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

44
Review Question III
Abuse status
Seven quantitative studies reported results by abuse
status, and there was no consistent difference in
acceptability by abuse status, although several
found that a lower proportion of women with
a history of partner violence were in favour of
screening compared with women without that
history. Caralis and Musialowski reported that 77%
of non-abused women and 70% of abused women
agreed with screening. 109 Glass et al. reported that
80% of women who were acutely abused or who
were physically or sexually abused in the past year
agreed with routine screening compared with 89%
of women who reported a lifetime history of abuse
or who reported no partner violence. 105 Zeitler
and colleagues reported a similar result: women
who had experienced physical violence in the last
year were significantly less likely to report that they
felt it was a good idea for health-care providers to
ask all women about violence; but even so, 80%
of this group were in favour of all women being
asked. 115 However, Friedman and colleagues found
that 80% of those who reported sexual abuse
favoured routine physician enquiry about sexual
abuse compared with 64% of those who reported
never being sexually abused. 110 In the same study,
patients who reported abuse were just as likely to
favour routine enquiry as patients who reported
never being abused. Gielen and colleagues found
that 48% percent of their sample agreed that
health-care providers should routinely screen all
women, with abused women more likely than nonabused
women to support this policy (54% versus
42%), 111 which concurred with the findings of Sethi
and colleagues that 43% of accident and emergency
department patients with a history of abuse
thought that women should always be asked about
experience of partner violence, compared with 30%
among those who had not been abused. 48
Screening settings
There were no consistent differences in
acceptability of screening by health-care setting.
Most of the studies were conducted in various
hospital settings, with some in general practices,
in refuges or where women attended their support
groups; one was in a family planning clinic and
some included different settings. In several of
the qualitative studies, informants did say that
they would prefer screening to be carried out
by a clinician with whom they already had a
relationship, which implies that primary care is
a more acceptable context than an accident and
emergency department. This finding also implies
that it may be less appropriate to ask about
abuse at the first antenatal appointment than at
subsequent appointments.
Method of administering
screening questions
Most quantitative studies did not test acceptability
of screening in relation to screening modality.
Those that did and the qualitative studies found a
range of preferences; there was no single preferred
modality.
Type of health-care professional
Acceptability of screening may vary according
to the gender and the profession of the healthcare
provider asking the questions. Some women
preferred being screened by female health-care
professionals; however, the qualitative studies
found that most women felt that a professional’s
interpersonal skills were more important than their
gender or profession. Others voiced a preference
for being screened by older health-care providers
and doctors. Richardson and colleagues 41 found
that 20% of women reported that they would mind
being asked by their general practitioner about
abuse or violence in their relationship if they had
come about something else, with 23% objecting to a
nurse asking; 42% reported that they would find it
easier to discuss these issues with a woman doctor,
and 3% expressed a preference for a male doctor.
Romito and colleagues found that women’s
responses concerning who they would like to
discuss violence issues with ranged from (more
than one answer was possible) the family doctor
(54%), a psychologist (28%), women who had
similar experiences (22%), a social worker (9%)
and the police (7%). 107 Webster and colleagues 116
also reported a range of responses from women
when asked about which health-care professionals
should screen for partner violence: 1068 (65%)
of the women nominated midwives, 1055 (64%)
nominated general practitioners, 809 (49%)
selected social workers, and 771 (47%) selected
hospital doctors. Only 42 (2%) thought no one
should ask. A number of women wrote comments
such as ‘anyone who cares should ask’.
From the qualitative studies it seems that in
general women gain a sense of support and
relief from discussing their situation with a
health-care professional. Some women found
it more acceptable to be screened by a healthcare
professional where there was an alreadyestablished
relationship and trust had been built