Effect of face-to-face interview versus computer-assisted self-interview on disclosure of intimate partner violence among African American women in WIC clinics

Tools for the identification of victims of domestic abuse and modern slavery in remote services: A systematic review

OBJECTIVE

To explore the technology-based tools available for supporting the identification of victims of domestic abuse and modern slavery in remote services and consider the benefits and challenges posed by the existing tools.

METHODS

We searched six academic databases. Studies were considered for inclusion if they were published in English between 2000 and 2023. The QuADS quality appraisal tool was used to assess the methodological quality of included studies. A narrative synthesis was conducted using the convergent integrated approach.

RESULTS

Twenty-four studies were included, of which two were professional guidelines; each reported on a distinct technology-based tool for remote services. All tools related to domestic abuse and 21 focused on screening for intimate partner violence among young and mid-life women (18-65) in high-income countries. The review did not identify tools that support the identification of victims of modern slavery. We identified eight common themes of tool strengths, highlighting that the remote approach to screening was practical, acceptable to victims, and, in some circumstances, elicited better outcomes than face-to-face approaches. Five themes pointed to tool challenges, such as concerns around privacy and safety, and the inability of computerised tools to provide empathy and emotional support.

CONCLUSIONS

Available technology-based tools may support the identification of victims of domestic abuse by health and social care practitioners in remote services. However, it is important to be mindful of the limitations of such tools and the effects individuals' screening preferences can have on outcomes. Future research should focus on developing tools to support the identification of victims of modern slavery, as well as empirically validating tools for screening during remote consultations.

Comparison of different methods of screening to identify intimate partner violence: A randomized controlled trial

OBJECTIVE

Screening for intimate partner violence in the home is often challenging due to the lack of privacy. The aim of this study was to compare two different screening methods (paper-pencil vs. tablet) for identifying intimate partner violence during perinatal home visits.

DESIGN

Randomized control trial.

SAMPLE

Pregnant women (N = 416) in perinatal home visiting programs were randomized to either paper-pencil or computer assisted, intimate partner violence screening.

MEASUREMENTS

The Abuse Assessment Screen was used to screen for physical and sexual IPV and Women's Experiences with Battering for emotional intimate partner violence.

RESULTS

No significant differences in prevalence were found between the screening methods. Intimate partner violence prevalence rates for the year before and/or during pregnancy using paper-pencil was 21.8% versus 24.5% using tablets (p = .507). There were significant differences in prevalence among the three race/ethnic groups (Caucasian, 36.9%; African American, 26.7%; Hispanics, 10.6%; p < .001) and significant differences in rates across three geographical areas: urban 16.0%; rural 27.6%, suburban women 32.3% (p < .001).

CONCLUSIONS

This study provides evidence that both methods are useful for identifying intimate partner violence during perinatal home visits.

Comparison of Computer-Assisted Self-Interview Versus Clinician Interview for Self-Reported Vulvovaginal Symptoms

ABSTRACT

This secondary analysis (N = 43) compared computer-assisted self-interview (CASI) to clinician interview for self-report of 8 vulvovaginal symptoms. Concordance was moderate between interview modes (range, 70-86%) with itching and odor having highest agreement. Although prior reports suggest more responses on CASI, we found CASI did not significantly increase self-report of symptoms over clinician interview.

Bidirectional intimate partner violence: Evidence from a list experiment in Kenya

Intimate Partner Violence (IPV) continues to be a major public health concern that can both respond to economic policies and affect economic outcomes. Few studies regarding IPV, however, take a gender inclusive approach towards its identification. Using a sample of both men and women from rural Kenya, we are the first, to our knowledge, to conduct a list experiment with cohabiting married couples to identify the prevalence of physical violence on both men and women. We find that 14 percent of respondents agree with the statement "my spouse regularly hits me". In contrast to other survey evidence that uses direct elicitation, we find no differences in the prevalence of male-to-female and female-to-male violence. We provide supporting evidence that bidirectional IPV accounts for the lack of gender differences. A complete understanding of the typology of IPV can be crucial for policies seeking IPV reduction.

The impact of the COVID-19 pandemic on help-seeking behaviours of Indigenous and Black women experiencing intimate partner violence in the United States

AIMS

This article discusses possible barriers to help-seeking that Indigenous and Black women encountered when seeking help related to experiences of intimate partner violence during the COVID-19 pandemic.

DESIGN

This article is focused on understanding the impact of the COVID-19 pandemic on populations at highest risk for intimate partner violence in its most severe forms.

DATA SOURCES

Literature sources range from 2010 to 2022. The article is also informed by the experiences of scholars and advocates working with Indigenous and Black women experiencing intimate partner violence in Wisconsin. In our write-up, we draw on Indigenous feminism and Black feminist thought.

IMPLICATIONS FOR NURSING

Help seeking is contextual. The context in which help seeking occurs or does not occur for Indigenous and Black women, due to the barriers we discuss is vital for nurses to understand in order to provide efficient and meaningful nursing care.

CONCLUSION

Our goal is to center the nursing profession in a leadership position in addressing the complex and unique needs of Indigenous and Black women who experience the highest rates of intimate partner violence and also experience the greatest barriers to care and support.

IMPACT

We seek to contribute theory-driven knowledge that informs the work of nurses who are often the first to encounter survivors of intimate partner violence within the clinical setting. Help-seeking is often hindered by factors such as geographic and jurisdictional, economic, and structural response barriers. This knowledge will enhance nurses' ability to lead and advocate for clinical practice and policies that minimize the barriers women experience following intimate partner violence, especially during pandemics, disasters, and other extraordinary circumstances.

PUBLIC CONTRIBUTIONS

This article is based on the collaboration of community advocates, nurse scientists, and public health scholars, who work closely with Indigenous and Black survivors of violence and seek to meet their needs and offer them meaningful support.

Longitudinal inconsistencies in women's self-reports of lifetime experience of physical and sexual IPV: evidence from the MAISHA trial and follow-on study in North-western Tanzania

Background

Intimate partner violence (IPV) against women is pervasive throughout the world, with profound consequences for women’s health. Research to understand the extent, causes and consequences of IPV relies on self-reported data on violence, and yet there is a paucity of research into the consistency with which women report lifetime IPV over time.

Methods

We use data from the control group of the cluster randomised trial and a follow-on longitudinal study in Tanzania to examine discrepancies in women’s reported experience of lifetime physical IPV and sexual IPV over three time-points (T0, T29, T53 months). Among those reporting lifetime history of IPV at T0, we calculate the proportion who subsequently report no lifetime history at T29 and/or T53 (‘discrepant’ reporting). We use logistic regression to explore associations between discrepant reporting and respondent baseline characteristics, the nature of their IPV experiences at baseline, and situational factors at T53.

Results

Complete IPV data were available for 301 women. At T0, 154 (51%) women reported lifetime history of physical IPV, of whom 62% gave a discrepant ‘never’ report in a subsequent round. Among 93 (31%) with lifetime history of sexual IPV at T0, 73% provided a subsequent discrepant report. 73% of women reported lifetime physical IPV, and 55% lifetime sexual IPV in at least one survey round. For both IPV outcomes, women were less likely to provide discrepant reports if they had recent IPV at baseline, poor mental health (T53) and poor communication with partner (T53). For physical IPV only, reduced discrepant reporting was also associated with baseline household-level financial hardship and more severe or extensive experience of IPV.

Conclusions

A large proportion of women provided discrepant reports over the course of the study. Prevalence estimates of lifetime IPV from one-off cross-sectional surveys are likely to be underestimates, biased towards more recent and severe cases. To improve the stability of IPV measures, researchers should explicitly clarify the meaning of reference periods such as ‘ever’, consider using shorter reference periods (e.g. past-year), and avoid filter questions that use positive reports of lifetime IPV as a gateway to asking about more recent experiences.

Trial registration: Maisha CRT01 registered at ClinicalTrials.gov #NCT02592252, registered retrospectively (13/08/2015).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01697-y.

Disclosure of sensitive material at routine antenatal psychosocial assessment: The role of psychosocial risk and mode of assessment

PROBLEM

While routine psychosocial assessment is acceptable to most pregnant women, some women will not fully disclose psychosocial concerns to their clinician.

AIMS

To assess the impact of psychosocial risk, current symptoms and mode of assessment on women's honesty of disclosure at psychosocial assessment.

METHODS

Logistic regression was used to examine associations between disclosure and a range of psychosocial characteristics in women who were 'always honest' and 'not always honest'. Mixed ANOVAs were used to test the influence of mode of assessment and honesty on scores on a repeated measure of psychosocial risk.

FINDINGS

10.8% (N=193 of 1788) of women did not fully disclose at psychosocial assessment. Non-disclosure was associated with a mental health history (aOR=1.78, 95%CI: 1.18-2.67, p<0.01) and lack of social and partner support (aOR=1.74, 95%CI: 1.16-2.62, p<0.05; aOR=2.08, 95%CI: 1.11-3.90, p<0.05, respectively). Those reporting not always being honest at face to face assessment showed a greater increase in psychosocial risk score when the assessment was repeated online via self-report, compared to women who were always honest.

DISCUSSION

A history of mental health issues and lack of social and partner support are associated with reduced disclosure at face to face assessment. Online self-report assessment may promote greater disclosure, however this should always be conducted in the context of clinician feedback.

CONCLUSION

Greater psychosocial vulnerability is associated with a lower likelihood of full disclosure. Preliminary findings relating to mode of assessment warrant further exploration within a clinical context.

Threat Bias and Emotion Recognition in Victims of IPV

Although there is growing evidence of the association between threat bias and psychopathology in many trauma-exposed populations, there are few studies with intimate partner violence (IPV) victims. The present study assessed threat bias in IPV victims. It also examined potential differences in facial recognition ability between victims and nonvictims. Participants were 153 female college students currently in a dating relationship. Participants completed demographic and abuse severity measures. They then completed a dot-probe task to assess threat bias, and a facial expression recognition task to assess speed and accuracy of recognition. Approximately 32% of the students sampled were currently in a physically abusive relationship. Results indicated that IPV victims had a bias toward fearful faces, and showed worse recognition of happy faces than nonvictims. These data suggest that the psychological impact of threat bias might vary temporally. Vigilance during threat may serve as a protective mechanism, whereas postthreat vigilance might be associated with psychopathology. Researchers should carefully consider the presence of threat bias in victim samples and include other victim groups in future assessments of threat bias. It will be important to test these relationships in other IPV victim samples, such as help-seeking victims and other community living victims.

Evidence for Better Lives Study: a comparative birth-cohort study on child exposure to violence and other adversities in eight low- and middle-income countries - foundational research (study protocol)

INTRODUCTION

Violence against children is a health, human rights and social problem affecting approximately half of the world's children. Its effects begin at prenatal stages with long-lasting impacts on later health and well-being. The Evidence for Better Lives Study (EBLS) aims to produce high-quality longitudinal data from cities in eight low- and middle-income countries-Ghana, Jamaica, Pakistan, the Philippines, Romania, South Africa, Sri Lanka and Vietnam-to support effective intervention to reduce violence against children. EBLS-Foundational Research (EBLS-FR) tests critical aspects of the planned EBLS, including participant recruitment and retention, data collection and analysis. Alongside epidemiological estimates of levels and predictors of exposure to violence and adversity during pregnancy, we plan to explore mechanisms that may link exposure to violence to mothers' biological stress markers and subjective well-being.

METHODS AND ANALYSES

EBLS-FR is a short longitudinal study with a sample of 1200 pregnant women. Data are collected during the last trimester of pregnancy and 2 to 6 months after birth. The questionnaire for participating women has been translated into nine languages. Measures obtained from mothers will include, among others, mental and physical health, attitudes to corporal punishment, adverse childhood experiences, prenatal intimate partner violence, substance use and social/community support. Hair and dry blood spot samples are collected from the pregnant women to measure stress markers. To explore research participation among fathers, EBLS-FR is recruiting 300 fathers in the Philippines and Sri Lanka.

ETHICS AND DISSEMINATION

The study received ethical approvals at all recruiting sites and universities in the project. Results will be disseminated through journal publications, conferences and seminar presentations involving local communities, health services and other stakeholders. Findings from this work will help to adjust the subsequent stages of the EBLS project.

Effectiveness of ICT-based intimate partner violence interventions: a systematic review

BACKGROUND

Intimate Partner Violence is a "global pandemic". Meanwhile, information and communication technologies (ICT), such as the internet, mobile phones, and smartphones, are spreading worldwide, including in low- and middle-income countries. We reviewed the available evidence on the use of ICT-based interventions to address intimate partner violence (IPV), evaluating the effectiveness, acceptability, and suitability of ICT for addressing different aspects of the problem (e.g., awareness, screening, prevention, treatment, mental health).

METHODS

We conducted a systematic review, following PRISMA guidelines, using the following databases: PubMed, PsycINFO, and Web of Science. Key search terms included women, violence, domestic violence, intimate partner violence, information, communication technology, ICT, technology, email, mobile, phone, digital, ehealth, web, computer, online, and computerized. Only articles written in English were included.

RESULTS

Twenty-five studies addressing screening and disclosure, IPV prevention, ICT suitability, support and women's mental health were identified. The evidence reviewed suggests that ICT-based interventions were effective mainly in screening, disclosure, and prevention. However, there is a lack of homogeneity among the studies' outcome measurements and the sample sizes, the control groups used (if any), the type of interventions, and the study recruitment space. Questions addressing safety, equity, and the unintended consequences of the use of ICT in IPV programming are virtually non-existent.

CONCLUSIONS

There is a clear need to develop women-centered ICT design when programming for IPV. Our study showed only one study that formally addressed software usability. The need for more research to address safety, equity, and the unintended consequences of the use of ICT in IPV programming is paramount. Studies addressing long term effects are also needed.

Improving the Primary Care Consultation for Diabetes and Depression Through Digital Medical Interview Assistant Systems: Narrative Review

Background

Digital medical interview assistant (DMIA) systems, also known as computer-assisted history taking (CAHT) systems, have the potential to improve the quality of care and the medical consultation by exploring more patient-related aspects without time constraints and, therefore, acquiring more and better-quality information prior to the face-to-face consultation. The consultation in primary care is the broadest in terms of the amount of topics to be covered and, at the same time, the shortest in terms of time spent with the patient.

Objective

Our aim is to explore how DMIA systems may be used specifically in the context of primary care, to improve the consultations for diabetes and depression, as exemplars of chronic conditions.

Methods

A narrative review was conducted focusing on (1) the characteristics of the primary care consultation in general, and for diabetes and depression specifically, and (2) the impact of DMIA and CAHT systems on the medical consultation. Through thematic analysis, we identified the characteristics of the primary care consultation that a DMIA system would be able to improve. Based on the identified primary care consultation tasks and the potential benefits of DMIA systems, we developed a sample questionnaire for diabetes and depression to illustrate how such a system may work.

Results

A DMIA system, prior to the first consultation, could aid in the essential primary care tasks of case finding and screening, diagnosing, and, if needed, timely referral to specialists or urgent care. Similarly, for follow-up consultations, this system could aid with the control and monitoring of these conditions, help check for additional health issues, and update the primary care provider about visits to other providers or further testing. Successfully implementing a DMIA system for these tasks would improve the quality of the data obtained, which means earlier diagnosis and treatment. Such a system would improve the use of face-to-face consultation time, thereby streamlining the interaction and allowing the focus to be the patient's needs, which ultimately would lead to better health outcomes and patient satisfaction. However, for such a system to be successfully incorporated, there are important considerations to be taken into account, such as the language to be used and the challenges for implementing eHealth innovations in primary care and health care in general.

Conclusions

Given the benefits explored here, we foresee that DMIA systems could have an important impact in the primary care consultation for diabetes and depression and, potentially, for other chronic conditions. Earlier case finding and a more accurate diagnosis, due to more and better-quality data, paired with improved monitoring of disease progress should improve the quality of care and keep the management of chronic conditions at the primary care level. A somewhat simple, easily scalable technology could go a long way to improve the health of the millions of people affected with chronic conditions, especially if working in conjunction with already-established health technologies such as electronic medical records and clinical decision support systems.

Depression and Intimate Partner Violence Among African American Women Living in Impoverished Inner-City Neighborhoods

Mental health correlates of intimate partner violence (IPV) victimization including negative physical and mental health outcomes are well documented. However, certain subgroups of African American women, such as those living in impoverished, urban communities, are underrepresented in most studies and may experience IPV at higher rates. Furthermore, the circumstances of this women including poverty makes them at risk to IPV and its consequences. The present study estimated the prevalence of IPV victimization and its association with depression in a sample of low-income African American women participating in the Mobile Youth and Poverty Study. Participants in this study were caregivers of adolescents living in extremely impoverished conditions and were part of the Mobile Youth Survey, a community-based, longitudinal, multiple cohort survey conducted between the years 1998 and 2011. Data for the current study were collected between the years 2001 and 2010. The dependent variable was depressive symptoms as measured by the Center for Epidemiological Studies-Depression Scale (CES-D). The independent variable was IPV measured using a subsample of items from the Conflict Tactics Scale. Nearly three quarters (73.6%, n = 489) of the sample experienced some form of IPV and 49.1% (n = 326) had a CES-D depression score of 16 or greater indicating mild to severe depression symptoms. The highest proportion of women who met the CES-D criteria for depression were those experiencing the most severe IPV irrespective of category (i.e., physical, psychological, or combined). Logistic regression analyses showed that women reporting the most severe abuse, irrespective of category, were significantly more likely to meet the CES-D criteria for depression. In addition, low education and receipt of economic assistance were significantly associated with depressive symptoms. The combination of poor economic conditions and IPV may predispose African American women living in impoverished, urban communities to mental health outcomes such as depression.

Measurement of Economic Abuse Among Women Not Seeking Social or Support Services and Dwelling in the Community

Scholars have defined economic abuse (EA) as tactics used by abusive partners to undermine the self-sufficiency and economic self-efficacy of survivors of intimate partner violence (IPV). However, no measures of EA have been tested in non-IPV-service seeking samples. The current study assesses the psychometric properties of the Scale of Economic Abuse (SEA)-12 (Postmus, Plummer, & Stylianou, 2016) in a nonservice seeking sample of adult females attending community college. A quantitative web-based survey was administered to a simple random sample of female community college students (n = 435). Analyses included confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). CFA indicated a poor fit for the three-factor model of the SEA-12 in this sample. The results of the EFA found a single factor model retaining four items (the Scale of Economic Abuse-Short, or SEAS). Women are experiencing EA outside of IPV service-seeking populations, and that tactics of economic control seem to be central to EA in this sample.

Collecting Self-Reported Data on Dating Abuse Perpetration From a Sample of Primarily Black and Hispanic, Urban-Residing, Young Adults: A Comparison of Timeline Followback Interview and Interactive Voice Response Methods

Dating abuse is a prevalent and consequential public health problem. However, relatively few studies have compared methods of collecting self-report data on dating abuse perpetration. This study compares two data collection methods-(a) the Timeline Followback (TLFB) retrospective reporting method, which makes use of a written calendar to prompt respondents' recall, and (b) an interactive voice response (IVR) system, which is a prospective telephone-based database system that necessitates respondents calling in and entering data using their telephone keypads. We collected 84 days of data on young adult dating abuse perpetration using IVR from a total of 60 respondents. Of these respondents, 41 (68%) completed a TLFB retrospective report pertaining to the same 84-day period after that time period had ended. A greater number of more severe dating abuse perpetration events were reported via the IVR system. Participants who reported any dating abuse perpetration were more likely to report more frequent abuse perpetration via the IVR than the TLFB (i.e., may have minimized the number of times they perpetrated dating abuse on the TLFB). The TLFB method did not result in a tapering off of reported events past the first week as it has in prior studies, but the IVR method did result in a tapering off of reported events after approximately the sixth week. We conclude that using an IVR system for self-reports of dating abuse perpetration may not have substantial advantages over using a TLFB method, but researchers' choice of mode may vary by research question, resources, sample, and setting.

Trauma-Informed Personalized Scripts to Address Partner Violence and Reproductive Coercion: Preliminary Findings from an Implementation Randomized Controlled Trial

Background: Family planning (FP) providers are in an optimal position to address harmful partner behaviors, yet face several barriers. We assessed the effectiveness of an interactive app to facilitate implementation of patient-provider discussions about intimate partner violence (IPV), reproductive coercion (RC), a wallet-sized educational card, and sexually transmitted infections (STIs). Materials and Methods: We randomized participants (English-speaking females, ages 16-29 years) from four FP clinics to two arms: Trauma-Informed Personalized Scripts (TIPS)-Plus and TIPS-Basic. We developed an app that prompted (1) tailored provider scripts (TIPS-Plus and TIPS-Basic) and (2) psychoeducational messages for patients (TIPS-Plus only). Patients completed pre- and postvisit surveys. We compared mean summary scores of IPV, RC, card, and STI discussions between TIPS-Plus and TIPS-Basic using Wilcoxon rank-sum tests, explored predictors with ordinal regression, and compared implementation with historical data using chi-square. Results: Of the 240 participants, 47.5% reported lifetime IPV, 12.5% recent IPV, and 7.1% recent RC. No statistically significant differences emerged from summary scores between arms for any outcomes. Several significant predictors were associated with higher scores for patient-provider discussions, including race, reason for visit, contraceptive method, and condom nonuse. Implementation of IPV, RC, and STI discussions increased significantly (p < 0.0001) when compared with historical clinical data for both TIPS-Basic and TIPS-Plus. Conclusions: We did not find an added benefit of patient activation messages in increasing frequency of sensitive discussions. Several patient characteristics appear to influence providers' likelihood of conversations about harmful partner behaviors. Compared with prior data, this pilot study suggests potential benefits of using provider scripts to guide discussions.

The influence of interviewers on survey responses among female sex workers in Zambia

BACKGROUND

Interviewers can substantially affect self-reported data. This may be due to random variation in interviewers' ability to put respondents at ease or in how they frame questions. It may also be due to systematic differences such as social distance between interviewer and respondent (e.g., by age, gender, ethnicity) or different perceptions of what interviewers consider socially desirable responses. Exploration of such variation is limited, especially in stigmatized populations.

METHODS

We analyzed data from a randomized controlled trial of HIV self-testing amongst 965 female sex workers (FSWs) in Zambian towns. In the trial, 16 interviewers were randomly assigned to respondents. We used hierarchical regression models to examine how interviewers may both affect responses on more and less sensitive topics, and confound associations between key risk factors and HIV self-test use.

RESULTS

Model variance (ICC) at the interviewer level was over 15% for most topics. ICC was lower for socio-demographic and cognitively simple questions, and highest for sexual behaviour, substance use, violence and psychosocial wellbeing questions. Respondents reported significantly lower socioeconomic status and more sex-work related violence to female interviewers. Not accounting for interviewer identity in regressions predicting HIV self-test behaviour led to coefficients moving from non-significant to significant.

CONCLUSIONS

We found substantial interviewer-level effects for prevalence and associational outcomes among Zambian FSWs, particularly for sensitive questions. Our findings highlight the importance of careful training and response monitoring to minimize inter-interviewer variation, of considering social distance when selecting interviewers and of evaluating whether interviewers are driving key findings in self-reported data.

TRIAL REGISTRATION

clinicaltrials.gov NCT02827240 . Registered 11 July 2016.

Methods, system errors, and demographic differences in participant errors using daily text message-based short message service computer-assisted self-interview (SMS-CASI) to measure sexual risk behavior in a RCT of HIV self-test use

BACKGROUND

Assessment of sexual risk behavior is crucial to HIV prevention trials. Currently, there are no biomarkers or objective measures to detect and characterize sexual risk behavior; therefore, we must rely on self-reports. Self-report accuracy may be improved by collecting data in real-time. Our objective was to demonstrate how a text message-based short message service computer-assisted self-interview (SMS-CASI) system can collect daily sexual risk behavior data.

METHODS

During the course of a 2-arm randomized controlled trial, confidential daily SMS-CASI was used to assess sexual risk behavior over three months for participants using only condoms in the control condition and using condoms and HIV self-tests to test themselves and their non-monogamous sexual partner over six months for participants in the intervention condition (total N=272). Active monitoring of participants responses and data cleaning took place concurrently with trial execution. Descriptive statistics were used to examine frequencies related to system functionality, participant reporting, system errors, communication patterns, and overall feasibility of using the SMS-CASI system for reporting sexual risk behavior.

RESULTS

The SMS-CASI system processed 272,565 messages. In addition, 87 classifications of metadata were collected, for a total of 22,895,460 different data points. Types of messages included these sent (N=171,749; 63.01%) to participants, received (N=100,646; 36.93%) from participants, and failed (N=168; 0.06%) to be sent. Most errors (N=1,858) were due to system malfunctions (N=535; 28.79%) or participants' mistakes (N=1,289; 69.38%). Participant errors included: wrong password, incomplete surveys, and invalid response. The highest error rates by demographic characteristics were by age among older participants [ages 30-39; 383 errors (29.71%), and 40-69; 545 errors (42.28%)] and by race among Hispanic/Latino participants [487 errors (37.78%)].

CONCLUSIONS

The SMS-CASI system was effective at confidentially collecting sexual risk behavior data on a daily basis, potentially contributing to reduced recall and social desirability bias. This study provides methodological examples and data demonstrating how SMS-CASI can be used for sexual health data collection.

Intimate partner violence, trauma, and mental health need among female community college students

OBJECTIVE

The impact of interpersonal violence on college students has received considerable attention, yet no studies have been conducted among community college students, who comprise 40% of all American college students, and have unique risk factors and needs. Community College students are more likely to be women, people of color, working, parenting, and first generation college students.

PARTICIPANTS

Data were collected from a simple random sample from four community colleges (n=435).

METHODS

A cross-sectional quantitative survey was used to assess the extent of intimate partner violence, trauma exposure, sexual violence, and associated mental health consequences among female students.

RESULTS

Over 27% of participants reported IPV in the past year, while 25% reported sexual assault and 34% reported other uncomfortable sexual experiences in their lifetime. Nearly 20%of participants were currently reporting PTSD symptoms.

CONCLUSIONS

Community Colleges should work with service providers to build their capacity to respond to students' needs.

Protective Factors associated with Resilience in Women Exposed to Intimate Partner Violence

OBJECTIVE

Research on adversity is often skewed toward assessing problematic functioning; yet many women display resilience following traumatic experiences. Examining individual, relational, community, and cultural variables can provide new knowledge about protective factors associated with resilience in women exposed to intimate partner violence (IPV). Controlling for demographics and circumstances of the violence, this study evaluated predictors of resilience, including spirituality, social support, community cohesion, and ethnic identity.

METHOD

The sample consisted of 112 women (M_age =32.12, SD=5.78) exposed to physical, psychological, and/or sexual intimate partner violence in the past 6 months. Approximately 70% of participants were Black. Hierarchical linear regression modeling was conducted to examine factors related to resilience. Model 1 included demographics (age, education, and socioeconomic status) and stressful life experiences. Model 2 added circumstances of the violence: IPV severity, IPV perpetration by participant, and number of violent partners. The third and final model added spirituality, social support, community cohesion, and ethnic identity.

RESULTS

The final model was significant, F(11, 97)=6.63; p<.001, adj. R² =36.5%; with greater social support (β=.24; p=.009), more spirituality (β=.28; p=.002), and fewer violent relationships (β= -.25; p=.003) predicting higher resilience among women exposed to IPV.

CONCLUSION

While risk factors associated with IPV are well-researched, little is known about factors related to resilient functioning, especially among minority populations. Knowledge gained from this study can advance the field of violence research by its identification of potentially mutable variables related to resilience. Such research could be applied to developing strength-based interventions for at-risk populations of violence-exposed women.

Intimate partner violence screening in the dental setting: Results of a nationally representative survey

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.

Implementation of a Brief Abuse and Basic Needs Tool: Impact on Utilization of Social Services in Ambulatory Medical Clinics

Domestic violence (DV) screening has become increasingly common in recent years; however, many organizations still do not practice universal screening, and there is considerable debate concerning the best screening tool for detecting DV. The current research suggests that a brief tool would be ideal and that existing brief tools are comparable to more extensive instruments. Per Joint Commission standards, the ambulatory clinics at West Virginia University Hospitals instituted the use of the Functional Health Screening (FHS), a three-item tool that screens for unexplained weight changes, DV, and basic needs deficits. This tool is administered at the beginning of every outpatient clinic visit. This study includes a retrospective chart review to investigate the detection rate of this tool for DV and basic needs deficits, the increased utilization of social services, and nursing attitudes concerning FHS.

A Scoping Review of Intimate Partner Violence Screening Programs for Health Care Professionals

INTRODUCTION

Between 38 and 59 percent of women presenting to health care professionals have experienced intimate partner violence. Consequently, multiple intimate partner violence identification or screening programs within health care settings have been developed; however, substantial variations in program content and interpretation of program effectiveness has resulted in conflicting practice guidelines. The purpose of our scoping review is to broadly identify and synthesize the available literature evaluating intimate partner violence identification programs within health care settings to identify key areas for potential evidence-based recommendations and to focus research priorities in the field.

MATERIALS AND METHODS

We conducted a search of MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and psycINFO. We used broad eligibility criteria to identify studies that evaluated intimate partner violence identification programs in health care settings. We completed all screening and data extraction independently and in duplicate. We used descriptive statistics to summarize all data.

RESULTS

We identified 59 eligible studies evaluating intimate partner violence identification programs within health care settings. The most commonly reported outcome themes were IPV disclosure (69%, n = 35), number of patients screened (39%, n = 20), HCP opinions towards screening (37%, n = 19), and patient opinions towards screening (29%, n = 15). The majority of studies (36 studies (70.6%)) reported positive program evaluation results.

DISCUSSION

The majority of studies reported positive program evaluation results. This may suggest that many different intimate partner violence identification programs are beneficial for identifying victims of abuse, however, it remains unknown as to whether identification programs prevent future episodes of abuse. Additionally, the substantial heterogeneity of the intervention characteristics, study methodology, and outcome measures assessed limits the ability to make clear recommendations as to the optimal method(s) of screening.

Measuring Substance Use Among System-Involved IPV Survivors: A Research Note

This research note presents findings from a qualitative study exploring female, system-involved intimate partner violence (IPV) survivors' perspectives on substance use disclosure in the context of research studies. The study sample includes 22 women who completed a court- and/or child protective services (CPS)-mandated IPV parenting program. Analyses revealed three key areas of participants' perspectives on substance use assessment and disclosure: (a) administration setting/format and measurement clarity, (b) administrator characteristics, and (c) repercussions due to breach of confidentiality. Findings from the current study offer insights into barriers for survivors reporting their substance use and suggestions for researchers seeking to assess substance use among this population.

Physicians' Perceived Roles, as Well as Barriers, Toward Caring for Women Sex Assault Survivors

BACKGROUND

Sexual assault (SA) affects about 40% of women in the United States and has many mental and physical health sequelae. Physicians often do not address SA with patients, although SA survivors describe a desire to talk to physicians to obtain additional help. Little information exists on how providers perceive their roles regarding caring for women SA survivors and what barriers they face in providing this care.

METHODS

We performed a qualitative study using semistructured one-on-one interviews with 16 faculty physicians from five specialties: obstetrics and gynecology (n = 4), internal medicine (n = 4), family medicine (n = 1), emergency medicine (n = 3), and psychiatry (n = 4). Interviews were conducted between July 2011 and July 2012, transcribed verbatim, and coded using a constant comparative approach. Once a final coding scheme was applied to all transcripts, we identified patterns and themes related to perceived roles and barriers to caring for SA survivors.

RESULTS

Physicians described two main categories of roles: clinical tasks (e.g., testing and treating for sexually transmitted infections, managing associated mental health sequelae) and interpersonal roles (e.g., providing support, acting as patient advocate). Physician barriers fell into three main categories: 1) internal barriers (e.g., discomfort with the topic of SA), 2) physician-patient communication, and 3) system obstacles (e.g., competing priorities for time).

CONCLUSIONS

Although physicians describe key roles in caring for SA survivors, several barriers hinder their ability to fulfill these roles. Training interventions are needed to reduce the barriers that would ultimately improve clinical care for SA survivors.

Screening women for intimate partner violence in healthcare settings

BACKGROUND

Intimate partner violence (IPV) damages individuals, their children, communities, and the wider economic and social fabric of society. Some governments and professional organisations recommend screening all women for IPV rather than asking only women with symptoms (case-finding). Here, we examine the evidence for whether screening benefits women and has no deleterious effects.

OBJECTIVES

To assess the effectiveness of screening for IPV conducted within healthcare settings on identification, referral, re-exposure to violence, and health outcomes for women, and to determine if screening causes any harm.

SEARCH METHODS

On 17 February 2015, we searched CENTRAL, Ovid MEDLINE, Embase, CINAHL, six other databases, and two trial registers. We also searched the reference lists of included articles and the websites of relevant organisations.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials assessing the effectiveness of IPV screening where healthcare professionals either directly screened women face-to-face or were informed of the results of screening questionnaires, as compared with usual care (which could include screening that did not involve a healthcare professional).

DATA COLLECTION AND ANALYSIS

Two authors independently assessed the risk of bias in the trials and undertook data extraction. For binary outcomes, we calculated a standardised estimation of the odds ratio (OR). For continuous data, either a mean difference (MD) or standardised mean difference (SMD) was calculated. All are presented with a 95% confidence interval (CI).

MAIN RESULTS

We included 13 trials that recruited 14,959 women from diverse healthcare settings (antenatal clinics, women's health clinics, emergency departments, primary care) predominantly located in high-income countries and urban settings. The majority of studies minimised selection bias; performance bias was the greatest threat to validity. The overall quality of the body of evidence was low to moderate, mainly due to heterogeneity, risk of bias, and imprecision.We excluded five of 13 studies from the primary analysis as they either did not report identification data, or the way in which they did was not consistent with clinical identification by healthcare providers. In the remaining eight studies (n = 10,074), screening increased clinical identification of victims/survivors (OR 2.95, 95% CI 1.79 to 4.87, moderate quality evidence).Subgroup analyses suggested increases in identification in antenatal care (OR 4.53, 95% CI 1.82 to 11.27, two studies, n = 663, moderate quality evidence); maternal health services (OR 2.36, 95% CI 1.14 to 4.87, one study, n = 829, moderate quality evidence); and emergency departments (OR 2.72, 95% CI 1.03 to 7.19, three studies, n = 2608, moderate quality evidence); but not in hospital-based primary care (OR 1.53, 95% CI 0.79 to 2.94, one study, n = 293, moderate quality evidence).Only two studies (n = 1298) measured referrals to domestic violence support services following clinical identification. We detected no evidence of an effect on referrals (OR 2.24, 95% CI 0.64 to 7.86, low quality evidence).Four of 13 studies (n = 2765) investigated prevalence (excluded from main analysis as rates were not clinically recorded); detection of IPV did not differ between face-to-face screening and computer/written-based assessment (OR 1.12, 95% CI 0.53 to 2.36, moderate quality evidence).Only two studies measured women's experience of violence (three to 18 months after screening) and found no evidence that screening decreased IPV.Only one study reported on women's health with no differences observable at 18 months.Although no study reported adverse effects from screening interventions, harm outcomes were only measured immediately afterwards and only one study reported outcomes at three months.There was insufficient evidence on which to judge whether screening increases uptake of specialist services, and no studies included an economic evaluation.

AUTHORS' CONCLUSIONS

The evidence shows that screening increases the identification of women experiencing IPV in healthcare settings. Overall, however, rates were low relative to best estimates of prevalence of IPV in women seeking healthcare. Pregnant women in antenatal settings may be more likely to disclose IPV when screened, however, rigorous research is needed to confirm this. There was no evidence of an effect for other outcomes (referral, re-exposure to violence, health measures, lack of harm arising from screening). Thus, while screening increases identification, there is insufficient evidence to justify screening in healthcare settings. Furthermore, there remains a need for studies comparing universal screening to case-finding (with or without advocacy or therapeutic interventions) for women's long-term wellbeing in order to inform IPV identification policies in healthcare settings.

Kiosk versus in-person screening for alcohol and drug use in the emergency department: patient preferences and disclosure

INTRODUCTION

Annually eight million emergency department (ED) visits are attributable to alcohol use. Screening ED patients for at-risk alcohol and substance use is an integral component of screening, brief intervention, and referral to treatment programs, shown to be effective at reducing substance use. The objective is to evaluate ED patients' acceptance of and willingness to disclose alcohol/substance use via a computer kiosk versus an in-person interview.

METHODS

This was a cross-sectional, survey-based study. Eligible participants included those who presented to walk-in triage, were English-speaking, ≥18 years, were clinically stable and able to consent. Patients had the opportunity to access the kiosk in the ED waiting room, and were approached for an in-person survey by a research assistant (9am-5pm weekdays). Both surveys used validated assessment tools to assess drug and alcohol use. Disclosure statistics and preferences were calculated using chi-square tests and McNemar's test.

RESULTS

A total of 1,207 patients were screened: 229 in person only, 824 by kiosk, and 154 by both in person and kiosk. Single-modality participants were more likely to disclose hazardous drinking (p=0.003) and high-risk drug use (OR=22.3 [12.3-42.2]; p<0.0001) via kiosk. Participants who had participated in screening via both modalities were more likely to reveal high-risk drug use on the kiosk (p=0.003). When asked about screening preferences, 73.6% reported a preference for an in-person survey, which patients rated higher on privacy and comfort.

CONCLUSION

ED patients were significantly more likely to disclose at-risk alcohol and substance use to a computer kiosk than an interviewer. Paradoxically patients stated a preference for in-person screening, despite reduced disclosure to a human screener.