Does Stage of Change Predict Improved Intimate Partner Violence Outcomes Following an Emergency Department Intervention

Objectives The objective was to assess the effect of an emergency department (ED)-based computer screening and referral intervention on the safety-seeking behaviors of female intimate partner violence (IPV) victims at differing stages of change. The study also aimed to determine which personal and behavioral characteristics were associated with a positive change in safety-seeking behavior. The hypothesis was that women who were in contemplation or action stages of change would be more likely to endorse safety behaviors during follow-up. Methods This was a prospective cohort study of female IPV victims at three urban EDs, using a computer kiosk to deliver targeted education about IPV to provide referrals to local resources. All noncritically ill adult English-speaking women triaged to the ED waiting room during study hours were eligible to participate. Women were screened for IPV using the validated Universal Violence Prevention Screening Protocol (UVPSP), and all IPV-positive women further responded to validated questionnaires for alcohol and drug abuse, depression, and IPV severity. The women were assigned a baseline stage of change using the University of Rhode Island Change Assessment (URICA) scale for readiness to change their IPV behaviors. Study participants were contacted at 1 week and 3 months to assess a variety of predetermined safety behaviors to prevent further IPV during that period. Descriptive analyses were performed to determine if stage of change at enrollment and a variety of specific sociodemographic characteristics were associated with taking protective action during follow-up. Results A total of 1,474 women were screened for IPV; 154 (10.4%) disclosed IPV and completed the full survey. Approximately half (47.4%) of the IPV victims were in the precontemplation stage of change, and 50.0% were in the contemplation stage. A total of 110 women returned at 1 week of follow-up (71.4%), and 63 (40.9%) women returned for the 3-month follow-up. Fifty-five percent of those who returned at 1 week and 73% of those who returned at 3 months took protective action against further IPV. Stage of change at enrollment was not significantly associated with taking protective action during follow-up. There was no association between demographic characteristics and taking protective action at 1 week or 3 months. Conclusions Emergency department–based kiosk screening and health information delivery is a feasible method of health information dissemination for women experiencing IPV and was associated with a high proportion of study participants taking protective action. Stage of change was not associated with actual IPV protective measures. Resumen ?Puede la Etapa del Cambio Predecir la Mejoria de los Resultados de Violencia de Pareja tras una Intervencion en el Servicio de Urgencias? Objetivos Los objetivos fueron evaluar el impacto de un despistaje computarizado en un servicio de urgencias (SU) y la intervencion de derivacion en los comportamientos que intentan conseguir la seguridad de las mujeres victima de violencia de pareja (VP) en las diferentes etapas del cambio. Tambien se determino que caracteristicas personales y de comportamiento se asociaron con un cambio positivo en la actitud de busqueda de seguridad. La hipotesis fue que las mujeres que estaban en la etapa de contemplacion o activa tenian mas probabilidad de buscar comportamientos seguros durante el seguimiento. Metodologia Se trata de un estudio de cohorte prospectivo de mujeres victimas de VP de tres SU urbanos, que utilizo una cabina computarizada para entregar formacion dirigida sobre VP y proporcionar derivaciones a recursos locales. Se eligio para participar a toda mujer de habla inglesa clasificada como no criticamente enferma en la sala de espera del SU durante las horas del estudio. Se realizo el despistaje de las mujeres victima de VP mediante el protocolo validado de despistaje de prevencion de violencia universal Universal Violence Prevention Screening Protocol (UVPSP), y todas las mujeres positivas para VP posteriormente respondieron a unos cuestionarios validados para el abuso de drogas y alcohol, la depresion y la gravedad de la VP. Las mujeres se asignaron a una etapa de cambio basal mediante la escala University of Rhode Island Change Assessment (URICA) para prepararlas para cambiar sus comportamientos respecto a la VP. Se contacto con las participantes del estudio a la semana y a los tres meses para valorar una variedad de comportamientos de seguridad predeterminados para prevenir una futura VP durante ese periodo. Se realizo un analisis descriptivo para determinar si la etapa de cambio en la inclusion y una variedad de caracteristicas sociodemograficas especificas se asociaban con el tomar acciones de proteccion durante el seguimiento. Resultados Se realizo el despistaje para VP a 1.474 mujeres, 154 (10,4%) revelaron VP y completaron la encuesta totalmente. Aproximadamente la mitad (47,4%) de las victimas de VP estaban en la etapa de cambio de precontemplacion y el 50,0% en la etapa de contemplacion. Ciento diez mujeres volvieron a la semana de seguimiento (71,4%), y 63 (40,9%) a los tres meses de seguimiento. El 55% de aquellas que volvieron a la semana, y el 73% de aquellas que volvieron a los tres meses tomaron acciones protectoras contra una futura VP. La etapa de cambio a la inclusion no se asocio de forma estadisticamente significativa con el tomar acciones de proteccion durante el seguimiento. No hubo asociacion entre las caracteristicas demograficas y el tomar acciones protectoras a la semana o a los tres meses. Conclusiones El despistaje mediante una cabina en el SU y el proporcionar informacion de salud es un metodo viable para distribuir informacion sanitaria a las mujeres que sufren VP, y se asocio con una alta proporcion de participantes del estudio que tomaron acciones de proteccion. La etapa del cambio no se asocio con las medidas de proteccion frente a la VP.