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Screening for intimate partner violence in healthcare settings: An implementation-oriented systematic review
Christopher J Miller1,2, Omonyêlé L Adjognon1,3, Julianne E Brady1,3
1Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.
Implementation Research and Practice
|January 30, 2023
Summary
This systematic review found that intimate partner violence (IPV) screening by frontline clinical staff is effective, with high reach and comparable screen-positive rates to research settings. However, successful implementation requires ongoing training, available referrals, and institutional support for sustainability.
Area of Science:
- Public Health
- Healthcare Implementation Science
- Clinical Practice
Background:
- Intimate partner violence (IPV) is a significant global health issue affecting millions of women.
- Healthcare settings offer a crucial opportunity for IPV screening to identify affected individuals and facilitate interventions.
- Existing IPV screening programs have primarily been evaluated in research contexts, limiting understanding of their real-world clinical utility.
Purpose of the Study:
- To systematically review the utility and implementation of intimate partner violence (IPV) screening administered by frontline clinical personnel in healthcare settings.
- To assess the effectiveness and challenges of integrating IPV screening into routine clinical care.
- To provide evidence-based recommendations for improving the implementation and sustainability of IPV screening programs.
Main Methods:
- A systematic literature review was conducted, focusing on studies evaluating IPV screening programs for women delivered by frontline healthcare staff.
- Data synthesis was performed using two established implementation models: Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) and Proctor's dimensions of implementation effectiveness.
- Data from 59 qualifying studies were extracted and analyzed.
Main Results:
- IPV screening programs demonstrated high median reach (80%), though Emergency Department (ED) settings showed lower reach (47%).
- The median screen-positive rate was 11%, similar to research-based studies, with 32% of positive screens receiving referrals.
- Challenges to implementation included a lack of available referral services, and only half of the programs reported sustained screening rates during the maintenance phase.
Conclusions:
- Successful implementation of IPV screening by frontline clinical personnel is feasible and important for addressing this public health problem.
- Key factors for successful and sustainable IPV screening programs include continuous provider training, accessible referral resources, and consistent institutional backing.
- Findings can guide future efforts to enhance IPV screening and response in clinical settings, improving access to care for survivors.
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