Screening for intimate partner violence in healthcare settings: An implementation-oriented systematic review

Abstract

Background Intimate partner violence (IPV) is a population health problem affecting millions of women worldwide. Screening for IPV within healthcare settings can identify women who experience IPV and inform counseling, referrals, and interventions to improve their health outcomes. Unfortunately, many screening programs used to detect IPV have only been tested in research contexts featuring externally funded study staff and resources. This systematic review therefore investigated the utility of IPV screening administered by frontline clinical personnel. Methods We conducted a systematic literature review focusing on studies of IPV screening programs for women delivered by frontline healthcare staff. We based our data synthesis on two widely used implementation models (Reach, Effectiveness, Adoption, Implementation and Maintenance [RE-AIM] and Proctor's dimensions of implementation effectiveness). Results We extracted data from 59 qualifying studies. Based on data extraction guided by the RE-AIM framework, the median reach of the IPV screening programs was high (80%), but Emergency Department (ED) settings were found to have a much lower reach (47%). The median screen positive rate was 11%, which is comparable to the screen-positive rate found in studies using externally funded research staff. Among those screening positive, a median of 32% received a referral to follow-up services. Based on data extraction guided by Proctor's dimension of appropriateness, a lack of available referral services frustrated some efforts to implement IPV screening. Among studies reporting data on maintenance or sustainability of IPV screening programs, only half concluded that IPV screening rates held steady during the maintenance phase. Other domains of the RE-AIM and Proctor frameworks (e.g., implementation fidelity and costs) were reported less frequently. Conclusions IPV is a population health issue, and successfully implementing IPV screening programs may be part of the solution. Our review emphasizes the importance of ongoing provider trainings, readily available referral sources, and consistent institutional support in maintaining appropriate IPV screening programs. Plain language abstract Intimate partner violence (IPV) is a population health problem affecting millions of women worldwide. IPV screening and response can identify women who experience IPV and can inform interventions to improve their health outcomes. Unfortunately, many of the screening programs used to detect IPV have only been tested in research contexts featuring administration by externally funded study staff. This systematic review of IPV screening programs for women is particularly novel, as previous reviews have not focused on clinical implementation. It provides a better understanding of successful ways of implementing IPV screening and response practices with frontline clinical personnel in the context of routine care. Successfully implementing IPV screening programs may help mitigate the harms resulting from IPV against women. Findings from this review can inform future efforts to improve implementation of IPV screening programs in clinical settings to ensure that the victims of IPV have access to appropriate counseling, resources, and referrals.

Experience of introducing screening for intimate partner violence and reproductive coercion in an urban sexual health clinic

“…This paper is the first study of its kind in Western Australia, and our findings and experience, along with those from other countries, 21 may encourage and guide other clinical services in implementing screening for IPV/RC.…”

The Evaluation of a Domestic Abuse Response Team Program in an Emergency Department

“…Over the year of the evaluation, approximately 58,214 individuals visited the regional hospital ED with 60.8% and 63% being screened via questions 1 and 2, respectively. In comparison, Miller et al (2021) observed a median reach of IPV screening of 47% after conducting a systematic review, demonstrating the larger proportion of domestic abuse screens in this regional hospital ED relative to other EDs, if domestic abuse is even screened for. Though nurses or other health professionals have expressed discomfort in screening for domestic abuse (Garbin et al, 2015;Henriksen et al, 2017;Mauri et al, 2015), most patients expressed that they felt it was appropriate and important to screen for domestic abuse in the ED (Ben Natan et al, 2012).…”

Intimate partner violence in women with breast and gynaecologic cancers: A systematic review

“…Successfully implementing IPV screening programmes may help mitigate the harms resulting from IPV against women. IPV screening and response can identify women who experience IPV and form interventions to improve their health outcomes (Miller et al, 2021). Patients and providers agreed that one of the most critical factors for successful IPV screening is facilitating reporting of IPV.…”

“…An intimate relationship is an interpersonal relationship that involves physical or emotional intimacy, those in such a relationship may experience partner violence (GoPal et al, 2021). Intimate Partner Violence (IPV), is a severe public health problem, a human rights violation (Bandara et al, 2021), and an important barrier to equal participation, quality of life and personal, social and economic development (Weaver & Riebel, 2021); IPV affects millions of women globally (Miller et al, 2021).…”