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Intimate partner violence (IPV) is a significant health issue faced by women veterans, but little has been known up until now about their preferences for IPV-related care. A new study has found that most of these women support routine screening for IPV and want options, follow-up support, transparent documentation and Veterans Health Administration (VHA) and community resources. These findings appear in the journal Research in Nursing and Health.
Although women of all socio-demographic groups are at risk for IPV, population-based research suggests that women veterans are at higher risk for IPV than non-veteran women. In order to better understand their attitudes and preferences regarding IPV screening and response issues, five focus groups were conducted with 24 female patients of the Veterans Health Administration (VHA) with and without a lifetime history of IPV.
“In general, we found that women veterans support routine IPV screening and comprehensive IPV-related care within the VHA,” explained corresponding author Katherine Iverson, PhD, assistant professor of psychiatry at Boston University School of Medicine (BUSM) and a clinical research psychologist at the VA Boston Healthcare System and the VA’s National Center for PTSD. “As we move forward with routine IPV screening, it is important that these women are offered options in terms of what, how, when, and to whom to disclose and follow-up support. In addition, these women must be approached with sensitivity and connectedness with the understanding that different patients are in different stages of recovery.”
Overall, women indicated that the HITS screening tool [the four-item screening tool (Hurt/Insult/Threaten/Scream) tested by Iverson and her colleagues that can be used in under four minutes] could be useful in helping VHA providers identify women who have experienced IPV. Using the existing clinical reminder dialogue system a notification could be imbedded into a patients’ electronic medical records (EMR’s) to use HITS to assess IPV, ensuring that screening is occurring. This would be similar to clinical EMRs for mammograms and pap smears.
The researchers point out that use of EMRs may be a potential barrier to disclose for some women because of privacy and confidentiality concerns. Study participants suggested that this barrier can be overcome by providers’ use of transparency with respect to documentation. For example, providers can talk with their patients about what they would like to document in the EMR and problem-solve any concerns the patients may raise. In addition, providers can discuss privacy protections in place at VHA and engage patients in conversations about the advantages and disadvantages of documentation. EMRs can also prompt providers to engage in other procedures that were recommended by participants in this study, such as offering information about VHA and community resources.
The researchers believe the VHA has a timely opportunity and is well-positioned to serve as a national model for the implementation of best practices for IPV screening and response. “By incorporating the recommendations expressed by women in this study, VHA and other health care providers may increase the likelihood of identifying IPV, improve patient satisfaction with care, connect veterans with the services they need, reduce healthcare costs to the patient and system at large, and ultimately improve the health and well-being of female veteran patients,” added Iverson.
This research was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development (HSR&D) as part of Iverson’s HSR&D Career Development Award (CDA-2; 10-029) and the BUSM Lynne Stevens Award, which Iverson received in 2011.