A systematic review of intimate partner violence educational interventions delivered to allied health care practitioners

Gender Representations, Empathy, and Gender-Based Violence Awareness Among Medical Students: A Proposal for a Specific Training Program

INTRODUCTION

In recent decades, the topic of gender differences has become central to many areas of study, including medicine. The present study explored gender differences in empathy, gender role ideologies, and gender sensitivity among medical students, highlighting significant variations that can inform medical education and training programs.

MATERIALS AND METHODS

The study involved 155 students (52.1% male; mean age: 22.68±2.48 years) from the Department of Medicine, Surgery, and Dentistry of the University of Salerno in Baronissi, Southern Italy. Participants completed two standardized scales: the Jefferson Scale of Empathy (JSE) to assess empathy, and the Nijmegen Gender Awareness in Medicine Scale (N-GAMS) to evaluate gender awareness. Six open-ended questions were also included in the gender-based violence representations.

RESULTS

The ANOVA analysis reveals significant differences in scores between male and female students across the N-GAMS scales, indicating a strong role of gender in these variations. These findings suggest the necessity for further research to understand the contributing factors and inform targeted interventions in medical education. Additionally, there are significant differences in compassionate care (Factor 2) and walking in the patient's shoes (Factor 3), highlighting the substantial impact of gender on these latter aspects of empathy.

CONCLUSIONS

These gender differences have significant implications for medical education. Training programs should be tailored to address the specific needs and characteristics of both male and female students. For example, encouraging male students to maintain their gender sensitivity while challenging traditional gender role ideologies can promote a more inclusive approach to patient care. For female students, fostering confidence in their compassionate care abilities and providing opportunities to express empathy in diverse ways can help overcome societal constraints.

Readiness of Exercise Physiologists, Physiotherapists and Other Allied Health Professionals to Respond to Gender-Based Violence: A Mixed-Methods Study

Experiencing gender-based violence (GBV) is associated with health conditions that are common indications for referral to exercise physiologists, physiotherapists and other allied health professionals (AHPs). The readiness of AHPs to identify and respond to GBV is currently unknown. This study aimed to determine the readiness of AHPs to respond to a person who had experienced GBV. Participants completed the modified Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) and/or an interview. The AHPs felt underprepared, had low perceived knowledge and lacked confidence to respond to and support people who have experienced GBV, despite recognition of the importance and agreement of the relevance to AHPs' practice.

Improving Health Professional Recognition and Response to Child Maltreatment and Intimate Partner Violence: Protocol for Two Mixed Methods Pilot Randomized Controlled Trials

BACKGROUND

The optimal educational approach for preparing health professionals with the knowledge and skills to effectively recognize and respond to family violence, including child maltreatment and intimate partner violence, remains unclear. The Violence, Evidence, Guidance, and Action (VEGA) Family Violence Education Resources is a novel intervention that can be completed via self-directed learning or in a workshop format; both approaches focus on improving health professional preparedness to address family violence.

OBJECTIVE

Our studies aim to determine the acceptability and feasibility of conducting a randomized controlled trial to evaluate the effectiveness of the self-directed (experimental intervention) and workshop (active control) modalities of VEGA, as an adjunct to standard education, to improve learner (Researching the Impact of Service provider Education [RISE] with Residents) and independent practice (RISE with Veterans) health professional preparedness, knowledge, and skills related to recognizing family violence in their health care encounters.

METHODS

The RISE with Residents and RISE with Veterans research studies use embedded experimental mixed methods research designs. The quantitative strand for each study follows the principles of a pilot randomized controlled trial. For RISE with Residents, we aimed to recruit 80 postgraduate medical trainees; for RISE with Veterans, we intended to recruit 80 health professionals who work or have worked with Veterans (or their family members) of the Canadian military or the Royal Canadian Mounted Police in a direct service capacity. Participants complete quantitative assessments at baseline, after intervention, and at 3-month follow-up. A subset of participants from each arm also undergoes a qualitative semistructured interview with the aim of describing participants' perceptions of the value and impact of each VEGA modality, as well as research burden. Scores on potential outcome measures will be mapped to excerpts of qualitative data via a mixed methods joint display to aid in the interpretation of findings.

RESULTS

We consented 71 individuals to participate in the RISE with Residents study. Data collection was completed on August 31, 2023, and data are currently being cleaned and prepared for analysis. As of January 15, 2024, we consented 34 individuals in the RISE with Veterans study; data collection will be completed in March 2024. For both studies, no data analysis had taken place at the time of manuscript submission. Results will be disseminated through peer-reviewed publications; academic conferences; and posting and sharing of study summaries and infographics on social media, the project website, and via professional network listserves.

CONCLUSIONS

Reducing the impacts of family violence remains a pressing public health challenge. Both research studies will provide a valuable methodological contribution about the feasibility of trial methods in health professions education focused on family violence. They will also contribute to education science about the differences in the effectiveness of self-directed versus facilitator-led learning strategies.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05490121, https://clinicaltrials.gov/study/NCT05490121; ClinicalTrials.gov NCT05490004, https://clinicaltrials.gov/study/NCT05490004.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50864.

Development and evaluation of a training program for interpreters in the field of trauma-focused cognitive behavioral therapy

Background

The treatment of traumatized refugee minors is often challenging because of language barriers. International guidelines, therefore, recommend the use of language mediators. However, there is a scarcity of evaluated training programs that prepare language mediators to translate during psychotherapy developed specifically for this patient group, for instance trauma-focused cognitive behavioral therapy (TF-CBT).

Methods

Based on an extensive literature review and in collaboration with an expert focus group, a one-day TF-CBT-specific online training program was developed for language mediators willing to work with minor refugees, and delivered on nine occasions between November 2020 and June 2021. The participants answered pre- and post-training questions about trauma- and TF-CBT-related knowledge and attitudes relevant to therapy, as well as the perceived usefulness of the training. Bayesian estimation was used to determine pre-post changes.

Results

A total of 129 participants speaking 35 different languages participated in the training program. Analyses revealed 95% highest density intervals not containing the null with respect to knowledge gain (effect size median 0.28) and change in treatment-appropriate attitudes (effect size median 0.31). The participants rated the training as useful.

Conclusion

The TF-CBT-specific training course was successfully carried out. It was likely to disseminate both knowledge gains and a shift toward more treatment-appropriate attitudes. It was perceived as useful by the participants. Given the scarcity of evaluated training programs for language mediators working with minor refugees, the results are promising. The limitations include the lack of both a control group and the verification of the results using an external outcome measure.

Promoting Survivor Safety in Immigrant Communities: Online Simulation Training for Korean American Faith Leaders

This study examined the efficacy of a short virtual case simulation for Korean American (KA) faith leaders, "Religious Leaders for Healthy Families." The goal of the program is to increase knowledge about intimate partner violence (IPV) and healthy intimate partner relationships, enhance self-efficacy in IPV prevention and intervention, strengthen attitudes that support their roles on IPV prevention and intervention, increase positive outcome expectations of their actions, and increase behavioral intentions and behaviors on IPV prevention and intervention. KA faith leaders from two large metropolitan areas with a high concentration of KA immigrants were invited to participate in the study (N=102). Participants completed three online assessments: baseline, a 3-month, and a 6-month follow-up. After the baseline assessment, participants were randomized to either intervention (n = 53) or control (n = 49). The intervention consisted of four online simulation modules, each taking approximately 15-20 min to complete. At the 6-month follow-up, faith leaders in the intervention group significantly increased their knowledge and self-efficacy in IPV prevention and intervention compared to the control group. Mean scores for attitudes against IPV and prevention behaviors increased from baseline to the 6-month follow-up for the intervention group more than the control group, but the differences were not statistically significant. "Religious Leaders for Healthy Families" has the potential to reduce disparities in accessing resources and services for immigrant survivors of IPV. With its ease of use, this short, free online intervention has a high potential for uptake among faith leaders. Results are promising, but the COVID-19 pandemic negatively affected the study, with participants having scarce opportunities to practice the skills learned from the intervention. A larger follow-up study that combines "Religious Leaders for Healthy Families" with a community-wide intervention that targets all community members is warranted to reach more faith leaders and community members.

The Effect of an Intimate Partner Violence Against Women Training Program Based on the Theory of Planned Behavior on the Approaches of Nurses and Midwives: A Randomized Controlled Study

The aim of this study was to analyze the effect of intimate partner violence against women training program based on the theory of planned behavior on nurses' and midwives' approaches of violence. A randomized controlled trial was performed at nurses and midwives in Turkey, between December 2016 and August 2017. The participants were separated into an intervention group (n = 50) and control group (n = 49). According to the result of study, training given to the intervention group was more effective in increasing the intimate partner violence attitudes, practices, and reporting compared to the control group. These results show that this training program effectively developed the nurses' and midwives' approaches about intimate partner violence against women.

Dentists’ perceptions and attitudes towards emergency care for women in situations of violence: a scope review

Abstract The purpose of this study was to evaluate, through a scope review, studies that address the perceptions and attitudes of dentists regarding the care of women in situations of violence. Using the descriptors women violence, dentist attendance or dentist care, 473 articles were identified, of which 13 were included at the end of the selection process. Although the need for training was predominant, it was not sufficient. There is a weakness in understanding violence as a health problem, in understanding the role of the professional in solving this problem, and the factors that can contribute to its growth or its control. The results revealed that the dentist had greater difficulty than other professionals in coping with the issue and required extensive training. The recognition of these cases of abuse by the dentist requires the incorporation of educational measures that cause cultural changes, deconstruction of gender norms and the denaturalization of this social phenomenon.

Dentists' perceptions and attitudes towards emergency care for women in situations of violence: a scope review

The purpose of this study was to evaluate, through a scope review, studies that address the perceptions and attitudes of dentists regarding the care of women in situations of violence. Using the descriptors women violence, dentist attendance or dentist care, 473 articles were identified, of which 13 were included at the end of the selection process. Although the need for training was predominant, it was not sufficient. There is a weakness in understanding violence as a health problem, in understanding the role of the professional in solving this problem, and the factors that can contribute to its growth or its control. The results revealed that the dentist had greater difficulty than other professionals in coping with the issue and required extensive training. The recognition of these cases of abuse by the dentist requires the incorporation of educational measures that cause cultural changes, deconstruction of gender norms and the denaturalization of this social phenomenon.

A New Scale of Readiness for Health Care Students to Encounter Partner Abuse

Partner abuse (PA) is associated with significant morbidity and mortality worldwide. Health care practitioners regularly encounter patients experiencing PA and require comprehensive education on how to respond. This study describes the creation and validation of a new measure of readiness to encounter patients experiencing PA for health care practitioners and students.Initial item development and content validation were informed by expert feedback. Psychometric properties were assessed using data collected from Australian health care students, using Principal Components Analysis (PCA) and Confirmatory Factor Analysis (CFA). Internal consistency, inter-scale correlations, and test-retest analysis were performed.An initial pool of 67 items was reduced to 48 following content validation by 5 experts as a measure of construct validity. A total of n = 926 responses were collected, which were randomly split into two groups to perform a PCA and CFA. The PCA resulted in a 31-item version, which was further reduced to a 27-item version following the CFA, containing four factors. Internal consistency and test-retest analyses demonstrated good reliability.The produced scale is a 27-item measure of readiness to encounter patients experiencing PA, which has demonstrated good psychometric properties with a sample of Australian health care students. Results indicate that self-efficacy and Emotional-readiness are a large component of readiness. The scale may be used to measure the readiness of a cohort, or as a pre and post-intervention measure, and results may provide insight into the educational needs of a cohort.

Researching the Impact of Service provider Education (RISE) Project - a multiphase mixed methods protocol to evaluate implementation acceptability and feasibility

BACKGROUND

Health and social service providers receive limited education on recognizing and responding to family violence. With adequate education, providers could be prepared to identify individuals subjected to family violence and help reduce the risk of associated impairment. Informed by the Active Implementation Frameworks, our research will determine the scope of strategies needed for the uptake and sustainability of educational interventions focused on family violence for providers. It will also determine the acceptability, feasibility, and proof-of-concept for a new educational intervention, called VEGA (Violence, Evidence, Guidance, Action), for developing and improving primary care provider knowledge and skills in family violence.

METHODS

This paper details the protocol for the Researching the Impact of Service provider Education (RISE) Project. The RISE Project follows a sequential multiphase mixed method research design; qualitative and quantitative data are being collected and integrated over three conceptually and methodologically linked research phases. Activities primarily occur in Ontario, Alberta, and Quebec. Phase 1 uses a sequential exploratory mixed method research design to characterize the scope and salience of learning and implementation needs and preferences for family violence education. Phase 2 will use an embedded mixed method research design to determine whether VEGA technology supports providers to achieve their family violence learning goals with effectiveness, efficiency, and satisfaction. Phase 3 will use a concurrent mixed method research design to determine acceptability, feasibility, and proof-of-concept for evaluating whether VEGA improves primary care providers' knowledge and skills in family violence. This final phase will provide information on implementation strategies for family violence education in the "real world." It will also generate data on provider recruitment, retention, and data completeness, as well as exploratory estimates of the effect for provider outcome measures proposed for a randomized controlled trial.

DISCUSSION

The RISE Project comprehensively integrates an implementation approach to improve family violence education for the health and social service professions. It will provide important information about factors that could influence the uptake and effectiveness of a health profession's educational intervention into the real world, as well as provide foundational evidence concerning the tenability of using a randomized controlled trial to evaluate the impact of VEGA in primary care settings.

Organization-Based Factors Bearing on Provider Screening and Referral Practices for Women Exposed to Intimate Partner Violence

Essential steps in the provision of health care for women exposed to intimate partner violence (IPV) are screening and referral for specialized services, as might occur in primary care settings. Prior to participating in a cross-disciplinary IPV training program, medical care (N = 223) and social/behavioral practitioners (N = 197) completed a survey that ascertained current practices, provisions, and perceived barriers related to IPV screening and referral. Roughly half of the study participants did not routinely screen their patients/clients for IPV, with no differences for the professional groupings. Utilization of referral resources was significantly lower for medical care providers, 78.5% of whom did not use any. Perceived barriers to screening and referral were examined as practitioner-based and organization-based, and we identified tangible provisions (protocols and practice materials) as a relevant variable. As we conjectured, organization-based barriers were more strongly associated with lower rates of screening and referral than were practitioner-based barriers, regardless of professional grouping. Moreover, tangible provisions, controlling for perceived barriers, significantly added to routine screening and frequency of referral resources usage, particularly for medical care providers. Results are discussed in the context of a systems-level approach to improving IPV services in health care with organizational practice enhancements.

Psychometric properties of the Turkish version of the Readiness to Encounter Partner Abuse Patients Scale

AIM

Partner abuse is a global public health issue with both short- and long-term health effects. Healthcare professionals frequently encounter patients who experience partner abuse and should be knowledgeable about how to respond to these individuals. The aim of this study was to examine the validity and reliability of the Turkish version of The Readiness to Encounter Partner Abuse Patients (READI) Scale.

DESIGN

A descriptive, methodological and cross-sectional design was used.

METHODS

Data were collected with a sociodemographics form and the READI-T Scale between 13 December 2021 and 5 January 2022. The study sample comprised nursing students (n = 323) at or over the age of 18 years and accepting to take part in the study. The linguistic and content validity and confirmatory factor analysis were used to assess the validity of the scale. The reliability of the scale was achieved using Cronbach's alpha, item-total correlations and test-retest.

RESULTS

The READI-T Scale had a content validity index of 0.99 and adequate sensitivity. The factor loadings ranged from 0.63 to 0.84 for the self-efficacy sub-dimension, from 0.82 to 0.91 for the emotional readiness sub-dimension, from 0.47 to 0.81 for the motivational readiness sub-dimension and from 0.28 to 0.64 for the partner abuse knowledge sub-dimension. The CFA showed that the model had a good fit (x² /df = 1.792; GFI = 0.88; CFI = 0.94; RMSEA = 0.050). Cronbach's alpha was found to be 0.92 for the scale.

CONCLUSION

The READI-T Scale is a valid and reliable tool to determine whether Turkish nursing students are knowledgeable enough to encounter partner abuse patients.

IMPACT

This scale can be used to determine the training needs of healthcare professionals on partner abuse and may be useful as a pre-and posttest to determine the effects of partner abuse education programs. Thus, this scale may also assist early identification of persons who have a risk for partner abuse.

The Readiness of Australian Health Care Students to Encounter Patients Experiencing Partner Abuse

Partner abuse is a significant contributor to mortality and morbidity worldwide, and has been identified as a priority health care issue. Most health care students rarely receive education on partner abuse and report not feeling ready to encounter patients experiencing partner abuse. Analysis of the current readiness of health care students and can inform educational needs to address this gap. The READIness to encounter partner abuse patients Scale was delivered to a convenience sample of Australian prequalification health care students. Participant demographics and estimated hours of education were also reported. Mean readiness scores were calculated by discipline. The relationship between hours of education and readiness scores was calculated using linear regression. A total of 926 participants were included in the analysis. Approximately half of the participants (47.5%) reported less than two hours of education. Mean readiness of students was 4.99 out of 7 (SD 0.73, range 4.39-5.95). Linear regression revealed a significant association between hours of education and readiness, r(925) = .497, p < .000. Australian health care students receive little education about partner abuse, and do not report feeling ready to encounter patients experiencing partner abuse. An individual's confidence and belief in their abilities appear to be the key factor influencing overall readiness. Participants indicated a strong belief that responding to partner abuse was part of their professional role, which is a positive change from previous research. Higher hours of education is associated with higher readiness, though which educational methodologies are most impactful remains unclear.

Perceptions of Australian paramedicine students on a novel multi-modal, skills-based intimate partner violence training: A qualitative, exploratory study

BACKGROUND

Intimate partner violence is a global problem with significant adverse sequelae. Healthcare education in this area is limited, and healthcare students and professionals generally lack the confidence to communicate with, and clinically manage patients experiencing intimate partner violence.

OBJECTIVES

This study aimed to examine the perceptions of undergraduate paramedicine students about intimate partner violence and its management, and intimate partner violence education.

DESIGN

A qualitative, exploratory study.

SETTING

An Australian undergraduate paramedicine program.

PARTICIPANTS

Second- and third-year paramedicine students.

METHODS

Second-year paramedicine students were provided with intimate partner violence information in the form of relevant literature, a lecture and an online educational package, and a group clinical scenario session. Third-year students were not offered this information or experience. Both 2nd and 3rd year students then participated in a one-on-one clinical scenario with a standardised patient. The students interviewed the patient regarding health concerns, with appropriate questioning eliciting intimate partner violence disclosure. Subsequently, focus groups examined students' views regarding intimate partner violence management and education. Focus group transcripts were thematically analysed.

RESULTS

Twelve students participated in a standardised patient one-on-one clinical scenario and nine of these students took part in focus groups. Four major themes were identified from the focus groups: i) confidence, ii) uncertainty-what to do now? iii) value of intimate partner violence education, and iv) future of intimate partner violence education. The discourse around lack of confidence appeared to be more pronounced in the students who had not received the intimate partner violence educational package.

CONCLUSION

The inclusion of a multi-modal intimate partner violence education package, including the utilisation of a standardised patient can be useful in improving paramedicine student confidence to interact with and manage patients impacted by intimate partner violence. Students value this education and are supportive of its incorporation in undergraduate paramedicine programs.

IMPACT: Effects of an Online Capacity-Building Intervention for IPV Prevention Professionals

IMPACT, an online, interactive, capacity-building intervention for professionals engaged in direct intimate partner violence (IPV) work, was evaluated for preliminary efficacy. The IMPACT intervention comprised 13 training modules developed using the Rotheram-Borus Common Factors approach to prevention program development. In total, 156 participants from a diverse range of organizational settings across the United States completed baseline assessments and were randomized to the IMPACT intervention or to the control condition. Participants completed a follow-up assessment 3 months after baseline. Compared with control participants, IMPACT participants significantly increased their general IPV-related knowledge and their self-efficacy to utilize best practice IPV prevention strategies; effect sizes for these outcomes were moderate to large, indicating that these results are meaningful for IPV prevention practice. No differences by condition were observed in other outcomes such as scenario-based skills implementation or utilization of IPV-related strategies in participants' work. In addition, analyses showed that these findings were consistent across IPV prevention experience levels. Results suggest that IMPACT is flexible, generalizable, scalable, and a promising tool for disseminating IPV research into practice and helping to prevent IPV.

Nurse-Family Partnership nurses' attitudes and confidence in identifying and responding to intimate partner violence: An explanatory sequential mixed methods evaluation

AIMS

To evaluate the effect of an intimate partner violence intervention education component on nurses' attitudes in addressing intimate partner violence; complementary aims included understanding nurses' perceptions of the education and how it influenced their attitudes and confidence to address intimate partner violence in practice.

DESIGN

An explanatory sequential mixed methods design embedded within a 15-site cluster randomized clinical trial that evaluated an intimate partner violence intervention within the Nurse-Family Partnership programme.

METHODS

Data were collected between February 2011 and September 2016. Quantitative assessment of nurses' attitudes about addressing intimate partner violence was completed by nurses in the intervention (n = 77) and control groups (n = 101) at baseline, 12 months and at study closure using the Public Health Nurses' Responses to Women Who Are Abused Scale. Qualitative data were collected from nurses in the intervention group at two timepoints (n = 14 focus groups) and focused on their perceptions of the education component. Data were analysed using content analysis.

RESULTS

Nurses in the intervention group reported large improvements in their thoughts, feelings and perceived behaviours related to addressing intimate partner violence; a strong effect of the education was found from baseline to 12 months and baseline to study closure timepoints. Nurses reported that the education component was acceptable and increased their confidence to address intimate partner violence.

CONCLUSION

Nurses reported improved attitudes about and confidence in addressing intimate partner violence after receiving the education component. However, these findings need to be considered together with trial results showing no main effects for clients, and a low level of intervention fidelity.

IMPACT

These evaluation findings underscore that improvement in nurses' self-reported educational outcomes about addressing intimate partner violence cannot be assumed to result in adherence to intervention implementation or improvement in client outcomes. These are important considerations for developing nurse education on intimate partner violence.

Training healthcare providers to respond to intimate partner violence against women

BACKGROUND

Intimate partner violence (IPV) includes any violence (physical, sexual or psychological/emotional) by a current or former partner. This review reflects the current understanding of IPV as a profoundly gendered issue, perpetrated most often by men against women. IPV may result in substantial physical and mental health impacts for survivors. Women affected by IPV are more likely to have contact with healthcare providers (HCPs) (e.g. nurses, doctors, midwives), even though women often do not disclose the violence. Training HCPs on IPV, including how to respond to survivors of IPV, is an important intervention to improve HCPs' knowledge, attitudes and practice, and subsequently the care and health outcomes for IPV survivors.

OBJECTIVES

To assess the effectiveness of training programmes that seek to improve HCPs' identification of and response to IPV against women, compared to no intervention, wait-list, placebo or training as usual.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase and seven other databases up to June 2020. We also searched two clinical trials registries and relevant websites. In addition, we contacted primary authors of included studies to ask if they knew of any relevant studies not identified in the search. We evaluated the reference lists of all included studies and systematic reviews for inclusion. We applied no restrictions by search dates or language.

SELECTION CRITERIA

All randomised and quasi-randomised controlled trials comparing IPV training or educational programmes for HCPs compared with no training, wait-list, training as usual, placebo, or a sub-component of the intervention.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures outlined by Cochrane. Two review authors independently assessed studies for eligibility, undertook data extraction and assessed risks of bias. Where possible, we synthesised the effects of IPV training in a meta-analysis. Other analyses were synthesised in a narrative manner. We assessed evidence certainty using the GRADE approach.

MAIN RESULTS

We included 19 trials involving 1662 participants. Three-quarters of all studies were conducted in the USA, with single studies from Australia, Iran, Mexico, Turkey and the Netherlands. Twelve trials compared IPV training versus no training, and seven trials compared the effects of IPV training to training as usual or a sub-component of the intervention in the comparison group, or both. Study participants included 618 medical staff/students, 460 nurses/students, 348 dentists/students, 161 counsellors or psychologists/students, 70 midwives and 5 social workers. Studies were heterogeneous and varied across training content delivered, pedagogy and time to follow-up (immediately post training to 24 months). The risk of bias assessment highlighted unclear reporting across many areas of bias. The GRADE assessment of the studies found that the certainty of the evidence for the primary outcomes was low to very low, with studies often reporting on perceived or self-reported outcomes rather than actual HCPs' practices or outcomes for women. Eleven of the 19 included studies received some form of research grant funding to complete the research. Within 12 months post-intervention, the evidence suggests that compared to no intervention, wait-list or placebo, IPV training: · may improve HCPs' attitudes towards IPV survivors (standardised mean difference (SMD) 0.71, 95% CI 0.39 to 1.03; 8 studies, 641 participants; low-certainty evidence); · may have a large effect on HCPs' self-perceived readiness to respond to IPV survivors, although the evidence was uncertain (SMD 2.44, 95% CI 1.51 to 3.37; 6 studies, 487 participants; very low-certainty evidence); · may have a large effect on HCPs' knowledge of IPV, although the evidence was uncertain (SMD 6.56, 95% CI 2.49 to 10.63; 3 studies, 239 participants; very low-certainty evidence); · may make little to no difference to HCPs' referral practices of women to support agencies, although this is based on only one study (with 49 clinics) assessed to be very low certainty; · has an uncertain effect on HCPs' response behaviours (based on two studies of very low certainty), with one trial (with 27 participants) reporting that trained HCPs were more likely to successfully provide advice on safety planning during their interactions with standardised patients, and the other study (with 49 clinics) reporting no clear impact on safety planning practices; · may improve identification of IPV at six months post-training (RR 4.54, 95% CI 2.5 to 8.09) as in one study (with 54 participants), although three studies (with 48 participants) reported little to no effects of training on identification or documentation of IPV, or both. No studies assessed the impact of training HCPs on the mental health of women survivors of IPV compared to no intervention, wait-list or placebo. When IPV training was compared to training as usual or a sub-component of the intervention, or both, no clear effects were seen on HCPs' attitudes/beliefs, safety planning, and referral to services or mental health outcomes for women. Inconsistent results were seen for HCPs' readiness to respond (improvements in two out of three studies) and HCPs' IPV knowledge (improved in two out of four studies). One study found that IPV training improved HCPs' validation responses. No adverse IPV-related events were reported in any of the studies identified in this review.

AUTHORS' CONCLUSIONS

Overall, IPV training for HCPs may be effective for outcomes that are precursors to behaviour change. There is some, albeit weak evidence that IPV training may improve HCPs' attitudes towards IPV. Training may also improve IPV knowledge and HCPs' self-perceived readiness to respond to those affected by IPV, although we are not certain about this evidence. Although supportive evidence is weak and inconsistent, training may improve HCPs' actual responses, including the use of safety planning, identification and documentation of IPV in women's case histories. The sustained effect of training on these outcomes beyond 12 months is undetermined. Our confidence in these findings is reduced by the substantial level of heterogeneity across studies and the unclear risk of bias around randomisation and blinding of participants, as well as high risk of bias from attrition in many studies. Further research is needed that overcomes these limitations, as well as assesses the impacts of IPV training on HCPs' behavioral outcomes and the well-being of women survivors of IPV.

Which Violence Against Women Educational Strategies Are Effective for Prequalifying Health-Care Students?: A Systematic Review

Gender-based violence (GBV) is a global public health issue which disproportionately affects women. Health-care providers have an important role in recognizing and addressing GBV in practice, yet research suggests that the issue remains underrecognized, with many qualified professionals reporting lack of confidence and a sense of unpreparedness. Prequalifying GBV educational strategies are inconsistent in both quantity and quality worldwide, and to date, there has been no comprehensive review of those programs' effectiveness. This internationally focused literature review aimed to identify best educational practices in GBV for prequalifying health-care students. A systematic search of six databases yielded 17 studies meeting the inclusion criteria, with all studies examining one or more educational intervention. Quality appraisal was undertaken and data were tabulated to capture relevant information. Thematic findings suggest that interactive educational strategies yield better results than didactic approaches. Similarly, interventions with a focus on practical application of learning are generally preferred over strictly theoretical approaches. Courses of longer duration seem to be more effective in instilling attitudinal changes. Lastly, gendered differences were noted in a number of studies, with female students consistently outperforming males. However, more research is needed before conclusions can be drawn about the effectiveness of single- versus mixed-gender audiences. This review makes a useful contribution to the literature of health education, supporting many findings from previous studies and identifying knowledge gaps to be explored in future research. There are implications for both educators and practitioners in creating discernible change for women in their care.

Relationship of knowledge about and attitudes towards violence with recognition of violence against women among health staff in pre-hospital emergency medical services

BACKGROUND

Domestic violence, specifically, violence against women, is prevalent in all segments of society regardless of social class, ethnicity, culture or country. In other words, domestic violence is a global concern.

AIM

The study aims to investigate the relationship between the attitude and knowledge of the health staff in pre-hospital emergency medical services about violence against women and their recognition of such form of violence.

METHODS

This descriptive study was conducted on 1023 paramedics and emergency medicine technicians who work in the pre-hospital emergency health setting and are members of the Paramedic and Pre-hospital Emergency Medicine Association. The Attitudes towards Violence against Women Scale (ATVAWS) and Health Staff's Recognition of Signs of Violence against Women Scale (HPRSVAWS) were used for data collection.

RESULTS

The mean scores for the ATVAWS and HPRSVAWS were 46.68 ± 6.92 and 20.31 ± 3.23, respectively. Of the participants, 48.5% had been subjected to violence, 43.93% had been subjected to violence perpetrated by their mothers, 41.53% had been exposed to physical violence and 4.2% remain exposed to domestic violence. Participants who had been exposed and those who remain exposed to domestic violence produced high scores in ATVAWS, which indicates an improvement in the traditional approach (less opposing view) to violence. High scores in the ATVAWS for (a) those who were exposed to violence in their workplaces, (b) who had never attended to actual or suspected cases of violence against women in their professional life, (c) who had attended to seven or more cases of violence against women, (d) who were less competent in physically examining actual or suspected cases of violence and (e) who had not been trained on violence against women, which indicates an increase in the traditional approach to violence.

CONCLUSION

The study found that health staff in emergency health stations better recognised the signs of violence against women as their attitudes towards violence were less similar to the traditional approach. That is, they mostly held non-violent views. The characteristics, attitudes, perceptions and values of health professionals were considered important factors in addressing violence.

Paramedics as a New Resource for Women Experiencing Intimate Partner Violence

Intimate partner violence (IPV) has a major impact on the health and well-being of women. The need for a coordinated response from health care professions encountering IPV patients is well established, and guidelines for individual health care professions are needed. Paramedics are believed to frequently encounter IPV patients, and this study aims to create a guideline to direct their response based on expert opinion. A clinical guideline for paramedics was created using current evidence and recommendations from health agencies. A panel of family violence researchers and service delivery experts such as physicians, family violence support agencies, and police commented on the guideline via a Policy Delphi Method to obtain consensus agreement. A total of 42 experts provided feedback over three rounds resulting in 100% consensus. Results include clinical indicators to recognize IPV patients in the prehospital environment, a description of how paramedics should discuss IPV with patients, recommended referral agencies and pathways, and appropriate documentation of case findings. This study has created the first comprehensive, consensus-based guideline for paramedics to recognize and refer IPV patients to care and support. The guideline could potentially be modified for use by ambulance services worldwide and can be used as the basis for building the capacity of paramedics to respond to IPV, which may lead to increased referrals to care and support.

Australian nursing and midwifery student beliefs and attitudes about domestic violence: A multi-site, cross-sectional study

Nurses and midwives have a professional responsibility to identify and provide effective care to those experiencing domestic violence. Pre-registration preparation may develop this capability. In order to inform curriculum development, this study explored Australian nursing and midwifery students' attitudes and beliefs about domestic violence. Data were collected between June and October 2017. Descriptive statistics were calculated and comparative analysis performed on independent variables. Thematic analysis was performed on open-ended qualitative responses. Participants included 1076 students from nine Australian universities. The majority were enrolled in nursing programs (88.4%), followed by midwifery (8.6%), and combined nursing/midwifery (2.4%) programs. There was no statistically significant difference in scores by year level across all subscales, suggesting there was no developmental change in beliefs and attitudes toward domestic violence over the course of study. Nursing students held views that were more violence-tolerant than midwifery students. Australian and Chinese-born males were more likely to refute that domestic violence is more common against women. Students had a limited understanding of domestic violence suggesting a critical need to address undergraduate nursing and midwifery curricula.

The psychometric properties of an intimate partner violence education outcome measure

BACKGROUND

The need for increased education on intimate partner violence (IPV) for healthcare practitioners has been well established. Most Australian healthcare practitioners are educated at university, where educational interventions could be delivered to students. Specific IPV outcome measurement instruments demonstrating sound psychometric properties would enable accurate evaluation of educational interventions to ensure effectiveness.

METHODS

The psychometric properties of the Modified Physician REadiness to Manage Intimate partner violence Scale (Modified PREMIS) were measured when delivered to a cohort of Australian paramedic and nursing students, performing principal component analysis, and evaluating dimensionality, internal consistency, and test-retest reliability.

RESULTS

In total, 260 responses were received, participants were primarily paramedicine students (85.0%) with the remainder double degree nursing and paramedicine students (15.0%). Actual and Perceived Knowledge and Perceived Preparation subscales demonstrated variable validity and reliability. Principal component analysis of opinion items revealed a 5-factor solution, with identified subscales demonstrating mostly low internal consistency (Cronbach's alpha between 0.47 and 0.80). Correlations between subscales demonstrated few significant correlations above r = 0.3 which may indicate problems with construct validity. Medium to high test-retest reliability was found for subscales with spearman's rho values between 0.63 and 0.88.

CONCLUSIONS

The scale did not demonstrate robust psychometric properties and some items may not be appropriate for use with Australian healthcare student cohorts. Pending revisions and subsequent psychometric appraisal the instrument should be used with caution; however an updated instrument may contribute as a valuable tool for IPV educational research and this paper provides several findings which may be of use when revising the scale.

Examining the perceived versus the actual knowledge about forensic odontology: A cross-sectional survey among dentists

Dentists should have the basic essential skills and knowledge about forensic odontology, to better collaborate with law enforcement and investigations. The objective of this survey was to assess the perceived and actual knowledge toward forensic odontology among dentists and to question their willingness to attend training courses on this specialty. A cross-sectional survey based on a self-administered questionnaire was conducted in various districts of Saudi Arabia. Four hundred dentists responded to a questionnaire that tested their actual knowledge of forensic odontology based on answering 15 statements using the alternatives correct, incorrect, do not know. The perceived knowledge was registered as strongly agree, agree, neutral, disagree, and strongly disagree, then assigned scores respectively from four to zero. A willingness to attend a training course in the future was recorded by (yes/no). Scores were summated then subjected to descriptive statistics and regression analyses. Responses were received from 360 study participants (89% response rate). The percentage of correct answers, that is, the actual knowledge, was 67.9 (standard deviation [SD] ± 18.4). About two thirds of the responders (n = 251, 69.7%) indicated a willingness to attend a forensic odontology course in the future. Differences in both actual and perceived knowledge were identified on the basis of gender, work experience, education level, attended a course in forensic odontology, and having previously provided a past bite-mark examination. The perceived knowledge on forensic odontology among dentists was moderate to low. The gap between perceived and actual knowledge signifies low self-confidence. Dentists with higher education levels and experience tend to have better knowledge.

Inclusion of intimate partner violence-related content within undergraduate health care professional curriculum: mixed methods study of academics' attitudes and beliefs

BACKGROUND

Undergraduate preparation is important in ensuring health care professionals are prepared to identify and respond to intimate partner violence (IPV). Previous studies confirm this education is highly variable and IPV-related content remains marginalised in undergraduate nursing, midwifery and paramedicine curricula.

AIM

To investigate frontline academics' attitudes and beliefs in relation to the inclusion of IPV-related content in the aforementioned degrees.

DESIGN

A large multi-phase mixed methods Australian case study of Australian undergraduate nursing, midwifery and paramedicine degrees. In this paper, components of the survey and interviews from this study will be reported on.

METHODS

Quantitative comparative analysis of a 51-item on-line survey and qualitative thematic analysis of guided conversational interviews.

RESULTS

Across Australian universities IPV remains poorly embedded in nursing, midwifery and paramedicine programmes. Academics report a range of barriers to such inclusion, including an already overcrowded curriculum, a lack of confident and competent academics to teach this content area and a lack of support for this content inclusion. One factor statistically significant in its association with non-inclusion of IPV-related content was academic attitudes of professional role resistance. Gender was also identified as a significant factor associated with non-inclusion and resistant professional attitudes. Qualitative interviews revealed that only six of the 18 participants identified IPV-related care as within their scope of practice, with professional role resistance a common theme identified.

CONCLUSION

Though professional organisation and policy makers now advocate for the inclusion of IPV-related content in the undergraduate preparation of nurses and midwives, work remains to address gendered and resistant attitudes amongst academics.

Impact of an Intimate Partner Violence Training on Home Visitors’ Perceived Knowledge, Skills, and Abilities to Address Intimate Partner Violence Experienced by Their Clients

Aims. The aims of this study were to (1) evaluate the effects of a statewide intimate partner violence (IPV) training on home visitors’ perceived knowledge, skills, and abilities to address IPV experienced by their clients and (2) examine home visitors’ perceived barriers to addressing IPV during client home visits. Methods. In 2015, five equivalent, daylong IPV trainings were held throughout West Virginia. Attendance was mandatory for all home visitors in the state. Pre- and posttraining surveys were administered to every attendee ( N = 125). The surveys assessed home visitors’ perceived knowledge, skills, and abilities to address IPV experienced by their clients and perceived barriers to addressing IPV during a client home visit. Results. The results showed (1) home visitors’ knowledge, skills, and abilities significantly improved from pre- to posttraining (all p < .05) and (2) the most commonly reported barriers to addressing IPV were “the partner is present for the visit” (86.2%), “worried that asking may risk my relationship with my client” (30.2%), “not sure how to ask questions without seeming too intrusive” (25.9%), and “worried about upsetting the client” (21.6%). Conclusions. Our findings highlight the immediate positive effects of an IPV training on home visitors’ professional capabilities to address IPV experienced by clients and the most prevalent barriers home visitors face when addressing IPV that should be targeted in future health education interventions.

Evaluation of a Standardized Patient Simulation on Undergraduate Nursing Students' Knowledge and Confidence Pertaining to Intimate Partner Violence

INTRODUCTION

Intimate partner violence (IPV) is a serious and preventable public health problem. Nurses are at the front lines of assessing and intervening with patients subjected to IPV. Lack of training and confidence is cited as a major barrier to assessing for IPV.

OBJECTIVE

The purpose of this study was to evaluate a standardized patient (SP) simulation experience depicting a victim of IPV on undergraduate nursing student knowledge and confidence in assessment and intervention of IPV.

METHODS

The Physician Readiness to Manage Intimate Partner Violence Survey tool was adapted to measure confidence, and a 10-item multiple-choice test was developed to measure knowledge, completed pretest, postlecture, and post-SP simulation.

RESULTS

There was a statistically significant increase in confidence from pretest to postlecture, 14.04 (SD = 3.01) to 20.61 (SD = 2.39), F(1, 56) = 345, p < 0.001, to postsimulation, 14.04-21.93 (SD = 2.18), F(1, 56) = 21.1, p < 0.001. Only statistically significant increases in knowledge occurred from pretest to postlecture, 6.96 (SD = 1.36) to 7.95 (SD = 1.47), F(1,56) = 29.84, p < 0.001. Increase in knowledge from postlecture to postsimulation was not found to be statistically significant, 7.95 (SD = 1.47) to 8.05 (SD = 1.27), F(1,56) = 0.632, p > 0.10.

CONCLUSION

Healthcare professionals need to be adequately educated and trained to screen for IPV. This study provides preliminary evidence that the addition of an SP simulation appears to enhance nursing student confidence and knowledge of assessing and intervening with victims of IPV.

Forced sexual intercourse and its association with HIV status among people attending HIV Voluntary Counseling and Testing in a healthcare center in Kinshasa (DRC)

INTRODUCTION

Sexual violence, an HIV determinant, is an integrated behavior in the D.R.Congo. We aimed to analyze the prevalence of forced sexual intercourse (FSI) among people receiving HIV Voluntary Counseling and Testing in a hospital in Kinshasa, and its association with socio-demographics, behaviors and HIV status.

METHODOLOGY

Case-control study (2010-2012). Two-hundred and seventy-four cases with a new HIV+ test and 1,340 controls with an HIV- test were interviewed about HIV-related knowledge, attitudes and behaviors, including FSI.

RESULTS

Thirty-four percent of the participants declared having had FSI (38% of women and 32% of men). Being a woman, aged 25-49 and reporting multiple sexual partners were associated with reporting FSI. For men, being single was protective against FSI; and cohabiting, having a high socioeconomic status, and alcohol consumption increased the odds. For women, being single, divorced/separated and widow was associated with reporting FSI. A significant positive association was found between FSI and an HIV positive test.

CONCLUSION

Among our Congolese population, FSI was strongly associated with HIV infection and it was also associated with alcohol consumption and multiple sexual partnerships, other key HIV determinants. These behaviors need to be identified as potential risk factors of FSI during counseling interventions. Researchers, practitioners and decision-makers should work together to get violence prevention integrated into health, social and educational policies.

[Legal medicine specialists within the framework of acute care : Analysis of legal medicine consultations in relation to the victims' statistics of the state office of criminal investigation in Saxony-Anhalt]

BACKGROUND

In acute medical care, there are patients who have been injured by the influence of others. The aim of this study was to analyze all cases which were presented to the Institute for Legal Medicine of the University Halle (Saale). The cases where analyzed in relation to the victims' statistics of the state office of criminal investigation in Saxony-Anhalt.

MATERIALS AND METHODS

The consultations of the Institute for Legal Medicine Halle-Wittenberg for 2012-2015 were evaluated with regard to the age and gender distribution, the reasons for the consultation and time until the request for consultations. These cases were statistically compared to the victims' statistics of the state office of criminal investigation in Saxony-Anhalt 2014-2015.

RESULTS

A total of 536 cases (55.6% male and 44.4% female patients) were evaluated. In all, 62.1% of patients were under 18 years of age; 43.5% of all consultations were requested by pediatric (surgery) clinics. The most common reasons for consultation were sexual child abuse or violence against children (50.7%). Compared to the victims' statistics, significantly more children were examined by legal medicine specialists than could have been expected (p < 0.001). In adult patients, the most common causes for consultation were acts of violence (20.4%) and domestic violence (10.1%). Among adults, significantly more women and fewer men were presented than expected (p = 0.001).

CONCLUSION

There were only a small number of consultations of legal medicine specialists in relation to the victims' statistics. Most of them were children and women. The temporal latency between the act of violence and the consultations was one day and more. The latency and the renunciation of the consultation of the legal medicine specialists can lead to loss of evidence.