrals received by advocates are the outcomes.
Interviews with clinicians and women migrant and refugee patients will yield feedback on the process, and the value that such an intervention might offer as a health systems and inter-sectoral response to family violence. We are also conducting an economic evaluation to examine the cost-benefit of the intervention.
Who we are
The research team
Harmony is a collaborative, cross cultural project conducted by an international multi-disciplinary team of social science and medical academics who specialise in family violence research at leading Australian and UK institutions.
The chief investigators of the project are:
- Prof Angela Taft at La Trobe University, Melbourne, Australia (Lead)
- Prof Kelsey Hegarty, The University of Melbourne, Melbourne, Australia
- A/Prof Jane Yelland, Murdoch Children's Institute, Melbourne, Australia
- Prof Gene Feder, Bristol University, Bristol, UK
- Prof Danielle Mazza, Monash University, Melbourne, Australia
- A/Prof Richard Norman, Curtin University, Perth, Australia
The associate investigators are:
- Dr Claudia Garcia-Moreno, World Health Organisation
- A/Prof Douglas Boyle, The University of Melbourne, Melbourne, Australia
- Dr Cattram Nguyen, Murdoch Children's Research Institute, Melbourne, Australia
The Harmony project team at La Trobe University, Melbourne Australia are:
- Felicity Young, Research Manager
- Molly Allen-Leap, Research Officer
- Dr Xia Li, Statistician,
Collaboration with InTouch Multicultural Centre against Family Violence (inTouch)
La Trobe University is collaborating with inTouch, the only accredited family violence specialist agency working with women from migrant and refugee communities. inTouch will co-facilitate the GP training, and provide specialist family violence case work support for patients and ad-hoc consultations with doctors at participating practices.
Our collaborator at inTouch:
- Ruth Fox, Executive Manager Client Services
- Naime Cevik, Client Services Team Leader
- Asha Padisetti, HARMONY Advocate Educator and Caseworker
Partnering with Federal and State Governments
Our partners in government combine investigators responsible for national Family Safety strategies (including the National Strategy to reduce Violence against Women and Children) and state government departments implementing responses to the Royal Commission on Family Violence.
Our partners in government are:
- Alexis Diamond, Family Safety Branch, Department of Social Services (Cth)
- Dana Krause, Department of Families, Fairness and Housing (Vic.) (formally DPC)
- Eleri Butler, Family Safety Victoria
The HARMONY study is a randomised controlled trial where GPs, particularly those seeing south Asian refugee and migrant women patients, have been trained to identify, safety plan and refer women to appropriate services. The training is RACGP accredited and support is provided by a bilingual advocate educator and caseworker (from InTouch Multicultural Centre Against Family Violence) for the term of the intervention (1 year). This type of study has been shown to be effective in the UK (IRIS) where they are now in the process of rolling this program out to all GPs. Likewise, in Australia, such programs have shown to be effective also.
Taft A, Young F, Hegarty K, Yelland J, Mazza D, Boyle D, Norman R, Garcia-Moreno C, Nguyen C, Li X, Pokharel B, Allen M, Feder G. HARMONY: A pragmatic cluster randomised controlled trial of a culturally competent systems intervention to prevent and reduce domestic violence among migrant and refugee families in general practice: a study protocol. BMJ Open Jul 29;11(7):e046431. doi: 10.1136/bmjopen-2020-046431.