Background: A survey conducted in the occupied Palestinian Territories (oPT) reported that 37% of Palestinian women [pcbs.gov.ps/portals/_pcbs/pressrelease/el3onf2011_e.pdf] have experienced violence against women (VAW). Our recent systematic review [doi.org/10.1186/s12889-019-6619-2] found that within clinical populations in Arab countries, over 70% of women had experienced a form of domestic violence (DV) (physical, sexual, psychological or other).  Exposure to DV is associated with multiple adverse health outcomes.

Prior work: Our work in oPT builds on an MRC funded study in which we developed and piloted a primary care-based intervention to enhance the identification and referral of female patients experiencing DV. Our formative evaluation led to the development of an intervention which included training healthcare providers, and establishing a clear referral pathway. A mixed-methods evaluation found that the intervention increased identification and referral within the clinic, but also identified a need for improved ongoing support for the safety and psychological health of the women.

Research outline: For our ongoing NIHR Global Health Group work, we will expand into reproductive health services (RHS), including within primary care clinics and outpatient gynaecology settings, since DV exposure is associated with adverse reproductive health outcomes. Other compelling reasons for RHS to respond to VAW include the intensive and frequent follow-up of women of reproductive age in this population and the potential for women to access support for violence under the guise of accessing healthcare at RHS clinics. We also plan to expand our scope to include further marginalised groups within oPT society including women with disabilities and women from the Bedouin population, among whom the adverse effects of violence might be greater. We will conduct a mixed-methods process evaluation.

Our study aims to develop and test the feasibility of an intervention within RHS settings that can improve outcomes for women who experience domestic violence.

Objectives:

1. Assessing the readiness of oPT RHS to respond to the needs of women experiencing DV.
2. Modify an intervention which was developed for primary health care clinics, including increasing psychological support for patients experiencing DV or VAW and test its feasibility and acceptability in RHS.