II. violence prevention and intervention in health care and community settingsScreening for intimate partner violence by health care providers: Barriers and interventions
Introduction
In recent years, intimate partner violence (IPV) (also referred to as domestic violence, spouse abuse, and battering) has gained recognition as a serious public health problem. Recent estimates show that 1.5 million women in the United States are physically or sexually assaulted each year by an intimate partner.1
Recognizing the significant morbidity from IPV and the opportunities for health professionals to identify and refer victims of IPV, many health care organizations recommend routine screeninga of patients for IPV.2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 These recommendations emphasize that appropriate referral and treatment of IPV victims are essential components of any screening protocol.
Although numerous health professional organizations endorse screening for IPV, evidence suggests that actual screening rates in health care settings remain low. One study that examined screening rates found that only 13% of victims of acute IPV presenting to an emergency department (ED) were asked by a doctor or nurse about violence.13 Others have found that only 1.5% to 12% of patients seen at primary care clinics had ever been asked by their physician about possible abuse.14, 15 Although reproductive health organizations have been among the most active in endorsing IPV screening of patients,5, 6 a recent survey showed self-reported routine screening rates of only 10% among obstetricians and gynecologists.16
Reasons for the gap between recommendations for IPV screening and their implementation have been the subject of numerous commentaries.17, 18, 19, 20, 21 Although some studies have been designed to determine barriers to implementation of screening, few have evaluated interventions to improve IPV screening and referral practices among health care providers. In addition, although gaps between screening and treatment recommendations and clinical practice have been a common focus in many other areas of preventive health care,22, 23, 24, 25, 26, 27, 28, 29, 30, 31 few studies focusing on IPV screening reference findings from this broader context.
In this report, we identify and summarize studies involving original research on: (1) barriers to IPV screening as perceived by health care providers, and (2) interventions designed to increase identification and referral of IPV victims in health care settings.
Section snippets
Methods
The MEDLINE, PsychLIT, and Sociological Abstracts databases from 1966 to January 1999 were searched by crossing several subject headings (violence, domestic violence, spouse abuse, and battered women) or text words (abuse + domestic, female, marriage, marital, partner, physical, spouse, wife, wives, woman; violence + domestic, family, female, marital, marriage, partner, physical, spouse, wife, wives, woman; batter + female, partner, spouse, wife, wives, woman; assault + behavior, sexual).
Barriers to IPV screening
Table 1 shows results of the 12 studies identifying barriers to IPV screening among different groups of health care providers. Five studies used qualitative methods with results reported as lists of barriers abstracted from interview transcripts.32, 33, 34, 35, 36 In all five studies, respondents reported that their greatest concern was the lack of effective interventions for IPV once patients were identified by the provider,32, 33, 34, 35, 36 followed by fear of offending patients,32, 33, 35,
Discussion
We identified 24 studies addressing barriers to IPV screening by health care providers by either identifying the barriers or evaluating interventions designed to increase screening. In the 12 studies on barriers to IPV screening as perceived by health professionals, similar lists of barriers were found despite differences in methods and provider population. Lack of effective interventions and lack of provider education were the most commonly mentioned barriers in both open-ended interviews and
Conclusion
Despite the limitations of this study, its findings hold potential lessons for future efforts to increase IPV screening by health care providers in clinical settings. Many of the barriers to IPV screening in health care settings parallel those encountered in screening for other conditions. Thus, components of models successful in changing provider behavior related to other screening and counseling practices may be applicable to efforts to increase IPV screening. Greater attention is also needed
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