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 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 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 28 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 safely to family violence, focusing on working with south-Asian migrant and refugee populations
- Case work support for women by a specialist bilingual South Asian case worker based at a family violence specialist agency for south-Asian migrant and refugee communities
- Ad hoc consultations between clinicians and the case worker for support and feedback on referrals
The feasibility and effectiveness of this intervention will be measured through process evaluations and outcome assessments. Primary outcomes are the rates of family violence identification and referral as recorded in patient medical records and referrals received by advocates.
Interviews with clinicians and women 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.
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
- Prof Alan Sheill, La Trobe University, Melbourne, Australis
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
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 CALD 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:
- Roshan Bhandary, Program Manager
Roshan has a Master's degree in Sustainable International Development and a post graduate diploma in Women's Studies. She has worked in the area of family violence, women's rights and community development internationally and locally for over 15 years. Being from a CALD background and a migrant herself, she brings a wealth of knowledge and skills in working with multicultural communities across the violence continuum. She has been instrumental to the development and implementation of various innovative projects at inTouch. She is a trainer for the inTouch DV-alert program.
- Nadine Handke is a social worker and trainer in cultural diversity, mental health and family violence.
- Harmony South Asian case workers
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)
- Kate O'Sullivan, DPC MASC (Vic)
There are a couple of important statistics around regarding domestic violence, such as 1 in 6 women in Australia have experienced family violence in their lifetime, and that the first person they may see for help is their local GP. But did you know that according to the RACGP up to 5 abused women per week per doctor attend unsuspecting GPs, many of whom do not know how to approach these women without upsetting or offending them, let alone identifying them as women experiencing violence?
The HARMONY study is a randomised controlled trial where GPs, particularly those seeing south Asian refugee and migrant women patients, will be trained to identify, sensitively treat and refer these women to appropriate services. The training is RACGP accredited and you will have the services of a bilingual 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 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.
We believe that this training will eventually help the victims of family violence, the women. We would very much like your participation in this study [PDF 200KB].
Prof Angela Taft
ph: +61 3 9479 8809