MOSAIC: a GP cluster randomised trial to reduce partner violence among pregnant women and women with pre-school children

亲密伴侣虐待或家庭暴力是常见的，对早育年龄的妇女造成伤害。这对妇女及其子女的身心健康产生了负面影响。由于健康状况不佳，残疾妇女和儿童经常去看家庭医生，但医生在作出有效反应方面面临许多障碍。这些障碍之一是严重缺乏证据，说明什么可以帮助参加全科医生治疗的妇女处理伴侣虐待问题。这对全科医生培训和临床实践都至关重要。有充分的证据表明，家访或同伴的支持改善了处境不利的母亲和儿童的健康。同样，宣传也能改善受虐待妇女的健康和福祉。MOSAIC社区干预试验结合了这两个要素：家访-同伴支持和家庭暴力宣传，这一战略将在随机试验中进行评估。该试验旨在减少怀孕妇女或5岁以下儿童参加全科医生的伴侣虐待和抑郁症。它还旨在加强母子关系。来自40个参与实践的经过培训和支持的全科医生将在40周内确定700名受虐待或有风险的妇女。在试验的干预组中，被其全科医生确定为虐待或有风险的妇女将获得训练有素的准专业“指导母亲”的支持长达一年，而对照组将提供标准的全科医生护理。最近获得的资金使2003年能够对母亲辅导员的征聘和培训进行试点研究。这项研究将加强全科医生对这一难题的支持，并在5个参与部门建立对伴侣虐待管理感兴趣的全科医生的“临界质量”。MOSAIC研究将评估加强受害者护理支助系统对全科医生和妇女的价值，并提供急需的证据，证明在一般做法中嵌入了干预措施，以减少伴侣虐待孕妇和有幼儿的妇女。

Intimate partner abuse or domestic violence is common and damaging for women in the early childbearing years. It has a negative effect on the mental and physical health of women and their children. Because of poor health, victimised women and children are frequent attenders to family doctors (GPs), but doctors face many barriers in making an effective response. One of these barriers is the critical absence of evidence for what would help women attending GPs in dealing with partner abuse. This is vital to inform both GP training and clinical practice. There is sound evidence that home visiting or support by peers improves the health of disadvantaged mothers and children. Similarly, advocacy improves the health and wellbeing of abused women. The MOSAIC community intervention trial combines these two elements: home visiting-peer support and domestic violence advocacy and this strategy will be evaluated in a randomised trial. The trial aims to reduce partner abuse and depression among women pregnant or with children under 5 attending GPs. It also aims to strengthen mother-child bonds. Trained and supported GPs from 40 participating practices will identify 700 abused or at risk women over a 40 week period. Women in the intervention arm of the trial, identified as abused or at risk by their GPs will be offered the support of trained para-professional 'mentor mothers' for up to a year, while the comparison arm will be offered standard GP care. Recent funding allows a pilot study of mentor mother recruitment and training to be undertaken in 2003. The study will strengthen GP support for this difficult issue and build a 'critical mass' of GPs interested in partner abuse management in the 5 participating divisions. The MOSAIC study will assess the value to GPs and women of an enhanced support system for victims' care and provide much needed evidence of an intervention embedded in general practice to reduce partner abuse of pregnant women and women with young children.