Barriers and Facilitators to Screening for Anxiety and Intimate Partner Violence

Periodic universal screening for anxiety and for intimate partner violence (IPV) for women and adolescent girls are national clinical practice recommendations. However, screening rates in primary care settings are low. This study aimed to increase awareness and adoption of screening for anxiety and for IPV in women and adolescent girls by identifying screening barriers and facilitators to inform clinical resource development.

Two-phase, qualitative study using semistructured interviews to identify screening barriers and facilitators; thematic analysis of interview data using a rapid evaluation approach.

Twenty-seven clinicians and staff members were interviewed in 12 clinics in 2 primary care networks in Oregon. All participants recognized the importance of screening in primary care settings but were generally unaware of screening recommendations and insurance coverage and were unsure of their clinic's policies and practices, citing a lack of protocols for referrals for positive screens. Barriers to both anxiety and IPV screening included screening fatigue, lack of metrics, uncertain documentation and reporting, and unclear referral and follow-up procedures. For IPV screening specifically, barriers included discomfort with screening, privacy concerns, and perceived low occurrence. Facilitators for both services included leveraging existing screening practices and electronic health record tools, and clear recommendations for universal screening best practices.

Implementation of routine screening for anxiety and IPV in women and adolescents in primary care is low but may improve with targeted clinician resources and education. Workflow diagrams and resource guides responsive to identified screening barriers and facilitators, including clarification of insurance coverage for preventive services, and resources to support implementation of protocols of screening methods, clinical documentation, and referrals for anxiety and IPV in primary care settings, could improve screening practices.