Open Access Research article

A comprehensive model for intimate partner violence in South African primary care: action research

Kate Joyner1* and Bob Mash2

Author affiliations

1 Nursing Division, Faculty of Medicine and Health Sciences, Stellenbosch University, P O Box 19063, Tygerberg 7505, South Africa

2 Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zijl Ave, Parow, South Africa

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Citation and License

BMC Health Services Research 2012, 12:399  doi:10.1186/1472-6963-12-399

Published: 14 November 2012



Despite extensive evidence on the magnitude of intimate partner violence (IPV) as a public health problem worldwide, insubstantial progress has been made in the development and implementation of sufficiently comprehensive health services. This study aimed to implement, evaluate and adapt a published protocol for the screening and management of IPV and to recommend a model of care that could be taken to scale in our underdeveloped South African primary health care system.


Professional action research utilised a co-operative inquiry group that consisted of four nurses, one doctor and a qualitative researcher. The inquiry group implemented the protocol in two urban and three rural primary care facilities. Over a period of 14 months the group reflected on their experience, modified the protocol and developed recommendations on a practical but comprehensive model of care.


The original protocol had to be adapted in terms of its expectations of the primary care providers, overly forensic orientation, lack of depth in terms of mental health, validity of the danger assessment and safety planning process, and need for ongoing empowerment and support. A three-tier model resulted: case finding and clinical care provision by primary care providers; psychological, social and legal assistance by ‘IPV champions’ followed by a group empowerment process; and then ongoing community-based support groups.


The inquiry process led to a model of comprehensive and intersectoral care that is integrated at the facility level and which is now being piloted in the Western Cape, South Africa.

Interpersonal violence; Intimate partner violence; Domestic violence; Spouse abuse; Mental health; Action research; Co-operative inquiry; Primary care; South Africa; Health services; Health systems