Screening for Intimate Partner Violence in Healthcare in Kano,Nigeria: Extent and Determinants

There has been increased advocacy to involve healthcare providers in domestic violence prevention through screening for it in healthcare. The extent and determinants of screening for Intimate Partner Violence (IPV) against women in a healthcare facility in Kano, Nigeria was assessed. Two hundred and seventy four healthcare providers responded to the Domestic violence healthcare provider survey probing the frequency of screening for IPV, staff attitudes towards domestic abuse, efficacy in screening, availability of support networks and staff/patient safety in regard to IPV inquiry. T-test and logistic regression were employed to study determinants of screening. The majority of participants (74%) had not screened for IPV during the preceding 3 months. Male gender, old age, and being of Yoruba ethnic belonging increased the likelihood of screening. With increasing perceived efficacy and increasing blame of the victim for abuse the likelihood of screening for IPV increased. Implications of findings for staff education and research are discussed.     

Optimal methods to screen men and women for intimate partner violence: results from an internal medicine residency continuity clinic

Contradictory data exist regarding optimal methods and instruments for intimate partner violence (IPV) screening in primary care settings. The purpose of this study was to determine the optimal method and screening instrument for IPV among men and women in a primary-care resident clinic. We conducted a cross-sectional study at an urban, academic, internal medicine residency continuity clinic in Connecticut among English or Spanish speaking adult patients. One group of patients ( n = 340) received a self-administered questionnaire (SAQ) containing the partner violence screen (PVS) and the Hurt, Insulted, Threatened or Screamed at Questionnaire (HITS). A second group (n = 126) was screened with PVS and HITS by their primary care providers during face-to-face (FTF) clinical encounters. Multivariable logistic regression models were used to determine the association between IPV prevalence and screening method (SAQ or FTF) after adjusting for socio-demographic effects. The overall IPV prevalence was 17.3% using the SAQ and 9.0% with FTF screening (p = .008). Patients receiving the SAQ were more likely to report IPV than those who were screened FTF (adjusted odds ratio [AOR]: 2.6, 95% confidence interval [CI]: 1.2-5.6). This effect persisted for women, who had a higher odds of IPV when screened through a SAQ than when screened FTF (AOR: 3.5, 95% CI: 1.4-8.6). Men did not differ in reporting IPV between methods: 11% with SAQ versus 9.4% FTF (p = .69). In internal medicine residency continuity clinics, a SAQ for IPV may result in higher disclosure and completion rates among female patients compared to FTF screening. Unique screening instruments and methods may be needed for men.     

A forensic medicine perspective on recurring episodes of intimate partner violence

During a three year period, 418 victims of intimate partner violence (IPV) were examined and their injuries documented at the Center for Victims of Violence (CVV) in Hamburg, Germany. All victims were questioned if their acute injuries were attributable to recurring acts of violence by the same intimate partner. The victims' experiences with recurring IPV were analyzed and associated risk factors as well as findings of acute physical injuries were integrated into the assesment. Overall, women were significantly more often victims of recurring episodes of IPV than men. In 35.4% of cases, victims of recurring IPV sustained injuries to three or more body regions. However, women who were victimized during a single act of violence, presented with the same distribution of injuries in only 21.1% of cases (p = 0.01). The results emphasize the fact that IPV often manifests itself in a spiraling escalation of physical violence. Furthermore, blunt force trauma to the head was diagnosed significantly more often (p = 0.05). The risk of sustaining a head injury was equally high for women who experienced a first-time violent episode by their ex-partner as it was for married women or women living in a non-marital partnership during recurring episodes of IPV. In an effort to reduce the increased risk for victims of IPV, health care personnel are highly encouraged to partake in forensic medicine based continuing education. This preventative measure may prepare clinicians to recognize IPV earlier as well as to treat and advise clients appropriately.     

Bruise Documentation,Race and Barriers to Seeking Legal Relief for Intimate Partner Violence Survivors: a Retrospective Qualitative Study

Documentation of physical injuries from intimate partner violence (IPV) is critically important when a victim seeks legal help. Bruising, a common IPV injury, is often less visible on victims of color. This retrospective qualitative study is focused on IPV survivors’ and service providers’ experiences with the complex interrelationship between IPV injury, bruise documentation, race and legal assistance. Focus group results with a racially diverse group of female IPV survivors and legal service providers indicate that all victims struggle with documenting their bruises, but for women of color, even documentation of visible bruising underrepresents the severity of their IPV injuries. Further, there are a number of social, logistic, and systemic barriers to injury documentation that may make legal relief for IPV difficult for all women, but particularly more difficult for women of color. Proposed solutions to address the gap include, improved documentation techniques, and greater education for legal service providers. Implications for the field of family violence generally and potential future research directions are also discussed.     

Economic Burden of Child Exposure to Intimate Partner Violence in the United States

Because the effects of children’s exposure to intimate partner violence (IPV) carry long lasting consequences for the affected children, IPV exposure may impose a significant economic burden to localities, states, and society at large, made explicit over the victim’s lifetime and over a wide range of behaviors and outcomes, including use of social services, health and healthcare utilization, educational outcomes, workforce productivity, and criminal behavior. While much research has been conducted on the effect of IPV exposure on multiple short- and long-term outcomes, no research to date has examined the economic burden associated with IPV exposure. Using an incidence-based approach, we estimated the aggregate discounted costs associated with healthcare spending, criminal behavior, and labor market productivity accrued by a 20-year-old victim in 2016 projected to the age of 65, applying a 3% discount rate. The average lifetime costs derived from childhood IPV exposure are estimated to be over $50,000 per victim (2016 U.S. dollars) due to increased healthcare costs ($11,000), increased crime costs ($14,000), and productivity losses ($26,000). Over an annual birth cohort of young adults, these costs amount to over $55 billion nationwide. IPV exposure imposes a substantial economic burden to society at large in the form of increased healthcare costs, increased crime costs, and reduced productivity. This study offers an explicit quantification of substantial lifetime costs, which should encourage policy makers to redouble efforts to reduce the incidence of IPV and successfully ameliorate its effects on IPV-exposed children.     

Screening for intimate partner violence in orthopedic patients: a comparison of three screening tools

Accurately identifying victims of intimate partner violence (IPV) can be a challenge for clinicians and clinical researchers. Multiple instruments have been developed and validated to identify IPV in patients presenting to health care practitioners, including the Woman Abuse Screening Tool (WAST) and the Partner Violence Screen (PVS). The purpose of the current study is to determine if female patients attending an outpatient orthopaedic fracture clinic who screen positive for IPV using three direct questions (direct questioning) also screen positive on the WAST and PVS. We conducted a prevalence study at two Level I trauma centres to determine the prevalence of IPV in female patients presenting to orthopaedic fracture clinics for treatment of injuries. We used three methods to determine the prevalence of IPV; 1) direct questioning, 2) WAST, and 3) PVS. We compared the prevalence rates across the three screening tools. Ninety-four women screened positive for IPV using any method. The prevalence of IPV was 30.5% when a direct questioning approach was utilized, 12.4% using the WAST, and 9.2% using the PVS. The WAST identified 37.2% (35/94) of the IPV victims detected and the PVS identified 27.7% (53/94) of the IPV victims detected, whereas direct questioning identified 89.4% of the IPV victims. Identification of IPV may be under-estimated by the WAST and PVS screening tools. Our findings suggest direct questioning may increase the frequency of disclosure of IPV among women attending outpatient orthopaedic clinics.     

Opinions and Experiences of Primary Healthcare Providers Regarding Violence against Women: a Systematic Review of Qualitative Studies

The aim of this systematic review of qualitative studies is to explore the opinions and experiences of primary care providers regarding violence against women. Structured searches were conducted in nine bibliographic databases (March 2016). Study identification, critical appraisal (using the CASP tool), and analyses (thematic synthesis) were conducted. 46 qualitative studies were selected. Three main themes were identified: 1) Defining violence against women and its causes; 2) Awareness of violence against women and disclosure, with subthemes: 2.1.) Barriers experienced by primary care providers; 2.2) Facilitators for providing appropriate help; 3) Actions taken by providers to help women. Violence against women was generally considered as an unacceptable act with important health consequences. Barriers to address violence against women included organizational factors, providers’ subjective feelings and perceived role, and providers’ perceptions about women facing violence against women. Facilitators included a trusting relationship with women, attentive non-judgmental listening, participate in the community, team-work and continuing education. Providing emotional support and offering information about resources were the main actions taken by primary care providers. Women-centred care, respecting women’s decision making processes and a biopsychosocial approach may provide direction to more compassionate and supportive care while strengthening primary healthcare response.     

Acculturation and reported intimate partner violence among Latinas in Los Angeles

This study sought to understand the relationship between acculturation and reporting intimate partner violence (IPV) among Latinas. A cross-sectional interviewer-administered survey was conducted at public health care clinics throughout Los Angeles County. Logistic regression was used to estimate the effect of acculturation on reporting IPV. An increasing trend of reporting IPV was observed among Latinas who were more acculturated (chi-square = 41.02, p = .0006). Highly acculturated Latinas were more likely to report IPV compared with least acculturated Latinas (prevalence odds ration = 2.18, 95% confidence level = 0.98, 4.89) and moderately acculturated Latinas were more likely to report IPV compared with least acculturated Latinas (prevalence odds ration = 1.29, 95% confidence level = 0.69, 2.43). Culturally competent IPV prevention programs may be the key to significantly reducing the number of women exposed to this serious public health problem.     

Professionalizing Arts Management in Healthcare Facilities

An urgent need exists for trained specialists to manage organizational policies and practices involving arts programs and activities in healthcare facilities. This article introduces the field of arts in health and argues for what is currently needed within the academic and professional field of arts management to advance this emerging arena of arts management theory and practice. The authors integrate key references from existing scholarship alongside additional survey data to offer recommendations for developing professional management of the arts in healthcare facilities like hospitals, hospices, and long-term care centers. The article provides an overview of the responsibilities of arts managers in healthcare institutions, as well as insight into the knowledge, competencies, and skills that arts managers require to effectively work in these settings. The article concludes with articulating a conceptual framework for a long-term research trajectory to inform further advancement of this distinct sub-field of arts management.     

Detection of intimate partner violence in a general medicine practice

In this study, an assessment phase is undertaken to determine intimate partner violence (IPV) prevalence. An anonymous survey is followed by a chart review documenting identification of IPV. Two methods are attempted to increase assessment/documentation of IPV: a physician educational intervention and a nursing routine inquiry intervention in one quadrant of the practice. The IPV physician educational intervention includes didactic sessions, an IPV counselor, and resource information. The routine inquiry intervention involves nurses screening female patients for IPV at check-in. IPV is found to be prevalent in a general medicine clinic. An enhanced educational intervention does not increase IPV documentation. A routine inquiry intervention significantly increases documentation of lifetime IPV but does not impact current IPV identification.     

VHA Primary Care Providers’ Perspectives on Screening Female Veterans for Intimate Partner Violence: A Preliminary Assessment

Female Veterans experience intimate partner violence (IPV) at alarming rates. The Veterans Health Administration (VHA) requires foundational research to guide the development of policy and programs to detect IPV among women Veterans and provide interventions. This pilot study reports findings from in-depth qualitative interviews conducted with 12 VHA primary care providers treating female Veterans in the New England region. Although most providers indicated that they were not currently routinely screening for IPV, they expressed positive attitudes and beliefs about screening in VHA primary care settings. Themes also included the importance of a comprehensive health care response to IPV, such as interdisciplinary coordination of care and team-based approaches to detection and intervention. Barriers to routine screening were identified, as well as recommendations for training programs and clinical tools to inform the successful implementation of a standardized IPV screening and response program in VHA. Although preliminary, these findings represent an initial step in an essential line of research.     

Factors Contributing to Intimate Partner Violence among Men in Kerala,India

Kerala is one of the most progressive states in India in terms of women’s opportunities for higher education and employment. Despite these advancements in gender equality, intimate partner violence (IPV) against women remains high, with some studies finding increased rates of IPV in Kerala relative to other states. This study examines contributing factors to male-to-female IPV in Kerala. One hundred and thirty-four men were surveyed on perceived marital power, early exposure to violence, drinking habits, depression, and marital satisfaction in relation to current IPV. Forty percent of participants reported incidents of IPV in the past year. Batterers scored significantly higher on childhood abuse, drinking, depression, and marital dissatisfaction. These four predictor variables were all significantly correlated with male-to-female IPV, but perceived marital power was only partially correlated with IPV. Abuse in childhood emerged as the strongest predictor of current IPV. Implications and suggestions for further research are discussed.     

The devil is in the details: Managed care and the unforeseen costs of utilization review as a cost containment mechanism

This article addresses issues of liability when a single-payor in a national health care system makes a decision based on a utilization review program that injures the patient as a result. In Part I, the history of Managed Care Organizations (MCOs) is discussed to establish an understanding of the current health care landscape. Part II explains MCOs' use of utilization review to contain costs and analyzes the manner in which courts have addressed the issue of MCO liability for patient injuries sustained from denial ofcoverage. Finally, Part III concludes that current case law may limit a patient's access to a remedy for injuries sustained from a utilization review decision in a single-payor national health care system.     

Understanding economic abuse in the lives of survivors

Intimate partner violence (IPV) often includes economic abuse as one tactic commonly used by an abuser; unfortunately, there is a lack of empirical understanding of economic abuse. Additionally, research is limited on the predictors of economic self-sufficiency in the lives of women experiencing IPV. This paper furthers our knowledge about economic abuse and its relationship with economic self-sufficiency by presenting the results from an exploratory study with IPV survivors participating in a financial literacy program. Of the 120 individuals who participated in the first wave, 94% experienced some form of economic abuse, which also correlated highly with other forms of IPV. Seventy-nine percent experienced some form of economic control, 79% experienced economic exploitative behaviors, and 78% experienced employment sabotage. MANOVA results also indicated that economic control differed significantly based on education with those with a high school education experiencing higher rates than those with less than high school education or those with some college. Finally, results from the OLS regressions indicated that experiencing any form of economic abuse as well as economic control significantly predicted a decrease in economic self sufficiency. Implications suggest that advocates should assess for economic abuse when working with survivors and should be prepared to offer financial tools to increase survivors' economic self-sufficiency. Policymakers should understand the ramifications of economic abuse and create policies that support survivors and prohibit economic abuse. Finally, more research is needed to fully understand economic abuse and its impact on survivors and their economic self-sufficiency.     

Intimate Partner Violence Involving Children and the Parenting Role: Associations with Maternal Outcomes

The aim of the present study was to investigate intimate partner violence (IPV) involving children and the parenting role (e.g., preventing an intimate partner from providing parental care or threatening to take one’s children away). Specifically, the study examined whether this form of IPV affects maternal functioning above and beyond other IPV experiences. Participants included a community sample of 120 primarily low-income, single women, diverse in age, education, and ethnicity, who were interviewed 1 year after giving birth, as part of a longitudinal study. IPV involving children and the parenting role was significantly associated with other experiences of IPV, especially general psychological IPV. Multiple regression analyses revealed that this form of IPV significantly affected mothers’ personal, relational, and parental functioning. Results suggest that it is important to assess for IPV involving children and the parenting role when working with mothers. More research on this unique type of IPV is needed.     

Racial differences in the prevalence of intimate partner violence against women and associated factors

Intimate partner violence against women (IPV) affects all populations, but significant variations among these groups have been suggested. However, research results on racial differences in IPV are not only inconclusive, they are also limited-particularly with regard to racial minorities. As a result, it has been challenging for practitioners and service providers in many communities to serve an increasing number of racial minority clients. This study used the Collaborative Psychiatric Epidemiology Surveys (CPES) to examine differences in the prevalence of IPV, and associated factors, among major race groups in the U.S. Included variables were age, race, financial security, employment, education, social network, IPV perpetration and victimization, and severity of IPV. The results showed that Blacks were victimized the most, followed by Whites and Latinos, and Asians were victimized the least. Asians were the least likely to be victimized by IPV, even when controlling for sociodemographic variables. The odds of victimization for Blacks and Latinos were not significantly different from Whites. Financial security and age affected IPV victimization. Those who perceived themselves as financially secure were less likely to be victimized than those who did not. The older were less likely to be victimized than the younger. Employment, education, and social networks did not affect victimization. Race was not a significant predictor of perpetration, when controlling for other variables. Age was the only predictor of perpetration: the older were less likely to perpetrate IPV than the younger.