Screening method can play role in disclosure of intimate partner violence
Reported prevalence rates for intimate partner violence can vary, depending on the screening method, type of questionnaire used and health care setting, and women prefer self-completed questionnaires, compared to face-to-face interviews, according to a study in the August 2 issue of JAMA, a theme issue on violence and human rights.
As intimate partner violence (IPV) has gained recognition as a major public health problem, research efforts have focused on the development of universal screening instruments and protocols for use in health care settings to identify women exposed to IPV, according to background information in the article. Previous studies have demonstrated that women will disclose experiences of violence in response to screening; however, few studies have compared methods of screening.
Harriet L. MacMillan, M.D., of McMaster University, Hamilton, Ontario, Canada, and colleagues compared two screening instruments with the goal of determining an optimal method of screening for IPV in health care settings, based on 3 criteria: (1) 12-month prevalence, (2) extent of missing data, and (3) participant preference. The study included women age 18 to 64 years who were well enough to participate and could be seen individually. Of 2,602 eligible women, 141 (5 percent) refused participation. The randomized trial was conducted from May 2004 to January 2005 at 2 each of emergency departments, family practices, and women's health clinics in Ontario, Canada.
Participants were randomized to 1 of 3 screening approaches: a face-to-face interview with a health care provider (physician or nurse), written self-completed questionnaire, and computer-based self-completed questionnaire. Two screening instruments–the Partner Violence Screen (PVS) and the Woman Abuse Screening Tool (WAST)–were administered and compared with the Composite Abuse Scale (CAS) as the criterion standard.
The researchers found that the 12-month prevalence of IPV ranged from 4.1 percent to 17.7 percent, depending on screening method, instrument, and health care setting. Although no statistically significant main effects on prevalence of IPV were found for screening method or screening instrument, a significant interaction between method and instrument was found: prevalence was lower on the written WAST vs. other combinations. The face-to-face approach was least preferred by participants. The WAST and the written format yielded significantly less missing data than the PVS and other methods.
"The result of least missing data by written self-completed questionnaire is worth noting, especially for research applications, but also when considering clinical policies for IPV detection and intervention. Prevalence, missing data, and preference are all important considerations for both clinical and research efforts in IPV screening," the authors conclude.
(JAMA. 2006;296:530-536. Available pre-embargo to the media at www.jamamedia.org)
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