”Don’t be afraid to ask”: The role of primary care clinicians in facilitating meaningful change for women experiencing domestic violence and abuse-why waiting for women to speak-up may be harmful

Alice Malpass 1, Kim Sales3, Annie Howell3 ,1, Medina Johnson2 ,1, Roxanne Agnes-Davies4 ,1
1University of Bristol, Bristol, UK, 2nextlink Bristol, Bristol, UK, 3Nia project, London, UK, 4Domestic Violence Training Ltd, London, UK


Women experiencing domestic violence and abuse (DVA) are more likely to be in touch with health services than any other agency, yet doctors and nurses rarely ask about DVA, often failing to identify signs of DVA in their patients.

Aims: to understand women’s experience of disclosure of DVA in primary care settings in the context of the IRIS trial (an RCT testing the effectiveness of DVA training for primary care clinicians); explore from the women’s perspective what they identified as meaningful change; and the role, if any, of clinicians in supporting women to make meaningful changes in relation to improving their sense of safety.


Methods: This was a service-user led study using a qualitative research design. We recruited 12 women who had been referred to a specialist DVA agency by a GP taking part in IRIS. Women were interviewed by a survivor of DVA. Interviews were recorded and transcribed verbatim. Each transcript was coded by two members of the research team. Analysis was thematic involving constant comparison.


Our analysis identified internal and external barriers to disclosure. Negative experiences of attempted disclosure, in which GP’s medicalised signs of DVA, reinforced internal barriers to disclosure, such as self-blame and shame.

Five important shifts were described by women as a consequence of GP referral to a specialised DVA advocate: an emotional shift away from a sense of shame, guilt and fear; a greater sense of control; a shift away from self-blame thoughts- realising the problem is the perpetrators;  a shift in outlook-  feeling excited and hopeful about the future;  and lastly feeling motivated to make changes that were not externally driven.



Women experiencing DVA see their primary care clinician’s role as being one of referral to specialised advocacy services rather than being a source of direct-action.  Drawing upon critiques of models of change, we highlight the types of GP behaviours that facilitate women at key points to initiate and maintain meaningful changes in well-being and safety.