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Getting Routine Intimate Partner Violence Screening Right: Implementation Strategies Used in Veterans Health
Omonyêlé L Adjognon1, Julianne E Brady2, Megan R Gerber2
1From the Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA (OLA, JEB, ARG, KMI); Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA (OLA, JEB); Women's Health Center, VA Boston Healthcare System, Boston MA (MRG); Section of General Internal Medicine, Boston University School of Medicine, Boston, MA (MRG); VA Center for Health Equity Research and Promotion (CHERP), Crescenz VA Medical Center, Philadelphia, PA (MED); School of Social Work, Temple University, Philadelphia, PA (MED); Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC (ARG); VA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA (ABH); Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA (ABH); Dissemination and Training Division, National Center for PTSD, VA Palo Alto Healthcare System, Palo Alto, CA (SWS); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA (SWS); Department of Psychiatry, Boston University School of Medicine, Boston MA (KMI). omonyele.adjognon@va.gov.
Background:
Evidence supports the clinical effectiveness of intimate partner violence (IPV) screening programs, but less is known about implementing and sustaining them. This qualitative study identified implementation strategies used to integrate IPV screening programs within Veterans Health Administration (VHA) women's health primary care.
Methods:
Thirty-two administrators and clinician key informants from 11 VHA facilities participated in semistructured interviews. Implementation strategies were identified using established definitions from implementation science literature, through multistep content analysis, involving site comparisons by implementation status.
Results:
We identified 8 implementation strategies. Three were present across all sites: (1) conduct ongoing IPV trainings, (2) conduct educational meetings and outreach visits, and (3) develop and distribute educational materials. Five strategies were unique to early adopting sites: (4) identify and prepare champions, (5) change record systems to remind clinicians, (6) create a learning collaborative through advisory boards or workgroups, (7) audit and provide feedback with relay of clinical data to providers, and (8) access new funding.
Discussion:
Strategies align with and extend literature addressing barriers to screening. Evidence shows that effective IPV screening implementation in primary care requires a bundle of well-defined, carefully selected strategies.
Conclusions:
Implementation strategies used collectively can enable integration of IPV screening programs in primary care.
