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Jarnecke AM, Saraiya TC. Identifying best practices for substance-related intimate partner violence screening and referral: a narrative review. Front Psychiatry 2024; 15:1380102. [PMID: 38957738 PMCID: PMC11217329 DOI: 10.3389/fpsyt.2024.1380102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/29/2024] [Indexed: 07/04/2024] Open
Abstract
Introduction Substance use is strongly associated with intimate partner violence (IPV) and is a modifiable risk factor for IPV. However, lack of comprehensive screening and referral for co-occurring IPV and substance use, along with their psychiatric sequalae, limits the identification and implementation of effective interventions for substance-related IPV. This narrative review (1) investigates the literature on screening and referral practices for IPV, and if these include screening for substance use or other psychiatric comorbidities, (2) provides recommendations for current best practices, and (3) suggests future directions for research and practice aimed at identifying and reducing substance-related IPV. Methods A narrative literature review examined studies investigating IPV screening and referral programs in clinics. Selected studies were reviewed for: (1) effectiveness, (2) barriers to implementation and sustainability, and (3) responsivity to psychiatric comorbidity, including substance use and substance use disorders (SUD). Results Findings suggest that effective IPV screening and referral programs have been developed, but disparities in IPV screening exist and many programs only screen for IPV victimization. Barriers to the implementation and sustainability of IPV screening programs include lack of ongoing provider training, funding or institutional support, and direct connection to referral services. Further, many IPV screening programs lack assessment of and referral for comorbid psychiatric conditions, including substance use, and tend not to be routinely implemented in SUD clinics. Discussion Additional systematic work is needed to develop universal and comprehensive screening and referral programs for substance-related IPV and address issues of long-term sustainability, particularly within SUD treatment settings.
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Affiliation(s)
- Amber M. Jarnecke
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Tanya C. Saraiya
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
- Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick, Piscataway, NJ, United States
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Evans DP, Pawcio J, Wyckoff K, Wilkers L. "And then the person sort of just drops off the radar…": barriers in the transition from hospital to community-based care among survivors of intimate partner violence in Metropolitan Atlanta. Front Public Health 2024; 12:1332779. [PMID: 38841664 PMCID: PMC11150547 DOI: 10.3389/fpubh.2024.1332779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/22/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Hospitals and community-based organizations (CBOs) provide the service-base for survivors of intimate partner violence (IPV), particularly those in acute crisis. Both settings face discrete challenges in meeting survivors' needs. In hospitals these challenges include the pressures of a fast-paced work setting, and a lack of trauma-informed and survivor-centered care. Connections to community care are often unmeasured, with relatively little known about best practices. Often IPV survivors who receive hospital care fail to connect with community-based services after discharge. Despite the critical role of CBOs in supporting IPV survivors, there is limited research examining the perspectives and insights of CBO staff on the challenges and opportunities for improving care coordination with hospitals. The purpose of this study was to address this knowledge gap by characterizing CBO staff perceptions of IPV care coordination between hospital and community-based organizations in Metropolitan Atlanta. Methods We used a qualitative study design to conduct a cross-sectional examination of the perceptions and experiences of staff working at CBOs serving IPV survivors in Metropolitan Atlanta, Georgia. The adapted in-depth interview (IDI) guide was used to explore: (1) IPV survivor experiences; (2) Survivors' needs when transitioning from hospital to community-based care; (3) Barriers and facilitators to IPV care coordination; and (4) Ideas on how to improve care coordination. Data analysis consisted of a thematic analysis using MAXQDA Analytics Pro 2022. Results Participants (N = 14) included 13 women and one man who were staff of CBOs serving IPV survivors in Metropolitan Atlanta. CBO staff perceived that: (1) IPV survivors face individual-, organizational-, and systems-level barriers during help seeking and service provision; (2) Care coordination between hospitals and CBOs is limited due to siloed care provision; and (3) Care coordination can be improved through increased bidirectional efforts. Conclusion Our findings highlight the multi-level barriers IPV survivors face in accessing community-based care following medical care, the limitations of existing hospital-CBO coordination, and opportunities for improvement from the perspectives of CBO staff. Participants identified silos and inconsistent communication/relationships between hospital and CBOs as major barriers to care connections. They also suggested warm handoffs and a Family Justice Center to support care connection.
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Affiliation(s)
- Dabney P. Evans
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States
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Kennedy AC, Prock KA, Adams AE, Littwin A, Meier E, Saba J, Vollinger L. Can This Provider Be Trusted? A Review of the Role of Trustworthiness in the Provision of Community-Based Services for Intimate Partner Violence Survivors. TRAUMA, VIOLENCE & ABUSE 2024; 25:982-999. [PMID: 37132638 DOI: 10.1177/15248380231168641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
While there is a growing literature on intimate partner violence (IPV) survivors and service providers, it is limited by its largely atheoretical and descriptive nature, and its emphasis on individual-level survivors' help-seeking. We seek to broaden our understanding by shifting the focus onto organizations and service systems and introducing the concept of these providers' trustworthiness toward survivors. Provider trustworthiness in delivering services includes benevolence (locally available and caring), fairness (accessible to all and non-discriminatory), and competence (acceptable and effective in meeting survivors' needs). Guided by this conceptualization, we conducted an integrative review drawing on four databases: PsycINFO, PubMed, Web of Science, and Westlaw. We identified studies for inclusion that were published between January 2005 and March 2022, and we examined the trustworthiness of community-based providers serving adult IPV survivors in the United States, including domestic violence services, health and mental health care, the legal system, and economic support services (N = 114). Major findings include (1) many survivors live in communities with no shelter beds, mental health care, or affordable housing; (2) many services are inaccessible because they lack, for example, bilingual staff, sliding fees, or telehealth options; (3) too many providers are harmful or discriminatory toward survivors, especially those who are, for example, sexual or gender minorities, immigrants or non-English-speaking, poor, or Native, Black, or Latinx; (4) many providers appear to be incompetent, lack evidence-based training, and are ineffective in meeting survivors' needs. We call on researchers, advocates, and providers to examine provider trustworthiness, and we offer an introduction to measuring it.
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Decker H, Schwab M, Shao S, Kaki D, Melhado C, Cuschieri J, Bongiovanni T. Screening for Intimate Partner Violence in Trauma: Results of a Quality Improvement Project. J Surg Res 2024; 295:376-384. [PMID: 38064979 DOI: 10.1016/j.jss.2023.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Intimate partner violence (IPV) is common, especially among patients presenting with traumatic injury. We implemented an IPV screening program for patients admitted after trauma. We sought to determine whether specific demographic or clinical characteristics were associated with being screened or not screened for IPV and with IPV screen results. METHODS Retrospective cohort study evaluating all patients admitted after trauma from July 2020-July 2022 in an Adult Level 1 Trauma Center. RESULTS There were 4147 admissions following traumatic injury, of which 70% were men and 30% were women. The cohort was 46% White, 20% Asian, 15% Black, and 17% other races. Twenty-three percent were Hispanic or Latino/a. Seventy-seven percent were admitted for blunt injuries and 16% for penetrating injuries. Thirteen percent (n = 559) of the cohort was successfully screened for IPV. Screening rates did not differ by gender, race, or ethnicity. After adjustment for demographic and clinical factors, patients admitted to the intensive care unit were significantly less likely to be screened. Of the screened patients, 30% (165) screened positive. These patients were more commonly Hispanic or Latino/a, insured by Medicaid and presented with a penetrating injury. There were no differences in injury severity in patients who screened positive versus those who screened negative. CONCLUSIONS There are significant barriers to universal screening for IPV, including injury acuity, in patients admitted following trauma. However, the 30% rate of positive screens for IPV in patients admitted following trauma highlights the urgent need to understand and address barriers to screening in trauma settings to enable universal screening.
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Affiliation(s)
- Hannah Decker
- Department of Surgery, University of California at San Francisco, San Francisco, California.
| | - Marisa Schwab
- Department of Surgery, University of California at San Francisco, San Francisco, California
| | - Shirley Shao
- Department of Surgery, University of California at San Francisco, San Francisco, California
| | - Dahlia Kaki
- Department of Surgery, University of California at San Francisco, San Francisco, California
| | - Caroline Melhado
- Department of Surgery, University of California at San Francisco, San Francisco, California
| | - Joseph Cuschieri
- Department of Surgery, University of California at San Francisco, San Francisco, California
| | - Tasce Bongiovanni
- Department of Surgery, University of California at San Francisco, San Francisco, California
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Thomas D, Nalumansi A, Reichman M, Metitiri M, Kamusiime B, Kasiita V, Nalukwago GK, Kibuuka J, Nakabugo L, Nambi F, Muwonge T, Simoni J, Montgomery ET, Ware N, Wyatt MA, Mujugira A, Heffron R. "Gender-based Violence (GBV) and HIV, they are like sister and brother": barriers and facilitators to GBV screening and referral in public HIV treatment settings in Uganda. BMC Health Serv Res 2023; 23:1383. [PMID: 38082407 PMCID: PMC10712148 DOI: 10.1186/s12913-023-10400-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND People living with HIV are vulnerable to gender-based violence (GBV), which can negatively impact HIV treatment outcomes. National guidelines in Uganda recommend GBV screening alongside HIV treatment services. We explored barriers and facilitators to providers implementing GBV screening and referral in public antiretroviral therapy (ART) clinics in Uganda. METHODS We conducted qualitative in-depth interviews. Providers were purposively sampled from 12 ART clinics to represent variation in clinical specialty and gender. We used the Theoretical Domains Framework to structure our deductive analysis. RESULTS We conducted 30 in-depth interviews with providers implementing GBV screening and/or referral. Respondents had a median age of 36 (IQR: 30, 43) years and had been offering post-GBV care to clients for a median duration of 5 (4, 7) years. 67% of respondents identified as female and 57% were counselors. Facilitators of GBV screening and referral included providers having access to post-GBV standard operating procedures and screening tools, trainings offered by the Ministry of Health, facility-sponsored continuing medical education units and support from colleagues. Respondents indicated that referrals were uncommon, citing the following barriers: negative expectations regarding the quality and quantity of referral services; lack of financial resources to support clients, facilities, and referral partners throughout the referral process; and sociocultural factors that threatened client willingness to pursue post-GBV support services. CONCLUSIONS Findings from this evaluation support the refinement of GBV screening and referral implementation strategies that leverage facilitators and address barriers to better support individuals living with HIV and who may have heightened vulnerability to GBV.
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Affiliation(s)
- Dorothy Thomas
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Mira Reichman
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Mine Metitiri
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Brenda Kamusiime
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Vicent Kasiita
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Joseph Kibuuka
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Florence Nambi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Timothy Muwonge
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Jane Simoni
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Elizabeth T Montgomery
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA
- Department of Epidemiology and Biostatistics, UCSF: University of California, San Francisco, San Francisco, CA, USA
| | - Norma Ware
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Monique A Wyatt
- Harvard Medical School, Boston, MA, USA
- Harvard Global, Cambridge, MA, USA
| | - Andrew Mujugira
- Department of Global Health, University of Washington, Seattle, WA, USA
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, WA, USA.
- Department of Medicine, University of Alabama at Birmingham, 845 19th Street South, Birmingham, AL, 35294-2170, USA.
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Stanford KA, Macias-Konstantopoulos W, Linden J, Agrawal P, Cortes E, Barron RJ, Stoklosa H, Dekker AM, Paxton J, Knack S, Sharp WW. SAEM Response to the National Institutes of Health request for information: Future directions in violence against women research. Acad Emerg Med 2023; 30:1161-1167. [PMID: 37423251 DOI: 10.1111/acem.14775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Affiliation(s)
- Kimberly A Stanford
- Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | | | - Judith Linden
- Department of Emergency Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale University, New Haven, Connecticut, USA
| | - Emma Cortes
- Department of Emergency Medicine, Jefferson Health Northeast, Philadelphia, Pennsylvania, USA
| | - Rebecca J Barron
- Department of Emergency Medicine, UMass Chan Medical School-Baystate, Springfield, Massachusetts, USA
| | - Hanni Stoklosa
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- HEAL Trafficking, Long Beach, California, USA
| | - Annette M Dekker
- Department of Emergency Medicine, UCLA, Los Angeles, California, USA
| | - James Paxton
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
| | - Sarah Knack
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Willard W Sharp
- Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA
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Das KJH, Peitzmeier S, Berrahou IK, Potter J. Intimate Partner Violence (IPV) Screening and Referral Outcomes among Transgender Patients in a Primary Care Setting. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP11720-NP11742. [PMID: 33629628 DOI: 10.1177/0886260521997460] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Transgender patients are at elevated risk of intimate partner violence (IPV), but national guidelines do not recommend routine screening for this population. This paper explores the feasibility and effectiveness of routine IPV screening of transgender patients in a primary care setting by describing an existing screening program and identifying factors associated with referral and engagement in IPV-related care for transgender patients. An IPV "referral cascade" was created for 1,947 transgender primary care patients at an urban community health center who were screened for IPV between January 1, 2014 to May 31, 2016: (a) Of those screening positive, how many were referred? (b) Of those referred, how many engaged in IPV-specific care within 3 months? Logistic regression identified demographic correlates of referral and engagement. Of the 1,947 transgender patients screened for IPV, 227 screened positive. 110/227 (48.5%) were referred to either internal or external IPV-related services. Of those referred to on-site services, 65/103 (63.1%) had an IPV-related appointment within 3 months of a positive screen. IPV referral was associated with being assigned male at birth (AMAB) versus assigned female at birth (AFAB) (AOR = 2.69, 95% CI 1.52, 4.75) and with nonbinary, rather than binary, gender identity (AOR = 2.07, 95%CI 1.09, 3.73). Engagement in IPV-related services was not associated with any measured demographic characteristics. Similar to published rates for cisgender women, half of transgender patients with positive IPV screens received referrals and two-thirds of those referred engaged in IPV-specific care. These findings support routine IPV screening and referral for transgender patients in primary care settings. Provider training should focus on how to ensure referrals are made for all transgender patients who screen positive for IPV, regardless of gender identity, to ensure the benefits of screening accrue equally for all patients.
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Paphitis SA, Bentley A, Asher L, Osrin D, Oram S. Improving the mental health of women intimate partner violence survivors: Findings from a realist review of psychosocial interventions. PLoS One 2022; 17:e0264845. [PMID: 35299229 PMCID: PMC8929660 DOI: 10.1371/journal.pone.0264845] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/17/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is highly prevalent and is associated with a range of mental health problems. A broad range of psychosocial interventions have been developed to support the recovery of women survivors of IPV, but their mechanisms of action remain unclear. METHODS Realist review following a prospectively published protocol in PROSPERO (CRD42018114207) and reported using the Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMSES) guidelines. RESULTS Evidence was extracted from 60 reviews and triangulated in expert consultations. Mechanisms of action were categorised as either associated with intervention design and delivery or with specific intervention components (access to resources and services; safety, control and support; increased knowledge; alterations to affective states and cognitions; improved self-management; improved family and social relations). CONCLUSIONS Findings suggest that psychosocial interventions to improve the mental health of women survivors of IPV have the greatest impact when they take a holistic view of the problem and provide individualised and trauma-informed support.
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Affiliation(s)
- Sharli Anne Paphitis
- Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
- * E-mail:
| | - Abigail Bentley
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura Asher
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - David Osrin
- Institute for Global Health, University College London, London, United Kingdom
| | - Sian Oram
- Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
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Brignone L, Gomez AM. Access to domestic violence advocacy by race, ethnicity and gender: The impact of a digital warm handoff from the emergency department. PLoS One 2022; 17:e0264814. [PMID: 35302999 PMCID: PMC8932576 DOI: 10.1371/journal.pone.0264814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/17/2022] [Indexed: 11/19/2022] Open
Abstract
Background Racial/ethnic minority survivors of domestic violence (DV) referred from emergency departments (EDs) face barriers connecting with advocacy services due to systemic inequities. This study assesses the impact of Domestic Violence Report and Referral (DVRR), a digital mandatory reporting compliance system with integrated direct-to-advocacy referrals sent with patient consent, on survivors’ likelihood of receiving advocacy by race/ethnicity and gender. Methods We assessed ED charts between 2014–2018 in an urban, Level 1 trauma center for DV-related positive screening, chief concern, or documentation in medical/social work notes. We matched these visits by name to local DV advocacy agency records. Using logistic regression, we assessed survivor odds of reaching advocacy by DVRR receipt, race/ethnicity and gender. We used predicted probabilities to identify between-group differences in advocacy services received. Results Of the 1366 visits, 740 received the DVRR intervention; 323 received advocacy services Without DVRR, compared to white, female survivors (n = 87), male survivors (n = 132) had 0.20 (95% CI: 0.07–0.56) times the odds of reaching advocacy compared to female survivors; Latinx survivors (n = 136) had 2.53 (95% CI: 1.58–4.07) times the odds of reaching advocacy compared to white survivors. With DVRR, the odds and predicted probabilities of reaching advocacy increased significantly for all survivors. White, female survivors (n = 74) who received DVRR experienced 2.60 (95% CI: 1.66–4.07) times the odds of connecting with advocacy. Compared to this reference group, Black survivors (n = 480) who received DVRR experienced 4.66 additional times the odds of reaching advocacy services (95% CI: 3.09–7.04) and male survivors (n = 84) experienced 8.96 additional times the odds (95% CI: 2.81–28.56). Overall, we predict 43% (95% CI: 38–53%) of Latinx survivors (n = 177), 36% (95% CI: 31–40%) of Black survivors (n = 480) and 23% (95% CI: 14–32%) of white survivors (n = 83); 37% (95% CI: 33–40%) of women (n = 656) and 29% (95% CI: 18–42%) of men (n = 84) received advocacy services with DVRR. Conclusion Direct-to-advocacy ED referrals facilitated by eHealth technology improve access to advocacy care for all survivors in this sample; marginalized racial and ethnic groups most often victimized by DV appear to have the highest rates of connection to advocacy.
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Affiliation(s)
- Laura Brignone
- Sexual Health and Reproductive Equity Program (SHARE), University of California, Berkeley, Berkeley, California, United States of America
- * E-mail:
| | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program (SHARE), University of California, Berkeley, Berkeley, California, United States of America
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Hoops K, Fahimi J, Khoeur L, Studenmund C, Barber C, Barnhorst A, Betz ME, Crifasi CK, Davis JA, Dewispelaere W, Fisher L, Howard PK, Ketterer A, Marcolini E, Nestadt PS, Rozel J, Simonetti JA, Spitzer S, Victoroff M, Williams BH, Howley L, Ranney ML. Consensus-Driven Priorities for Firearm Injury Education Among Medical Professionals. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:93-104. [PMID: 34232149 DOI: 10.1097/acm.0000000000004226] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
PURPOSE Firearm injury is a leading cause of morbidity and mortality in the United States. However, many medical professionals currently receive minimal or no education on firearm injury or its prevention. The authors sought to convene a diverse group of national experts in firearm injury epidemiology, injury prevention, and medical education to develop consensus on priorities to inform the creation of learning objectives and curricula for firearm injury education for medical professionals. METHOD In 2019, the authors convened an advisory group that was geographically, demographically, and professionally diverse, composed of 33 clinicians, researchers, and educators from across the United States. They used the nominal group technique to achieve consensus on priorities for health professions education on firearm injury. The process involved an initial idea-generating phase, followed by a round-robin sharing of ideas and further idea generation, facilitated discussion and clarification, and the ranking of ideas to generate a prioritized list. RESULTS This report provides the first national consensus guidelines on firearm injury education for medical professionals. These priorities include a set of crosscutting, basic, and advanced learning objectives applicable to all contexts of firearm injury and all medical disciplines, specialties, and levels of training. They focus on 7 contextual categories that had previously been identified in the literature: 1 category of general priorities applicable to all contexts and 6 categories of specific contexts, including intimate partner violence, mass violence, officer-involved shootings, peer (nonpartner) violence, suicide, and unintentional injury. CONCLUSIONS Robust, data- and consensus-driven priorities for health professions education on firearm injury create a pathway to clinician competence and self-efficacy. With an improved foundation for curriculum development and educational program-building, clinicians will be better informed to engage in a host of firearm injury prevention initiatives both at the bedside and in their communities.
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Affiliation(s)
- Katherine Hoops
- K. Hoops is assistant professor, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jahan Fahimi
- J. Fahimi is associate professor, Department of Emergency Medicine, University of California, San Francisco School of Medicine and Institute for Health Policy Studies, San Francisco, California
| | - Lina Khoeur
- L. Khoeur is a third-year medical student, University of California, San Francisco School of Medicine, San Francisco, California
| | - Christine Studenmund
- C. Studenmund is a third-year medical student, University of California, San Francisco School of Medicine, San Francisco, California
| | - Catherine Barber
- C. Barber is senior researcher, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Amy Barnhorst
- A. Barnhorst is associate professor, Department of Psychiatry and Behavioral Sciences and Department of Emergency Medicine, University of California, Davis School of Medicine, Davis, California
| | - Marian E Betz
- M.E. Betz is associate professor, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Cassandra K Crifasi
- C.K. Crifasi is assistant professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John A Davis
- J.A. Davis is professor and associate dean for curriculum, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - William Dewispelaere
- W. Dewispelaere is a resident, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Lynn Fisher
- L. Fisher is assistant professor, Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita, Kansas
| | - Patricia K Howard
- P.K. Howard is adjunct assistant professor, University of Kentucky, Lexington, Kentucky
| | - Andrew Ketterer
- A. Ketterer is clinical instructor, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Evie Marcolini
- E. Marcolini is assistant professor, Department of Emergency Medicine and Department of Neurology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Paul S Nestadt
- P.S. Nestadt is assistant professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John Rozel
- J. Rozel is associate professor, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joseph A Simonetti
- J.A. Simonetti is assistant professor, Department of Medicine, University of Colorado School of Medicine, and Veterans Health Administration, Aurora, Colorado
| | - Sarabeth Spitzer
- S. Spitzer is a resident, Department of Surgery, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael Victoroff
- M. Victoroff is clinical professor, Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian H Williams
- B.H. Williams is associate professor, Department of Surgery, University of Chicago Pritzker School of Medicine and Biological Sciences, Chicago, Illinois
| | - Lisa Howley
- L. Howley is senior director of strategic initiatives and partnerships, Association of American Medical Colleges, Washington, DC
| | - Megan L Ranney
- M.L. Ranney is associate professor, Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Johnson KF, Brookover DL, Bradbrook K. Social health needs and promotive health factors scale for college students: Scale development and initial validation. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:74-83. [PMID: 32101095 DOI: 10.1080/07448481.2020.1725021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/26/2019] [Accepted: 01/26/2020] [Indexed: 06/10/2023]
Abstract
Objective The psychometric properties of a measure of social determinants of health for college students entitled, The LIFESCREEN-C was developed. Participants: A sample of 226 college students completing an online survey during the 2018-2019 academic year. Methods: Tetrachoric correlations were used to confirm a three factor model. Results: Results found model fit; convergent validity with a measure of general health; and adequate internal reliability. Conclusions: The three model fit included: general social health needs, college student social health needs, and promotive social health factors. Implications for health professionals in college settings concludes.
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Affiliation(s)
- Kaprea F Johnson
- Department of Special Education, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dana L Brookover
- Department of Counseling and Special Education, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Keighly Bradbrook
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA
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Callander EJ, Bull C, Baird K, Branjerdporn G, Gillespie K, Creedy D. Cost of intimate partner violence during pregnancy and postpartum to health services: a data linkage study in Queensland, Australia. Arch Womens Ment Health 2021; 24:773-779. [PMID: 33856553 DOI: 10.1007/s00737-021-01130-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/03/2021] [Indexed: 11/27/2022]
Abstract
To quantify health service costs of intimate partner violence (IPV) during pregnancy and postpartum; and to compare health service costs between women who reported IPV, versus women who did not report IPV. This was a cohort study using linked data for a publicly funded Australian tertiary hospital maternity service. Participants included all women accessing antenatal services between August 2016 and August 2018. Routinely collected IPV data were linked to women's admitted, non-admitted, emergency department, perinatal, and costing data from 6 months prior to reporting IPV through to 12 months post-birth. Of the 9889 women receiving maternity care, 280 (2.9%) reported some form of IPV with 72 (24.8%) referred to support. Women who reported IPV generated higher mean total costs than women not reporting IPV ($12,772 vs $10,166, respectively). Between-group differences were significant after adjusting for demographic and clinical factors (cost ratio 1.24, 95% CI: 1.15-1.34). There were no significant differences in mean total costs for babies where IPV was and was not reported ($4971 vs $5340, respectively). IPV is costly for health services. However, greater research is needed to comprehensively estimate the long-term health service costs associated with IPV. Furthermore, the limitations associated with routinely collected IPV data suggest that standardised screening practices and innovative data linkage and modelling approaches are required to collect data that truly represents the burden and costs associated with IPV.
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Affiliation(s)
- Emily J Callander
- Transforming Maternity Care Collaborative, Griffith University, Southport, 4215, QLD, Australia. .,School of Nursing and Midwifery, Griffith University, Southport, 4215, QLD, Australia. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, 3181, VIC, Australia.
| | - Claudia Bull
- School of Nursing and Midwifery, Griffith University, Southport, 4215, QLD, Australia
| | - Kathleen Baird
- Transforming Maternity Care Collaborative, Griffith University, Southport, 4215, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Southport, 4215, QLD, Australia.,School of Nursing and Midwifery, University of Technology Sydney, Ultimo, 2007, NSW, Australia
| | | | - Kerri Gillespie
- Gold Coast Hospital and Health Service, Southport, 4215, QLD, Australia
| | - Debra Creedy
- Transforming Maternity Care Collaborative, Griffith University, Southport, 4215, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Southport, 4215, QLD, Australia
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13
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Burnett C, Crowder J, Bacchus LJ, Schminkey D, Bullock L, Sharps P, Campbell J. "It Doesn't Freak Us Out the Way It Used to": An Evaluation of the Domestic Violence Enhanced Home Visitation Program to Inform Practice and Policy Screening for IPV. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP7488-NP7515. [PMID: 30741071 DOI: 10.1177/0886260519827161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Domestic Violence Enhanced Home Visitation (DOVE) intervention used in the Perinatal Nurse Home Visiting Intervention Enhanced With mHealth Technology (RCT: R01HD071771) is a nurse-lead evidenced-based intervention that has been shown to decrease violence overtime. This summative mixed-methods impact evaluation is intended to provide insight to enhance the DOVE IPV protocol for screening and intervention by (a) identifying which core aspects of DOVE facilitated or inhibited its success and what was most critical to optimal IPV (intimate partner violence) screening and intervention practices, (b) informing how DOVE IPV screening and intervention were influenced by the experiences of home visitor (HV), and (c) identifying policy considerations and best practice recommendations for the DOVE protocol. Participants were HVs and managers (N = 13) in rural/urban home visiting programs delivering DOVE across three states. The sample had a mean age of 48.76. Three fourths were baccalaureate-prepared nurses with an average of 10.5 years of home visiting experience. The method used in this study was one-to-one qualitative in-depth interviews with HVs. Data were interpretively analyzed using Nvivo 10 to generate three themes. Participants endorsed screening women for IPV with DOVE being the approach of choice to facilitate IPV screening and intervening with women. HVs found DOVE helped enhance their IPV knowledge, screening, and intervening capabilities while filling an existing void in this type of preparation of HV nurses. Establishing a relationship with the women before initiating screening was an important aspect in delivering DOVE as was the training, support, and increased comfort level in addressing IPV. The evidence offers an understanding of which core aspects of DOVE contributed to its success and what was most critical to optimal IPV screening and intervention practices. Furthermore, this evaluation provided multilevel insights into how best to advance home visiting practices and policies when screening and intervening with perinatal women exposed to IPV.
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Cunningham KB, Rogowsky RH, Carstairs SA, Sullivan F, Ozakinci G. Methods of connecting primary care patients with community-based physical activity opportunities: A realist scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1169-1199. [PMID: 33075180 DOI: 10.1111/hsc.13186] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
Deemed a global public health problem by the World Health Organization, physical inactivity is estimated to be responsible for one in six deaths in the United Kingdom (UK) and to cost the nation's economy £7.4 billion per year. A response to the problem receiving increasing attention is connecting primary care patients with community-based physical activity opportunities. We aimed to explore what is known about the effectiveness of different methods of connecting primary care patients with community-based physical activity opportunities in the United Kingdom by answering three research questions: 1) What methods of connection from primary care to community-based physical activity opportunities have been evaluated?; 2) What processes of physical activity promotion incorporating such methods of connection are (or are not) effective or acceptable, for whom, to what extent and under what circumstances; 3) How and why are (or are not) those processes effective or acceptable? We conducted a realist scoping review in which we searched Cochrane, Medline, PsycNET, Google Advanced Search, National Health Service (NHS) Evidence and NHS Health Scotland from inception until August 2020. We identified that five methods of connection from primary care to community-based physical activity opportunities had been evaluated. These were embedded in 15 processes of physical activity promotion, involving patient identification and behaviour change strategy delivery, as well as connection. In the contexts in which they were implemented, four of those processes had strong positive findings, three had moderately positive findings and eight had negative findings. The underlying theories of change were highly supported for three processes, supported to an extent for four and refuted for eight processes. Comparisons of the processes and their theories of change revealed several indications helpful for future development of effective processes. Our review also highlighted the limited evidence base in the area and the resulting need for well-designed theory-based evaluations.
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Affiliation(s)
- Kathryn B Cunningham
- Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Rayna H Rogowsky
- Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Sharon A Carstairs
- Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Frank Sullivan
- Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Gozde Ozakinci
- Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, Fife, UK
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15
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Colombini M, Scorgie F, Stangl A, Harvey S, Ramskin L, Khoza N, Mashauri E, Baron D, Lees S, Kapiga S, Watts C, Delany-Moretlwe S. Exploring the feasibility and acceptability of integrating screening for gender-based violence into HIV counselling and testing for adolescent girls and young women in Tanzania and South Africa. BMC Public Health 2021; 21:433. [PMID: 33658000 PMCID: PMC7927237 DOI: 10.1186/s12889-021-10454-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 02/17/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Gender-based violence (GBV) undermines HIV prevention and treatment cascades, particularly among women who report partner violence. Screening for violence during HIV testing, and prior to offering pre-exposure prophylaxis (PrEP) to HIV uninfected women, provides an opportunity to identify those at heightened HIV risk and greater potential for non-adherence or early discontinuation of PrEP. The paper describes our experience with offering integrated GBV screening and referral as part of HIV counselling and testing. This component was implemented within EMPOWER, a demonstration project offering combination HIV prevention, including daily oral PrEP, to young women in South Africa and Tanzania. METHODS Between February 2017 and March 2018, a process evaluation was conducted to explore views, experiences and practices of stakeholders (study participants and study clinical staff) during implementation of the GBV screening component. This article assesses the feasibility and acceptability of the approach from multiple stakeholder perspectives, drawing on counselling session observations (n = 10), in-depth interviews with participants aged 16-24 (n = 39) and clinical staff (n = 13), and notes from debriefings with counsellors. Study process data were also collected (e.g. number of women screened and referred). Following a thematic inductive approach, qualitative data were analysed using qualitative software (NVivo 11). RESULTS Findings show that 31% of young women screened positive for GBV and only 10% requested referrals. Overall, study participants accessing PrEP were amenable to being asked about violence during HIV risk assessment, as this offered the opportunity to find emotional relief and seek help, although a few found this traumatic. In both sites, the sensitive and empathetic approach of the staff helped mitigate distress of GBV disclosure. In general, the delivery of GBV screening in HCT proved to be feasible, provided that the basic principles of confidentiality, staff empathy, and absence of judgment were observed. However, uptake of linkage to further care remained low in both sites. CONCLUSION Most stakeholders found GBV screening acceptable and feasible. Key principles that should be in place for young women to be asked safely about GBV during HIV counselling and testing included respect for confidentiality, a youth-friendly and non-judgmental environment, and a functioning referral network.
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Affiliation(s)
- Manuela Colombini
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Fiona Scorgie
- Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | - Anne Stangl
- International Center for Research on Women, Washington, DC USA
| | - Sheila Harvey
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Lethabo Ramskin
- Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | - Nomhle Khoza
- Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | | | - Deborah Baron
- Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | - Shelley Lees
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Charlotte Watts
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | - on behalf of the EMPOWER study team
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
- Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
- International Center for Research on Women, Washington, DC USA
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Davidov DM, Coffman J, Dyer A, Bias TK, Kristjansson AL, Mann MJ, Vasile E, Abildso CG. Assessment and Response to Intimate Partner Violence in Home Visitation: A Qualitative Needs Assessment With Home Visitors in a Statewide Program. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP1762-1787NP. [PMID: 29366396 PMCID: PMC6026570 DOI: 10.1177/0886260518754869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There is growing recognition that home visitation programs serving at-risk families may be an appropriate mechanism for detecting and reducing intimate partner violence (IPV). More research is needed about how home visitors assess and respond to IPV, especially in rural and underserved areas with unique social and geographic challenges. This study describes the qualitative, needs assessment phase of a larger mixed-methods evaluation of IPV assessment, referral processes, and safety planning with clients within a statewide home visitation program. Three focus groups were conducted with home visitors (n = 16) in West Virginia's Home Visitation Program in May 2015. Home visitors represented four separate home visitation models and provided services across 12 of West Virginia's 55 counties. Guiding questions focused on home visitors' current protocol, experiences, barriers, and facilitators to (a) screening and assessment for IPV, (b) making referrals after disclosures of IPV, and (c) developing safety plans with IPV-exposed clients. Barriers identified by home visitors included the nature of assessment tools, issues with service availability and access in rural areas, and lack of education and training surrounding safety planning. Facilitators included building relationships and trust with clients, providing anticipatory guidance when making referrals, and tailoring safety plans to clients' unique situations. Participants also expressed a critical need to develop procedures for assuring home visitor safety when supporting IPV-exposed clients. These qualitative data highlight issues surrounding the management of IPV in home visitation and have the potential to inform future enhancements to programs that are specifically tailored to the needs of rural, disadvantaged communities.
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Sparrow K, Alves-Costa F, Alves A, Greenberg N, Howard LM, Fear NT, MacManus D. The experience of health and welfare workers in identifying and responding to domestic abuse among military personnel in the UK. BMC Health Serv Res 2020; 20:947. [PMID: 33059688 PMCID: PMC7559780 DOI: 10.1186/s12913-020-05672-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/20/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Awareness of domestic violence and abuse (DVA) as a problem among military personnel (serving and veterans) has grown in recent years, and there is a need for research to inform improvements in the identification of and response to DVA in this population. This study aimed to explore the experience of health and welfare professionals in identifying and responding to DVA among the UK military population (serving personnel and veterans). METHODS Thirty-five semi-structured telephone interviews were conducted with health and welfare staff who work with serving UK military personnel and veterans. Interviews were analysed using thematic analysis. RESULTS Three superordinate themes were identified: i) patterns of DVA observed by health and welfare workers (perceived gender differences in DVA experiences and role of mental health and alcohol); (ii) barriers to identification of and response to DVA (attitudinal/knowledge-based barriers and practical barriers), and iii) resource issues (training needs and access to services). Participants discussed how factors such as a culture of hypermasculinity, under-reporting of DVA, the perception of DVA as a "private matter" among military personnel, and lack of knowledge and awareness of emotional abuse and coercive controlling behaviour as abuse constitute barriers to identification and management of DVA. Healthcare providers highlighted the need for more integrated working between civilian and military services, to increase access to support and provide effective care to both victims and perpetrators. Furthermore, healthcare and welfare staff reflected on their training needs in the screening and management of DVA to improve practice. CONCLUSIONS There is a need for increased awareness of DVA, particularly of non-physical forms of abuse, and of male victimisation in the military. Standardised protocols for DVA management and systematic training are required to promote a consistent and appropriate response to DVA. There is a particular training need among healthcare and first-line welfare staff, who are largely relied upon to identify cases of DVA in the military. Employing DVA advocates within military and civilian healthcare settings may be useful in improving DVA awareness, management and access to specialist support.
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Affiliation(s)
- Katherine Sparrow
- Forensic and Neurodevelopmental Science Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Filipa Alves-Costa
- Forensic and Neurodevelopmental Science Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.
- Barnet Enfield and Haringey Mental Health NHS Trust, London, UK.
| | - Ana Alves
- Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Neil Greenberg
- King's Centre for Military Health Research (KCMHR) Academic Department of Military Mental Health (ADMMH), King's College London, London, UK
| | - Louise M Howard
- Section of Women's Mental Health, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research (KCMHR) Academic Department of Military Mental Health (ADMMH), King's College London, London, UK
| | - Deirdre MacManus
- Forensic and Neurodevelopmental Science Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
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Portnoy GA, Colon R, Gross GM, Adams LJ, Bastian LA, Iverson KM. Patient and provider barriers, facilitators, and implementation preferences of intimate partner violence perpetration screening. BMC Health Serv Res 2020; 20:746. [PMID: 32791967 PMCID: PMC7424651 DOI: 10.1186/s12913-020-05595-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The substantial prevalence and consequences of intimate partner violence (IPV) underscore the need for effective healthcare response in the way of screening and follow up care. Despite growing evidence regarding perspectives on healthcare-based screening for IPV experiences (i.e., victimization), there is an extremely limited evidence-base to inform practice and policy for detecting IPV use (i.e., perpetration). This study identified barriers, facilitators, and implementation preferences among United States (US) Veterans Health Administration (VHA) patients and providers for IPV use screening. METHODS We conducted qualitative interviews with patients enrolled in VHA healthcare (N = 10) and focus groups with VHA providers across professional disciplines (N = 29). Data was analyzed using thematic and content analyses. RESULTS Qualitative analysis revealed convergence between patients' and providers' beliefs regarding key factors for IPV use screening, including the importance of a strong rapport, clear and comprehensive processes and procedures, universal implementation of screening, and a self-report screening tool that assesses for both IPV use and experiences concurrently. CONCLUSIONS Findings provide foundational information regarding patient and provider barriers, facilitators, and preferences for IPV use screening that can inform clinical practice and next steps in this important but understudied aspect of healthcare.
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Affiliation(s)
- Galina A Portnoy
- VA Connecticut Healthcare System, VA PRIME Center, 950 Campbell Ave, West Haven, CT, 06516, USA.
- Department of Psychiatry, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06511, USA.
| | - Richard Colon
- VA Connecticut Healthcare System, VA PRIME Center, 950 Campbell Ave, West Haven, CT, 06516, USA
| | - Georgina M Gross
- VA Connecticut Healthcare System, VA PRIME Center, 950 Campbell Ave, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06511, USA
| | - Lynette J Adams
- VA Connecticut Healthcare System, VA PRIME Center, 950 Campbell Ave, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06511, USA
| | - Lori A Bastian
- VA Connecticut Healthcare System, VA PRIME Center, 950 Campbell Ave, West Haven, CT, 06516, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Katherine M Iverson
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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Hegarty K, McKibbin G, Hameed M, Koziol-McLain J, Feder G, Tarzia L, Hooker L. Health practitioners' readiness to address domestic violence and abuse: A qualitative meta-synthesis. PLoS One 2020; 15:e0234067. [PMID: 32544160 PMCID: PMC7297351 DOI: 10.1371/journal.pone.0234067] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/18/2020] [Indexed: 11/19/2022] Open
Abstract
Health practitioners play an important role in identifying and responding to domestic violence and abuse (DVA). Despite a large amount of evidence about barriers and facilitators influencing health practitioners' care of survivors of DVA, evidence about their readiness to address DVA has not been synthesised. This article reports a meta-synthesis of qualitative studies exploring the research question: What do health practitioners perceive enhances their readiness to address domestic violence and abuse? Multiple data bases were searched in June 2018. Inclusion criteria included: qualitative design; population of health practitioners in clinical settings; and a focus on intimate partner violence. Two reviewers independently screened articles and findings from included papers were synthesised according to the method of thematic synthesis. Forty-seven articles were included in the final sample, spanning 41 individual studies, four systematic reviews and two theses between the years of 1992 and 2018; mostly from high income countries. Five themes were identified as enhancing readiness of health practitioners to address DVA: Having a commitment; Adopting an advocacy approach; Trusting the relationship; Collaborating with a team; and Being supported by the health system. We then propose a health practitioners' readiness framework called the CATCH Model (Commitment, Advocacy, Trust, Collaboration, Health system support). Applying this model to health practitioners' different readiness for change (using Stage of Change framework) allows us to tailor facilitating strategies in the health setting to enable greater readiness to deal with intimate partner abuse.
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Affiliation(s)
- Kelsey Hegarty
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
- The Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Gemma McKibbin
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Mohajer Hameed
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Koziol-McLain
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Gene Feder
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Laura Tarzia
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Leesa Hooker
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
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Iverson KM, Adjognon O, Grillo AR, Dichter ME, Gutner CA, Hamilton AB, Stirman SW, Gerber MR. Intimate Partner Violence Screening Programs in the Veterans Health Administration: Informing Scale-up of Successful Practices. J Gen Intern Med 2019; 34:2435-2442. [PMID: 31420827 PMCID: PMC6848589 DOI: 10.1007/s11606-019-05240-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/27/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Screening women for intimate partner violence (IPV) is increasingly expected in primary care, consistent with clinical prevention guidelines (e.g., United States Preventive Services Task Force). Yet, little is known about real-world implementation of clinical practices or contextual factors impacting IPV screening program success. This study identified successful clinical practices, and barriers to and facilitators of IPV screening program implementation in the Veterans Health Administration (VHA). DESIGN Descriptive, qualitative study of a purposeful sample of 11 Veterans Affairs Medical Centers (VAMCs) categorized as early and late adopters of IPV screening programs within women's health primary care clinics. VAMCs were categorized based on performance measures collected by VHA operations partners. PARTICIPANTS Thirty-two administrators and clinician key informants (e.g., Women's Health Medical Directors, IPV Coordinators, and physicians) involved in IPV screening program implementation decisions from six early- and five late-adopting sites nationwide. MAIN MEASURES Participants reported on IPV screening and response practices, and contextual factors impacting implementation, in individual 1-h semi-structured phone interviews. Transcripts were analyzed using rapid content analysis with key practices and issues synthesized in profile summaries. Themes were identified and iteratively revised, utilizing matrices to compare content across early- and late-adopting sites. KEY RESULTS Five successful clinical practices were identified (use of two specific screening tools for primary IPV screening and secondary risk assessment, multilevel resource provision and community partnerships, co-location of mental health/social work, and patient-centered documentation). Multilevel barriers (time/resource constraints, competing priorities and mounting responsibilities in primary care, lack of policy, inadequate training, and discomfort addressing IPV) and facilitators (engaged IPV champions, internal and external supports, positive feedback regarding IPV screening practices, and current, national attention to violence against women) were identified. CONCLUSIONS Findings advance national efforts by highlighting successful clinical practices for IPV screening programs and informing strategies useful for enhancing their implementation within and beyond the VHA, ultimately improving services and women's health.
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Affiliation(s)
- Katherine M Iverson
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, South Huntington Avenue, Boston, MA, USA.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.
| | - Omonyêlé Adjognon
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, South Huntington Avenue, Boston, MA, USA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
| | - Alessandra R Grillo
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, South Huntington Avenue, Boston, MA, USA
| | - Melissa E Dichter
- VA Center for Health Equity Research and Promotion (CHERP), Crescenz VA Medical Center, Philadelphia, PA, USA
- School of Social Work, Temple University, Philadelphia, PA, USA
| | - Cassidy A Gutner
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, South Huntington Avenue, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Alison B Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Shannon Wiltsey Stirman
- Dissemination and Training Division, National Center for PTSD, VA Palo Alto Healthcare System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Megan R Gerber
- Women's Health Center, VA Boston Healthcare System, Boston, MA, USA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
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21
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Otero-García L, Briones-Vozmediano E, Vives-Cases C, García-Quinto M, Sanz-Barbero B, Goicolea I. A qualitative study on primary health care responses to intimate partner violence during the economic crisis in Spain. Eur J Public Health 2019; 28:1000-1005. [PMID: 29917072 DOI: 10.1093/eurpub/cky095] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The objective of this study was to explore how health professionals perceived the effect of the economic crisis and associated austerity measures on the detection of and cares for intimate partner violence (IPV) in primary care in Spain. Methods Qualitative study designed using semi-structured interviews carried out with 145 health professionals in 16 primary health care centres in different regions of Spain. An inductive thematic analysis was made of the transcriptions. Results Three main themes were identified: 'Women endure more violence during times of economic crisis', 'Fewer resources, fewer professionals and less time to respond to IPV' and 'Professionals' motivation as a requirement to respond to IPV'. Professionals perceived that economic precariousness triggered violence against women and made women more hesitant to put an end to violent relationships. They also reported that the austerity measures applied to primary health care negatively affected their ability to detect and adequately care for cases of IPV due to a heavy workload, reduced human resources, difficulties in training and the loss of resources to which women could be referred. To counteract these obstacles, health professionals' motivation played a vital role in the response to IPV. Conclusions Institutional efforts to organize awareness programmes and training in order to improve and promote early diagnosis, care and rehabilitation of these women cannot stop during times of crisis and primary health care centres should facilitate health professionals' access to these programmes.
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Affiliation(s)
- Laura Otero-García
- Department of Nursing, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.,Ciber of Epidemiology and Public Health (CIBERESP), Spain.,Society, Health, Education and Culture Research Group (GESEC), University of Lleida, Lleida, Spain
| | - Erica Briones-Vozmediano
- Society, Health, Education and Culture Research Group (GESEC), University of Lleida, Lleida, Spain.,Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Healthcare Research Group (GRECS), Biomedical Research Institute (IRB), Lleida, Spain.,Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Public Health Research Group, University of Alicante, Alicante, Spain
| | - Carmen Vives-Cases
- Ciber of Epidemiology and Public Health (CIBERESP), Spain.,Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Public Health Research Group, University of Alicante, Alicante, Spain
| | - Marta García-Quinto
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Public Health Research Group, University of Alicante, Alicante, Spain
| | - Belén Sanz-Barbero
- Ciber of Epidemiology and Public Health (CIBERESP), Spain.,National Health School, Institute of Health Carlos III, Madrid, Spain
| | - Isabel Goicolea
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Public Health Research Group, University of Alicante, Alicante, Spain.,Department of Clinical Medicine and Public Health, Epidemiology and Global Health Unit, University of Umeå, Umeå, Sweden
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Hatcher AM, Woollett N, Pallitto CC, Mokoatle K, Stöckl H, Garcia-Moreno C. Willing but Not Able: Patient and Provider Receptiveness to Addressing Intimate Partner Violence in Johannesburg Antenatal Clinics. JOURNAL OF INTERPERSONAL VIOLENCE 2019; 34:1331-1356. [PMID: 27215666 DOI: 10.1177/0886260516651094] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Intimate partner violence (IPV) during pregnancy is associated with maternal and infant health. However, in South Africa, where 20% to 35% of pregnant women report experiencing IPV, antenatal care rarely addresses violence. Little research has explored how clinic staff, community members, or pregnant women themselves view IPV. We conducted formative, qualitative research with 48 participants in urban Johannesburg. Focus group discussions with pregnant women ( n = 13) alongside qualitative interviews with health providers ( n = 10), managers and researchers ( n = 10), non-governmental organizations ( n = 6), community leaders ( n = 4), and pregnant abused women ( n = 5) explored the context of IPV and health care response. Data were analyzed using a team approach to thematic coding in NVivo 10. We found that pregnant women in the urban Johannesburg setting experience multiple forms of IPV, but tend not to disclose violence to antenatal care providers. Providers are alert to physical injuries or severe outcomes from IPV, but miss subtler cues, such as emotional distress or signs of poor mental health. Providers are uncertain how to respond to IPV, and noted few existing tools, training, or referral systems. Nevertheless, providers were supportive of addressing IPV, as they noted this as a common condition in this setting. Providers and managers considered the safety and well-being of mother and infant to be a strong rationale for the identification of IPV. Pregnant women were receptive to being asked about violence in a kind and confidential way. Understaffing, insufficient training, and poorly developed referral systems were noted as important health system problems to address in future interventions. South African patients and providers are receptive to the identification of and response to IPV in antenatal care, but require tools and training to be able to safely address violence in the health care setting. Future interventions should consider the urban South African antenatal clinic a supportive, if under-resourced, entry point for improving the health of pregnant women experiencing violence.
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Affiliation(s)
- Abigail M Hatcher
- 1 University of the Witwatersrand, JHB, South Africa
- 2 University of California, San Francicso, CA, USA
| | | | | | | | - Heidi Stöckl
- 4 London School of Hygiene and Tropical Medicine, England, UK
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Goicolea I, Marchal B, Hurtig AK, Vives-Cases C, Briones-Vozmediano E, San Sebastián M. Why do certain primary health care teams respond better to intimate partner violence than others? A multiple case study. GACETA SANITARIA 2019; 33:169-176. [DOI: 10.1016/j.gaceta.2017.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/20/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
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Briones-Vozmediano E, Maquibar A, Vives-Cases C, Öhman A, Hurtig AK, Goicolea I. Health-Sector Responses to Intimate Partner Violence: Fitting the Response Into the Biomedical Health System or Adapting the System to Meet the Response? JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:1653-1678. [PMID: 26691205 DOI: 10.1177/0886260515619170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study aims to analyze how middle-level health systems' managers understand the integration of a health care response to intimate partner violence (IPV) within the Spanish health system. Data were obtained through 26 individual interviews with professionals in charge of coordinating the health care response to IPV within the 17 regional health systems in Spain. The transcripts were analyzed following grounded theory in accordance with the constructivist approach described by Charmaz. Three categories emerged, showing the efforts and challenges to integrate a health care response to IPV within the Spanish health system: "IPV is a complex issue that generates activism and/or resistance," "The mandate to integrate a health sector response to IPV: a priority not always prioritized," and "The Spanish health system: respectful with professionals' autonomy and firmly biomedical." The core category, "Developing diverse responses to IPV integration," crosscut the three categories and encompassed the range of different responses that emerge when a strong mandate to integrate a health care response to IPV is enacted. Such responses ranged from refraining to deal with the issue to offering a women-centered response. Attempting to integrate a response to nonbiomedical health problems as IPV into health systems that remain strongly biomedicalized is challenging and strongly dependent both on the motivation of professionals and on organizational factors. Implementing and sustaining changes in the structure and culture of the health care system are needed if a health care response to IPV that fulfills the World Health Organization guidelines is to be ensured.
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Affiliation(s)
- Erica Briones-Vozmediano
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Spain
- Public Health Research Group of the University of Alicante, Spain
- Interuniversity Institute for Social Development and Peace, World Health Organization Collaborating Centre for Health and Social Inclusion of the University of Alicante, Spain
| | - Amaia Maquibar
- Department of Nursing I, University of the Basque Country, Leioa, Bizkaia, Spain
| | - Carmen Vives-Cases
- Public Health Research Group of the University of Alicante, Spain
- Interuniversity Institute for Social Development and Peace, World Health Organization Collaborating Centre for Health and Social Inclusion of the University of Alicante, Spain
- Epidemiology and Public Health CIBER, Madrid, Spain
| | - Ann Öhman
- Umeå Centre for Gender Studies, Umeå University, Sweden
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Anna-Karin Hurtig
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Isabel Goicolea
- Public Health Research Group of the University of Alicante, Spain
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Sweden
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Intimate partner violence (IPV): The validity of an IPV screening instrument utilized among pregnant women in Tanzania and Vietnam. PLoS One 2018; 13:e0190856. [PMID: 29389954 PMCID: PMC5794062 DOI: 10.1371/journal.pone.0190856] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/21/2017] [Indexed: 11/19/2022] Open
Abstract
Background Intimate partner violence (IPV) is a global problem that affects one-third of all women. The present study aims to develop and determine the validity of a screening instrument for the detection of IPV in pregnant women in Tanzania and Vietnam and to determine the minimum number of questions needed to identify IPV. Method An IPV screening instrument based on eight questions was tested on 1,116 Tanzanian and 1,309 Vietnamese women who attended antenatal care before 24 gestational weeks. The women were re-interviewed during their 30th-34th gestational week where the World Health Organization (WHO) IPV questionnaire was used as the gold standard. In all, 255 combinations of eight different questions were first tested on the Tanzanian study population where sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. In the evaluation of the performance of the question combinations, different IPV types and the frequency of abusive acts were considered. The question combinations that performed best in Tanzania were subsequently evaluated in the Vietnamese study population. Results In Tanzania, a combination of three selected questions including one question on emotional IPV, one on physical IPV and one on sexual IPV was found to be most effective in identifying women who are exposed to at least one type of IPV during pregnancy (sensitivity = .80; specificity = .74). The performance of the identified combination was slightly less effective in Vietnam (sensitivity = .74; specificity = .68). Focusing on different IPV types, the best performance was found for exposure to physical IPV in both Tanzania (sensitivity = .93; specificity = .70) and Vietnam (sensitivity = .96; specificity = .55). In both countries, the sensitivity increased with the frequency of abuse whereas the specificity decreased. Conclusion By asking pregnant women three simple questions we were able to identify women who were exposed to IPV during pregnancy in two different countries. The question combination performed best in assessing physical IPV where it identified 93% and 96% of Vietnamese and Tanzanian women, respectively, who were exposed to physical IPV.
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Sprague S, Swaminathan A, Slobogean GP, Spurr H, Arseneau E, Raveendran L, Memon M, Scott T, Agarwal G, Bhandari M. A scoping review of intimate partner violence educational programs for health care professionals. Women Health 2018; 58:1192-1206. [DOI: 10.1080/03630242.2017.1388334] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sheila Sprague
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Aparna Swaminathan
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, Hamilton, Ontario, Canada
| | - Gerard P. Slobogean
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Hayley Spurr
- Graduate Entry Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Erika Arseneau
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lucshman Raveendran
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Muzammil Memon
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Taryn Scott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gina Agarwal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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27
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Vives-Cases C, Goicolea I, Hernández A, Sanz-Barbero B, Davó-Blanes MC, La Parra-Casado D. Priorities and strategies for improving Roma women's access to primary health care services in cases on intimate partner violence: a concept mapping study. Int J Equity Health 2017; 16:96. [PMID: 28592306 PMCID: PMC5463323 DOI: 10.1186/s12939-017-0594-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/31/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND With an explicit focus on Roma women in Spain (Kale/Spanish Gypsies), this study aims to integrate key informants' opinions about the main actions needed to improve primary health care services' and professionals' responses to Roma women in an Intimate Partner Violence (IPV) situation. METHODS Concept mapping study. A total of 50 (brainstorming phase), 36 (sorting and rating phase) and 16 (interpretation phase) participants from Roma civil society groups, primary health care professionals and other related stakeholders (social services, academic experts and other IPV NGOs representatives) from different cities in Spain were involved in the different study phases. RESULTS Among the 55 action proposals generated, ten priority actions were identified through consensus as most important for improving primary health care's response to Romani women in an IPV situation, and these included primary, secondary and tertiary prevention activities. CONCLUSION Results indicated that efforts to address this challenge should take an integrated approach that reinforces the primary health care response to IPV in general, while also promoting more specific actions to address barriers to access that affect all Roma women and those who experience IPV in particular.
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Affiliation(s)
- Carmen Vives-Cases
- Department of Community Nursing, Public Health and Preventive Medicine and History of Science, Alicante University, Alicante, 03080, Spain. .,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. .,Public Health Research Group, Alicante University, Alicante, Spain.
| | - Isabel Goicolea
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Alison Hernández
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Belen Sanz-Barbero
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,National School of Public Health, Health Institute Carlos III, Madrid, Spain
| | - MCarmen Davó-Blanes
- Department of Community Nursing, Public Health and Preventive Medicine and History of Science, Alicante University, Alicante, 03080, Spain.,Public Health Research Group, Alicante University, Alicante, Spain
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Linkage and Referral to HIV and Other Medical and Social Services: A Focused Literature Review for Sexually Transmitted Disease Prevention and Control Programs. Sex Transm Dis 2016; 43:S76-82. [PMID: 26779689 DOI: 10.1097/olq.0000000000000290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sexually transmitted disease (STD) program and clinic staff play an important role in providing linkage and referrals to programs and services that address the complex medical and psychosocial needs of their clients. We synthesized recent published literature related to effective practices for linkage to care for HIV and referral to other medical and social services. METHODS Three PubMed searches were conducted to identify relevant studies published since 2004 on (1) linkage to HIV care, (2) referral within STD clinical contexts, and (3) (review articles only) referral practices among all medical specialties. Systematic review procedures were not used. RESULTS Thirty-three studies were included in this review. Studies highlight the limited value of passive referral practices and the increased effectiveness of active referral and linkage practices. Numerous studies on linkage to HIV care suggest that case management approaches, cultural-linguistic concordance between linkage staff and clients, and structural features such as colocation facilitate timely linkage to care. Integration of other medical and social services such as family planning and alcohol screening services into STD settings may be optimal but resource-intensive. Active referral practices such as having a written referral protocols and agreements, using information technology to help transfer information between providers, and making appointments for clients may offer some benefit. Few studies included information on program costs associated with linkage and referral. CONCLUSIONS Recent literature provides some guideposts for STD program and clinical staff to use in determining their approach to helping link and refer clients to needed care. Much experience with these issues within STD services remains unpublished, and key gaps in the literature remain.
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Williams JR, Halstead V, Salani D, Koermer N. An exploration of screening protocols for intimate partner violence in healthcare facilities: a qualitative study. J Clin Nurs 2016; 26:2192-2201. [PMID: 27507759 DOI: 10.1111/jocn.13353] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES Explore different methods by which intimate partner violence screening practices are implemented in clinic and emergency settings and better understand barriers and facilitators. BACKGROUND Healthcare visits provide an opportunity for providers to identify and provide assistance to victims of intimate partner violence. However, wide variation exists in the implementation of screening and response protocols. In addition, providers experience barriers and facilitators to intimate partner violence screening and response. A comprehensive understanding of these factors is necessary to improve the role that providers play in detection and intervention of intimate partner violence. DESIGN Qualitative descriptive research design. METHODS Sixteen healthcare facilities were recruited from a large metropolitan area in the USA. Data were collected through semi-structured, in-depth interviews with individuals knowledgeable about intimate partner violence screening and response within their facility. Data were analysed using directive content analysis. RESULTS Major themes and patterns concerning intimate partner violence screening and response were identified within the following areas: procedural characteristics, barriers, facilitators and additional needs. Patient-provider communication and operational/facility characteristics emerged as critical aspects that impact the successful implementation of intimate partner violence screening and response programmes. Differences were found between clinic and emergency settings stemming from variations in health delivery models. CONCLUSIONS Results provide important information on how healthcare facilities implement intimate partner violence screening and response, suggestions for practice improvement and directions for future interventions. Additional guidance is needed to ensure intimate partner violence identification, and response procedures are effective and tailored to needs of patients, providers and the facility. RELEVANCE TO CLINICAL PRACTICE Nurses are in a strategic position to play a pivotal role in identification of and response to intimate partner violence. It is essential that nurses are cognizant of this, and understand the actions they can take to assist patients who have been victims of intimate partner violence. Recommendations on how to do this are provided.
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Affiliation(s)
- Jessica R Williams
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Valerie Halstead
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Deborah Salani
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Natasha Koermer
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
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Goicolea I, Vives-Cases C, Hurtig AK, Marchal B, Briones-Vozmediano E, Otero-García L, García-Quinto M, San Sebastian M. Mechanisms that Trigger a Good Health-Care Response to Intimate Partner Violence in Spain. Combining Realist Evaluation and Qualitative Comparative Analysis Approaches. PLoS One 2015; 10:e0135167. [PMID: 26270816 PMCID: PMC4536036 DOI: 10.1371/journal.pone.0135167] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/18/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Health care professionals, especially those working in primary health-care services, can play a key role in preventing and responding to intimate partner violence. However, there are huge variations in the way health care professionals and primary health care teams respond to intimate partner violence. In this study we tested a previously developed programme theory on 15 primary health care center teams located in four different Spanish regions: Murcia, C Valenciana, Castilla-León and Cantabria. The aim was to identify the key combinations of contextual factors and mechanisms that trigger a good primary health care center team response to intimate partner violence. METHODS A multiple case-study design was used. Qualitative and quantitative information was collected from each of the 15 centers (cases). In order to handle the large amount of information without losing familiarity with each case, qualitative comparative analysis was undertaken. Conditions (context and mechanisms) and outcomes, were identified and assessed for each of the 15 cases, and solution formulae were calculated using qualitative comparative analysis software. RESULTS The emerging programme theory highlighted the importance of the combination of each team's self-efficacy, perceived preparation and women-centredness in generating a good team response to intimate partner violence. The use of the protocol and accumulated experience in primary health care were the most relevant contextual/intervention conditions to trigger a good response. However in order to achieve this, they must be combined with other conditions, such as an enabling team climate, having a champion social worker and having staff with training in intimate partner violence. CONCLUSIONS Interventions to improve primary health care teams' response to intimate partner violence should focus on strengthening team's self-efficacy, perceived preparation and the implementation of a woman-centred approach. The use of the protocol combined with a large working experience in primary health care, and other factors such as training, a good team climate, and having a champion social worker on the team, also played a key role. Measures to sustain such interventions and promote these contextual factors should be encouraged.
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Affiliation(s)
- Isabel Goicolea
- Unit of Epidemiology and Global Health, Department of Clinical Medicine and Public Health, Umeå University, Umeå, Sweden
- Grupo de Investigación de Salud Pública, Universidad de Alicante, Alicante, Spain
| | - Carmen Vives-Cases
- Grupo de Investigación de Salud Pública, Universidad de Alicante, Alicante, Spain
- Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Universidad de Alicante, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Anna-Karin Hurtig
- Unit of Epidemiology and Global Health, Department of Clinical Medicine and Public Health, Umeå University, Umeå, Sweden
| | | | - Erica Briones-Vozmediano
- Unit of Epidemiology and Global Health, Department of Clinical Medicine and Public Health, Umeå University, Umeå, Sweden
- Grupo de Investigación de Salud Pública, Universidad de Alicante, Alicante, Spain
| | | | - Marta García-Quinto
- Grupo de Investigación de Salud Pública, Universidad de Alicante, Alicante, Spain
- Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Universidad de Alicante, Alicante, Spain
| | - Miguel San Sebastian
- Unit of Epidemiology and Global Health, Department of Clinical Medicine and Public Health, Umeå University, Umeå, Sweden
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Choi AWM, Wong JYH, Kam CW, Lau CL, Wong JKS, Lo RTF. Injury Patterns and Help-seeking Behavior in Hong Kong Male Intimate Partner Violence Victims. J Emerg Med 2015; 49:217-26. [DOI: 10.1016/j.jemermed.2015.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 03/11/2015] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
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Taft AJ, Hooker L, Humphreys C, Hegarty K, Walter R, Adams C, Agius P, Small R. Maternal and child health nurse screening and care for mothers experiencing domestic violence (MOVE): a cluster randomised trial. BMC Med 2015; 13:150. [PMID: 26111528 PMCID: PMC4480893 DOI: 10.1186/s12916-015-0375-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 05/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mothers are at risk of domestic violence (DV) and its harmful consequences postpartum. There is no evidence to date for sustainability of DV screening in primary care settings. We aimed to test whether a theory-informed, maternal and child health (MCH) nurse-designed model increased and sustained DV screening, disclosure, safety planning and referrals compared with usual care. METHODS Cluster randomised controlled trial of 12 month MCH DV screening and care intervention with 24 month follow-up. The study was set in community-based MCH nurse teams (91 centres, 163 nurses) in north-west Melbourne, Australia. Eight eligible teams were recruited. Team randomisation occurred at a public meeting using opaque envelopes. Teams were unable to be blinded. The intervention was informed by Normalisation Process Theory, the nurse-designed good practice model incorporated nurse mentors, strengthened relationships with DV services, nurse safety, a self-completion maternal health screening checklist at three or four month consultations and DV clinical guidelines. Usual care involved government mandated face-to-face DV screening at four weeks postpartum and follow-up as required. Primary outcomes were MCH team screening, disclosure, safety planning and referral rates from routine government data and a postal survey sent to 10,472 women with babies ≤ 12 months in study areas. Secondary outcomes included DV prevalence (Composite Abuse Scale, CAS) and harm measures (postal survey). RESULTS No significant differences were found in routine screening at four months (IG 2,330/6,381 consultations (36.5 %) versus CG 1,792/7,638 consultations (23.5 %), RR = 1.56 CI 0.96-2.52) but data from maternal health checklists (n = 2,771) at three month IG consultations showed average screening rates of 63.1 %. Two years post-intervention, IG safety planning rates had increased from three (RR 2.95, CI 1.11-7.82) to four times those of CG (RR 4.22 CI 1.64-10.9). Referrals remained low in both intervention groups (IGs) and comparison groups (CGs) (<1 %). 2,621/10,472 mothers (25 %) returned surveys. No difference was found between arms in preference or comfort with being asked about DV or feelings about self. CONCLUSION A nurse-designed screening and care model did not increase routine screening or referrals, but achieved significantly increased safety planning over 36 months among postpartum women. Self-completion DV screening was welcomed by nurses and women and contributed to sustainability. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12609000424202, 10/03/2009.
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Affiliation(s)
- Angela J Taft
- Judith Lumley Centre, La Trobe University, Melbourne, Australia.
| | - Leesa Hooker
- Judith Lumley Centre, La Trobe University, Melbourne, Australia.
| | - Cathy Humphreys
- School of Social Work, University of Melbourne, Melbourne, Australia.
| | - Kelsey Hegarty
- Primary Care Research Unit, Department of General Practice, University of Melbourne, Melbourne, Australia.
| | - Ruby Walter
- College of Health and Biomedicine, Victoria University, Melbourne, Australia.
| | - Catina Adams
- Judith Lumley Centre, La Trobe University, Melbourne, Australia.
| | - Paul Agius
- Centre for Population Health, Burnet Institute, Melbourne, Australia.
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Melbourne, Australia.
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Goicolea I, Hurtig AK, San Sebastian M, Vives-Cases C, Marchal B. Developing a programme theory to explain how primary health care teams learn to respond to intimate partner violence: a realist case-study. BMC Health Serv Res 2015; 15:228. [PMID: 26054758 PMCID: PMC4460973 DOI: 10.1186/s12913-015-0899-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 06/02/2015] [Indexed: 11/28/2022] Open
Abstract
Background Despite the progress made on policies and programmes to strengthen primary health care teams’ response to Intimate Partner Violence, the literature shows that encounters between women exposed to IPV and health-care providers are not always satisfactory, and a number of barriers that prevent individual health-care providers from responding to IPV have been identified. We carried out a realist case study, for which we developed and tested a programme theory that seeks to explain how, why and under which circumstances a primary health care team in Spain learned to respond to IPV. Methods A realist case study design was chosen to allow for an in-depth exploration of the linkages between context, intervention, mechanisms and outcomes as they happen in their natural setting. The first author collected data at the primary health care center La Virgen (pseudonym) through the review of documents, observation and interviews with health systems’ managers, team members, women patients, and members of external services. The quality of the IPV case management was assessed with the PREMIS tool. Results This study found that the health care team at La Virgen has managed 1) to engage a number of staff members in actively responding to IPV, 2) to establish good coordination, mutual support and continuous learning processes related to IPV, 3) to establish adequate internal referrals within La Virgen, and 4) to establish good coordination and referral systems with other services. Team and individual level factors have triggered the capacity and interest in creating spaces for team leaning, team work and therapeutic responses to IPV in La Virgen, although individual motivation strongly affected this mechanism. Regional interventions did not trigger individual and/ or team responses but legitimated the workings of motivated professionals. Conclusions The primary health care team of La Virgen is involved in a continuous learning process, even as participation in the process varies between professionals. This process has been supported, but not caused, by a favourable policy for integration of a health care response to IPV. Specific contextual factors of La Virgen facilitated the uptake of the policy. To some extent, the performance of La Virgen has the potential to shape the IPV learning processes of other primary health care teams in Murcia. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0899-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Isabel Goicolea
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umea University, SE-90187, Umea, Sweden. .,Public Health Research Group, Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Alicante University, Alicante, Spain.
| | - Anna-Karin Hurtig
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umea University, SE-90187, Umea, Sweden.
| | - Miguel San Sebastian
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umea University, SE-90187, Umea, Sweden.
| | - Carmen Vives-Cases
- Public Health Research Group, Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Alicante University, Alicante, Spain. .,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
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Abstract
Purpose
– The purpose of this paper is to present findings on the efficacy of documents that US police are required to provide to domestic violence survivors, specifically intimate partner violence (IPV) survivors. Triangulating data from survivors, shelter staff, and law enforcement officers across four stages of IPV experiences, this national study identifies priorities among essential information needs and proposes information guidelines for law enforcement.
Design/methodology/approach
– A nationally distributed, 13-item, e-mail questionnaire was submitted to a stratified sample (ten largest, median, and smallest) of law enforcement agencies in all 50 states. Domestic violence shelters in each of the 1,500 cities were similarly recruited; survivors were recruited indirectly via shelter staff. The questions were clustered in terms of four common situations. Responses from 839 individuals were obtained, self-identified as police officers (481), shelter staff (263), and IPV survivors (95).
Findings
– Documents should be formatted for safety (i.e. small), developed for specific situations, and written simply. They should also offer information about non-law enforcement services. All three of the populations queried agreed that the immediate needs of survivors are stronger than their long-term needs.
Research limitations/implications
– The primary limitations are that the survey could include no means of determining the degree to which the respondents match the sample, and the response rate was insufficient to support inferential statistical analysis.
Originality/value
– This national study, the first of its kind, explicates the nuances of information elements in the personally situated experiences of survivors, and it presents the first set of suggested law-enforcement document design guidelines.
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Dutton MA, James L, Langhorne A, Kelley M. Coordinated public health initiatives to address violence against women and adolescents. J Womens Health (Larchmt) 2014; 24:80-5. [PMID: 25549182 DOI: 10.1089/jwh.2014.4884] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Intimate partner violence (IPV) is a well-recognized public health problem. IPV affects women's physical and mental health through direct pathways, such as injury, and indirect pathways, such as a prolonged stress response that leads to chronic health problems. The influence of abuse can persist long after the violence has stopped and women of color are disproportionately impacted. Successfully addressing the complex issue of IPV requires multiple prevention efforts that target specific risk and protective factors across individual, interpersonal, institutional, community, and societal levels. This paper includes examples of community-based, state led and federally funded public health programs focused on IPV along this continuum. Two community-based efforts to increase access to mental health care for low income, women of color who had experienced IPV, Mindfulness-Based Stress Reduction, and a telehealth intervention are discussed. Core tenets of a patient-centered comprehensive approach to assessment and responses and strategies for supporting a statewide comprehensive response are described in Project Connect: A Coordinated Public Health Initiative to Prevent Violence Against Women. Project Connect provides technical assistance to grantees funded through the Violence Against Women Act's health title and involves developing, implementing, and evaluating new ways to identify, respond to, and prevent domestic and sexual violence and promote an improved public health response to abuse in states and Native health programs. Health care partnerships with domestic violence experts are critical in order to provide training, develop referral protocols, and to link IPV victims to advocacy services. Survivors need a comprehensive response that addresses their safety concerns and may require advocacy around housing or shelter, legal assistance, and safety planning. Gaps in research knowledge identified are health system readiness to respond to IPV victims in health care settings and partner with domestic violence programs, effects of early IPV intervention, and models for taking interventions to scale.
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Westbrook L. Intimate partner violence online: Expectations and agency in question and answer websites. J Assoc Inf Sci Technol 2014. [DOI: 10.1002/asi.23195] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Lynn Westbrook
- School of Information; University of Texas; 1 University Station D7000 Austin TX 78712-0390
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Davila YR, Mendias EP, Juneau C. Under the RADAR: Assessing and Intervening for Intimate Partner Violence. J Nurse Pract 2013. [DOI: 10.1016/j.nurpra.2013.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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