In the framework of the project Recognizing and treating victims of domestic violence in health care settings: Guidelines and training for health professionals, the project group at ZRC SAZU examined attitudes, experiences, obstacles and needs of both victims of domestic violence as well as of health care and other professional workers involved in its recognition and treatment. The research was divided into a quantitative and qualitative part. The aim of the quantitative part was to study opinions, attitudes and experiences of both health workers and victims of domestic violence regarding the treatment of domestic violence in the health care sector. Two self-assessment questionnaires (an online questionnaire for health care workers and a printed questionnaire for victims of domestic violence) were developed for this purpose. Data collection took place from April until June 2015. Data were analysed using descriptive statistical methods.
Health care workers (N = 448) completed the online questionnaire (86.2% women and 13.8% men), their average age was 42.7 years. 54.0% of the respondents were doctors, 34.9% worked in the nursing care and 10.6% were other employees in the health care sector. Lack of knowledge and experience on the subject of domestic violence and lack of cooperation with other competent institutions and other health care workers were identified as the main obstacles in dealing with domestic violence. It was also found that health care workers often don’t use the prescribed protocols for dealing with domestic violence. They mainly viewed the role of the health sector in informing victims of domestic violence about possible sources of help, in providing them with psychological support and in counselling and cooperating with other institutions in this field. Over 80% of participants in our research have not yet participated in domestic violence training. Nevertheless, those who have already participated in such training activities provided more appropriate responses in domestic violence cases, took more time to communicate with victims of domestic violence, provided them with more support and notified the Centre for social work more often than those individuals who have not yet taken part in such activities.
In the second questionnaire, 80 victims of domestic violence provided their views on their attitudes, experiences and expectations regarding their treatment in the health care sector. The sample was mostly composed of women (90.0%); 5.0% were men and 5.0% did not provide the information on gender. The average age of the respondents was 39.9 years. The victims’ main expectations regarding health care provision were that health care workers listen to them, believe them and respect their privacy. Over half of all the participants viewed the health care sector as an appropriate environment to talk about domestic violence. About a quarter of victims also reported that the perpetrators limited their access to the health care setting. Victims believed that the main reasons for the health workers’ insufficient recognition and treatment of domestic violence were their fear of revenge on the part of the perpetrator, health care workers’ sense of powerlessness, excessive work load, lack of experience and knowledge to provide appropriate help to the victims of domestic violence and lack of cooperation with other competent institutions in this area.
In the qualitative part of the research 30 semi-structured expert interviews with health care workers (specialists in family medicine, paediatrics, psychiatry, traumatology, obstetrics and gynaecology, family visitors, social workers in the health care sector) and other professionals (social workers, NGO representatives and a researcher) were conducted. The aim of the research was to obtain in-depth opinions, recommendations and examples of good and bad practice in recognising and dealing with domestic violence in different settings. Interviews were conducted from April to June 2015.
The health care workers identified a void in the area of recognising and dealing with domestic violence in the health sector, as systematic educational courses in this area are not yet being conducted. They pointed to the difficulties of recognising and reporting domestic violence especially when the victims try to conceal its occurrence. They identified the lack of knowledge, experience and competencies in communication as the main factors hindering a more efficient recognition of domestic violence. Health care workers are generally also not sufficiently familiarised with responsibilities of competent institutions in the area of domestic violence and with their legal obligations to act in this area.
In line with the observations of the health care workers, other professional workers in the area of domestic violence also noted a general insufficient recognition and reporting of domestic violence cases within the health care sector and observed a lack of cooperation among different competent authorities in this field. Zero tolerance towards the issue, sufficient knowledge on the dynamics of domestic violence and especially an emphatic and humane approach in communicating with victims of domestic violence were identified by our collocutors as the key to a more successful recognition and treatment of domestic violence in health care settings.
Prepared by Sanja Cukut Krilić, ZRC SAZU