The HARMONY trial: assessing general practitioner knowledge, attitudes and confidence following culturally safe domestic violence and abuse training.

Abstract

Background Domestic violence and abuse (DVA) impacts all communities, including migrant/refugee populations. Although general practitioners (GPs) are often a first point of contact for victim-survivors, most lack training in culturally safe responses to DVA. Methods We evaluated culturally safe DVA training (HARMONY), co-delivered by a GP educator and bilingual South Asian DVA advocate, to general practice clinics in Victoria, Australia. The program included clinical audits, case studies, simulated migrant/refugee patients and lived experience videos. Pre- and post-training surveys assessed practitioners' attitudes, understanding and confidence in responding to DVA. Results Twenty-three of 43 practitioners (53.5%) completed both surveys. Pre-training, 10 practitioners (43.5%) felt confident asking about violence when they thought it might be culturally accepted, and eight (34.8%) were confident locating support resources. Post-training, most practitioners (82.6%) reported increased confidence and communication skills. The training met learning needs for 19 of 23 (82.6%) participants, with 17 of 23 (73.9%) participants reporting greater understanding of cultural safety and South Asian patients' needs. Practitioners particularly valued the advocate educator's involvement, with 17 of 23 (73.9%) finding this 'quite useful' (n =4) or 'very useful' (n =13). Conclusion Although DVA training often improves knowledge and confidence, and may not change clinical behaviour or patient outcomes, embedding cultural safety in such training remains important in responding effectively to the specific needs of ethnically diverse patients and their families experiencing DVA. The HARMONY program demonstrates potential benefits of combining clinical expertise with cultural advocacy, although further research is needed to evaluate its impact on practice and patient care among other minoritised patient communities.