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Health Pathfinder Evaluation (SAFELIVES)

Principal Investigator 

Prof G.J. Melendez-Torres (University of Exeter)


Prof Amanda Robinson; Dr Honor Young; Dr Rhiannon Evans; Dr Heather Trickey; Dr Kelly Buckley; Bethan Pell


Domestic violence and abuse (DVA) is a global public health issue that can be experienced by anyone regardless of socioeconomic status, cultural or religious group (WHO, 2019) and is associated with detrimental physical and psychological health effects (Afifi et al., 2009; Boyle et al., 2006; Devries et al., 2013; Oram et al., 2017). DVA is highly prevalent, with an estimated 2.4 million adults aged 16-74 experiencing DVA across England and Wales in 2019 (ONS, 2019).

As it is so prevalent in our society, it is inevitable that NHS staff will be in contact with adult and child survivors (and perpetrators) across the full range of health services. The cost of domestic abuse to health services has been calculated at £1.73 billion (Safelives, 2016) with mental health costs estimated at an additional £176 million, so there is a pressing need to find cost effective and safe ways of supporting survivors. Yet the response of health services to survivors is variable and best practice is frequently short-term and dependent on individual practitioners.

It aims to recommend comprehensive health practice in relation to domestic abuse and wider issues related to Violence Against Women & Girls in acute hospital trusts, mental health trusts and community-based IRIS programmes in GP practices.

This project will independently and objectively evaluate the effectiveness of the outcomes achieved at sites, as a result of the intervention. Learnings and recommendations from the evaluation will be shared in a final report for replication of best practice.

Aims and Objectives

Aim: The overarching aim of the proposed project is to independently evaluate the ‘Health Pathfinder’ Project in eight ‘Pathfinder’ Sites (in acute hospital trusts, mental health trusts and community-based IRIS programmes in GP Practices).

This research, funded by the ‘Health Pathfinder’ Project, will assess the effectiveness of the interventions by evaluating overall change created, and the barriers and facilitators of implementation. It will also assess the overall systemic change in referral pathways.

Study Design

The evaluation brings together four inter-related work packages (WP) to answer this overarching research question: What is the effectiveness of Health Pathfinder as a model in improving intended programme outcomes?

WP1 Logic Model Development

RQ1. What is a plausible, generalisable model for how the intervention works, in which contexts, for which individuals, and with respect to which outcomes?

RQ2. What are priority areas and uncertainties for understanding the implementation and effectiveness of the intervention?

WP2 Process Evaluation

RQ3. What is the acceptability and feasibility of different intervention components included as part of Health Pathfinder?

RQ4. How do stakeholders’ perceptions of acceptability and feasibility change over time?

RQ5. How do interventions implemented in Health Pathfinder sites achieve proposed outcomes, and where does this relate to contextual characteristics?

RQ6. Are there any unintended causal pathways or unexpected outcomes that should be added to the logic model?

WP3 Impact Evaluation

RQ7. What is the effectiveness of Health Pathfinder as a model in improving intended programme outcomes?

RQ8. What is the effectiveness of individual interventions included in Health Pathfinder?


A summary of the study will be presented to consortium partners and the professional and practice communities in dissemination events. Journal articles will be submitted to high impact peer-reviewed academic journals. These will report on: the process evaluation, the impact evaluation and other findings. A summary report with recommendations for service organisation and delivery improvement will be provided to the consortium partners.

Further Information and Publications

Health Pathfinder (SafeLives website)

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SafeLives; Imkaan; Against Violence and Abuse (AVA); Identification and Referral to Improve Safety (IRISi); Standing Together Against Domestic Violence (STADV)