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

DOI: 10.3310/hta13160 Health Technology Assessment 2009; Vol. 13: No. 16
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Chapter 9
Is screening for partner violence acceptable to
health-care professionals? (Question VI)
Qualitative studies
We identified 10 journal articles and one UK
Home Office report reporting the attitudes of
health-care professionals towards screening for
partner violence. For details of study design and
quality scores see Appendix 9.1. Four studies were
conducted in the USA, three in the UK, two in
Sweden, one in Australia and one in New Zealand.
There are six studies exploring midwives’ attitudes,
one about nurses, two about physicians, one about
nurses and mental health service providers, and
one about a range of professionals. The total
number of recruited health-care professionals was
446, ranging between 8 and 124 per study. The
methodological quality score assessed by CASP was
between 19 and 37, with most of the studies scoring
more than 31.
First-order constructs
We identified 12 first-order constructs concerning
health-care professionals’ views about partner
violence screening. There were variations between
studies regarding the first-order constructs but
there were no systematic differences in relation to
country or health-care setting.
1. Screening for partner violence is acceptable to
some health-care professionals
Edin and Högberg found that the idea of asking
all pregnant women questions about abuse, as
is done with respect to smoking and alcohol,
was acceptable to almost all the midwives they
interviewed. 175 Stenson and colleagues also
found that health-care professionals generally
consider routine questioning about partner
violence acceptable. A typical statement from their
informants: ‘Regarding certain questions, routine is
very important; to raise them at this point in time
because then you know it will get done’. 176
2. Health-care professionals felt that they have a
responsibility to screen for partner violence
It was felt that all health professionals need to be
aware of the issues involved and share responsibility
for detecting partner violence and supporting the
women concerned. 177,178 Screening was seen as an
expression of wanting to make a difference to the
social issue of partner violence. 179
3. Asking about abuse helps remove stigma attached
to partner violence and indicates openness to the
issue
Edin and Högberg reported that one justification
for screening expressed by their midwife
informants was that asking every pregnant woman
in their antenatal clinics questions about abuse
‘would play down the issue; no one would need to
feel singled out when confronted with a sensitive
question’. 175
4. Screening for partner violence is an indicator of
good care
Some accident and emergency staff thought that
asking all women about abuse was an indication of
good care. 180
5. Screening for partner violence is conditioned by
the way professionals ask and timing is important for
screening
Timing of screening was considered important
by informants. Screening during routine medical
intake, such as during the triage process, was
considered inappropriate. 120 Concerns were
raised about patients with a range of conditions:
drug and alcohol intoxication, acute psychosis,
active labour, stroke, heart attack or other acute
conditions. These groups might be unable to
respond appropriately to screening or their
priority is immediate medical management. 181
The informants of Edin and Högberg suggested
the issue could be brought up during the first
antenatal visit of the women or at a later visit. 175
In the study by Stenson and colleagues, midwives
did not perceive questions about violence as being
more delicate than many other questions that are
ordinarily asked in antenatal care. 176 Others said
that ‘they did not feel it to be a problem to ask,
although they reported different situations when
they found questioning about abuse inappropriate’.
Although different opinions were expressed
regarding screening, some midwives suggested
the use of routine questions; other informants
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