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

DOI: 10.3310/hta13160 Health Technology Assessment 2009; Vol. 13: No. 16
ambulatory care clinic. Three studies recruited
women patients from general practices, two from
health maintenance organisations (HMOs), one
recruited women attending a family planning clinic
and one recruited women from a combination of
general practice, partner violence programmes and
refuges. There was variation in attitudes towards
screening between countries and between settings
within the same country (agreement with partner
violence screening varied between 35% and 99%).
The quality score assessed by STROBE 30 was
between 9 106 and 20, 107 with most of the studies
scoring more than 14 out of a possible 22. For
quality scores and results see Appendix 6.3.
Bair-Merritt and colleagues 108 conducted a survey
in an US paediatric emergency department,
comparing responses of mothers and other
female caregivers before (pre) and after (post)
implementation of a screening programme that
included displaying partner violence posters and
cards in the waiting area. The two groups did
not significantly differ with respect to age, race,
education or personal partner violence history.
The post group was less likely to find paediatric
emergency department partner violence screening
acceptable (pre, 76%; post, 63%; odds ratio 0.5;
95% confidence interval 0.3–0.9) and was less likely
to say that they would disclose abuse (pre, 85%;
post, 75%; odds ratio 0.6; 95% confidence interval
0.3–1.1). Notwithstanding this reduction, the
majority of respondents found screening acceptable
and said they would disclose if asked. There was
no difference between previously abused and nonabused
women with regard to the acceptability of
displaying resources or routine screening.
Brzank and colleagues 106 surveyed 18–60-yearold
women attending an accident and emergency
department in a German hospital. Overall, 32% of
the 806 participants would have wanted to be asked
about partner violence by their physicians. This
number increased to 41% in the case of patients
who had experienced sexual violence, and to 44%
in the case of patients who experienced physical or
emotional violence. Almost 65% of the participants
generally thought that questions about partner
violence experience should be part of routine
history taking.
Caralis and Musialowski 109 administered a
questionnaire to 406 women in ambulatory clinics
at a US Veterans Affairs Medical Center. They
reported that 77% of non-abused and 70% of
abused women agreed that doctors should routinely
screen for abuse in their practices.
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Friedman and colleagues 110 administered a
questionnaire to 164 women attending a primary
care physician in the USA. Routine enquiry about
physical and sexual abuse was favoured by 78%
and 68% respectively. Older patients were more
in favour of routine physical abuse enquiry, but
responses about sexual abuse enquiry did not vary
by age. Among patients who had not graduated
from high school education, there was a higher
proportion in favour of routine enquiry about
physical abuse and sexual abuse.
The study by Gielen and colleagues 111 included 202
abused women and 240 randomly selected nonabused
women recruited from a US metropolitan
health maintenance organisation. Forty-eight
percent of the sample agreed that health-care
providers should routinely screen all women.
Women thought that screening would make
it easier for abused women to get help (86%),
although concerns were raised about increased risk
of abuse with screening (43%).
Glass and colleagues 105 conducted a study based in
11 mid-sized community-level hospital emergency
departments in the USA, and recruited 3455
women patients. Those who were physically or
sexually abused in the past year were less likely
to agree with routine screening than women
who reported a lifetime history of abuse or who
reported no partner violence (80% versus 89%,
p < 01), although the majority of both groups
agreed with screening.
The participants in a study by Hurley and
colleagues 103 were 304 non-critically ill women,
aged 16–95 years, who presented to emergency
departments at two Canadian health centres.
Eighty-six percent supported universal screening of
women patients for partner violence, with no age
differences.
McCaw and colleagues 101 selected two random
samples of women patients (total 397) – members
of a non-profit, closed-panel, group-model
US health maintenance organisation (Kaiser
Permanente) – before and after an intervention that
included a screening programme. The majority of
women (80%) felt that clinicians should screen all
their women patients for partner abuse. Responses
to questions about the appropriateness of clinicians
screening all women patients were similar pre- and
post-intervention and did not differ by abuse status
or by age.
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