Barbadian Primary Care Practitioners & Domestic Violence Screening: Factors Impacting Past Behavior and Future Intention

Background: Research indicates that gender-based violence rates in the Caribbean are among the highest in the world, with domestic violence (DV) exposure rates between 17% and 69%. In 2012, the United Nations (UN) cited Barbados for the gravity of DV in the island. Recent country reports to UN bodies show DV remains a significant concern, despite the 2016 revamping of Barbados’ DV law. Although DV carries overwhelming physical and psychological sequelae, the Barbadian healthcare sector has been seen as minimal or tangential in addressing DV. Numerous studies (in high-income countries) indicate that despite their strategic position to screen and intervene on behalf of DV victims, most HCPs do not. The literature is inconclusive regarding the role of personal factors on HCPs’ DV screening behavior, and lacks research on HCP screening in low to middle-income countries like Barbados. This research addresses these gaps. Exploring Barbadian HCPs’ DV screening practices has implications for abused women’s health-seeking and feelings of safety, given the lack of resources to address DV in the island.

Methods: Utilizing the Integrated Behavioral Model (IBM), this mixed-method study explored Barbadian HCPs’ attitudes and beliefs regarding DV screening, and the role of personal and professional factors on past screening behavior and future screening intention. Purposive sampling of primary care practitioners (physicians, nurses and dentists) was conducted for the elicitation phase focus groups (N=35), and a census of primary care practitioners was conducted for the survey phase (N=176). Participants were predominantly female (focus groups – 86%; survey - 76%); physicians were the majority practitioner type (46% in the focus groups and survey) and public clinics was the predominant work setting (focus groups - 83%; survey - 58%). Mean age was 47 (SD=11.7).

Results: A multiple regression was run with three control variables (frequency of DV inquiry; experienced physical violence; DV training) and six independent variables (IBM constructs: self-efficacy; perceived control; descriptive norms; injunctive norms; instrumental attitudes; descriptive attitudes) to predict screening intention. Control variables explained 14% of the variance, with only “experienced physical violence” being significant (p=.01), accounting for 4% of the variance. The IBM constructs explained an additional 16% of the variance, with "self-efficacy" being the strongest theoretical predictor (β=.23, p<.05). The entire model explained 30% of the total variance (F(9,127)=6.14, p<.001).

Conclusion/Implications: Over a third of Barbadian HCPs have experienced violence with physical violence having the greatest impact on screening intention. Despite reporting more DV training than their peers globally, Barbadian HCPs screen at levels on par with them. They report more favorable attitudes toward screening, viewing it as part of their role, despite time being a barrier. Future research should use participatory action methodologies to engage HCPs and patients to develop strategies to address DV. Barbadian social work programs should offer their students family violence, medical social work and trauma-informed care content, to enable them to serve as medical social workers in primary care settings, and assist HCPS in addressing DV. This includes screening, advocacy and engagement in chronic disease models of care to empower women experiencing DV.