How far does screening women for domestic (partner) - NIHR Health ...

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Review methods
and comparator tools. In those cases we calculated
the diagnostic accuracy of the index tool. If the
raw data were not available, we requested it from
the authors. Reliability was judged by Cronbach’s
alpha, coefficient alpha or Cohen’s kappa.
Question III: Is screening for partner violence
acceptable to women?
In addition to summarising the data in terms
of the acceptability of screening to women, we
also examined if attitudes varied as a function of
women-related variables (such as age, ethnicity,
abuse status, educational status), demographic
features (such as the country where the study was
conducted, the setting in which the women were
recruited) and features relating to the screening
process (such as the questions asked and who asked
them). In a synthesis of the interview- and focus
group-based qualitative and questionnaire-based
quantitative studies, we explored whether and how
these factors are associated with women’s positive
attitudes towards partner violence screening. We
did not perform a meta-regression of the surveys
because of the heterogeneity of the clinical settings,
of the demographic data collected from the
informants, and the measures of acceptability.
Question IV: Are interventions effective once partner
violence is disclosed in a health-care setting?
We calculated effect sizes where means and
standard deviations were reported or were
obtainable from the authors of studies. Metaanalyses
of the studies were planned, but the data
could not be pooled because of the heterogeneity
of settings, demographics of the women
participants, study designs (including the duration
of follow-up) and the outcomes measured. It was
not possible to construct funnel plots to investigate
potential publication bias.
Question V: Can mortality or morbidity be reduced
following screening?
Where data were reported, we calculated
confidence intervals for differences in identification
and referrals between intervention and control
groups. Pooling of data to calculate an overall effect
size was not feasible because of the weak study
designs: there was only one RCT.
Question VI: Is a partner violence screening
programme acceptable to health professionals and
the public?
These data were summarised in terms of the
acceptability of screening to health professionals
(women’s views are given above and we did not
seek to include studies examining the views of
male members of the public). We also analysed
if attitudes varied as a function of individual
health professional-related variables (such as age,
ethnicity, previous training on partner violence,
personal experience of caring for abused patients),
demographic features (such as the country where
the study was conducted, the occupation of the
health professional) and features relating to the
screening process (such as the questions asked,
who should ask the questions, where the screening
should occur, barriers to screening). By examining
these factors we explored whether and how these
factors interact to increase or decrease health
professionals’ positive attitudes towards screening
women for partner violence.
Question VII: Is screening for partner violence costeffective?
In anticipation of a paucity of cost-effectiveness
(or any economic) studies of screening for partner
violence in health-care settings, we modelled the
impact of an intervention in general practice to
increase identification and referral of women
experiencing partner violence. We used real cost
data from a pilot study (PreDoVe, Prevention of
Domestic Violence) we completed in three east
London practices. 28 This model allowed us to
link intermediate outcomes such as referrals and
levels of abuse, to medium- and longer-term
outcomes and costs such as abuse measures, quality
of life, employment, housing and civil justice.
We combined our data with secondary sources to
estimate the impact on outcomes and costs that
could not be measured within the pilot study.
The model estimated the cost-effectiveness of
the intervention and gave special attention to the
following aspects:
• Micro-level data collection – PreDoVE collected
detailed resource use by women data, and
we have combined these with unit cost data
available from the NHS and relevant studies. 29
• Confidence intervals around the estimates
– we estimated the distribution of costs and
outcomes of partner violence. This allowed
us to investigate the probability that the
intervention is cost-effective and to establish
a confidence interval around the costeffectiveness
estimate.
• Sensitivity analyses – we varied all costs and
outcomes by 25% in univariate analyses.
• The time lag between cause and effect – the
study captured the extent to which women
access services over time, including periods of
time when the women choose to delay seeking
additional help.