Barriers to screening for domestic violence

Abstract

CONTEXT: Domestic violence has an estimated 30% lifetime prevalence among women, yet physicians detect as few as 1 in 20 victims of abuse. OBJECTIVE:To identify factors associated with physicians' low screening rates for domestic violence and perceived barriers to screening. DESIGN:Cross-sectional postal survey. PARTICIPANTS:A national systematic sample of 2,400 physicians in 4 specialties likely to initially encounter abused women. The overall response rate was 53%.MAIN OUTCOME MEASURE: Self-reported percentage of female patients screened for domestic violence; logistic models identified factors associated with screening less than 10%. RESULTS:Respondent physicians screened a median of only 10% (interquartile range, 2 to 25) of female patients. Ten percent reported they never screen for domestic violence; only 6% screen all their patients. Higher screening rates were associated with obstetrics-gynecology specialty (odds ratio Lower screening rates were associated with emergency medicine specialty (OR, 1.72; CI, 1.13 to 2.63), agreement that patients would volunteer a history of abuse (per Likertscale point, OR, 1.60; CI, 1.25 to 2.05), and forgetting to ask about domestic violence (OR, 1.69; CI, 1.42 to 2.02).CONCLUSIONS: Physicians screen few female patients for domestic violence. Further study should address whether domestic violence training can correct misperceptions and improve physician self-confidence in caring for victims and whether the use of specific intervention strategies can enhance screening rates.

Intimate Partner Violence: What Are Physicians' Perceptions?

“…Ten percent or less of adult providers routinely screen their patients for IPV. [11][12][13][14] Barriers to screening include time constraints, discomfort with the subject, fear of offending the patient, frustration with patient's denial, lack of skills and resources to manage IPV, and the fear of opening "Pandora's box." [15][16][17][18] For these reasons, and because physicians do not think of older women as victims of IPV, screening for IPV rarely occurs with older patients.…”

How Much Health Promotion and Disease Prevention Is Enough? Should Chiropractic Colleges Focus on Efficacy Training in Screening for Family Violence?

“…It is noteworthy, however, that physician retrospective self-reports of even relatively brief training exposures are associated with some increased probability of provider screening relative to no training at all. 13,34,38,78,84 However, consistent with the current emphasis on continuing education, the time elapsed since training is an especially important predictor of screening. 13,38 Based on the evidence supporting the benefits of interdisciplinary collaboration and coordination of care, several emerging models of interagency training and service delivery also are proposed.…”

“…13,34,38,78,84 However, consistent with the current emphasis on continuing education, the time elapsed since training is an especially important predictor of screening. 13,38 Based on the evidence supporting the benefits of interdisciplinary collaboration and coordination of care, several emerging models of interagency training and service delivery also are proposed. Some illustrative published programs represent elder abuse, 85 child protection, 86 and family violence.…”

“…19,20,31,[34][35][36][37] Across a variety of different health provider groups, reported rates of routine assessment remain quite low, ranging from an estimated 10-15% for physicians 1,13,27,[38][39][40][41] to < 19% for psychologists, 19 although rates may increase somewhat when physical injury is the presenting concern. 42 Hence, across traditional health care disciplines (chiropractic is discussed later in the article), providers' behaviors have remained seemingly refractory to professional recommendations for universal screening.…”

“…36 These low rates of routine screening are especially noteworthy given that family violence is unlikely to be spontaneously reported by patients in the absence of direct questioning by providers. 41,43 Given the common focus across professional groups on screening and detecting family violence, 13,20,27,29,31,34,37,38 the data indicating that screening enhances detection, 18,29,44 and health care providers' own acknowledgment of the importance of early detection, 6 considerable research has sought to identify the obstacles to universal family violence screening. Among the wide variety of barriers reported over the past several years, those most commonly reported have centered on four broad categories, including limitations in professional preparation, scope of practice concerns, inadequate system support, and a lack of interdisciplinary collaboration.…”