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Kunes JA, Ulrich MN, Orr CE, Cannada LK, Russo CM. Intimate Partner Violence in the Orthopaedic Patient Population: What Surgeons Need to Know. JBJS Rev 2023; 11:01874474-202304000-00006. [PMID: 37079704 DOI: 10.2106/jbjs.rvw.22.00199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
» Intimate partner violence (IPV) is under-reported and pervasive in the orthopaedic surgical setting. » Screening programs that could increase reporting and assist in treatment and prevention are commonly underutilized. » There is little formalized education during orthopaedic surgery training for IPV. » The incidence of IPV continues to increase in the setting of recent stressors, such as COVID-19, and the orthopaedic surgeon should play a role in the screening and identification of patients presenting with IPV injuries and provide resources and referral.
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Affiliation(s)
- Jennifer A Kunes
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Marisa N Ulrich
- Department of Orthopedic Surgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Charlotte E Orr
- Department of Orthopedic Surgery, Miami Valley Hospital, Terre Haute Regional Hospital, Dayton, Ohio
| | - Lisa K Cannada
- Department of Orthopaedic Surgery, Novant Health Orthopaedics, Charlotte, North Carolina
| | - Christen M Russo
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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Intimate partner violence: A practice development issue for orthopaedic nurses. Int J Orthop Trauma Nurs 2023; 48:100998. [PMID: 36805315 DOI: 10.1016/j.ijotn.2023.100998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
Intimate Partner Violence (IPV) is an underrecognized healthcare phenomenon that causes significant harm to the health of those affected. The lifetime estimated global prevalence of IPV is one in three for women and one in twelve for men. Orthopaedic fracture clinics care for patients affected by IPV and, in fact, orthopaedic patients themselves believe they should be screened for IPV. Almost three percent of women seen for an acute musculoskeletal injury is a direct consequence of IPV. A major concern is that, in the absence of screening and no outward signs of IPV, healthcare providers do not screen patients. Current screening practices and policies are influenced by the nurses' practice or the organizational structure in which nurses work. The purpose of this article is to raise awareness of IPV in the orthopaedic patient population and to provide a review on IPV for orthopaedic nurses. It is important for organizational leaders to recognize the relationship between the barriers and facilitators in relation to IPV intervention. Facilitators and barriers to addressing IPV are discussed. In addition, the need to implement change in practice combined with empowering nurses to address IPV is described. Empowering orthopaedic nurses necessarily involves the provision of appropriate resources, information, and support to overcome barriers. The authors discuss unit policies, guidelines, and resources to address IPV.
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Giordano V, Giordano C, Lopes IM, Pires RE, Godoy-Santos A, Giannoudis PV. Orthopaedic surgeons can play important role in identifying victims of domestic violence in the emergency department - narrative review of Brazilian literature. Medicine (Baltimore) 2022; 101:e31461. [PMID: 36550911 PMCID: PMC9771306 DOI: 10.1097/md.0000000000031461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Over the last year, with the social isolation imposed by the coronavirus disease pandemic, there has been a significant increase in complaints associated with physical violence against women. In the present study, an exploratory literature review was carried out on the role of the on-call orthopedic surgeon when faced with a suspicion of domestic violence, in accordance with Brazilian legislation. The main objective of the study was to show the role of this specialist in identifying victims of domestic violence by recognizing their profiles and associated risk factors. The secondary objectives were to demonstrate the most common skeletal and non-skeletal injuries in this type of violence and to present a quick and practical guide on how to identify, approach, and manage cases of domestic violence against women. The findings revealed that the main aggressors were close partners, such as spouses and ex-spouses. Young adult women, black or multiracial, and low socioeconomic status are major risk factors for intimate partner violence. Head and neck injuries are the most frequently observed lesions in this population, with more than one-third of victims reporting falls. Musculoskeletal injuries are present in up to 42% of victims of domestic violence, occurring predominantly in the upper limbs and chest, and are the leading cause of death in women aged 1 to 34 years. A practical guide for orthopedic surgeons who work in emergency departments is proposed, with basic information about their role and responsibility in identifying potential victims of intimate partner violence.
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
- Clínica São Vicente, Rede D’or São Luiz, Rio de Janeiro, Brazil
- *Correspondence: Vincenzo Giordano, Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, 22430-160, Rio DE Janeiro, RJ, Brazil (e-mail: )
| | - Carolina Giordano
- Clínica da Família Maria do Socorro Silva e Souza, Secretaria Municipal de Saúde do Rio de Janeiro, Clínica da Família Estácio de Sá, Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isadora Maria Lopes
- Clínica da Família Maria do Socorro Silva e Souza, Secretaria Municipal de Saúde do Rio de Janeiro, Clínica da Família Estácio de Sá, Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Robinson Esteves Pires
- Departamento de Ortopedia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Alexandre Godoy-Santos
- Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Peter V. Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, United Kingdom
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Downie S, Kanya I, Madden K, Bhandari M, Jariwala AC. Intimate partner violence (IPV) in male and female orthopaedic trauma patients: a multicentre, cross-sectional prevalence study. BMJ Open 2021; 11:e046164. [PMID: 34429306 PMCID: PMC8386229 DOI: 10.1136/bmjopen-2020-046164] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Identify the proportion of patients attending fracture clinics who had suffered intimate partner violence (IPV) within the past year. DESIGN Powered cross-sectional study using validated participant self-reported questionnaires. SETTING AND PARTICIPANTS Adult trauma patients (no gender/age exclusions) attending one of three Scottish adult fracture clinics over 16-month period (from October 2016 to January 2018). PRIMARY OUTCOME MEASURE Number of participants answering 'yes' to the Woman Abuse Screening Tool question: 'In your current relationship over the past twelve months, has your partner ever abused you physically/emotionally/sexually?' RESULTS Of 336 respondents, 46% (156/336 known) were women with 65% aged over 40 (212/328 known). The overall prevalence of IPV within the preceding 12 months was 12% 39/336) for both male and female patients. The lifetime prevalence of IPV among respondents was 20% (68/336). 38% of patients who had experienced IPV within the past 12 months had been physically abused (11/29). None of the patients were being seen for an injury caused by abuse. Two-thirds of respondents thought that staff should ask routinely about IPV (55%, 217/336), but only 5% had previously been asked about abuse (18/336). CONCLUSIONS This is the first study worldwide investigating the prevalence of IPV in fracture clinics for both male and female patients. 12-month prevalence of IPV in fracture clinic patients is significant and not affected by gender in this study. Patients appear willing to disclose abuse within this setting and are supportive of staff asking about abuse. This presents an opportunity to identify those at risk within this vulnerable population.
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Affiliation(s)
- Samantha Downie
- Orthopaedics Department, NHS Tayside, Dundee, UK
- University Department of Orthopaedics and Trauma Surgery, University of Dundee, Dundee, UK
| | | | - Kim Madden
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Arpit C Jariwala
- Orthopaedics Department, NHS Tayside, Dundee, UK
- University Department of Orthopaedics and Trauma Surgery, University of Dundee, Dundee, UK
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Santesso N, Akl E, Bhandari M, Busse JW, Cook DJ, Greenhalgh T, Muti P, Schünemann H, Guyatt G. A practical guide for using a survey about attitudes and behaviors to inform health care decisions. J Clin Epidemiol 2020; 128:93-100. [PMID: 32987165 DOI: 10.1016/j.jclinepi.2019.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/21/2019] [Accepted: 11/06/2019] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Surveys can provide important information about what people think or do. There is little guidance about how to use surveys in decision-making. This article provides guidance for how to appraise and use a survey to answer health care questions. STUDY DESIGN AND SETTING A guidance article about the use a survey of a selected sample of people, who completed a self-report tool about their knowledge, beliefs and opinions, behaviors and experiences, or personal attributes. We use survey examples, one scenario, and a specific survey for illustration. RESULTS Decision makers should consider the credibility and applicability of the results of a survey. Key threats to credibility depend on the representativeness of the population and likelihood that it provides an accurate picture of the population's knowledge, attitudes, or self-reported practices. If survey investigators do not use rigorous strategies to develop or pretest questions, there is a greater risk that results will be misleading. Decision makers may want to consider the precision of estimates and whether it would change their decisions. Finally, they need to decide how similar the surveyed population is to their specific population before applying results. CONCLUSIONS Decision makers can follow this guidance to critically appraise, interpret, and apply the results of surveys to health care questions.
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Affiliation(s)
- Nancy Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Elie Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | | | - Paola Muti
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Holger Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Guyatt P, Bzovsky S, Bhandari M, Sprague S. Top 10 Things Every Radiologist Needs to Know About Intimate Partner Violence [Formula: see text]. Can Assoc Radiol J 2020; 72:222-227. [PMID: 32960099 DOI: 10.1177/0846537120956542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Intimate partner violence (IPV) is considered to be the leading cause of nonfatal injury to women worldwide. Moreover, the need for effective training for health care professionals (HCPs) and protocol for addressing IPV in health care contexts are well-documented. This article addresses key questions that radiologists may have related to supporting patients who have experienced IPV. METHODS Peer-reviewed journal articles and other formal reports were located using Google Scholar and PubMed in order to assemble this review. CONCLUSIONS Radiologists are well-equipped to help identify possible instances of IPV if they are aware of the injury patterns commonly associated with IPV. Along with other HCPs, radiologists can also advocate for the implementation of protocols that will guide their responses to victims of IPV within their own health care institution.
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Affiliation(s)
- Paige Guyatt
- Division of Orthopaedic Surgery, Department of Surgery, 3710McMaster University, Hamilton, Ontario, Canada
| | - Sofia Bzovsky
- Division of Orthopaedic Surgery, Department of Surgery, 3710McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, 3710McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada
| | - Sheila Sprague
- Division of Orthopaedic Surgery, Department of Surgery, 3710McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada
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Downie S, Madden K, Bhandari M, Jariwala A. A prospective questionnaire-based study on staff awareness of intimate partner violence (IPV) in orthopaedic trauma patients. Surgeon 2019; 17:207-214. [DOI: 10.1016/j.surge.2018.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/25/2018] [Accepted: 07/21/2018] [Indexed: 10/28/2022]
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Cohen AR, Clark TJ, Renner LM, Carter PC, Shriver EM. Intimate partner violence as a mechanism of traumatic ocular injury in women. Can J Ophthalmol 2019; 54:355-358. [DOI: 10.1016/j.jcjo.2018.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/19/2018] [Accepted: 05/30/2018] [Indexed: 10/28/2022]
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Prospective evaluation of intimate partner violence in fracture clinics (PRAISE-2): protocol for a multicentre pilot prospective cohort study. Pilot Feasibility Stud 2018; 4:115. [PMID: 29946480 PMCID: PMC6003159 DOI: 10.1186/s40814-018-0301-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background One third of women experience intimate partner violence (IPV) in their lifetime. Orthopaedic health care professionals are in a good position to identify women experiencing escalating physical violence and act to promote their immediate safety, connect them to IPV resources, and reduce the risk of further harm. However, there have been no studies that explore whether experiencing a musculoskeletal injury can trigger or worsen IPV, and there have been no studies on how experiences of IPV affect orthopaedic outcomes. The primary objective of the PRAISE-2 pilot study is to assess the feasibility of conducting a large cohort study to determine the association between IPV and injury-related complications. The secondary clinical objectives are to preliminarily explore how a history of IPV affects orthopaedic outcomes and how patterns of IPV change over time following an orthopaedic injury. Methods We will complete a pilot multicentre prospective cohort study of 250 women with musculoskeletal injuries to determine the feasibility of a multinational prospective cohort study that will determine if prior or ongoing IPV affects orthopaedic outcomes following an injury, and how patterns of IPV change over time. Our primary outcome is feasibility measured using recruitment rate (success criterion 50 patients/site in 12 months), adherence to visit windows (success criterion 75%), participant retention (success criterion 85%), and data completeness (success criterion 80%). Our secondary exploratory clinical outcomes are injury-related complications, return to function, new IPV disclosures, utilization and cost of support services, changes in abuse patterns, quality of life, and readiness to make relationship changes. We will assess feasibility based on pre-defined criteria for feasibility success and we will analyze secondary outcomes in an exploratory fashion. Discussion The PRAISE-2 pilot study is the first step toward determining how experiences of IPV affect orthopaedic outcomes such as injury-related complications. This study will determine feasibility and assist in the development of large-scale multinational prospective IPV studies for our future IPV research program. This study will engage health care professionals from around the world to increase awareness of how IPV affects patients' musculoskeletal and injury outcomes. Trial registration clinicaltrials.gov NCT02529267. Registered 20 Aug 2015.
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An intimate partner violence informational program in a hospital fracture clinic: a pre-test post-test intervention study. J Inj Violence Res 2017; 9:793. [PMID: 28039685 PMCID: PMC5279988 DOI: 10.5249/jivr.v9i1.793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 06/02/2016] [Indexed: 11/30/2022] Open
Abstract
Background: Many organizations have conducted Intimate Partner Violence (IPV) informational campaigns, but the extent to which such cost-effective, simple changes to the clinic environment can improve patient perceptions about IPV is largely unknown. Our primary objective was to determine how an IPV informational program affects patients’ perceptions about discussing IPV in a fracture clinic setting. Methods: We conducted a pre-post intervention study to evaluate the impacts of an IPV informational program on patients’ perceptions and willingness to discuss IPV in an orthopaedic fracture clinic setting. During the intervention phase, there were posters and brochures in each bed area and several places in the waiting area, and the surgeons received a button to wear on their lab coat stating their openness to discuss IPV and a set of instructions on how to ask patients about IPV and refer them to resources. Results: A total of 160 patients (80 pre-intervention and 80 post-intervention) have participated in this study. Overall perception of the clinic as an open place in which to discuss IPV did not change as a result of the informational program compared to the control setting. However, more patients exposed to posters and information about IPV believed the clinic staff possessed resources to help IPV victims compared to the control group; however, this difference did not reach statistical significance (62% vs. 53%, respectively, p=0.29). Conclusions: Passive interventions may serve an adjunctive role in facilitating active interventions in a clinic environment, but should not be considered in isolation as an effective approach.
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Affiliation(s)
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- Department of Clinical Epidemiology & Biostatistics, McMaster University, Ontario, Canada.
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Cochrane in CORR (®): Screening Women for Intimate Partner Violence in Healthcare Settings (Review). Clin Orthop Relat Res 2016; 474:1897-903. [PMID: 27385221 PMCID: PMC4965392 DOI: 10.1007/s11999-016-4957-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 06/21/2016] [Indexed: 01/31/2023]
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12
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Rathi VK, Samuel AM, Mehra S. Industry Ties in Otolaryngology. Otolaryngol Head Neck Surg 2015; 152:993-9. [DOI: 10.1177/0194599815573718] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/29/2015] [Indexed: 11/17/2022]
Abstract
Objective To characterize nonresearch payments made by industry to otolaryngologists in order to explore how the potential for conflicts of interests varies among otolaryngologists and compares between otolaryngologists and other surgical specialists. Study Design Retrospective cross-sectional database analysis. Setting Open Payments program database recently released by Centers for Medicare and Medicaid Services. Subjects Surgeons nationwide who were identified as receiving nonresearch payment from industry in accordance with the Physician Payment Sunshine Act. Methods The proportion of otolaryngologists receiving payment, the mean payment per otolaryngologist, and the standard deviation thereof were determined using the Open Payments database and compared to other surgical specialties. Otolaryngologists were further compared by specialization, census region, sponsor, and payment amount. Results Less than half of otolaryngologists (48.1%) were reported as receiving payments over the study period, the second smallest proportion among surgical specialties. Otolaryngologists received the lowest mean payment per compensated individual ($573) compared to other surgical specialties. Although otolaryngology had the smallest variance in payment among surgical specialties (SD, $2806), the distribution was skewed by top earners; the top 10% of earners accounted for 87% ($2,199,254) of all payment to otolaryngologists. Otolaryngologists in the West census region were less likely to receive payments (38.6%, P < .001). Conclusion Over the study period, otolaryngologists appeared to have more limited financial ties with industry compared to other surgeons, though variation exists within otolaryngology. Further refinement of the Open Payments database is needed to explore differences between otolaryngologists and leverage payment information as a tool for self-regulation.
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Affiliation(s)
- Vinay K. Rathi
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andre M. Samuel
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Saral Mehra
- Department of Surgery (Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, USA
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Ben Natan M, Muasi H, Farhan F, Shhada M, Masarwa G. Israeli Arab Muslim women's willingness to be screened for intimate partner violence: A survey. Nurs Health Sci 2014; 17:26-32. [PMID: 24636365 DOI: 10.1111/nhs.12125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 11/24/2013] [Accepted: 12/03/2013] [Indexed: 11/26/2022]
Abstract
In the present study, we explored whether the research model based on the Theory of Reasoned Action predicts Israeli Arab Muslim women's willingness to be screened for intimate partner violence at healthcare facilities. Three hundred women completed a questionnaire. Most women (68.4%) expressed willingness to be screened, however, only 16% of them had been screened over the past year. Women's beliefs about screening for intimate partner violence and the support of significant others were found to predict this willingness. The study may constitute an initial foundation for determining national policy with the aim of detecting and eradicating the phenomenon among this unique population.
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Affiliation(s)
- Merav Ben Natan
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera.,Department of Nursing, School of Health Professions, Tel Aviv University, Tel Aviv, Israel
| | - Hiba Muasi
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera
| | - Fidaa Farhan
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera
| | - Miada Shhada
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera
| | - Gada Masarwa
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera
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