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

DOI: 10.3310/hta13160 Health Technology Assessment 2009; Vol. 13: No. 16
Contradictions between studies
Although most of the informants thought it was
the responsibility of health-care professionals
to screen for partner violence, some midwives
remained anxious and sceptical about screening
women for abuse. 177 In the study by Minsky-Kelly
et al., 181 informants expressed frustration over
being required to screen all patients, feeling that
‘no one across the country ... is doing this’. They
further questioned, ‘How much responsibility do I
own to save the world?’. Many participants found
screening for partner violence to be a disconcerting
experience, arousing feelings of discomfort and
embarrassment. 179 When they felt that screening
was not having an impact, there was a sense of
hopelessness in the face of what seemed like an
insurmountable problem.
Informants in some studies expressed the view
that screening for partner violence indicates
openness of the health-care professional towards
the problem, but Loughlin and colleagues found
that clinical staff in an accident and emergency
department were concerned that a screening
protocol might have a negative impact on the
public’s perception of the department. 180
Quantitative studies
Twenty papers reporting 20 studies fulfilled
our inclusion criteria (see Appendix 9.2 for
characteristics of included studies). Eleven studies
were conducted in the USA, five in the UK, one
in Pakistan, one in Kuwait, one in Northern
Ireland and one in Belgium. Two studies were
self-report postal questionnaires, one was an
online self-report questionnaire, and the others
were based on face-to-face interviews or selfcompleted
questionnaires. There were seven
studies of physician attitudes, four of midwives,
one of nurses, one of medical students, one of
midwife students, and six including different
types of health-care professionals. Response rates
were between 17% and 100%, and the number of
recruited health-care professionals ranged between
27 and 976, with a total of 4553 respondents. The
quality score assessed by STROBE was between
11 and 19, with most of the studies scoring more
than 15. There was a wide range of acceptability
of partner violence screening among health-care
professionals, from 15% to 95%. Results and quality
scores are detailed in Appendix 9.3.
Bair-Merritt and colleagues 184 assessed residents’
views of partner violence screening in a postal
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questionnaire survey sent to all civilian paediatric
residency programmes in the USA, with a 68%
response rate. Ninety-three percent of chief
residents felt that paediatricians should screen
for partner violence. Seventy-one percent of
respondents felt that their training was not
sufficient to make them comfortable performing
this screening.
Bair-Merritt and colleagues 185 surveyed 151
clinicians in a US urban paediatric emergency
department. Sixty-five percent agreed that they
should screen for partner violence. Age, gender
and role in the emergency department did not
affect opinions about screening.
Baig and colleagues 186 surveyed 167 residents
across six primary care (internal medicine,
obstetrics and gynaecology, paediatrics, family
medicine, emergency medicine and combined
medicine/paediatrics) residency programmes in a
US hospital. Ninety-five percent of respondents
thought partner violence screening was ‘important’.
Resident characteristics, such as gender, year in
residency and personal history of abuse, were not
independently associated with importance placed
on screening or on stated intention to screen
for partner violence. Residents who managed a
survivor of partner violence were more likely to
report that screening was very important than
those who had never taken care of a partner
violence victim. In multivariate logistic regressions,
emergency medicine residents were less likely than
other residents to consider that partner violence
screening was important. Some paediatric residents
did not screen because of privacy concerns and
thus may miss partner violence among their
adolescent patients. Residents reported lack of
time, personal discomfort and forgetting to ask as
personal barriers to partner violence screening.
Although residents cited lack of or poor training in
partner violence as a barrier, training in residency
was not independently associated with priority
placed on screening or on stated intention to
screen.
Baird 187 surveyed 29 preregistration midwifery
students about their views on routine enquiry about
partner violence. Fifty-two percent of respondents
felt it was the midwife’s role routinely to inquire
about partner violence, 38% were unsure, whereas
10% felt there was no role for the midwife. Sixtyeight
percent thought that women may be offended
if asked about partner violence by a midwife.
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