Subject(s)
Family Practice , Rural Health Services , Humans , Ontario , Family Practice/education , Internship and ResidencyABSTRACT
Background: Intimate partner violence (IPV) is a prevalent global health problem. IPV that occurs before pregnancy often continues during the perinatal period, resulting in ongoing violence and many adverse maternal, obstetrical, and neonatal outcomes. Objectives: This scoping review is designed to broadly capture all potential interventions for perinatal IPV and describe their core components and measured outcomes. Search Methods: We conducted a search for empirical studies describing IPV interventions in the perinatal population in June 2022. The search was conducted in MEDLINE, EMBASE, PsycInfo, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science, Applied Social Sciences Index & Abstracts, ClinicalTrials.gov and MedRxiv. Hand searching of references from select articles was also performed. Selection Criteria: Included studies described an intervention for those experiencing IPV during the perinatal period, including 12 months before pregnancy, while pregnant or in the 12 months post-partum. The search encompassed January 2000 to June 2022 and only peer-reviewed studies written in either English or French were included. Included interventions focused on the survivor exposed to IPV, rather than healthcare professionals administering the intervention. Interventions designed to reduce IPV revictimization or any adverse maternal, obstetrical, or neonatal health outcomes as well as social outcomes related to IPV victimization were included. Data Collections and Analysis: We used standard methodological procedures expected by The Campbell Collaboration. Main Results: In total, 10,079 titles and abstracts were screened and 226 proceeded to full text screening. A total of 67 studies included perinatal IPV interventions and were included in the final sample. These studies included a total of 27,327 participants. Included studies originated from 19 countries, and the majority were randomized controlled trials (n = 43). Most studies were of moderate or low quality. Interventions included home visitation, educational modules, counseling, and cash transfer programs and occurred primarily in community obstetrician and gynecologist clinics, hospitals, or in participants' homes. Most interventions focused on reducing revictimization of IPV (n = 38), improving survivor knowledge or acceptance of violence, knowledge of community resources, and actions to reduce violence (n = 28), and improving maternal mental health outcomes (n = 26). Few studies evaluated the effect of perinatal IPV interventions on obstetrical, neonatal or child health outcomes. Authors' Conclusions: The majority of intervention studies for perinatal IPV focus on reducing revictimization and improving mental health outcomes, very few included obstetrical, neonatal, and other physical health outcomes. Future interventions should place a larger emphasis on targeting maternal and neonatal outcomes to have the largest possible impact on the lives and families of IPV survivors and their infants.
ABSTRACT
BACKGROUND: Survivors of sexual assault and intimate partner violence often face many challenges in seeking/receiving healthcare and are often lost to follow up. OBJECTIVES: Our study objectives are to evaluate the feasibility, acceptability, and satisfaction of using telemedicine technology among sexual assault and intimate partner violence patients who present to a Canadian Emergency Department. DESIGN: Qualitative research was conducted using a thematic approach. METHODS: Patients were identified from a case registry of all sexual assault and intimate partner violence cases seen between 1 April 2020 and 31 March 2022 from an emergency department of a large Canadian hospital. Qualitative trauma-informed interviews were conducted with consenting participants. Thematic qualitative analyses were performed to investigate barriers and drivers of telemedicine for follow-up care. RESULTS: Of the 1007 sexual assault and intimate partner violence patients seen during the study timeframe, 180 (8%) consented to be contacted for future research, and 10 completed an interview regarding telemedicine for follow-up care. All participants were cisgendered women, 5 (50%) experienced sexual assault, 6 (60%) physical assault, and 3 (30%) verbal assault. All knew their assailant, and 6 (60%) were assaulted by a current or former intimate partner. Three themes emerged as drivers of telemedicine use: increased comfort, increased convenience, and less time required for the appointment. Three thematic barriers to telemedicine use included lack of privacy from others, lack of safety from their assailant, and pressure to balance competing tasks during the appointment. CONCLUSION: This study illustrated that telemedicine for sexual assault and intimate partner violence follow-up care is feasible, acceptable, and can improve patient satisfaction with follow-up care. Ensuring safety and privacy are key considerations when offering telemedicine as an appropriate option for survivors.
A qualitative analysis of telemedicine and virtual healthcare for survivors of sexual assault and intimate partner violenceWhy was the study done? Sexual assault and intimate partner violence are prevalent issues in our society. More than 3/10 Canadian women have been sexually assaulted at least once since the age of 15 years and more than 4/10 Canadian women have experienced IPV in their lifetime. Survivors face many obstacles to receiving care after sexual assault and intimate partner violence and are often lost to follow up.What did the researchers do?The researchers studied the acceptability, feasibility, and satisfaction of using telemedicine technology among sexual assault and intimate partner violence survivors who presented to a Canadian Emergency Department. Sexual assault and intimate partner violence survivors were interviewed individually about their experience receiving follow-up care via telemedicine. The interviews were done using a trauma-informed approach, and data analyses were done to explore the barriers and drivers of telemedicine for follow-up care.What did the researchers find?The total number of interviews was 10, and all participants were cisgendered women. All knew their assailant and six were assaulted by a current or former intimate partner. Survivors found that telemedicine was an accessible way to have a follow-up appointment and were mostly satisfied with their experience. Three major drivers to using telemedicine included increased comfort being at home in their own space, increased convenience as they did not have to leave their house to have the appointment, and less time required for the appointment. Three major barriers to using telemedicine included lack of privacy from others during the appointment, pressure to balance competing tasks during the appointment, and lack of safety from their assailant.What do the findings mean?This study has shown that follow-up care for sexual assault and intimate partner violence survivors using telemedicine can be feasible, acceptable, and can improve patient satisfaction. However, it is important to consider factors such as safety and privacy on an individual basis when offering telemedicine as an option for follow-up care for survivors.