() Cohort III-2 250 women; 52 providers Aim: To compare in person versus computerized screening for intimate partner violence (IPV) in a hospital-based prenatal clinic and explore women's assessment of the screening methods. Setting: United States Population: Women in hospital-based antenatal care Methods: We compared patient IPV disclosures on a computerized questionnaire to audio-taped first obstetric visits with an obstetric care provider and performed semi-structured interviews with patient participants who reported experiencing IPV. Ninety-one (36%) patients disclosed IPV either via computer or in person. Of those who disclosed IPV, 60 (66%) disclosed via both methods, but 31 (34%) disclosed IPV via only one of the two methods. Twenty-three women returned for interviews. They recommended using both types together. While computerized screening was felt to be non-judgmental and more anonymous, in person screening allowed for tailored questioning and more emotional connection with the provider. opportunity for interpersonal rapport.
1.4 Is routine enquiry about domestic violence acceptable to women? Study ref Study design LoE Sample size Aim/setting/population/methods Findings Comments () Cohort III-2 32 interviews; data from 1,038 surveys Aim: to describe violence-related coping and help-seeking, and preferences for health care based intervention Setting: India Population: perinatal women residing in communities Methods: Indepth interviews were conducted with women who had recently given birth and self-reported recent violence from husbands, followed by survey data collection from mothers seeking immunization for their infants ages 6 months or younger at three large urban health centers. Qualitative and quantitative findings indicated that formal helpseeking is uncommon and that informal help sources are most frequently sought. Quantitative results revealed that, while few (<5%) women had been screened for violence in the health care setting, most (67%) would be willing to disclose abuse if asked. When presented with a list of possible clinic-based violence support interventions, participants endorsed crisis counseling and safety planning as most helpful (90.9%). () IV 27 Aim: to understand the risks and benefits of disclosing IPV to clinicians across specialties. Setting: United States Population: English-speaking female IPV survivors Methods: In-depth interviews describing medical encounters related to abuse were analyzed for common themes. Encounters with health care clinicians were categorized by outcome (IPV disclosure by patient, discovery evidenced by discussion of IPV by clinician without patient disclosure, or attribute (beneficial, unhelpful, harmful), and specialty (emergency department (ED), primary care (PC), obstetrics/gynecology (OB/GYN)). Seven of 9 ED disclosures were characterized as unhelpful; the majority of disclosures in PC and OB/GYN were characterized as beneficial. There were no harmful disclosures in any setting. Unhelpful disclosures resulted in emotional distress and alienation from health care. Regardless of whether disclosure occurred, beneficial encounters were characterised by familiarity with the clinician, acknowledgement of the abuse, respect and relevant referrals. income
() Cohort III-2 461 Aim: to estimate the self-reported prevalence of domestic violence and to determine the acceptability of domestic violence screening. Setting: United States Population: a pregnant military population presenting for emergency obstetric care Methods: Women were anonymously screened for domestic violence using the Abuse Assessment Screen. The majority of women 91.8% (95% CI=88.7-94.2) were not offended by domestic violence screening and 88.8% (95% CI=82.0-88.9) felt that patients should be routinely screened. () IV 200 (82 pregnant) Aim: to investigate the prevalence of IPV among patients of an out-patient clinic obstetrics gynecology, association with level of education, and women's opinion on asking about IPV by physicians. Setting: The Netherlands Population: women between 18 and 60 years in a waiting room of an out-patient obstetrics gynecology clinic Methods: We surveyed the women and used the Composite Abuse Scale to measure type and severity of IPV. 78% of the respondents found it important for physicians to ask about IPV. Prevalence of IPV: Ever: 23% Current: 9% Curent in pregnant women: 5% Higher among women with a lower educated partner.
1.5 Is routine enquiry about domestic violence acceptable to health professionals? Study ref Study design LoE Sample size Aim/setting/population/methods Findings Comments () IV 152 Aim: to investigate midwives' knowledge of intimate partner violence against women during pregnancy. Setting: Australia Population: midwives Methods: An online survey link was distributed through the Australian College of Midwives. The survey included personal, professional and practice details, and 25 questions that tested knowledge about intimate partner violence. Knowledge scores ranged from 27 to 48 (out of a possible 50), with the mean total score of 42.8 (SD = 3.3). Although 60% of participants scored 48, did not know about the risks and signs of intimate partner violence. of the midwives did not know about age risks associated with intimate partner violence. Around 25% incorrectly believed that perpetrators are violent because of alcohol or drug use. Nearly 90% (88%) of participants had some education or training about intimate partner violence. Those with some training achieved higher knowledge scores than those with no formal training (p= 0.003).
() IV 183 Aim: to (1) evaluate IPV knowledge, attitudes, and practices of physicians from different specialties and (2) determine significant differences by medical specialty. Setting: United States Population: Internal Medicine, Emergency Medicine, Family Medicine (FM) and Obstetrics/Gynecology (OB/GYN) residents and attending physicians Methods: Participants completed a online survey assessing knowledge, attitudes and current IPV screening practices. We evaluated associations between medical specialty and knowledge, attitudes and practice measures before and after controlling for covariates. Knowledge of how often IPV occurs in society, community resources, and screening tools differed significantly by specialty (all p values < 0.05). A majority of FM physicians (88%) reported that it is a physician's responsibility to find and treat IPV and 97% reported that IPV should be included in their training. Compared to OB/GYN physicians in multivariate analyses, FM physicians were less likely to report they were comfortable discussing IPV with their patients in crude (OR = 0.35; 95 % CI = 0.13, 0.94) and adjusted models (OR = 0.20; 95 % CI = 0.06, 0.60). FM physicians were also less likely to report screening female patients for IPV before (OR = 0.25; 95 % CI = 0.08, 0.86) and after adjusting for confounders (OR = 0.11; 95 % CI = 0.03, 0.47). () IV — Aim: To explore attitudes of women and health professionals towards screening for domestic violence Setting: Belgium Population: health professionals Methods: a questionnaire-based surveillance study among pregnant women constituting a regional probability sample and a questionnaire based Knowledge-Practice and Attitude Survey among obstetricians/ gynaecologists were conducted. It appeared that obstetricians/ gynaecologists feel uncomfortable with a routine screening policy. They underestimate the prevalence and perceive a lack of self-efficacy in dealing with the problem and properly referring patients, they lack time and perceive it as inappropriate to question patients about IPV. On the other hand they acknowledge that there is a need for training on violence. Full text not found
() IV 59 (29 antenatal) Aim: to understand challenges, and enablers of screening apply this to a model of how health policies become routinised in practice Setting: Australia Population: health care workers Methods: Focus groups were conducted, with health care workers at 10 health services (5 antenatal settings) within two of the eight NSW health regions Privacy, tensions between wanting to offer trust, and limited confidentiality, as well as worker’s frustration at women who elect not to end abusive relationships, remain challenges to the continued implementation of screening in an established program. Factors facilitating uptake included brief, scripted questions embedded in assessment schedules, training, access to referral services, familiarity, and women’s favourable reactions. () IV 232 Aim: to identify the incidence of violence against women seeking healthcare services and evaluate the use of clinical guidelines to identify interpersonal violence. Setting: Iceland Population: nurses, midwives and women visiting the emergency department of high risk prenatal care clinic Methods: Data were collected over a period of 7 months in 2005 and 2006. The samples consisted of 14 nurses, 10 midwives and 208 women in Iceland (101 women visiting the Emergency Department and 107 receiving prenatal care at the High Risk Prenatal Care Clinic). Twenty women (19.6%) who visited the Emergency Department and 21 women (19.8%) who came to the High Risk Prenatal Care Clinic had been sexually abused at some point in their lives by close family members. Within the preceding 12 months, 18 women at the Emergency Department (19.1%) and eight at the High Risk Prenatal Care Clinic (7.5%) reported physical abuse, and 22 women (22.2%) at the Emergency Department and 12 (11.5%) at the High Risk Prenatal Care Clinic reported emotional abuse. A majority of the nurses and midwives indicated that the guidelines were efficient for assessing/screening for gender violence in emergency and high risk clinical settings.
() IV 254 Aim: To identify maternity and sexual healthcare professionals' training needs regarding routine enquiry for domestic abuse. Setting: United Kingdom Population: Maternity professionals (n=228) and sexual health practitioners (n=46) Methods: Participants attended a 1-day domestic abuse training session. Pre-training questionnaires were completed by 208 respondents (80% response rate). The questionnaire elicited information about previous training experiences, dealing with cases of abuse, general knowledge, attitudes towards victims of abuse and views on routine enquiry. Bivariate and multivariate analyses were conducted to identify differences according to healthcare setting, prior training, and practitioners' demographic and experiential traits. Maternity and sexual health professionals reported positive attitudes towards women affected by abuse, but had limited domestic abuse training. Previously trained health professionals had good general knowledge, but failed to question attendees about abuse. Sexual health professionals were more likely to enquire about domestic abuse, and were more confident about implementing routine enquiry than maternity staff. Views on routine enquiry were influenced by health setting, demographic, attitudinal and experiential factors.
1.9 Excluded studies Systematic reviews included in AIHW report Nelson, H. D., et al. (2012). "Screening women for intimate partner violence: a systematic review to update the u.s. Preventive services task force recommendation." Annals of Internal Medicine 156(11): 796-808 713p. Included in AIHW review O'Reilly, R., et al. (2010) Screening and intervention for domestic violence during pregnancy care: a systematic review (Provisional abstract). 11, 190-201 Included in AIHW review Studies included in systematic reviews Baird, K., et al. (2013). "A five year follow-up study of the Bristol pregnancy domestic violence programme to promote routine enquiry." Midwifery 29(8): 1003-1010 1008p. Included in AIHW review Calderon, S. H., et al. (2008). "Cueing prenatal providers: Effects on discussions of intimate partner violence." American journal of preventive medicine 34(2): 134-137. Included in (; ) Kataoka, Y., et al. (2010) Self-administered questionnaire versus interview as a screening method for intimate partner violence in the prenatal setting in Japan: a randomised controlled trial. 10, 84 DOI: 10.1186/1471-2393-10-84 Included in () MacMillan, H. L., et al. (2009) Screening for intimate partner violence in health care settings: a randomized trial. 302, DOI: 10.1001/jama.2009.1089 Included in () Spangaro, J. M., et al. (2010). "Six months after routine screening for intimate partner violence: attitude change, useful and adverse effects." Women & Health 50(2): 125-143 119p. Included in AIHW review
() review IV — Aim: To examine the effectiveness and safety of interventions in preventing or reducing domestic violence against pregnant women. Setting: United Kingdom Methods: evaluation of a domestic violence intervention in the maternity and sexual health services of a UK hospital. The intervention encompassed guidelines, staff training, inclusion of routine enquiry for domestic violence with all patients, and referral of women disclosing violence to an on-site advocacy service. An "assumption querying" approach was applied to evaluate the intervention. Programmatic assumptions were identified and tested using interviews with service providers and patients, review of patient records, and and questionnaires. Domestic violence training resulted in changes in health professionals' knowledge and practice in the short-term, but universal routine enquiry was not achieved even in a context of organisational support, guidelines, training and advocacy. Potential and actual harm occurred, including breaches of confidentiality and failure to document evidence, limiting women's ability to access civil and legal remedies. Advocacy support led to positive outcomes for many women, as long as support to maintain positive changes, whether women stayed with or left the violent partner, continued to be given. Maternity and sexual health services were found to be opportune points of intervention for domestic violence services that combine routine enquiry by clinicians, support after disclosure and attention to harm reduction.
Study ref Evidence Level Sample size Aim/methods Findings Comments () IV 6 Aim: to interview bilingual (‘black and ethnic minority’) women in the community to explore: (1) how domestic abuse is viewed in their culture; and (2) who should be questioning women about this sensitive issue. Methods: a qualitative study using semi-structured interviews with bilingual workers within the local community. Women's lives were influenced by their in-laws and family, status, attitudes to marriage arrangements and gossiping in the community. All of these factors affected disclosure. Health-care professionals must understand that women take serious measures to hide the fact that they are victims of abuse in order to preserve family honour. Divulging information to interpreters or relatives is a problem because of lack of confidentiality and gossiping in the community. () IV 17 Aim: to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence. Methods: Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analysed using thematic analysis. The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience-based knowledge and collegial support.