Addressing domestic violence by obstetric and gynecological resident doctors: Pre-post intervention study

BACKGROUND: The World Health Organization indicates that 1 in 3 women worldwide have suffered psychological and/or sexual violence, the majority of which is committed by an intimate partner. Although several organizations support routine screening for violence, the screening rate in medical consultations is low and this can be partially explained by the lack of knowledge and difficulty in approaching the topic. This study aims to evaluate the knowledge, attitude and practice of Gynecology and Obstetrics residents before and after educational intervention on Domestic Violence. 

METHODS: We performed a mixed-method study with 4 phases: phase 1 - Initial domestic violence screening; phase 2 - pre-intervention (questionnaires applied); phase 3 - intervention (informative booklet and video); phase 4 - post-intervention (questionnaires reapplied). Content analyzes and comparative pre- and post-intervention responses were carried out. 

RESULTS: Thirty-seven residents participated. The majority were female, with white skin color in the third decade of life. Qualitative analysis identified four themes: (1) The Pain that Lives in Me: Feelings that emerge in professionals when faced with situations of domestic violence; (2) "What do I do now?!!": challenges regarding the initial approach and management of domestic violence; (3) "Who should I lean on?": The importance of institutional structure for addressing domestic violence in health services; (4) The Invisibility of Violence: a cultural issue. There was no difference in pre- and post-intervention data, but they referred more discomfort in approach gender-based violence issues than other topics like substance abuse or sexual practices. 

CONCLUSIONS: The lack of a domestic violence approach in medical training and health professionals' feelings were barriers to screening. Addressing gender-based violence must begin in the medical curriculum and continue with advanced training during specialization.