Daphne Toolkit

Evaluation of medical care in conjugal violence - Comparative analysis and recommendations

Project Reference Number: 

Evaluation of medical care in conjugal violence - Comparative analysis and recommendations

Analysis of data related to health-sector responses to conjugal violence with a view to preparing a synthesis report (entitled VIVIO) on the issue in the EU and recommending improvements to health interventions.


This project built on earlier Daphne projects during which a ‘réseau sentinelle’ was developed comprising medical personnel who record and exchange (via Intranet) information relating to the incidence and treatment of patients presenting with experiences of conjugal violence, and a public Internet site where the results of project work and related studies on conjugal violence can be consulted.
This present project aimed to take this work further by collating and analysing the data collected through the network, completing this with literature search and specialized research in a number of areas (social follow-up, medical treatment, for example) in participating countries, to compile national studies of the state of medical response to conjugal violence, and a comparative analysis across the European partner participants’ countries.
On the basis of these national/European studies, the project further aimed to recommend steps to be taken to improve medical treatment and follow-through of victims of conjugal violence.
Partners in the participating countries (France, Ireland, Belgium, Spain, Denmark, UK, Portugal) formed an expert group that carried out the research and jointly formulated the recommendations. The network developed during earlier Daphne projects was expanded through this new project by the participation of three new countries: Ireland, Belgium and Portugal.

The project to compile a European comparative report on the medical care of victims of conjugal violence in Europe started off from two observations:
· Healthcare professionals are relatively ill-trained to handle this problem.
· The victims do not turn to healthcare providers for help as much as they might.
The project aimed to approach medical care not only from a technical angle, but also from a problematic angle by identifying the processes which lead a doctor and a patient to bring up or not the subject of conjugal violence in consultation.

Conjugal violence is not a pathology but a societal problem which is expressed in interpersonal dramas with repercussions (in particular of a medical nature).
When a healthcare professional is faced with this kind of situation, s/he must act as doctor, citizen and witness, and sometimes also as a victim or the perpetrator. The trust the patient puts in the professional presents a challenge, not only in terms of the professional’s normal duties but also in terms of personal commitment and values and sometimes safety.
The position of the healthcare professional is complicated by the multiplicity of roles involved in such a distressing situation.

However, she must react as a professional when the problem arises in consultation.
For the patient, the doctor often represents not only the exclusive means of access to a medical improvement, but also to a general improvement in her situation. Thus, the assistance that the professional can offer will first and foremost involve a correct evaluation of the patient’s problem, not from a symptomatic point of view but from a causal analysis or detection.
The role that s/he plays vis-a-vis the patient consists in offering, on the one hand, pragmatic treatment of the symptoms and, on the other hand, information on the patient’s condition and on her rights, on her situation as a victim and on the resources that are available to her as well as directing her to the structures and agencies that can help her.
This role is not an easy one. Such situations, which are a combination of long-term intimate dramas and the effects on physical and mental health, often represent for the professional a challenge to the framework of the care relationship within which he works.
The fear of becoming personally involved and of gradually drifting from a medical and professional relationship to that of confidant, witness and protagonist may cause the doctor to be wary of giving actual medical care to a patient as a victim of conjugal violence.
The rate of detection of conjugal violence, including among patients who consult a doctor due to this violence but without stating this openly, is very low.
Furthermore, in view of the wide range of pathologies linked to this type of violence, healthcare professionals must pay very close attention not only to evident signs of physical and psychological abuse but also to discreet, indirect or latent signs. These signs may signal different causes.
Identifying a situation of conjugal violence is sometimes difficult. Responding is even more difficult as the caregiver has not received specific awareness-building or training.
Wrongly interpreted clinical signs and behaviour (traumatological, psychological and psychosomatic) can often result in unsuitable treatment.
To help healthcare professionals fulfil their role - from detection to care - within an efficient and manageable framework, certain measures, provisions and aids and more comprehensive information must be made available.
The VIVIO report discusses these issues and offers practical advice for healthcare professionals along with a series of recommendations for the bodies and institutions that define the guidelines in this area.
The report is intended both for healthcare operators in their normal professional practice and for women who are victims of conjugal violence.
The beneficiaries are the patients. However, the target audience is first of all the healthcare professionals and then healthcare decision-makers and administrators.
The task facing the partners was to draw up a report which would be easy to read and circulate and which would make a general contribution towards developing the medical relationship, the detection of conjugal violence and the medical care of victims. The resulting report is therefore initially directed at healthcare actors, policy-makers and administrators who have to face or react to this type of situation. However, the main purpose is to help improve the situation of the victims. It is therefore the victims of conjugal violence who are the beneficiaries.

Lessons and ideas

1. The evaluation of this project during its life was simple but effective.  It included both internal and external evaluation. In each country, the nominated representative reported on progress to the project coordinator, so that there was ongoing monitoring of progress and the chance to discuss obstacles/ideas. Additionally, the group of three experts who provided external evaluation of the project attended project meetings and followed progress of the project, thus providing a secondary source of ongoing project monitoring.

2. This project obviously has the potential to be extended to all 25 Member States of the EU. The mechanisms used (Intranet and Internet) are ideal vehicles for including more countries in the network, but there are obvious costs involved in translation and maintenance. The site was set up so that it could be expanded to include more languages. One other major task involved in expanding the network would be identifying suitable existing networks (rather than organizations or individuals) in other countries who would ‘buy in’ to the process in a sustainable way.



Material available

· Report: VIVIO, medical care for victims of conjugal violence(French, English, Spanish, Portuguese and Danish)
· Website on conjugal violence for referenced healthcare professionals (www.sivic.org )