Computer-Assisted Screening for Intimate Partner Violence and Control

doi:10.1059/0003-4819-151-2-200907210-00124

Computer-Assisted Screening for Intimate Partner Violence and Control

A Randomized Trial

Farah Ahmad, MBBS, MPH, PhD;
Sheilah Hogg-Johnson, PhD;
Donna E. Stewart, MD;
Harvey A. Skinner, PhD, CPsych;
Richard H. Glazier, MD, MPH; and
Wendy Levinson, MD

From the Dalla Lana School of Public Health, University of Toronto; Institute for Work & Health; Women's Health Program, University Health Network; York University; and Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada.

Abstract

Background: Intimate partner violence and control (IPVC) is prevalent and can be a serious health risk to women.

Objective: To assess whether computer-assisted screening can improve detection of women at risk for IPVC in a family practice setting.

Design: Randomized trial. Randomization was computer-generated. Allocation was concealed by using opaque envelopes that recruiters opened after patient consent. Patients and providers, but not outcome assessors, were blinded to the study intervention.

Setting: An urban, academic, hospital-affiliated family practice clinic in Toronto, Ontario, Canada.

Participants: Adult women in a current or recent relationship.

Intervention: Computer-based multirisk assessment report attached to the medical chart. The report was generated from information provided by participants before the physician visit (n = 144). Control participants received standard medical care (n = 149).

Measurements: Initiation of discussion about risk for IPVC (discussion opportunity) and detection of women at risk based on review of audiotaped medical visits.

Results: The overall prevalence of any type of violence or control was 22% (95% CI, 17% to 27%). In adjusted analyses based on complete cases (n = 282), the intervention increased opportunities to discuss IPVC (adjusted relative risk, 1.4 [CI, 1.1 to 1.9]) and increased detection of IPVC (adjusted relative risk, 2.0 [CI, 0.9 to 4.1]). Participants recognized the benefits of computer screening but had some concerns about privacy and interference with physician interactions.

Limitation: The study was done at 1 clinic, and no measures of women's use of services or health outcomes were used.

Conclusion: Computer screening effectively detected IPVC in a busy family medicine practice, and it was acceptable to patients.

Primary Funding Source: Canadian Institutes of Health Research and Ontario Women's Health Council.

Article and Author Information

Acknowledgment: The authors thank their collaborators, including Brenda McDowell and Bill Wetzel, for assistance with the planning phase by setting up of clinic for on-site screening and interviews, preparation of the research ethics application, modifications of the computer survey, and pilot testing. They also thank Natasha Driver, Shahjereen Shahidullah, Michelle DeIrish, and Sarah Keenan for their diligent research assistance in the recruitment and coding. Finally, they thank Karin V. Rhodes and colleagues for sharing Promote Health.
Grant Support: The study contributed toward doctoral and fellowship training of Dr. Ahmad, which was funded by the Canadian Institutes of Health Research (grants IGF 63976 and FOW 68219): Institute of Gender & Health, Ontario Women's Health Council, and Strategic Training on Health Care, Place & Technology Program. The authors gratefully acknowledge the support of the Ontario Ministry of Health and Long-Term Care. Support from the Centre for Research on Inner City Health, The Keenan Research Centre, in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, is much appreciated.
Potential Financial Conflicts of Interest: None disclosed.
Reproducible Research Statement: Study protocol and statistical code: Available from Dr. Ahmad (e-mail, farah.ahmad{at}utoronto.ca). Data set: Limited data set available from Dr. Ahmad (e-mail, farah.ahmad{at}utoronto.ca) after written agreement.
Requests for Single Reprints: Farah Ahmad, MBBS, MPH, PhD, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; e-mail, farah.ahmad{at}utoronto.ca.
Current Author Addresses: Dr. Ahmad: University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada.
Dr. Hogg-Johnson: Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, Ontario M5G 2E9, Canada.
Dr. Stewart: University Health Network, 200 Elizabeth Street, 7EN-229, Toronto, Ontario M5G 2C4, Canada.
Dr. Skinner: York University, Faculty of Health, 403 HNES, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada.
Dr. Glazier: Centre for Research on Inner City Health, 70 Richmond, 4th Floor, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
Dr. Levinson: Department of Medicine, University of Toronto, 190 Elizabeth Street, Suite 3-805, Toronto, Ontario M5G 2C4, Canada.
Author Contributions: Conception and design: F. Ahmad, S. Hogg-Johnson, D.E. Stewart, H.A. Skinner, R.H. Glazier, W. Levinson.
Analysis and interpretation of the data: F. Ahmad, S. Hogg-Johnson, D.E. Stewart, W. Levinson.
Drafting of the article: F. Ahmad, H.A. Skinner.
Critical revision of the article for important intellectual content: F. Ahmad, S. Hogg-Johnson, D.E. Stewart, H.A. Skinner, R.H. Glazier, W. Levinson.
Final approval of the article: F. Ahmad, S. Hogg-Johnson, D.E. Stewart, H.A. Skinner, R.H. Glazier, W. Levinson.
Provision of study materials or patients: F. Ahmad.
Statistical expertise: F. Ahmad, S. Hogg-Johnson, H.A. Skinner.
Obtaining of funding: F. Ahmad, W. Levinson.
Administrative, technical, or logistic support: F. Ahmad.
Collection and assembly of data: F. Ahmad.
ClinicalTrials.gov registration number: NCT00385034.