Abstract
BackgroundIntimate partner violence (IPV) including physical, sexual and emotional violence, causes short and long term ill-health. Brief questions that reliably identify women experiencing IPV who present in clinical settings are a pre-requisite for an appropriate response from health services to this substantial public health problem. We estimated the sensitivity and specificity of four questions (HARK) developed from the Abuse Assessment screen, compared to a 30-item abuse questionnaire, the Composite Abuse Scale (CAS).MethodsWe administered the four HARK questions and the CAS to women approached by two researchers in general practice waiting rooms in Newham, east London. Inclusions: women aged more than 17 years waiting to see a doctor or nurse, who had been in an intimate relationship in the last year. Exclusions: women who were accompanied by children over four years of age or another adult, too unwell to complete the questionnaires, unable to understand English or unable to give informed consent.ResultsTwo hundred and thirty two women were recruited. The response rate was 54%. The prevalence of current intimate partner violence, within the last 12 months, using the CAS cut off score of ≥3, was 23% (95% C.I. 17% to 28%) with pre-test odds of 0.3 (95% C.I. 0.2 to 0.4). The receiver operator characteristic curve demonstrated that a HARK cut off score of ≥1 maximises the true positives whilst minimising the false positives. The sensitivity of the optimal HARK cut-off score of ≥1 was 81% (95% C.I. 69% to 90%), specificity 95% (95% C.I. 91% to 98%), positive predictive value 83% (95% C.I. 70% to 91%), negative predictive value 94% (95% C.I. 90% to 97%), likelihood ratio 16 (95% C.I. 8 to 31) and post-test odds 5.ConclusionThe four HARK questions accurately identify women experiencing IPV in the past year and may help women disclose abuse in general practice. The HARK questions could be incorporated into the electronic medical record in primary care to prompt clinicians to ask about recent partner violence and to encourage disclosure by patients. Future research should test the effectiveness of HARK in clinical consultations.
Highlights
Intimate partner violence (IPV) including physical, sexual and emotional violence, causes short and long term ill-health
The prevalence of IPV is higher among women seeking primary care than in community surveys of the same geographic populations [3]
In a study in 12 east London general practices it was found that 41% of women waiting to see their general practitioner (GP) or practice nurse had experienced physical violence from a partner or former partner. 17% had experienced it within the past year [4]
Summary
Intimate partner violence (IPV) including physical, sexual and emotional violence, causes short and long term ill-health. Brief questions that reliably identify women experiencing IPV who present in clinical settings are a pre-requisite for an appropriate response from health services to this substantial public health problem. Intimate partner violence (IPV) including physical, sexual and emotional abuse is a major public health problem. The WHO Violence Against Women study [2] found that the prevalence of lifetime physical violence and sexual violence by an intimate partner, among ever-partnered women varied from 15 to 71% in urban and rural settings in 10 countries. In a study in 12 east London general practices it was found that 41% of women waiting to see their general practitioner (GP) or practice nurse had experienced physical violence from a partner or former partner. Consequences of IPV extend to perinatal health with it being an independent risk factor for deficit in gestational weight gain during pregnancy [6] and strong evidence of an IPV association with low birth weight [7]
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