Changes in Intimate Partner Violence Knowledge, Preparation, and Practices Among Behavioral Health, Medical, and Nursing Providers

Background and Purpose: Approximately 1 in 4 females and 1 in 10 males in the U.S. have experienced physical violence, sexual violence, or stalking by an intimate partner. Screening for intimate partner violence (IPV) is recommended by the US Preventive Services Task Force and Institute of Medicine for women of childbearing age. Screening rates for IPV among most health care providers are low; yet, positive interactions with providers can benefit people who experience IPV, with respect to increased safety, support, and self-efficacy. The purpose of our study was to assess changes in the IPV preparation, knowledge, opinions, and practices across three groups of healthcare providers as part of a community-university IPV-response project in a large multispecialty outpatient clinic setting.

Methods: We used an anonymous online survey and a modified version of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) to measure IPV preparation, knowledge, and opinions from healthcare providers. A random sample of 402 providers was drawn from 13 clinics. A total of 204 respondents participated in the baseline survey and 122 of these same respondents completed the endline survey, two years later. Respondents who completed both baseline and endline surveys (N = 122) included medical providers (n = 38), nursing staff (n = 64), and social/behavioral health providers (n =20). The majority of respondents identified as female (n = 91; 74.6%) and the average length of time since earning their last degree was 16.28 years. Between the two survey years, 76.2% (n = 93) of the respondents participated in some IPV training (average hours = 2.26, SD = 1.91). Baseline summary scores for IPV preparation, knowledge, opinion, and practice issues were compared among the three groups of providers using one-way ANOVAs. Associations between changes in the IPV summary scales (from baseline to endline) and provider type and were further examined using multivariate linear regression, adjusting for gender, years since graduation, and IPV training hours.

Results: Baseline results of the one-way ANOVAs showed that mean scores on Perceived Preparation (4.98 compared with 2.59 and 2.90, p <.001), Knowledge (23.26 compared with 21.36 and 20.74, p < .001), and Practice scales (10.08 compared with 8.39 and 8.61, p = .50) were higher among social/behavioral health providers compared with medical providers and nursing staff, respectively. IPV preparation, knowledge, practice, and opinion scale scores between baseline and endline did not significantly change among any of the three provider groups, except for a marginally significant increase in victim understanding among nursing staff compared to behavioral health providers. IPV training was positively associated (p = .023) with changes in IPV preparation but had no association with other changes in summary scores.

Conclusion: Interactions with a health care provider who expresses support and concern result in some patients recognizing they could obtain safety and a better situation. However, we found many health care providers were underprepared to identify and respond to IPV in the clinic setting. Our findings highlight the need to better educate and prepare healthcare providers to serve patients who experience IPV.