Primary care response to domestic violence and abuse in the COVID-19 pandemic: interrupted time series and qualitative study

During the COVID-19 pandemic, more people in the UK and globally have experienced domestic violence and abuse (DVA), trapped in a home with an abusive partner, spouse or other adult. It is difficult for victims to disclose abuse and seek help. We know that many victims, would choose to disclose to their GP, particularly if they are asked about abuse. In the past decade - in line with national policy - more and more GPs have been trained in how to ask and respond to these patients, providing general support and a crucial link to expert support from local DVA agencies. During the pandemic most consultations with GPs have been via telephone or video and even once the lockdown is relaxed, it is likely that more consultations will not be face-to-face. In this research proposal we will (i) measure how GP referral to DVA agencies has changed in 30 areas in England and Wales during and after the lockdown compared to the year before the pandemic referral (ii) explore whether and how GPs have managed to ask safely about abuse, offering support and referral in remote consultations, and also how they have adapted to online training about DVA.

Aim
To understand the impact of UK-wide COVID-19 social isolation policies on domestic violence and abuse (DVA) in the context of the general practice response during the pandemic and its aftermath,
Research questions
1. What is the impact of COVID-19 social isolation policies on referral to specialist DVA support for patients experiencing abuse?
2. In remote consultations, how have GPs managed asking about/identifying abuse, giving support and offering referral to patients experiencing DVA amd how have they adapted to online DVA training?

Methods
Question 1: Interrupted-time series (ITS) and non-linear regression analysis including sensitivity analyses, using practice level referral data across 30 areas. Incidence rate ratios (IRR) and 95% confidence intervals of changes in referral rate before, during and reversal of social isolation policies, quantifying the impact of these COVID-19 prevention policies on DVA referrals. The analysis will cover one year before and one year after the implementation of social isolation (23/03/2019 - 22/03/2021) and the sudden national shift - for at least part of the second period - to online GP consultations.
Question 2: Observation and interview-based qualitative study in a purposive sample of practices by ethnic and SES of population, and referral rates. Sampling of 30 GPs within selected practices and 10 other professionals (practice managers, DVA advocate educators); observation of 10 online training sessions. Thematic analysis.

Triangulation of ITS with qualitative findings, exploring variation in the referral rates between areas, rapidly reporting relevance, feasibility, and safety of GP responses to DVA during the COVID-19 pandemic and its aftermath.