1
|
Lenert L, Rheingold AA, Simpson KN, Scherbakov D, Aiken M, Hahn C, McCauley JL, Ennis N, Diaz VA. Electronic Health Record-Based Screening for Intimate Partner Violence: A Cluster Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2425070. [PMID: 39088215 PMCID: PMC11294960 DOI: 10.1001/jamanetworkopen.2024.25070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/31/2024] [Indexed: 08/02/2024] Open
Abstract
Importance Intimate partner violence (IPV) is a significant public health issue, with a 25% lifetime prevalence. Screening for IPV in primary care is a recommended practice whose effectiveness is debated. Objective To assess the effect of an electronic health record (EHR)-based multifactorial intervention screening on the detection of IPV risk in primary care practice. Design, Setting, and Participants This cluster randomized clinical trial used a stepped-wedge design to assign 15 family medicine primary care clinics in the Medical University of South Carolina Health System in the Charleston region to 3 matched blocks from October 6, 2020, to March 31, 2023. All women aged 18 to 49 years who were seen in these clinics participated in this study. Intervention A noninterruptive EHR alert combined with confidential screening by computer questionnaire using the EHR platform followed by risk assessment and a decision support template. Main Outcomes and Measures The main outcomes were the rate at which patients were screened for IPV across the clinics and the rate at which patients at risk for IPV were detected by screening procedures. Results The study clinics cared for 8895 unique patients (mean [SD] age, 34.6 [8.7] years; 1270 [14.3%] with Medicaid or Medicare and 7625 [85.7%] with private, military, or other insurance) over the study period eligible for the screening intervention. The intervention had significant effects on the overall rate of screening for IPV, increasing the rate of screening from 45.2% (10 268 of 22 730 patient visits) to 65.3% (22 303 of 34 157 patient visits) when the noninterruptive alert was active (relative risk, 1.46 [95% CI, 1.44-1.49]; P < .001). The confidential screening process was more effective than baseline nurse-led oral screening at identifying patients reporting past-year IPV (130 of 8895 patients [1.5%] vs 9 of 17 433 patients [0.1%]). Conclusions and Relevance The intervention was largely effective in increasing screening adherence and the positive detection rate of IPV in primary care. A highly private approach to screening for IPV in primary care may be necessary to achieve adequate detection rates while addressing potential safety issues of patients experiencing IPV. Trial Registration ClinicalTrials.gov Identifier: NCT06284148.
Collapse
Affiliation(s)
- Leslie Lenert
- Biomedical Informatics Center, Medical University of South Carolina, Charleston
| | - Alyssa A. Rheingold
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Kit N. Simpson
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston
| | - Dmitry Scherbakov
- Biomedical Informatics Center, Medical University of South Carolina, Charleston
| | - Michael Aiken
- Biomedical Informatics Center, Medical University of South Carolina, Charleston
| | - Christine Hahn
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Jenna L. McCauley
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Naomi Ennis
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Vanessa A. Diaz
- Department of Family Medicine, Medical University of South Carolina, Charleston
| |
Collapse
|
2
|
Wood L, Baumler E, Schrag RV, Guillot-Wright S, Hairston D, Temple J, Torres E. "Don't Know where to Go for Help": Safety and Economic Needs among Violence Survivors during the COVID-19 Pandemic. JOURNAL OF FAMILY VIOLENCE 2022; 37:959-967. [PMID: 33424111 PMCID: PMC7780076 DOI: 10.1007/s10896-020-00240-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 05/07/2023]
Abstract
The COVID-19 pandemic and related quarantine has created additional problems for survivors of interpersonal violence. The purpose of this study is to gain a preliminary understanding of the health, safety, and economic impacts of the COVID-19 pandemic on people that are experiencing or have previously experienced violence, stalking, threats, and/or abuse. An online survey, open from April to June 2020, was taken by people with safety concerns from interpersonal violence. Participants were recruited from IPV and sexual assault-focused agencies, state coalitions, and social media. Quantitative data were summarized using descriptive methods in SPSS and coding methods from thematic and content analysis was used to analyze qualitative data from open-ended questions. A total of 53 participants were recruited for the survey. Individuals with safety concerns have experienced increased challenges with health and work concerns, stress from economic instability, difficulties staying safe, and access resources and support. Over 40% of participants reported safety had decreased. Use of social media and avoidance strategies were the most common safety approaches used. Participants reported mixed experiences with virtual services. The COVID-19 pandemic has exacerbated existing structural concerns for survivors of violence like IPV and sexual assault. Increased support and economic resource access, coupled with modified safety planning and improved virtual approaches, would better help meet survivor needs.
Collapse
Affiliation(s)
- Leila Wood
- Department of Obstetrics and Gynecology, Center for Violence Prevention, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0587 USA
| | - Elizabeth Baumler
- Department of Obstetrics and Gynecology, Center for Violence Prevention, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0587 USA
| | - Rachel Voth Schrag
- The University of Texas at Arlington, PO Box 19129, 211 South Cooper Street, Arlington, TX 76019-0129 USA
| | - Shannon Guillot-Wright
- Department of Obstetrics and Gynecology, Center for Violence Prevention, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0587 USA
| | - Dixie Hairston
- Department of Obstetrics and Gynecology, Center for Violence Prevention, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0587 USA
| | - Jeff Temple
- Department of Obstetrics and Gynecology, Center for Violence Prevention, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0587 USA
| | - Elizabeth Torres
- Department of Obstetrics and Gynecology, Center for Violence Prevention, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0587 USA
| |
Collapse
|
3
|
Mazza M, Marano G, Gonsalez del Castillo A, Chieffo D, Albano G, Biondi-Zoccai G, Galiuto L, Sani G, Romagnoli E. Interpersonal violence: Serious sequelae for heart disease in women. World J Cardiol 2021; 13:438-445. [PMID: 34621488 PMCID: PMC8462046 DOI: 10.4330/wjc.v13.i9.438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/10/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
Experiencing various forms of violence in either childhood or adulthood has been associated with cardiovascular disease, both shortly after the event and during follow-up, particularly in women. The coronavirus disease 2019 pandemic has heightened the risk of domestic violence with serious sequelae for mental and cardiovascular health in women, possibly due to several contributing factors, ranging from lockdown, stay at home regulations, job losses, anxiety, and stress. Accordingly, it remains paramount to enforce proactive preventive strategies, at both the family and individual level, maintain a high level of attention to recognize all forms of violence or abuse, and guarantee a multidisciplinary team approach for victims of interpersonal or domestic violence in order to address physical, sexual, and emotional domains and offer a personalized care.
Collapse
Affiliation(s)
- Marianna Mazza
- Department of Neurosciences, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Giuseppe Marano
- Department of Neurosciences, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Angela Gonsalez del Castillo
- Unit of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Daniela Chieffo
- Unit of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Gabriella Albano
- Department of Neurosciences, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina 04100, Italy
- Mediterranea Cardiocentro, Napoli 80122, Italy
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Gabriele Sani
- Department of Neurosciences, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| |
Collapse
|
4
|
Blain M, Richardson BA, Kinuthia J, Poole DN, Jaoko W, Wilson KS, Kaggiah A, Simoni JM, Farquhar C, McClelland RS. Psychosocial Factors, Condomless Sex, and Detectable Viral Load in HIV-Positive Women in Serodiscordant Couples in Nairobi, Kenya. AIDS Behav 2020; 24:3346-3358. [PMID: 32394232 PMCID: PMC7655612 DOI: 10.1007/s10461-020-02907-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This prospective study of HIV-positive Kenyan women in serodiscordant couples examined relationships between psychosocial factors, viral suppression, and condomless sex. Participants were screened for alcohol use disorders and intimate partner violence (IPV) annually and depressive symptoms every 6 months. Prostate specific antigen (PSA) detection was used as a marker for condomless sex. A total of 151 participants contributed 349 person-years of follow-up. Hazardous/harmful alcohol use was associated with increased risk of detecting PSA in vaginal secretions (aRR 1.99, 95%CI 1.08-3.66, χ2 = 4.85 (1)), while IPV and depression were not. Events representing HIV transmission potential, where there was biological evidence of condomless sex at a visit with a detectable plasma viral load, were observed at 2% of visits. The high prevalence of IPV and association between alcohol use and sexual risk suggest the need for monitoring and support for these conditions as part of comprehensive HIV care for women.
Collapse
Affiliation(s)
- Michela Blain
- Department of Medicine, University of Washington, 1959 NE Pacific Street, UW Box 356423, Seattle, WA, 98195, USA.
| | - Barbra A Richardson
- Department of Biostatistics, University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, USA
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Danielle N Poole
- Department of Medicine, University of Washington, 1959 NE Pacific Street, UW Box 356423, Seattle, WA, 98195, USA
| | - Walter Jaoko
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Kate S Wilson
- Department of Global Health, University of Washington, Seattle, USA
| | | | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, USA
| | - Carey Farquhar
- Department of Medicine, University of Washington, 1959 NE Pacific Street, UW Box 356423, Seattle, WA, 98195, USA
- Department of Global Health, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - R Scott McClelland
- Department of Medicine, University of Washington, 1959 NE Pacific Street, UW Box 356423, Seattle, WA, 98195, USA
- Department of Global Health, University of Washington, Seattle, USA
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Epidemiology, University of Washington, Seattle, USA
| |
Collapse
|
5
|
Sharoni S, Klocke B. Faculty Confronting Gender-Based Violence on Campus: Opportunities and Challenges. Violence Against Women 2020; 25:1352-1369. [PMID: 31379292 DOI: 10.1177/1077801219844597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Faculty have played an important role in the ongoing efforts to confront gender-based violence on college campuses, as teachers, researchers, advocates, and policy advisors. Nevertheless, few institutions have welcomed faculty activism on this issue, especially when it took the form of vocal support for survivor-led efforts to transform campus policies and culture. This article examines the nature and scope of faculty involvement in confronting gender-based violence on college campuses across North America between 2014 and 2018. Our analysis of the range of roles and responsibilities faculty have assumed and the challenges and obstacles they have faced is informed by our own involvement with the U.S.-based group, Faculty Against Rape (FAR), which is dedicated to supporting faculty involvement in confronting gender-based violence on campus. Informed by the context of the #MeToo and #TimesUp movements on one hand, and the changes in Federal and State protections for student survivors in the Trump-DeVos era on the other, the article concludes with a list of best practices for faculty involvement.
Collapse
|
6
|
Frazier T, Sales JM. A preliminary study of early childhood parenting and adult past month drug use risk in low-income African American women. Addict Behav 2019; 97:84-89. [PMID: 31163293 DOI: 10.1016/j.addbeh.2019.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 04/27/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE This preliminary study was designed to assess the feasibility of examining early childhood parenting factors and their relationship with adult past month drug use among low-income African American women. METHODS A cross-sectional survey of 156 low-income African American women was conducted. Measures included the childhood parental bonding scale, frequency of exposure to corporal punishment (CP) in childhood, The Drug Abuse Screening Test (DAST) and The Differentiation of Self Scale. Structural equation modeling (SEM) was used to assess the relationship between the primary predictors, latent parental bonding and corporal punishment exposure, with past month drug use. The intermediary construct, emotional reactivity, was also included in the SEM model to test mechanisms of mediation. RESULTS There was a significant main effect for maternal care on lower emotional reactivity patterns in adulthood. There was also a significant main effect for frequent CP on higher emotional reactivity patterns in adulthood. The relationship between both parenting measures and drug use were mediated by emotional reactivity. CONCLUSION Childhood maternal factors are a strong predictor of adult past month drug use, and this may be accounted for, in part, by the influence that parenting patterns in childhood have on adult emotional reactivity patterns. These observations should be examined in a longitudinal study to determine the stability of our observation that CP in childhood, even when controlling for positive maternal bonding patterns, influences emotional reactivity patterns that predispose an individual to negative coping strategies, such as drug use, in adulthood, among low-income African American women.
Collapse
|
7
|
Field S, Onah M, van Heyningen T, Honikman S. Domestic and intimate partner violence among pregnant women in a low resource setting in South Africa: a facility-based, mixed methods study. BMC Womens Health 2018; 18:119. [PMID: 29973182 PMCID: PMC6030741 DOI: 10.1186/s12905-018-0612-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 06/22/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Rates of violence against women are reported to be highest in Africa compared to other continents. We aimed to determine associations between mental illness, demographic, psychosocial and economic factors with experience of intimate partner violence (IPV) among pregnant women in a low resource setting in Cape Town and to explore the contextual elements pertaining to domestic violence. METHODS We recruited adult women attending antenatal services at a primary-level maternity facility. Demographic, socioeconomic and psychosocial data were collected by questionnaire. The Expanded Mini- International Neuropsychiatric Interview (MINI) Version 5.0.0 was used to assess mental health status and the Revised Conflict Tactic Scale (CTS2) used to assess IPV in the six months prior to the study. Non-parametric tests, Wilcoxon sum of rank test, Fisher Exact and two sample T test and multicollinearity tests were performed. Descriptive, bivariate and logistic regression analyses were conducted to identify associations between the outcome of interest and key predictors. A probability value of p ≤ 0.05 was selected. From counselling case notes, a thematic content analysis was conducted to describe contextual factors pertaining to forms of domestic violence (DV). RESULTS The prevalence of IPV was 15% of a sample of 376 women. Women who were food insecure, unemployed, in stable but unmarried relationships, had experienced any form of past abuse and were not pleased about the current pregnancy were more likely to experience IPV. MINI-defined mental health problems and a history of mental illness were significantly associated with IPV. Qualitative analysis of 95 counselling case notes revealed that DV within the household was not limited to intimate partners and, DV in this context was often perceived as 'normal' behaviour by the participants. CONCLUSIONS This study contributes towards a greater understanding of the risk profile for IPV amongst pregnant women in low-income settings. Adversity, including food insecurity and mental ill-health are closely associated with IPV during the antenatal period. Advocates against violence against pregnant women are advised to consider that violence in the home may be perpetrated by non-intimate partners and may by enabled by a pervasive belief in the acceptability of the violence.
Collapse
Affiliation(s)
- Sally Field
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Building B, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
| | - Michael Onah
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Building B, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Thandi van Heyningen
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Building B, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
| | - Simone Honikman
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Building B, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
| |
Collapse
|