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Levin L, Bhatti C. The role of dental professionals in identifying, reporting, and supporting domestic violence victims. Dent Traumatol 2024; 40 Suppl 2:3-9. [PMID: 37840419 DOI: 10.1111/edt.12897] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/23/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
Domestic violence is a pervasive social issue affecting individuals across all demographics and has severe consequences for both the victims and society. Domestic violence is commonly defined as the exertion of power by one individual over another within a relationship, aiming to establish a sense of fear, control, and authority. The connection between domestic violence and oral health is established, with common oral health issues associated with domestic violence, such as dental trauma, head and neck bruises and injuries as well as facial fractures. Dental professionals play a crucial role in detecting signs of domestic violence by closely examining the head and neck region and the oral cavity during routine examinations. The significance of approaching patients suspected of experiencing domestic violence with sensitivity and empathy is of utmost importance. Recommendations include establishing trust, maintaining confidentiality, using open-ended questions, and providing information about local resources. Legal and ethical considerations are paramount, highlighting the obligations of dental professionals in cases of suspected domestic violence, including mandatory reporting laws and the balance between patient autonomy and safety. Challenges faced by dental professionals in reporting and intervening are discussed as well in this narrative review, emphasizing the importance of collaboration with other healthcare professionals and support services. This review underscores the vital role of dental care providers in recognizing signs of domestic violence, promoting intervention and support, and contributing to the well-being and safety of individuals impacted by domestic violence.
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Affiliation(s)
- Liran Levin
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Affiliation(s)
- Clement Seeballuck
- Clinical Lecturer in Paediatric Dentistry, Dundee Dental School and Hospital, Park Place, DD1 4HR, UK
| | - Sean Dolan
- Post Dental Core Trainee Fellow, Ninewells Hospital, James Arrott Drive, Dundee, DD2 1UB, UK
| | - Julie K Kilgariff
- Consultant in Endodontics, Dundee Dental Hospital and School, Park Place, Dundee, DD1 4HR, UK
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Kalra N, Hooker L, Reisenhofer S, Di Tanna GL, García-Moreno C. Training healthcare providers to respond to intimate partner violence against women. Cochrane Database Syst Rev 2021; 5:CD012423. [PMID: 34057734 PMCID: PMC8166264 DOI: 10.1002/14651858.cd012423.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) includes any violence (physical, sexual or psychological/emotional) by a current or former partner. This review reflects the current understanding of IPV as a profoundly gendered issue, perpetrated most often by men against women. IPV may result in substantial physical and mental health impacts for survivors. Women affected by IPV are more likely to have contact with healthcare providers (HCPs) (e.g. nurses, doctors, midwives), even though women often do not disclose the violence. Training HCPs on IPV, including how to respond to survivors of IPV, is an important intervention to improve HCPs' knowledge, attitudes and practice, and subsequently the care and health outcomes for IPV survivors. OBJECTIVES To assess the effectiveness of training programmes that seek to improve HCPs' identification of and response to IPV against women, compared to no intervention, wait-list, placebo or training as usual. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and seven other databases up to June 2020. We also searched two clinical trials registries and relevant websites. In addition, we contacted primary authors of included studies to ask if they knew of any relevant studies not identified in the search. We evaluated the reference lists of all included studies and systematic reviews for inclusion. We applied no restrictions by search dates or language. SELECTION CRITERIA All randomised and quasi-randomised controlled trials comparing IPV training or educational programmes for HCPs compared with no training, wait-list, training as usual, placebo, or a sub-component of the intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures outlined by Cochrane. Two review authors independently assessed studies for eligibility, undertook data extraction and assessed risks of bias. Where possible, we synthesised the effects of IPV training in a meta-analysis. Other analyses were synthesised in a narrative manner. We assessed evidence certainty using the GRADE approach. MAIN RESULTS We included 19 trials involving 1662 participants. Three-quarters of all studies were conducted in the USA, with single studies from Australia, Iran, Mexico, Turkey and the Netherlands. Twelve trials compared IPV training versus no training, and seven trials compared the effects of IPV training to training as usual or a sub-component of the intervention in the comparison group, or both. Study participants included 618 medical staff/students, 460 nurses/students, 348 dentists/students, 161 counsellors or psychologists/students, 70 midwives and 5 social workers. Studies were heterogeneous and varied across training content delivered, pedagogy and time to follow-up (immediately post training to 24 months). The risk of bias assessment highlighted unclear reporting across many areas of bias. The GRADE assessment of the studies found that the certainty of the evidence for the primary outcomes was low to very low, with studies often reporting on perceived or self-reported outcomes rather than actual HCPs' practices or outcomes for women. Eleven of the 19 included studies received some form of research grant funding to complete the research. Within 12 months post-intervention, the evidence suggests that compared to no intervention, wait-list or placebo, IPV training: · may improve HCPs' attitudes towards IPV survivors (standardised mean difference (SMD) 0.71, 95% CI 0.39 to 1.03; 8 studies, 641 participants; low-certainty evidence); · may have a large effect on HCPs' self-perceived readiness to respond to IPV survivors, although the evidence was uncertain (SMD 2.44, 95% CI 1.51 to 3.37; 6 studies, 487 participants; very low-certainty evidence); · may have a large effect on HCPs' knowledge of IPV, although the evidence was uncertain (SMD 6.56, 95% CI 2.49 to 10.63; 3 studies, 239 participants; very low-certainty evidence); · may make little to no difference to HCPs' referral practices of women to support agencies, although this is based on only one study (with 49 clinics) assessed to be very low certainty; · has an uncertain effect on HCPs' response behaviours (based on two studies of very low certainty), with one trial (with 27 participants) reporting that trained HCPs were more likely to successfully provide advice on safety planning during their interactions with standardised patients, and the other study (with 49 clinics) reporting no clear impact on safety planning practices; · may improve identification of IPV at six months post-training (RR 4.54, 95% CI 2.5 to 8.09) as in one study (with 54 participants), although three studies (with 48 participants) reported little to no effects of training on identification or documentation of IPV, or both. No studies assessed the impact of training HCPs on the mental health of women survivors of IPV compared to no intervention, wait-list or placebo. When IPV training was compared to training as usual or a sub-component of the intervention, or both, no clear effects were seen on HCPs' attitudes/beliefs, safety planning, and referral to services or mental health outcomes for women. Inconsistent results were seen for HCPs' readiness to respond (improvements in two out of three studies) and HCPs' IPV knowledge (improved in two out of four studies). One study found that IPV training improved HCPs' validation responses. No adverse IPV-related events were reported in any of the studies identified in this review. AUTHORS' CONCLUSIONS Overall, IPV training for HCPs may be effective for outcomes that are precursors to behaviour change. There is some, albeit weak evidence that IPV training may improve HCPs' attitudes towards IPV. Training may also improve IPV knowledge and HCPs' self-perceived readiness to respond to those affected by IPV, although we are not certain about this evidence. Although supportive evidence is weak and inconsistent, training may improve HCPs' actual responses, including the use of safety planning, identification and documentation of IPV in women's case histories. The sustained effect of training on these outcomes beyond 12 months is undetermined. Our confidence in these findings is reduced by the substantial level of heterogeneity across studies and the unclear risk of bias around randomisation and blinding of participants, as well as high risk of bias from attrition in many studies. Further research is needed that overcomes these limitations, as well as assesses the impacts of IPV training on HCPs' behavioral outcomes and the well-being of women survivors of IPV.
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Affiliation(s)
- Naira Kalra
- Gender Innovation Lab, Office of the Chief Economist, Africa Region, World Bank, Washington, DC, USA
| | - Leesa Hooker
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Sonia Reisenhofer
- College of Science, Health & Engineering, La Trobe University, Bundoora, Australia
| | - Gian Luca Di Tanna
- Statistics Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Claudia García-Moreno
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Chandan JS, Gokhale KM, Bradbury-Jones C, Nirantharakumar K, Bandyopadhyay S, Taylor J. Exploration of trends in the incidence and prevalence of childhood maltreatment and domestic abuse recording in UK primary care: a retrospective cohort study using 'the health improvement network' database. BMJ Open 2020; 10:e036949. [PMID: 32499272 PMCID: PMC7279643 DOI: 10.1136/bmjopen-2020-036949] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Describe the epidemiology of childhood maltreatment and domestic abuse (in women). DESIGN Analysis of longitudinal records between 1 January 1995 to 31 December 2018. SETTING UK primary care database: 'The Health Improvement Network' (THIN). PARTICIPANTS 11 831 850 eligible patients from 787 contributing practices. Childhood maltreatment and domestic abuse (women only) were defined as the presence of a recorded Read code. OUTCOME MEASURES The incidence rate (IR) and prevalence of childhood maltreatment (in children aged 0-18 years) and domestic abuse (in women aged over 18) between 1996 and 2017. An adjusted incidence rate ratio (aIRR) is given to examine the differences in IRs based on sex, ethnicity and deprivation. RESULTS The age and gender breakdown of THIN has been previously reported to be representative of the UK population, however, there is substantial missing information on deprivation quintiles (<20%) and ethnicity (approximately 50%). The IR (IR 60.1; 95% CI 54.3 to 66.0 per 100 000 child years) and prevalence (416.1; 95% CI 401.3 to 430.9 per 100 000 child population) of childhood maltreatment rose until 2017. The aIRR was greater in patients from the most deprived backgrounds (aIRR 5.14; 95% CI 4.57 to 5.77 compared with least deprived) and from an ethnic minority community (eg, black aIRR 1.25; 1.04 to 1.49 compared with white). When examining domestic abuse in women, in 2017, the IR was 34.5 (31.4 to 37.7) per 100 000 adult years and prevalence 368.7 (358.7 to 378.7) per 100 000 adult population. Similarly, the IR was highest in the lowest socioeconomic class (aIRR 2.30; 2.71 to 3.30) and in ethnic minorities (South Asian aIRR 2.14; 1.92 to 2.39 and black aIRR 1.64; 1.42 to 1.89). CONCLUSION Despite recent improvements in recording, there is still a substantial under-recording of maltreatment and abuse within UK primary care records, compared with currently existing sources of childhood maltreatment and domestic abuse data. Approaches must be implemented to improve recording and detection of childhood maltreatment and domestic abuse within medical records.
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Affiliation(s)
- Joht Singh Chandan
- University of Warwick Warwick Medical School, Coventry, UK
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Krishna Margadhamane Gokhale
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Caroline Bradbury-Jones
- School of Nursing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | | | - Julie Taylor
- School of Nursing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Almutairi GD, Alrashidi MR, Almerri AT, Kamel MI, El-Shazly M. How to screen for domestic violence against women in primary health care centers. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2012.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
| | | | - Ali T. Almerri
- Alwaha Center, Primary Health Care, MOH, KuwaitAlwaha Center, Primary Health Care, MOH, Kuwait
| | - Mohamed I. Kamel
- Community Medicine Department, Faculty of Medicine, Alexandria University, Egypt
- Department of Occupational Medicine, Ministry of Health, KuwaitDepartment of Occupational Medicine, Ministry of Health, Kuwait
| | - Medhat El-Shazly
- Department of Medical Statistics, Medical Research Institute, Alexandria University, Egypt
- Department of Health Information and Medical Record, Ministry of Health, Kuwait
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Chandan JS, Thomas T, Bradbury-Jones C, Taylor J, Bandyopadhyay S, Nirantharakumar K. Intimate partner violence and temporomandibular joint disorder. J Dent 2019; 82:98-100. [DOI: 10.1016/j.jdent.2019.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/20/2019] [Accepted: 01/23/2019] [Indexed: 02/02/2023] Open
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Purkey E, Patel R, Beckett T, Mathieu F. Primary care experiences of women with a history of childhood trauma and chronic disease: Trauma-informed care approach. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:204-211. [PMID: 29540391 PMCID: PMC5851399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/13/2023]
Abstract
OBJECTIVE To understand the primary care experiences of women who have a history of childhood trauma and chronic disease. DESIGN Qualitative study using in-depth interviews with directed content analysis. SETTING Family health team in Kingston, Ont. PARTICIPANTS Twenty-six women. METHODS Letters of invitation were sent to eligible participants followed by a telephone survey. Women with an adverse childhood experience (ACE) score of 4 or higher and with 2 or more chronic conditions were invited to participate in a one-on-one interview. MAIN FINDINGS Participants were frequent users of health care services. Most had not been asked about ACEs by their family physicians. Most participants believed that their history of ACEs was important to their health and that providers should ask about childhood experiences. When participants discussed their primary care experiences, the following 6 common themes evolved: the importance of continuity of care; challenges with family medicine residents; provider awareness of abuse history; distress due to triggering events; characteristics of clinic staff and space; and engagement in care plans and choice. These discussions revealed that participants' primary care experiences were not always informed by the principles of trauma-informed care. CONCLUSION Understanding the effect of ACEs on women's health is important. Incorporating a trauma-informed approach can be beneficial and enhance the experience of patients. Physicians should learn to ask patients about their childhood experiences, as it is important to their health care.
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Affiliation(s)
- Eva Purkey
- Assistant Professor and Director of Global Health in the Department of Family Medicine at Queen's University in Kingston, Ont.
| | - Rupa Patel
- Assistant Professor in the Department of Family Medicine at Queen's University and practises clinically at Kingston Community Health Centres
| | - Tracey Beckett
- At the time of the study was a Social worker for the Queen's Family Health Team in the Department of Family Medicine at Queen's University and is now a base hospital social worker with the Department of National Defence
| | - Françoise Mathieu
- Registered psychotherapist, a compassion fatigue specialist, and Co-Executive Director of TEND Academy in Kingston
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Parish CL, Pereyra MR, Abel SN, Siegel K, Pollack HA, Metsch LR. Intimate partner violence screening in the dental setting: Results of a nationally representative survey. J Am Dent Assoc 2018; 149:112-121. [PMID: 29389334 PMCID: PMC5797993 DOI: 10.1016/j.adaj.2017.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/31/2017] [Accepted: 09/03/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND The dental setting is a potential venue for identifying patients experiencing intimate partner violence (IPV). The study objective was to assess dentists' current practices and attitudes about IPV screening. METHODS A nationally representative survey of US general dentists assessed dentists' use of health history forms that queried about IPV and their acceptance of IPV screening as part of their professional roles. Parsimonious Poisson regression models were used in multivariable analysis to estimate risk ratios for the 2 dependent variables. RESULTS Almost all dentists did not include a question to screen for IPV on their patient history forms. More than one-half of dentists also did not know of a referral place for patients experiencing IPV and did not believe that IPV screening should be part of their professional roles. CONCLUSIONS Uptake of IPV screening and favorable attitudes toward screening were low among dentists studied. However, prior IPV training and clinical knowledge plus awareness of IPV referral mechanisms were positively associated with greater screening uptake and attitudes. PRACTICAL IMPLICATIONS The inclusion of brief, focused IPV interventions in dental education and the establishment of collaborations between dentists and IPV agencies for referral mechanisms, in conjunction with an overall shift in dentists' attitudes about their professional responsibilities, may facilitate IPV screening uptake in the dental setting.
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Kim YJ, Montano NP. Validity of Single Question for Screening Intimate Partner Violence among Urban Latina Women. Public Health Nurs 2017; 34:569-575. [DOI: 10.1111/phn.12348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Young-Ju Kim
- Sungshin Women's University College of Nursing; Seoul South Korea
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Carlson M, Kamimura A, Al-Obaydi S, Trinh HN, Franchek-Roa K. Background and Clinical Knowledge of Intimate Partner Violence: A Study of Primary Care Residents and Medical Students at a United States Medical School. Health Equity 2017; 1:77-82. [PMID: 30283836 PMCID: PMC6071885 DOI: 10.1089/heq.2017.0008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Intimate partner violence (IPV) is a significant public health issue that affects the physical and mental health of victims. However, residents and medical students may not receive adequate training to effectively identify and intervene with patients who may be victims of IPV. The purpose of this study is to examine the background and clinical knowledge of IPV among primary care residents and medical students in the United States of America. Methods: Third and fourth year medial students (n=65) and primary care residents (n=60) participated in an online survey in 2013. Results: While the majority of the participants reported IPV was an important and relevant issue for their practice, approximately half of them had never talked about IPV with patients. Residents reported higher levels of background and knowledge of IPV than medical students. Knowing a victim of IPV, confidence about talking to patients about IPV, and talking to patients about IPV would be helpful to increase levels of background and knowledge of IPV. Conclusions: This study found that background and clinical knowledge of IPV can potentially affect physicians' approach with IPV victims. This study also demonstrated the need for future research in the development of effective programs and trainings to help bridge the gap between knowledge and implementation in medical practice.
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Affiliation(s)
- Margaret Carlson
- Department of Sociology, University of Utah, Salt Lake City, Utah
| | - Akiko Kamimura
- Department of Sociology, University of Utah, Salt Lake City, Utah
| | - Sarah Al-Obaydi
- Department of Sociology, University of Utah, Salt Lake City, Utah
| | - Ha Ngoc Trinh
- Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, Texas
| | - Kathy Franchek-Roa
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
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Kalra N, Di Tanna GL, García-Moreno C. Training healthcare providers to respond to intimate partner violence against women. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012423] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Naira Kalra
- Johns Hopkins University; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health; 615 N. Wolf Street Baltimore Maryland USA 21205
| | - Gian Luca Di Tanna
- Queen Mary University of London; Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health; Blizard Institute, Yvonne Carter Building, 58 Turner Street London UK E1 2AB
| | - Claudia García-Moreno
- World Health Organization; Department of Reproductive Health and Research; Avenue Appia 20 Geneva 1211 Switzerland
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Zaher E, Keogh K, Ratnapalan S. Effect of domestic violence training: systematic review of randomized controlled trials. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2014; 60:618-24, e340-7. [PMID: 25022633 PMCID: PMC4096259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To describe and evaluate the effectiveness of domestic violence education in improving physicians' knowledge, recognition, and management of abused women. DATA SOURCES The Cochrane Database of Systematic Reviews, MEDLINE, PubMed, PsycINFO, ERIC, and EMBASE were searched for articles published between January 1, 2000, and November 1, 2012. This search was supplemented by manual searches for relevant articles using a combined text-word and MeSH-heading search strategy. STUDY SELECTION Randomized controlled trials were selected that used educational interventions among physicians and provided data on the effects of the interventions. SYNTHESIS Nine randomized controlled trials were included that described different educational approaches with various outcome measures. Three studies examined the effects of educational interventions among postgraduate trainee physicians and found an increase in knowledge but no change in behaviour with regard to identifying victims of domestic violence. Six studies examined educational interventions for practising physicians. Three of these studies used multifaceted physician training that combined education with system support interventions to change physician behaviour, such as increasing general awareness of domestic violence with brochures and posters, providing aids to remind physicians how to identify victims, facilitating physician access to victim support services, and providing audits and feedback. Multifaceted educational interventions included interactive workshops, Web-based learning, and experiential training. Another study used focus-group discussions and training, and showed improved domestic violence reporting among physicians. The remaining 2 studies showed improved perceptions of practising physicians' self-efficacy using problem-based online learning. CONCLUSION It was difficult to determine the most effective educational strategy, as the educational interventions and the outcome measures varied among the selected studies. Brief interventions for postgraduate trainee physicians improved knowledge but did not seem to affect behaviour. Online education using a problem-based learning format improved practising physicians' perceptions, knowledge, and skills in managing domestic violence. Physician training combined with system support interventions seemed to benefit domestic violence victims and increase referrals to domestic violence support resources.
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Affiliation(s)
- Eman Zaher
- Staff family physician at Prince Sultan Military Hospital in Saudi Arabia
| | - Kelly Keogh
- Pediatric emergency physician at the Hospital for Sick Children in Toronto, Ont
| | - Savithiri Ratnapalan
- Associate Professor in the Department of Paediatrics and the Dalla Lana School of Public Health at the University of Toronto and a staff physician in the Division of Emergency Medicine, Clinical Pharmacology, and Toxicology at the Hospital for Sick Children.
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Joyner K, Mash B. Quality of care for intimate partner violence in South African primary care: a qualitative study. VIOLENCE AND VICTIMS 2014; 29:652-669. [PMID: 25199392 DOI: 10.1891/0886-6708.vv-d-13-00005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Intimate partner violence (IPV) makes a substantial contribution to the burden of disease in South Africa. This article explores the current quality of care for IPV in public sector primary care facilities within the Western Cape. Only 10% of women attending primary care, while suffering from IPV, were recognized. Case studies, based on in-depth interviews and medical records, were used to reflect on the quality of care received among the women who were recognized. Care tended to be superficial, fragmented, poorly coordinated, and lacking in continuity. The recognition, management, and appropriate documentation of IPV should be prioritized within the training of primary care providers. It may be necessary to appoint IPV champions within primary care to ensure comprehensive care for survivors of IPV.
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DeBate RD, Severson HH, Cragun DL, Gau JM, Merrell LK, Bleck JR, Christiansen S, Koerber A, Tomar SL, McCormack Brown KR, Tedesco LA, Hendricson W. Evaluation of a theory-driven e-learning intervention for future oral healthcare providers on secondary prevention of disordered eating behaviors. HEALTH EDUCATION RESEARCH 2013; 28:472-487. [PMID: 23564725 PMCID: PMC3649212 DOI: 10.1093/her/cyt050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 02/21/2013] [Indexed: 06/02/2023]
Abstract
Oral healthcare providers have a clinical opportunity for early detection of disordered eating behaviors because they are often the first health professionals to observe overt oral and physical signs. Curricula regarding early recognition of this oral/systemic medical condition are limited in oral health educational programs. Web-based learning can supplement and reinforce traditional learning and has the potential to develop skills. The study purpose was to determine the efficacy of a theory-driven Web-based training program to increase the capacity of oral health students to perform behaviors related to the secondary prevention of disordered eating behaviors. Using the Reach, Effectiveness, Adoption, Implementation and Maintenance evaluation framework, a longitudinal group-randomized controlled trial involving 27 oral health classes from 12 oral health education programs in the United States was implemented to assess the efficacy of the Web-based training on attitudes, knowledge, self-efficacy and skills related to the secondary prevention of disordered eating behaviors. Mixed-model analysis of covariance indicated substantial improvements among students in the intervention group (effect sizes: 0.51-0.83) on all six outcomes of interest. Results suggest that the Web-based training program may increase the capacity of oral healthcare providers to deliver secondary prevention of disordered eating behaviors. Implications and value of using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework are discussed.
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Affiliation(s)
- Rita D DeBate
- Department of Community & Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Boulevard, Tampa, FL 33612, USA.
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Humphreys J, Epel ES, Cooper BA, Lin J, Blackburn EH, Lee KA. Telomere shortening in formerly abused and never abused women. Biol Res Nurs 2011; 14:115-23. [PMID: 21385798 DOI: 10.1177/1099800411398479] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent studies suggest that chronic psychological stress may accelerate aging at the cellular level. Telomeres are protective components that stabilize the ends of chromosomes and modulate cellular aging. Women exposed to intimate partner violence (IPV) experience chronic stress and report worse health. The purpose of this exploratory study was to examine telomeric DNA length in women who have experienced chronic stress related to IPV. We hypothesized that IPV exposure would be associated with shorter telomere length. The investigation used a cross-sectional design to study telomere length in women with a history of IPV exposure and control women who reported no prior exposure to IPV. Advertisements and public notices were used to recruit a convenience sample of healthy women. Mean leukocyte telomere length was measured in DNA samples from peripheral blood mononuclear cells (PBMCs) by a quantitative polymerase chain reaction assay (qPCR). Telomere length was significantly shorter in the 61 formerly abused women compared to the 41 controls (t = 2.4, p = .02). Length of time in the abusive relationship and having children were associated with telomere length after controlling for age and body mass index (BMI) (F(2, 99) = 10.23, p < .001). Numerous studies suggest that women who experience IPV have poorer overall health. It is often presumed that the stress of IPV may be causing greater morbidity. Findings from this descriptive study suggest a link between IPV exposure, duration of IPV-related stress, and telomere length molecular mechanisms that regulate cellular aging.
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Affiliation(s)
- Janice Humphreys
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA 94143, USA.
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Humphreys J, Tsoh JY, Kohn MA, Gerbert B. Increasing discussions of intimate partner violence in prenatal care using Video Doctor plus Provider Cueing: a randomized, controlled trial. Womens Health Issues 2011; 21:136-44. [PMID: 21185737 PMCID: PMC3053017 DOI: 10.1016/j.whi.2010.09.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 08/20/2010] [Accepted: 09/30/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE To report the effectiveness of a prenatal intervention and to provide evidence that prenatal visits provide an opportune time for health assessment and counseling with abused women. METHODS Fifty ethnically diverse pregnant women who presented for routine prenatal care and who also reported being at risk for intimate partner violence (IPV) were recruited to the study. Participants were assigned to either usual care or the Video Doctor plus Provider Cueing intervention. At baseline and 1 month later at another routine prenatal visit, intervention group participants received a 15-minute Video Doctor assessment and interactive tailored counseling. Their providers received a printed Cue Sheet alert and suggested counseling statements. MAIN FINDINGS Participants in the intervention group were significantly more likely to report provider-patient discussions of IPV compared with participants receiving usual care at baseline (81.8% vs. 16.7%; p < .001) and at the 1-month follow-up (70.0% vs. 23.5%; p = .005). Summing the number of patient-provider discussions across the two visits at baseline and 1 month later, intervention participants were significantly more likely to have IPV risk discussion with their providers at one or both visits (90.0% vs. 23.6%; p < .001) compared with the participants who received usual care. When specifically asked about the helpfulness of these IPV-related discussions, 20 out of 22 (90.9%) participants rated the discussion as helpful or very helpful at baseline and all 18 (100%) participants rated the discussion as helpful or very helpful at the 1-month follow-up. CONCLUSION Video Doctor plus Provider Cueing intervention significantly increases the likelihood of provider-patient IPV discussion with pregnant women with a history of abuse.
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Affiliation(s)
- Janice Humphreys
- Department of Family Health Care Nursing, University of California, San Francisco, 2 Koret Way, Box 0606, San Francisco, CA 94143-0606, (415) 476-4432, (415) 753-2161
| | - Janice Y. Tsoh
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue (0984-TRC), San Francisco, CA 94143-0984, (415) 502-8438, (415) 476-7734
| | - Michael A. Kohn
- Department of Epidemiology & Biostatistics, University of California, San Francisco, 185 Berry Street, Lobby 5, Suite 5700, San Francisco, CA 94107-1762, (415) 514-8142
| | - Barbara Gerbert
- Division of Behavioral Sciences, Professionalism, and Ethics, University of California, San Francisco, 707 Parnassus Avenue, Room 1032, Box 0758, San Francisco, CA 94143-0758, (415) 502-7283, (415) 476-0858
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Massoni ACDLT, Ferreira ÂMB, Aragão AKR, Menezes VAD, Colares V. Aspectos orofaciais dos maus-tratos infantis e da negligência odontológica. CIENCIA & SAUDE COLETIVA 2010; 15:403-10. [DOI: 10.1590/s1413-81232010000200016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 11/18/2008] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste artigo foi identificar os principais aspectos orofaciais dos maus-tratos infantis e da negligência odontológica, contribuindo com a identificação destas vítimas no ambiente odontológico. Foi realizada uma pesquisa bibliográfica nas bases de dados Adolec, MEDLINE, LILACS e BBO. Utilizaram-se como descritores: maus-tratos infantis, manifestações bucais, odontólogos, papel (figurativo) e responsabilidade legal. Verificou-se que os maus-tratos infantis acontecem em geral em domicílio e os ferimentos orofaciais decorrentes incluem trauma, queimaduras e lacerações dos tecidos duros e moles, marcas de mordida e hematomas em vários estágios de cura. Pode haver ferimentos que envolvem outras partes do corpo próximas à cavidade bucal, como hematoma periorbital e contusão nasal. Quanto ao abuso sexual, muitas vítimas não apresentam nenhum sinal físico associado; assim, indicadores comportamentais devem ser observados. A imediata identificação e o relato de maus-tratos infantis e da negligência odontológica pelo cirurgião-dentista são essenciais para a proteção das crianças, sendo fundamental uma maior atuação destes profissionais, através do registro e denúncia dos casos suspeitos às agências de proteção à criança.
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DeBate RD, Severson H, Zwald ML, Shaw T, Christiansen S, Koerber A, Tomar S, Brown KM, Tedesco LA. Development and Evaluation of a Web-Based Training Program for Oral Health Care Providers on Secondary Prevention of Eating Disorders. J Dent Educ 2009. [DOI: 10.1002/j.0022-0337.2009.73.6.tb04751.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rita D. DeBate
- Department of Community and Family Health; College of Public Health; University of South Florida
| | | | - Marissa L. Zwald
- Department of Community and Family Health; College of Public Health; University of South Florida
| | | | | | - Anne Koerber
- Division of Behavioral Sciences; Department of Pediatric Dentistry; College of Dentistry; University of Illinois at Chicago
| | - Scott Tomar
- Department of Community Dentistry and Behavioral Science; College of Dentistry; University of Florida
| | | | - Lisa A. Tedesco
- Vice Provost for Academic Affairs-Graduate Studies; Dean of the Graduate School; Rollins School of Public Health; Emory University
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Debate RD, Severson H, Zwald ML, Shaw T, Christiansen S, Koerber A, Tomar S, Brown KM, Tedesco LA. Development and evaluation of a web-based training program for oral health care providers on secondary prevention of eating disorders. J Dent Educ 2009; 73:718-729. [PMID: 19491349 PMCID: PMC2766261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Although oral health care providers (OHP) are key in the secondary prevention of eating disorders (ED), the majority are not engaged in assessment, referral, and case management. This innovative pilot project developed and evaluated a web-based training program for dental and dental hygiene students and providers on the secondary prevention of ED. The intervention combined didactic and skill-based objectives to train OHP on ED and its oral health effects, OHP roles, skills in identifying the oral signs of ED, communication, treatment, and referral. Using a convenience sample of OHP (n=66), a pre-/post-test evaluated short-term outcomes and user satisfaction. Results revealed statistically significant improvements in self-efficacy (p<.001); knowledge of oral manifestations from restrictive behaviors (p<.001) and purging behaviors (p<.001); knowledge of oral treatment options (p<.001); and attitudes towards the secondary prevention of ED (p<.001). Most participants strongly agreed or agreed that the program provided more information (89 percent) and resources (89 percent) about the secondary prevention of ED than were currently available; 91 percent strongly agreed or agreed that they would access this program for information regarding the secondary prevention of ED. This pilot project provides unique training in the clinical evaluation, patient approach, referral, and oral treatment that takes a multidisciplinary approach to address ED.
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Affiliation(s)
- Rita D Debate
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., Tampa, FL 33612, USA.
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DeBate RD, Tedesco LA. Increasing Dentists’ Capacity for Secondary Prevention of Eating Disorders: Identification of Training, Network, and Professional Contingencies. J Dent Educ 2006. [DOI: 10.1002/j.0022-0337.2006.70.10.tb04179.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rita DiGioacchino DeBate
- Department of Community and Family Health; College of Public Health; University of South Florida
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Hsieh NK, Herzig K, Gansky SA, Danley D, Gerbert B. Changing dentists' knowledge, attitudes and behavior regarding domestic violence through an interactive multimedia tutorial. J Am Dent Assoc 2006; 137:596-603. [PMID: 16739538 DOI: 10.14219/jada.archive.2006.0254] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Dentists have a unique opportunity to address the problem of domestic violence (DV). The authors tested the effectiveness of a tutorial designed to educate dentists in identifying and responding to DV. METHODS The authors developed a brief interactive multimedia tutorial for dentists and recruited practicing dentists (N = 174) for a randomized, controlled trial. A 24-question instrument assessed participants' knowledge, attitudes and practice behaviors regarding DV at two time points. The control group took the tutorial before completing a posttest. The authors also administered a 20-question empathy scale. RESULTS The experimental group demonstrated significantly greater improvement in scores on most items, including knowledge, attitudes and behaviors, relative to control subjects (P < .01). Empathy scores did not show significant correlation with change scores on the DV assessment instrument. CONCLUSIONS The tutorial is effective in helping dentists learn how to identify and help patients who are experiencing abuse. CLINICAL IMPLICATIONS Broad dissemination of the tutorial about DV would introduce dentists to simple strategies for responding to patients who experience DV.
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Affiliation(s)
- Nancy Kwon Hsieh
- Department of Orofacial Sciences, Division of Pediatric Dentistry, School of Dentistry, University of California San Francisco, CA 94117, USA
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Danley D, Gansky SA, Chow D, Gerbert B. Preparing dental students to recognize and respond to domestic violence: the impact of a brief tutorial. J Am Dent Assoc 2004; 135:67-73. [PMID: 14959876 DOI: 10.14219/jada.archive.2004.0022] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the impact of a brief, interactive multimedia tutorial designed to prepare dentists to recognize and respond to domestic violence. METHODS The authors randomly assigned dentists and dental students to one of three groups: a control group or one of two experimental groups in a modified Solomon four-group design. RESULTS One hundred sixty-one dental students and 13 dentists completed the multimedia tutorial. At the posttest, subjects in both experimental groups demonstrated significantly better scores than did subjects in the control group on most items. The two experimental groups (pretest and posttest, posttest only) did not differ significantly from each other. CONCLUSION An engaging, interactive tutorial presenting a simplified model for ways in which dental professionals can recognize and respond to domestic violence significantly improved dental students' knowledge of, and attitudes toward, the topic. CLINICAL IMPLICATIONS Clinicians may improve the care they provide to patients by accessing this brief tutorial and following the lessons contained in it.
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Affiliation(s)
- Dale Danley
- Department of Preventive and Restorative Dentistry, School of Dentistry, University of California San Francisco, 94117, USA
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Sitterding HA, Adera T, Shields-Fobbs E. Spouse/partner violence education as a predictor of screening practices among physicians. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2003; 23:54-63. [PMID: 12739260 DOI: 10.1002/chp.1340230109] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Spouse/partner violence is a major public health problem that affects 3 to 6 million women per year. Many studies show that the majority of health care practitioners do not detect or respond to cases of spouse/partner violence in their practice. Research suggests that there are potential barriers to reporting or detecting this problem. A barrier often cited is lack of proper education or training regarding spouse/partner violence. The objective of this study was to determine if physicians who received spouse/partner violence education at various stages of their careers were more likely to screen patients for spouse/partner violence. METHODS A survey was developed and administered to family physicians and obstetricians/gynecologists in Virginia. The data were analyzed to determine screening practice and spouse/partner violence education among respondents. Four different educational opportunities were analyzed to determine potential determinants of screening. RESULTS All respondents who had spouse/partner violence education were more likely to screen every patient than those who were lacking this education. Receiving lectures during residency training was found to be a significant predictor of screening every patient for spouse/partner violence among respondents. DISCUSSION Screening every patient for exposure to spouse/partner violence is the ideal situation. This study indicates that education about spouse/partner violence has a significant impact on screening tendencies if provided during a physician's residency program.
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Affiliation(s)
- Heather A Sitterding
- Child Transportation Safety Program, Center for Injury and Violence Prevention, Virginia Department of Health, 1500 East Main Street, Room 105, Richmond, VA 23219, USA
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Bryant SA, Spencer GA. Domestic violence: what do nurse practitioners think? JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 2002; 14:421-7. [PMID: 12375361 DOI: 10.1111/j.1745-7599.2002.tb00143.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To examine factors that influence nurse practitioners' (NPs) ability to incorporate universal domestic violence screening practices (e.g., asking, identifying, referring and reporting) into their practices. DATA SOURCES A stratified random survey of certified NPs in New York state was conducted in 1999. There were 118 family, women's health, OB/GYN, and adult NPs in the survey. Chi-square and ANOVA were used to analyze the data. CONCLUSIONS There were significant differences in the domestic violence screening practices among women's health, OB/GYN, adult, and family NPs. Women's health and OB/GYN NPs were more likely to ask screening questions and identify victims of domestic violence than their other NP counterparts. IMPLICATIONS FOR PRACTICE There is a need to identify strategies that encourage all NPs to incorporate universal domestic violence screening behaviors into their practices.
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Affiliation(s)
- Sharon A Bryant
- Decker School of Nursing, Binghamton University, Binghamton, NY, USA.
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Gerbert B, Gansky SA, Tang JW, McPhee SJ, Carlton R, Herzig K, Danley D, Caspers N. Domestic violence compared to other health risks: a survey of physicians' beliefs and behaviors. Am J Prev Med 2002; 23:82-90. [PMID: 12121795 DOI: 10.1016/s0749-3797(02)00460-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Physicians routinely confront patient risk behaviors once considered private, including tobacco use, alcohol abuse, and HIV/STD-risk behavior. We compared physicians' behaviors and beliefs on screening and intervention for domestic violence with each other risk. METHODS Survey of nationwide, random sample of 610 primary care physicians from the American Medical Association Physician Masterfile. RESULTS Fewer primary care physicians screened for domestic violence than for other risks (p <0.001); once domestic violence was identified, however, physicians intervened with equal or greater frequency than for other risks. Fewer believed that they knew how to screen or intervene for domestic violence compared with other risks, and significantly fewer believed that domestic violence interventions were successful compared with interventions for tobacco and HIV/STD risks (Bonferroni adjusted p<0.001). CONCLUSIONS Lower domestic violence screening rates may reflect physicians' beliefs that they do not know how to screen or intervene, and that interventions are less successful for domestic violence than for other risks. We may improve screening rates by educating physicians that a simplified role, as for other risks, can be effective for domestic violence.
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Affiliation(s)
- Barbara Gerbert
- Division of Behavioral Sciences (Gerbert, Carlton, Herzig, Danley, Caspers), University of California-San Francisco, San Francisco, California 94117, USA.
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Love C, Gerbert B, Caspers N, Bronstone A, Perry D, Bird W. Dentists' attitudes and behaviors regarding domestic violence. The need for an effective response. J Am Dent Assoc 2001; 132:85-93. [PMID: 11194405 DOI: 10.14219/jada.archive.2001.0032] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The authors examined the attitudes and behaviors of a national sample of dentists regarding domestic violence and the barriers dentists face in intervening to help victims. METHODS The authors surveyed a national random sample of 321 dentists by mail from November 1997 to March 1998 about their attitudes and clinical practice behaviors related to domestic violence. Survey items were developed based on the domestic violence and health care literature. The authors used the Total Design Method to maximize the response rate and analyzed data to determine differences between dentists who had received domestic violence education and those who had not. RESULTS Eighty-seven percent of responding dentists never screened for domestic violence; 18 percent never screened even when patients had visible signs of trauma on their heads or necks. Overall, respondents intervened only minimally to help patients whom they had identified as victims. Respondents reported that the major barriers to screening were the presence of a partner or children (77 percent), lack of training (68 percent), concern about offending patients (66 percent) and their own embarrassment about bringing up the topic of abuse (51 percent). Respondents who had received domestic violence education were significantly more likely to screen for domestic violence and to intervene. CONCLUSIONS Dentists face many barriers to identifying and helping patients who are abuse victims, yet these data suggest that education about domestic violence could help them overcome some of these barriers. CLINICAL IMPLICATIONS We suggest that dentists follow the AVDR model when approaching abused patients in their practice: Ask about abuse, provide Validating messages, Document presenting signs and Refer victims to domestic violence specialists.
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Affiliation(s)
- C Love
- School of Dentistry, University of California San Francisco, USA
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