Baseline cohort data from HARMONY, a cluster randomised controlled trial of culturally safe domestic violence management in general practice
Abstract Background Domestic violence and abuse (DVA) is a globally prevalent, health damaging problem. In high income countries, migrant /refugee populations from low/middle income countries often consist of young families. DVA is more prevalent, and barriers to disclosure greater among migrant/ref...
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2025-07-01
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| author | Angela J. Taft Felicity Young Kelsey L. Hegarty Jane Yelland Danielle Mazza Douglas Boyle Richard Norman Claudia García-Moreno Cattram Nguyen Xia Li Bijaya Pokharel Molly Allen Leap Gene Feder |
| author_facet | Angela J. Taft Felicity Young Kelsey L. Hegarty Jane Yelland Danielle Mazza Douglas Boyle Richard Norman Claudia García-Moreno Cattram Nguyen Xia Li Bijaya Pokharel Molly Allen Leap Gene Feder |
| author_sort | Angela J. Taft |
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| description | Abstract Background Domestic violence and abuse (DVA) is a globally prevalent, health damaging problem. In high income countries, migrant /refugee populations from low/middle income countries often consist of young families. DVA is more prevalent, and barriers to disclosure greater among migrant/refugee than native-born families. Consequently, general practice (GP) patient populations are increasingly diverse, but evidence for culturally safe and effective GP management is minimal. The HARMONY study tested a culturally safe DVA intervention to improve GP identification and referral among South Asian families. Methods HARMONY was a pragmatic cluster RCT in 19 GP clinics in two regions of Melbourne, Australia. Eligible practices required ≥ 1 South Asian GP; used one of two common software programs; and agreed to have GrHanite™ software on practice computers. This analysis investigated baseline DVA and ethnicity identification in routine electronic GP data. Deidentified aggregated data for female patients aged ≥ 18 with DVA identification, referral, and South Asian ethnicity data were extracted from medical records. Chi Square for comparison of proportions. Results Twenty-four clinics were recruited and randomised, but five dropped out due to Covid. Fifty-two percent (50/96) of 19 clinics' staff were South Asian. While 46.7% of female patients (21,220/45,438) were aged 26–45 years, 17.6% (7,874/45,438) were South Asian. There were more South Asian patients in Comparison 20.6% (4,193/20,312) than Intervention 14.7% (3,681/25,126) clinics. South Asian women had less access to Medicare (83% vs 97%) and pensions (13% vs 22%). At baseline, clinicians recorded 0.58% (265/45,438) DVA-affected women. Notably, they identified fewer South Asian (0.38%) (28/7,874) than non-South Asian women experiencing DVA (0.63%) (237/37,564),—0.28% (0.12%—0.43%), p = 0.004. No referrals were identified. Conclusion DVA was notably under-identified in these patient populations, but worse among South-Asian female patients. While almost one in six of HARMONY’s female population were South Asian, fewer than four in 1000 South Asian women were identified as experiencing DVA. Greater effort to regularly train and to support GP clinics to better identify DVA is vital but even more important in diverse communities to provide culturally safe DVA identification, care and documentation. Trial registration ACTRN12618001845224 on 13/11/2018. |
| format | Article |
| id | doaj-art-aeaacb9eb5f8456c82d3e56ef5321fd9 |
| institution | Kabale University |
| issn | 2731-4553 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | BMC Primary Care |
| spelling | doaj-art-aeaacb9eb5f8456c82d3e56ef5321fd92025-08-20T03:43:29ZengBMCBMC Primary Care2731-45532025-07-012611810.1186/s12875-025-02890-2Baseline cohort data from HARMONY, a cluster randomised controlled trial of culturally safe domestic violence management in general practiceAngela J. Taft0Felicity Young1Kelsey L. Hegarty2Jane Yelland3Danielle Mazza4Douglas Boyle5Richard Norman6Claudia García-Moreno7Cattram Nguyen8Xia Li9Bijaya Pokharel10Molly Allen Leap11Gene Feder12Judith Lumley Centre, La Trobe UniversityJudith Lumley Centre, La Trobe UniversityDepartment of General Practice and Primary Care, University of MelbourneMurdoch Children’s Research InstituteDepartment of General Practice, Monash UniversityDepartment of General Practice and Primary Care, University of MelbourneCurtin UniversityDepartment of Sexual and Reproductive Health and Research, WHOMurdoch Children’s Research InstituteStatistics Department, La Trobe UniversityJudith Lumley Centre, La Trobe UniversityJudith Lumley Centre, La Trobe UniversityCentre for Academic Primary Care, Bristol Medical School, University of BristolAbstract Background Domestic violence and abuse (DVA) is a globally prevalent, health damaging problem. In high income countries, migrant /refugee populations from low/middle income countries often consist of young families. DVA is more prevalent, and barriers to disclosure greater among migrant/refugee than native-born families. Consequently, general practice (GP) patient populations are increasingly diverse, but evidence for culturally safe and effective GP management is minimal. The HARMONY study tested a culturally safe DVA intervention to improve GP identification and referral among South Asian families. Methods HARMONY was a pragmatic cluster RCT in 19 GP clinics in two regions of Melbourne, Australia. Eligible practices required ≥ 1 South Asian GP; used one of two common software programs; and agreed to have GrHanite™ software on practice computers. This analysis investigated baseline DVA and ethnicity identification in routine electronic GP data. Deidentified aggregated data for female patients aged ≥ 18 with DVA identification, referral, and South Asian ethnicity data were extracted from medical records. Chi Square for comparison of proportions. Results Twenty-four clinics were recruited and randomised, but five dropped out due to Covid. Fifty-two percent (50/96) of 19 clinics' staff were South Asian. While 46.7% of female patients (21,220/45,438) were aged 26–45 years, 17.6% (7,874/45,438) were South Asian. There were more South Asian patients in Comparison 20.6% (4,193/20,312) than Intervention 14.7% (3,681/25,126) clinics. South Asian women had less access to Medicare (83% vs 97%) and pensions (13% vs 22%). At baseline, clinicians recorded 0.58% (265/45,438) DVA-affected women. Notably, they identified fewer South Asian (0.38%) (28/7,874) than non-South Asian women experiencing DVA (0.63%) (237/37,564),—0.28% (0.12%—0.43%), p = 0.004. No referrals were identified. Conclusion DVA was notably under-identified in these patient populations, but worse among South-Asian female patients. While almost one in six of HARMONY’s female population were South Asian, fewer than four in 1000 South Asian women were identified as experiencing DVA. Greater effort to regularly train and to support GP clinics to better identify DVA is vital but even more important in diverse communities to provide culturally safe DVA identification, care and documentation. Trial registration ACTRN12618001845224 on 13/11/2018.https://doi.org/10.1186/s12875-025-02890-2General practiceDomestic violenceCluster randomised controlled trialCultural safetyEthnicity |
| spellingShingle | Angela J. Taft Felicity Young Kelsey L. Hegarty Jane Yelland Danielle Mazza Douglas Boyle Richard Norman Claudia García-Moreno Cattram Nguyen Xia Li Bijaya Pokharel Molly Allen Leap Gene Feder Baseline cohort data from HARMONY, a cluster randomised controlled trial of culturally safe domestic violence management in general practice BMC Primary Care General practice Domestic violence Cluster randomised controlled trial Cultural safety Ethnicity |
| title | Baseline cohort data from HARMONY, a cluster randomised controlled trial of culturally safe domestic violence management in general practice |
| title_full | Baseline cohort data from HARMONY, a cluster randomised controlled trial of culturally safe domestic violence management in general practice |
| title_fullStr | Baseline cohort data from HARMONY, a cluster randomised controlled trial of culturally safe domestic violence management in general practice |
| title_full_unstemmed | Baseline cohort data from HARMONY, a cluster randomised controlled trial of culturally safe domestic violence management in general practice |
| title_short | Baseline cohort data from HARMONY, a cluster randomised controlled trial of culturally safe domestic violence management in general practice |
| title_sort | baseline cohort data from harmony a cluster randomised controlled trial of culturally safe domestic violence management in general practice |
| topic | General practice Domestic violence Cluster randomised controlled trial Cultural safety Ethnicity |
| url | https://doi.org/10.1186/s12875-025-02890-2 |
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