A primary care system-level training and support programme for the secondary prevention of domestic violence and abuse: a multicentre cluster randomised trial with economic and process evaluation

Background

Domestic violence and abuse (DVA) is a major public health challenge. The IRIS (Identification & Referral to Improve Safety) primary care training and support programme improves the general practice response to women experiencing DVA. The effectiveness and cost-effectiveness of interventions for men, children and young people (CYP) remain uncertain.

IRIS+ is a primary care training and support programme responding to the needs of all family members experiencing or perpetrating DVA. It adds to IRIS by expanding the clinical response, care pathways and specialist advocacy support to men and CYP without diminishing the focus on women. The pilot study of IRIS+ has demonstrated feasibility and gains in health-related quality of life (HRQoL) but needs to be rigorously evaluated.

Research question

Is the IRIS+ intervention effective, cost-effective and scalable with regards to referring adults and children affected by DVA from primary care for specialist advocacy support? Aims and objectives

Aim: Compare the effectiveness and cost-effectiveness of IRIS+ with IRIS for women, men and CYP in different implementation contexts in England and Wales.

Primary objective: Evaluate effectiveness of the IRIS+ intervention for men and CYP compared to IRIS. Secondary objectives: i) Evaluate effectiveness of the IRIS+ intervention for referral of women compared to IRIS; ii) Measure the intervention’s cost-effectiveness compared to IRIS; iii) Assess impact of IRIS+ on women, men and CYP’s health and wellbeing from GP-recorded health data, and participant-reported health and DVA exposure data compared to IRIS; iv) Gain site contextual insights into implementation, effectiveness and reach.

Methods

Cluster randomised trial with economic and mixed-method process evaluation. 84 general practices will either be randomised to IRIS+ or IRIS programme. Effectiveness evaluation will use 15-month referral rate of men and CYP (co-primary outcomes) or women (secondary outcome) to specialist DVA services. Economic evaluation will use GP-recorded digital data (12 months post-referral) on healthcare use for patients and modelling.

Evaluation of health outcomes will use GP-recorded digital data on patients’ health and wellbeing (for 12 months pre/post-referral), and participant-reported HRQoL, health and DVA exposure data through baseline/post advocacy support intervention questionnaires. A mixed-method process evaluation combining interviews (trial participants: 45, stakeholders: 30) and routinely collected service evaluation data will assess mechanisms of impact, scalability and reach.

Impact and dissemination

If IRIS+ is effective and cost-effective, implementation would improve the safety, wellbeing and health of DVA survivors and their children. There would also be a downstream economic benefit to the NHS and society. Evidence will benefit those involved in the delivery and commissioning of DVA interventions.

We will produce academic and non-academic outputs on effectiveness, cost-effectiveness and reach and commissioning guidance. We will disseminate findings through existing networks in the DVA and primary care sectors.