By Neil Osterweil, Senior Associate Editor, MedPage Today
Review
HAMILTON, Ontario, Aug. 2 -- When women are screened for domestic violence, they'd rather have it done via a private questionnaire than in a face-to-face interview, investigators here found.
They also found that either of two screening instruments they used, a three-item questionnaire and an eight-item questionnaire, were comparably effective at detecting women who may need help coping with violence directed against them by intimate partners.
But the eight-item tool, was significantly less effective in the written form, Harriet L. MacMillan, M.D., M.Sc., and colleagues, of the McMaster Violence Against Women Research Group reported in the Aug. 2 issue of the Journal of the American Medical Association.
In addition, "although some literature suggests that use of computer-based questionnaires may lead to higher disclosures of sensitive issues than other approaches, we did not find that computer-based screening increased the detection of intimate partner violence relative to other screening methods," Dr. MacMillan and colleagues wrote.
The authors conducted a cluster randomized trial to assess the best method for screening women for domestic/partner abuse in a health care setting.
They enrolled women between the ages of 18 and 64 at emergency departments, family practices, and women's health clinics in the province of Ontario.
A total of 2,602 women were eligible, and all but 141 (5%) agreed to participate. The women were randomized according to either the clinic day or shift or to one of three screening approaches using either one of two short screening instruments.
The screening methods were either a face-to-face interview with a physician or nurse, written self-completed questionnaire, or computer-based self-completed questionnaire.
The screening instruments included the Partner Violence Screen, which asks the following:
Have you been hit, kicked, punched, or otherwise hurt by someone in the past year (and if so, by whom)?
Do you feel safe in your current relationship?
Is there a partner from a previous relationship who is making you feel unsafe now?
The second instrument tested was the Woman Abuse Screening Tool, an eight-item questionnaire which asks about the degree of tension in the relationship; the couple's ability to work out arguments; whether arguments ever result in the respondent feeling put down or bad about herself; whether arguments ever result in hitting, kicking or pushing; whether she feels frightened by what her partner says or does; and whether her partner has ever abused her physically, emotionally, or sexually.
Each of the screening methods was administered in either a face-to-face interview, written questionnaire, or computerized questionnaire, and each approach was evaluated for the prevalence of intimate partner violence detected, the extent of missing data, and the preference of participants.
Each screening instrument was also checked by having the participants complete the Composite Abuse Scale, a 30-item validated research instrument, and patients were also asked to evaluate their experience.
The authors found that the reported prevalence of domestic violence ranged from 4.1% to 17.7%, depending on the screening method and instrument used, and the health care setting where the questions were asked.
The reported prevalence was significantly higher in emergency departments than in either private practices or women's clinics.
"Although no statistically significant main effects on prevalence were found for method or screening instrument, a significant interaction between method and instrument was found: prevalence was lower on the written Woman Abuse Screening Tool versus other combinations," the authors wrote.
On the other hand, the Woman Abuse Screening Tool was better at capturing data than the Partner Violence Screen, they found, although the tests had similar sensitivity, at 47.0% and 49.2% respectively, and similar specificity, at 95.6% and 93.7%, respectively.
Participants as a whole said that the written and computerized versions were better than the face-to-face interviews for reasons of ease of use, personal preference, and privacy.
Their finding that face-to-face interviews are the least favorite method of screening for domestic violence in women is supported by other recent studies, cited by the McMaster researchers.
For example, in one study comparing audiotaped screening with written screening in a pediatric emergency department, the authors found no statistically significant difference in disclosures of violence between either method, but there were specific patterns in women's preference about the method used.
"Specifically, women found the audiotaped method to be less risky and more private than the written approach, and among both the entire sample and the subgroup of women disclosing abuse, the written and audiotaped methods were significantly preferred to the idea of disclosing intimate partner violence directly to a health care provider," Dr. MacMillan and colleagues wrote.
An important limitation to the study was noted by the authors. "Review of the sample characteristics by method shows that the women completing the computer-based screen had a higher proportion of participants in the lowest income quintile compared with those administered the other two approaches."
Footnote:
When screening women for possible domestic or partner abuse, consider offering a private setting and the use of a written or computerized screening instrument rather than a face-to-face interview.
