Centering Survivor Voices to Improve Healthcare Response to Intimate Partner Violence

Background and Purpose

Intimate partner violence (IPV) contributes to morbidity, mortality, and psychological trauma. Despite widespread recommendations and support for IPV screening and referrals in the healthcare setting, healthcare systems struggle to provide consistent and adequate IPV services. Preliminary research from our team suggests that clinicians would feel more empowered to help individuals experiencing IPV if they knew more about the impact of their intervention, including patient experience of the intervention, what services were utilized and how patient health was impacted. IPV survivors have expressed interest in providing feedback about their experiences during the healthcare encounter to help improve policies and programs. Using a community-engaged action research approach, in partnership with survivors, community-based services, and healthcare systems, we developed and tested a process to enable providers to receive feedback directly from patients. This study examined the feasibility, acceptability, and preliminary impact—from both survivor and clinician perspectives—of using a structured feedback tool that enables survivors to share their experiences with referring clinicians.

Methods

IPV survivors who were referred to an on-site IPV specialist through the healthcare system were invited to complete a feedback tool developed by the research team with input from community partners, have the feedback shared with their referring clinician, and complete an in-depth interview about the tool and process. Referring clinicians were invited to complete a survey and in-depth interview about their experience receiving feedback. As an interdisciplinary research team, we analyzed feedback tool responses as well as survey and interview responses to identify feasibility, acceptability, and impacts. We then worked with IPV survivors to create brief videos sharing their lived-experience expertise to inform guidance for healthcare clinicians in addressing IPV in the healthcare setting.

Results

We found that a structured feedback tool and process can facilitate IPV survivor feedback to clinicians about the screening and referral process, ultimately serving to improve care experiences. Both survivors and clinicians found the tool and process easy to navigate. Survivors welcomed the opportunity to provide feedback to referring clinicians. Clinicians found the feedback tool to be valuable to improving their practice. Survivor videos highlighting first-person accounts and voices help to inform clinical and personalized care based on lived experience expertise.

Conclusions and Implications

Feedback to clinicians about survivor experience with screening and referral in the healthcare setting can help to fill the existing gaps in healthcare response to IPV. We found that survivors are willing—in fact often eager—to share their experiences in the service of improving care, and that clinical practice can benefit from the expertise of those with lived experience. Results showed preliminary success of an accessible, easy-to-use avenue for providing feedback that allows survivors to play a more active role in the development and implementation of services geared toward their needs. We will continue to evaluate the impact of the feedback on clinician experience and behavior, including change in screening and referral rates over time and survivor satisfaction and connection with resources. We will, further assess variation in survivor experience to identify potential disparities by survivor or clinician characteristics.