Intimate Partner Violence Screening Research Articles

Evaluation of the measurement properties of intimate partner violence screening instruments for the general population: A COSMIN-based international systematic review.

To systematically appraise, compare, and summarize the measurement properties of intimate partner violence screening instruments for the general population and provide recommendations. We searched PubMed, Embase, Web of Science, ProQuest Dissertations & Theses Global and EBSCO Psychology Behavioral Sciences Collection from their establishment to March 2024 using systematic search strategies. The methodological quality of the instruments that met the inclusion criteria and their measurement properties were assessed using the COSMIN methodology, and the COSMIN recommendations were followed. We reported this study using PRISMA 2020 checklist. A total of 23 studies were eventually included, and 18 instruments were identified. The evaluation of the methodological quality indicates poor content validity but good structural validity; however, that of the criterion validity in most of the studies was inadequate. Measurement error and responsiveness were not assessed. Four screening instruments could be used in the interim. The remaining 14 instruments were not recommended for use. The overall methodological quality of most of the assessed instruments was insufficient. A rigorous intimate partner violence screening instrument with good measurement properties is urgently required to identify and screen for intimate partner violence in the general population. CRD42022365247.

An assessment of the content of antenatal care provided by obstetricians in Lebanon: A cross-sectional study.

Quality and timely antenatal care is a vital component of pregnancy care for the well-being of mothers and babies. The aim of this study of to assess self-reported obstetricians' adherence to national and international antenatal care guidelines in Lebanon. This cross-sectional study approached all obstetricians registered with the Lebanese Society of Obstetrics and Gynecology and the Lebanese Order of Physicians to participate in an online and telephone-based survey. The study tool included all of the items from the World Health Organization and national guidelines for antenatal care. Obstetricians' self-reported adherence was assessed across five modules including dietary interventions, dietary supplements, antenatal care assessment, fetal growth assessment, and antenatal care preventive measures. A total of 134 obstetricians completed the survey. Overall, adherence was high for most antenatal care guidelines except for providing nutrition services to undernourished pregnant women, screening for intimate partner violence, and providing tetanus vaccines. The number of recommended antenatal care visits (≥8 vs. <8 visits) was higher among obstetricians in Mount Lebanon or Beirut compared to other areas in Lebanon (72.7%vs.48.6%; p-value <0.01). Provision of tetanus or diphtheria, tetanus, and pertussis (DTP) vaccination was lower for obstetricians who provide care for women who pay out-of-pocket compared to obstetricians who provide care to women who use other payment methods (25.3%vs.45.7%; p-value = 0.024). Group B streptococcus screening test and the provision of at least five ultrasounds were higher among obstetricians who provide care in private clinics or clinics in private hospitals compared to clinics in public hospitals or primary healthcare centers (88.8%vs.66.7%; p-value = 0.023) and (83.6%vs.55.6%; p-value = 0.011), respectively. Reinforcing the adherence to all antenatal care guidelines by continuous monitoring of health facilities is crucial for best practice. Subsidies for essential services may be required for those who are unable to afford components of antenatal care.

I had to tell to survive“- a cross-sectional study on exposure to intimate partner violence in pregnant women and the importance of screening

BackgroundThere is a lack of knowledge in Swedish healthcare regarding correlations of exposure to intimate partner violence (IPV) from before to during pregnancy, and associated factors as well as pregnant women’s perceptions related to screening for IPV in healthcare settings. The frequency of women exposed to IPV during pregnancy is difficult to establish as it is reported at different rates across different studies, depending on the definitions and screening strategies used. Aims1. Describe prevalence of IPV experienced by pregnant women. 2. Investigate changes in IPV exposure before and during pregnancy. 3. Examine frequency of screening and women’s opportunities and willingness to talk about IPV exposure. Methods.A cross-sectional survey in Stockholm, Sweden. Findings6.2 % of women (n = 202) reported exposure to IPV before pregnancy and 2.1 % (n = 72) reported exposure during pregnancy, of these, sixteen women reported exposure only during pregnancy. There were significant associations between exposure to IPV and symptoms of depression, age, living situations and employment status. Sixty-four percent of the exposed women were asked about violence in healthcare settings. DiscussionAn important finding was that the frequency of IPV decreased from before to during pregnancy. The reasons for this are unknown but may be multi-factorial. ConclusionOur investigation provides crucial insights into IPV during pregnancy. Results highlight that relying solely on prevalence rates is inadequate to understand the complexity of IPV exposure related to pregnancy. Screening for IPV and understanding how women perceive and disclose their exposure is complex yet vital for midwives in antenatal care.

The Associations Between Intimate Partner Violence and Mental Health Outcomes Among Sexual Minority Men: A Systematic Review and Meta-Analysis.

Sexual minority men (SMM) experience intimate partner violence (IPV) at a substantially high rate and also bear high burdens of adverse mental health outcomes. This systematic review and meta-analysis aimed to consolidate existing evidence on the associations between experiencing IPV and adverse mental health outcomes (depressive symptoms, anxiety, stress, etc.) among SMM. Following the Preferred Reporting Items For Systematic Reviews and Meta-Analyses guideline, we identified 22 published studies encompassing data from 18,454 individuals, all of which were cross-sectional in design and half of which were conducted in the U.S. We found that experiencing IPV was associated with an increased risk of depressive symptoms and anxiety with a pooled Adjusted Odds Ratios (AORs) of 1.71 (95% CI [1.43, 2.05]) and 1.89 (95% CI [1.46, 2.43]), respective. Studies also found that IPV was positively associated with suicide-related risk (AOR = 2.71, 95% CI [2.21, 3.32] and perceived loneliness. Studies varied in their IPV measures and recall periods and used diverse mental health measurement tools like PHQ-9/GAD-7, Perceived Stress Scale, and the Suicide Behaviors Questionnaire-Revised. This systematic review and meta-analysis revealed an urgent need to examine the effects of IPV on SMM's mental well-being in low- and middle-income countries using standardized IPV measurement tools. Future research should employ a longitudinal design to track the long-term effects of IPV on the mental well-being of SMM and explore potential interventions for mitigating these impacts over time. These insights are crucial for enhancing IPV screening within healthcare settings and identifying key intervention targets aimed at improving the mental health of SMM.

Relation Between Intimate Partner Violence During Pregnancy and Postpartum Mother Psychological Wellbeing

Background: Intimate partner violence (IPV) may be physical violence, psychological or sexual abuse by a current or former intimate partner. It is an avoidable global public health problem. IPV in pregnancy, despite being a common problem but remains a neglected condition (1). The severity of violence from a partner during pregnancy was reported to be greater than violence before pregnancy due to possibly change in a couple’s relationship and lifestyle accompanying pregnancy (2).Numerous studies revealed that experiencing IPV during pregnancy negatively affects both mothers and infants during the post- partum period(3).Objectives: to assess prevalence of postpartum depression and anxiety and assess possible relation between partner violence during pregnancy and postpartum psychological health. Design: prospective cohort study Method: This study was carried out on 176 pregnant women attending antenatal care to explore the possible relation between intimate partner violence and postpartum depression and anxiety. The assessment was done during the second trimester by screening the sociodemographic factors, screening of intimate partner violence was done using the Arabic version of the Composite Abuse Scale. Postpartum assessment by screening of maternal depression was done by the Arabic version of the Edinburgh post-partum depression scale, and screening of anxiety using the Arabic version of Perinatal Anxiety Screening Scale. Results: the prevalence of intimate partner violence during pregnancy was 19.3%. Near half of participants suffered from postpartum depressive illness and around one quarter suffered from possible depression. More than half of participants suffered from mild to moderate postpartum anxiety. Partner violence had also significant relation with depression during pregnancy and post-partum with p-value &lt;0.001 for both. Conclusions: intimate partner violence may be a risk factor for postpartum depression and anxiety.so, we should screen for it and learn how to deal with this problem.

Views from midwives and perinatal nurses on barriers and facilitators in responding to perinatal intimate partner violence in Japan: baseline interview before intervention

BackgroundMidwives and perinatal nurses play a crucial role in responding to intimate partner violence (IPV) against pregnant women; however, these roles are often not performed adequately. This study aimed to identify provider-related, healthcare system, and social barriers and facilitators to IPV response from the perspective of midwives and perinatal nurses.MethodsThis qualitative descriptive study used semi-structured interviews with five midwives and a nurse from perinatal care facilities in Tokyo, Japan. A framework approach was employed to analyze the interview transcripts.ResultsBarriers included inadequate knowledge about IPV and reluctance to provide support by healthcare providers. Barriers in the healthcare system included the absence of structural infrastructure for IPV response. This involved the lack of screening tool adoption, the partner’s presence during interviews, and time constraints. Additionally, there was insufficient systematic and collaborative coordination within and outside the team. Another barrier was the lack of in-service training to develop IPV-related knowledge and skills. Finally, there was uncertainty about how the support at healthcare facilities impacts women’s lives. Further barriers in the social system included the absence of additional reimbursement for IPV response. There was also a lack of a comprehensive approach to IPV that provides for the rehabilitation of perpetrators and care for the children of victims and a culture that discourages separation from the perpetrator. Conversely, facilitators included healthcare providers recognizing the perinatal period as an opportunity to address IPV. They also acknowledged IPV as a prevalent issue, practiced conscious self-care, and systematically collaborated within the healthcare team.ConclusionThis study emphasized the need for routine IPV screening in perinatal care and the importance of team-based educational interventions for healthcare providers to facilitate implementation.

Patterns of Intimate Partner Violence Among Veterans: A Latent Class Analysis.

The majority of intimate partner violence (IPV) research is unidirectional, focusing on IPV use (i.e., perpetration) or experience (i.e., victimization). However, when IPV use and experience data are simultaneously included in analyses, bidirectional IPV often emerges as a common IPV pattern. The objective of this study was to examine patterns of IPV use and experience, risk factors that may be associated with these patterns, and potential gender differences within a sample of post-9/11 Veterans. This study included a national sample of post-9/11 Veterans (N = 1,150; 50.3% women) who completed self-report measures at two timepoints. We performed a latent class analysis (LCA) to determine the appropriate number of IPV classes, conducted sensitivity analyses, and examined factors potentially associated with IPV class membership. We identified three distinct classes of IPV: Low to no IPV, Bidirectional Psychological IPV, and Bidirectional Multiform IPV. Men and women reported similar rates of IPV use and experience, and there were no gender differences in the LCA model. However, race and ethnicity, employment status, children in the household, marital status, child abuse or witnessing family violence, lifetime physical assault, posttraumatic stress symptoms, and binge drinking were differentially associated with class membership. This study extends existing knowledge on patterns of IPV among Veterans and factors associated with these patterns. Bidirectional IPV was the most common IPV pattern, underscoring the importance of examining IPV use and experience concurrently within research and clinical samples, and developing comprehensive IPV screening and treatment strategies that incorporate bidirectional IPV in work to advance relationship health and safety among Veterans.

Intimate Partner Violence and Its Effects on Maternal and Child Health: A Longitudinal Study in Bener Meriah Regency, Aceh, Indonesia

Intimate partner violence (IPV) is a significant public health issue with devastating consequences for maternal and child health. This study investigates the prevalence and impact of IPV on pregnant women and their children in Bener Meriah Regency, Aceh, Indonesia, a region with limited research on this topic. A longitudinal study was conducted with 250 pregnant women recruited from antenatal clinics in Bener Meriah Regency. Data were collected through questionnaires and interviews at three time points: during pregnancy, six months postpartum, and one year postpartum. The questionnaires assessed IPV experiences, maternal mental health (depression, anxiety, and stress), and child health outcomes (birth weight, growth, and development). The prevalence of IPV during pregnancy was 32%. Women who experienced IPV were significantly more likely to suffer from depression, anxiety, and stress during pregnancy and postpartum. IPV was also associated with lower birth weight and an increased risk of developmental delays in children. In conclusion, this study highlights the serious consequences of IPV for maternal and child health in Bener Meriah Regency. The findings underscore the urgent need for IPV screening and intervention programs in antenatal and postnatal care settings. Midwives play a critical role in identifying and supporting women experiencing IPV.

Rising to the challenge: The motivation to champion routine intimate partner violence screening in rural emergency departments.

To understand the motivations of champions who worked to bring about system and practice change that supported routine screening for intimate partner violence (IPV) in two rural emergency departments (EDs). Practice changes are required to achieve routine and effective identification and response to IPV. Nurses play a significant role in affecting such practice change. This paper identifies the motivations of champions in the ED setting who successfully brought about such change. The EDs of two Level 5 tertiary hospitals within a rural Local Health District (LHD) of New South Wales, Australia. Twenty-three individuals who identified as champions and worked to introduce routine IPV screening in two rural hospital EDs. Qualitative longitudinal semi-structured interviews employing a process of constant comparison and an interpretive framework to analyse data thematically. Interviews were carried out between June and August 2017 and again between July and August 2019. Over the period of the study, routine screening was established, and screening rates steadily increased from a low baseline to a significantly higher rate. Three aspects of champion motivation emerged from the analysis: formation of an identity as a champion, making a difference to a significant social justice issue and providing quality and community-relevant care. This study is the first study to report on champions and their motivation as they supported IPV practice change in the ED. The findings highlight the capacity for innovation in rural health services, with important implications for other settings looking to translate similar programs. Understanding motivating factors may assist in improved utilisation and support for champions. This is vital if champions are to bring about required practice change within their service and ensure the needs of individuals experiencing IPV are effectively met.

Untold Stories of Displaced Rohingya Pregnant Women Exposed to Intimate Partner Violence in Camp Settings

Intimate partner violence (IPV) strongly impacts the physical, sexual, social, and reproductive health of women, causing an array of psychological and behavioural problems. During pregnancy, the detrimental effects of violence extend to both the mother and the child. Rates of IPV are frequently higher among those in conflict‐affected and displaced communities, most of whom live in low and middle‐income countries. IPV against Rohingya women is common due to relocation, family breakups, patriarchal norms, and deep‐seated gender roles. Despite the high prevalence of IPV in Rohingya refugees in Bangladesh, the matter is often under‐examined. This qualitative study aims to explore and understand pregnant IPV victims’ unique experiences and hardships among the displaced population in a camp setting. A sample of six pregnant homemakers with no formal education was recruited from a healthcare service provider in Leda Camp 24, a remote camp in Cox’s Bazar, Bangladesh. Semi‐structured, in‐depth, face‐to‐face interviews were conducted. Participants reported diverse manifestations of IPV victimisation. Physical abuse, emotional abuse, economic abuse, sexual abuse, pregnancy‐related consequences, and impact on mental health were commonly experienced by participants of this study. The current research investigates the recurrent abuse experienced by this demography, providing detailed narrative information beyond quantitative descriptions of IPV experiences. This article contributes to the existing knowledge on the intersection of IPV, pregnancy, and mental health among displaced populations. Governmental and non‐governmental stakeholders must contextualise these findings in policies and practices by integrating IPV and violence screening, prevention, and treatment protocols into refugee camps and healthcare service providers.

A Clinical Decision Support Tool for Intimate Partner Violence Screening Among Women Veterans: Development and Qualitative Evaluation of Provider Perspectives.

Women veterans, compared to civilian women, are especially at risk of experiencing intimate partner violence (IPV), pointing to the critical need for IPV screening and intervention in the Veterans Health Administration (VHA). However, implementing paper-based IPV screening and intervention in the VHA has revealed substantial barriers, including health care providers' inadequate IPV training, competing demands, time constraints, and discomfort addressing IPV and making decisions about the appropriate type or level of intervention. This study aimed to address IPV screening implementation barriers and hence developed and tested a novel IPV clinical decision support (CDS) tool for physicians in the Women's Health Clinic (WHC), a primary care clinic within the Veterans Affairs Palo Alto Health Care System. This tool provides intelligent, evidence-based, step-by-step guidance on how to conduct IPV screening and intervention. Informed by existing CDS development frameworks, developing the IPV CDS tool prototype involved six steps: (1) identifying the scope of the tool, (2) identifying IPV screening and intervention content, (3) incorporating IPV-related VHA and clinic resources, (4) identifying the tool's components, (5) designing the tool, and (6) conducting initial tool revisions. We obtained preliminary physician feedback on user experience and clinical utility of the CDS tool via the System Usability Scale (SUS) and semistructured interviews with 6 WHC physicians. SUS scores were examined using descriptive statistics. Interviews were analyzed using rapid qualitative analysis to extract actionable feedback to inform design updates and improvements. This study includes a detailed description of the IPV CDS tool. Findings indicated that the tool was generally well received by physicians, who indicated good tool usability (SUS score: mean 77.5, SD 12.75). They found the tool clinically useful, needed in their practice, and feasible to implement in primary care. They emphasized that it increased their confidence in managing patients reporting IPV but expressed concerns regarding its length, workflow integration, flexibility, and specificity of information. Several physicians, for example, found the tool too time consuming when encountering patients at high risk; they suggested multiple uses of the tool (eg, an educational tool for less-experienced health care providers and a checklist for more-experienced health care providers) and including more detailed information (eg, a list of local shelters). Physician feedback on the IPV CDS tool is encouraging and will be used to improve the tool. This study offers an example of an IPV CDS tool that clinics can adapt to potentially enhance the quality and efficiency of their IPV screening and intervention process. Additional research is needed to determine the tool's clinical utility in improving IPV screening and intervention rates and patient outcomes (eg, increased patient safety, reduced IPV risk, and increased referrals to mental health treatment).

Evaluation of intimate partner violence screening administration formats in a court-affiliated family mediation program.

Evaluation of intimate partner violence screening administration formats in a court-affiliated family mediation program.

An Overview of Health Care Support of Intimate Partner Violence Survivors

Intimate Partner Violence (IPV) has severe physical and psychological effects on survivors. Despite growing awareness, accessing comprehensive health care remains a challenge for many survivors. This review aims to assess the impact of IPV on the survivors, health care needs, and interventions for IPV survivors, evaluate their effectiveness, and identify areas for improvement. This paper reviewed literature and guidelines from reputable journals with a focus on studies about health care support, including interventions and outcomes for IPV survivors. The paper found there is a need for routine IPV screening in health settings, effective multidisciplinary care, and better training for healthcare providers. Barriers such as stigma, resource limitations, and inadequate referral systems were common. Survivors also face difficulties accessing the healthcare system due to fear and confidentiality issues. Quality and effective support requires universal screening, trauma-informed care, and accessible services. While some practices are beneficial, there is a need for standard and improved provider training. Policymakers should focus on overcoming systemic barriers and enhancing support services. The support system for IPV survivors is improving but still faces significant challenges. Addressing these issues through better policies, resources, and training is crucial for providing effective care and reducing the long-term impact of IPV. Keywords: Intimate Partner Violence, Health Care Support, Survivor support, Multidisciplinary Approaches, Trauma-Informed Care

Implementation and Impact of Intimate Partner Violence Screening Expansion in the Veterans Health Administration: Protocol for a Mixed Methods Evaluation.

Intimate partner violence (IPV) is a significant public health problem with far-reaching consequences. The health care system plays an integral role in the detection of and response to IPV. Historically, the majority of IPV screening initiatives have targeted women of reproductive age, with little known about men's IPV screening experiences or the impact of screening on men's health care. The Veterans Health Administration (VHA) has called for an expansion of IPV screening, providing a unique opportunity for a large-scale evaluation of IPV screening and response across all patient populations. In this protocol paper, we describe the recently funded Partnered Evaluation of Relationship Health Innovations and Services through Mixed Methods (PRISM) initiative, aiming to evaluate the implementation and impact of the VHA's IPV screening and response expansion, with a particular focus on identifying potential gender differences. The PRISM Initiative is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and Consolidated Framework for Implementation Research (CFIR 2.0) frameworks. We will use mixed methods data from 139 VHA facilities to evaluate the IPV screening expansion, including electronic health record data and qualitative interviews with patients, clinicians, and national IPV program leadership. Quantitative data will be analyzed using a longitudinal observational design with repeated measurement periods at baseline (T0), year 1 (T1), and year 2 (T2). Qualitative interviews will focus on identifying multilevel factors, including potential implementation barriers and facilitators critical to IPV screening and response expansion, and examining the impact of screening on patients and clinicians. The PRISM initiative was funded in October 2023. We have developed the qualitative interview guides, obtained institutional review board approval, extracted quantitative data for baseline analyses, and began recruitment for qualitative interviews. Reports of progress and results will be made available to evaluation partners and funders through quarterly and end-of-year reports. All data collection and analyses across time points are expected to be completed in June 2026. Findings from this mixed methods evaluation will provide a comprehensive understanding of IPV screening expansion at the VHA, including the implementation and impact of screening and the scope of IPV detected in the VHA patient population. Moreover, data generated by this initiative have critical policy and clinical practice implications in a national health care system. PRR1-10.2196/59918.

Barriers and facilitators to screening for intimate partner violence at a level 1 trauma center

BackgroundIntimate partner violence (IPV) is a significant public health problem that is associated with substantial health sequelae, including traumatic injury. Surgical professional societies recommend universal intimate partner violence screening in patients presenting after trauma, but this recommendation is not uniformly implemented. We designed and implemented a quality improvement project at our institution in July 2020 to enhance intimate partner violence screening. Although screening rates improved, they remained suboptimal. Therefore, we sought to examine barriers and facilitators to intimate partner violence screening from trauma clinicians’ perspectives. Study DesignWe conducted a qualitative study using in-depth, semistructured interviews to understand the perspectives and experiences of trauma clinicians conducting intimate partner violence screening. A constructivist paradigm informed our study whereby our data collection approaches aimed to understand intimate partner violence screening from the perspectives of those tasked with implementing screening within real-world clinical settings. We used thematic analysis to analyze our data and generate themes related to barriers and facilitators to screening. ResultsWe conducted interviews with 12 resident physicians and 2 advance practice providers. We identified 6 themes, 3 reflecting facilitator themes as (1) standardized education and workflow, (2) benefits of interdisciplinary teamwork, and (3) context of screening, and 3 reflecting barrier themes as (1) lack of time, (2) language misinterpretation, and (3) perceived inappropriateness of universal screening. ConclusionTrauma clinicians described multiple facilitators and barriers to screening for intimate partner violence following traumatic injury, some of which were unique to the trauma setting. Projects seeking to achieve universal screening following traumatic injury may benefit from accounting for these factors when designing interventions.

Pediatricians’ Practices and Desired Resources for Addressing Intimate Partner Violence

To explore pediatricians’ perspectives on supporting intimate partner violence (IPV) survivors, including (a) clinical practices and resource use, (b) ideal resources, and (c) barriers to the use of existing resources, we conducted dyadic and individual virtual interviews with pediatricians recruited through Twitter and the American Academy of Pediatrics Council, section, and chapter listservs. The interviews were approximately 60 minutes in length, audio recorded, and transcribed verbatim. We used a thematic analysis approach and hybrid deductive–inductive coding. Twenty-three pediatricians participated in 14 interviews. We identified four themes. Participants’ current practices primarily focused on IPV screening and response to disclosure. They described strategies for IPV resource provision and decision-making involving child protective services. They identified multilevel barriers to addressing IPV, including barriers, such as time, identified in previous studies as well as barriers related to the COVID-19 pandemic, telehealth, the electronic health record, and disclosure-focused approaches. The participants desired provider-facing and caregiver-facing resources to strengthen the capacity to address IPV; some were unaware of currently available resources. They noted the need for continued attention to optimizing systems to enhance their capacity to support IPV survivors. Pediatricians report varying practices to address IPV and identify several surmountable barriers to supporting IPV survivors. Our study suggests that disclosure-driven clinical practices, confidentiality concerns, and lack of resources limit pediatricians’ capacity to address IPV. Additional resource development and dissemination efforts are needed to improve the awareness of IPV resources currently available to pediatricians and families.

The Intersection of Intimate Partner Violence, Strangulation, and Brain Injury Screening: A Pilot Project.

Survivors of intimate partner violence are at a high risk for having a brain injury because of high rates of strangulation and head and face injuries sustained from physical abuse. In addition to acute physical injuries, survivors experience various health complications. Many survivors do not seek medical attention for their injuries, and when they do, their brain injury often goes unrecognized and untreated. Research indicates that screening for brain injury can be an effective intervention to increase the identification of brain injuries and medical referrals for diagnosis and treatment. Unfortunately, brain injury screening is not a standard of care. Shelter-seeking clients were routinely screened for brain injury using a modified HELPS screening tool. A positive screen prompted a medical referral. A modified HELPS screening tool was utilized with permission for the project. Before implementation, 36 individuals entered shelter, 0 were screened for brain injury, and the medical referral rate was 19.4% (n = 7). After implementation, 40 clients entered shelter, 36 were screened for brain injury, 77.8% (n = 28) screened positive, and the medical referral rate was 80.6% (n = 29). Brain injury screening may be an effective evidence-based intervention for shelter-seeking survivors of intimate partner violence to increase medical referrals.

Twelve-Month Sustainment of IPV Screening and Response Programs in Primary Care: Contextual Factors Impacting Implementation Success

PurposeThe Veterans Health Administration (VHA) employed implementation facilitation (IF) as a strategy to boost uptake of intimate partner violence (IPV) screening programs in primary care. This study examined the sustainment of screening uptake 1 year after IF and identified factors impacting sustainment success. MethodsA mixed-methods evaluation using quantitative and qualitative data was conducted. IPV screening rates from the conclusion of the IF period (i.e., initial adoption) through the 1-year sustainment period served as the primary outcome. We categorized sites into four groups of screening adoption and sustainment success (high adoption and high sustainment, moderate adoption and moderate sustainment, low adoption and low sustainment, and no adoption and/or no sustainment). Qualitative analysis of key informant interviews was used to identify contextual factors affecting screening 12 months post-IF. A mixed sustainment analysis matrix integrated quantitative and qualitative findings and enabled the identification of cross-site patterns. Main FindingsSeven of the nine sites sustained IPV screening at the most basic level (saw static or increased screening rates). High adopting and high sustaining sites (n = 3) were marked by consistently supportive medical center leadership, ongoing training for clinicians, clear protocols for responding to positive screens, and robust referral options for women experiencing IPV. Nonsustaining sites (n = 2) were marked by a host of barriers including staffing shortages, competing priorities, and inconsistent messaging from leadership regarding the importance of IPV screening. ConclusionsKnowing barriers and facilitators to successful IPV screening sustainment can inform health care systems to tailor IF and other implementation strategies to sustain IPV screening in primary care. Sustainment of IPV screening requires attention to a combination of facilitators (e.g., consistent leadership support and robust referral options) as well as addressing key barriers (e.g., staff turnover and competing priorities).

Electronic Health Record–Based Screening for Intimate Partner Violence

Intimate partner violence (IPV) is a significant public health issue, with a 25% lifetime prevalence. Screening for IPV in primary care is a recommended practice whose effectiveness is debated. To assess the effect of an electronic health record (EHR)-based multifactorial intervention screening on the detection of IPV risk in primary care practice. This cluster randomized clinical trial used a stepped-wedge design to assign 15 family medicine primary care clinics in the Medical University of South Carolina Health System in the Charleston region to 3 matched blocks from October 6, 2020, to March 31, 2023. All women aged 18 to 49 years who were seen in these clinics participated in this study. A noninterruptive EHR alert combined with confidential screening by computer questionnaire using the EHR platform followed by risk assessment and a decision support template. The main outcomes were the rate at which patients were screened for IPV across the clinics and the rate at which patients at risk for IPV were detected by screening procedures. The study clinics cared for 8895 unique patients (mean [SD] age, 34.6 [8.7] years; 1270 [14.3%] with Medicaid or Medicare and 7625 [85.7%] with private, military, or other insurance) over the study period eligible for the screening intervention. The intervention had significant effects on the overall rate of screening for IPV, increasing the rate of screening from 45.2% (10 268 of 22 730 patient visits) to 65.3% (22 303 of 34 157 patient visits) when the noninterruptive alert was active (relative risk, 1.46 [95% CI, 1.44-1.49]; P < .001). The confidential screening process was more effective than baseline nurse-led oral screening at identifying patients reporting past-year IPV (130 of 8895 patients [1.5%] vs 9 of 17 433 patients [0.1%]). The intervention was largely effective in increasing screening adherence and the positive detection rate of IPV in primary care. A highly private approach to screening for IPV in primary care may be necessary to achieve adequate detection rates while addressing potential safety issues of patients experiencing IPV. ClinicalTrials.gov Identifier: NCT06284148.

Orthopaedic Injury Patterns in Intimate Partner Violence: Defensive Wounds and Fracture Patterns: A Systematic Literature Review.

Intimate partner violence (IPV) is a prevalent issue in the United States, despite universal screening measures for women of reproductive age. Orthopaedic surgeons have a unique opportunity to intervene in cases of IPV as musculoskeletal injuries, including fractures, are the second most common type of injury seen in IPV patients. This systematic literature review aims to identify patterns in musculoskeletal injuries caused by IPV to increase identification of patients afflicted by IPV. A comprehensive search of PubMed, PsycINFO, and Web of Science yielded 316 articles. Included were cohort studies and literature reviews of patients with an IPV-associated orthopaedic injury. Excluded were case studies, perspective articles, material predating 2003, and studies with pediatric or elderly populations. Sixteen articles met criteria. Data supported historical findings that musculoskeletal injury is the second most common injury in patients with IPV, with upper extremity fractures prevailing. Minimally displaced phalanges fractures were most common (9.9%-64%), and isolated ulnar fractures had significant relative risk of IPV association (8.5-12.8). Patients with multiple fractures of varying chronicity were more likely to be victims of IPV (sensitivity 25.2%, specificity 99.2%, positive predictive value 96.2%), and these chronic fractures matched patterns of acute injury caused by IPV. New findings in male victims included a higher proportion of lower extremity and pelvic fractures seen in male cohorts. This study synthesizes evidence of IPV-related orthopaedic injuries, offering objective criteria for identifying victims. Despite limitations in fracture descriptions, the findings aid various physicians in recognizing IPV victims. Considering ongoing IPV prevalence and screening challenges, further research on injury patterns is recommended. Level III. See Instructions for Authors for a complete description of levels of evidence.