A questionnaire that measured nurses' preparedness in encountering with women exposed to IPV, (i.e. identifying them and provide nursing interventions) was developed, based on a systematic literature review [33
] and the authors' knowledge and experience in this area. A draft was sent to a professional survey designer at Statistics Sweden who made modifications to it. The amended version consisting of 27 questions (including demographic) was pilot-tested by six nurses working in PHC who were asked to complete the questionnaire and comment on clarity and relevance of each question. Upon evaluating the returned questionnaires, two questions were removed; 'Do you participate in any kind of collaboration related to IPV?' and 'Do you have suggestions on training you think are important to your work with women facing IPV?' and two new questions were added; 'Are you a nurse or a district nurse?' and 'How many years have you worked as a nurse?'. The improved version of the questionnaire, still consisting of 27 questions (including demographic), was further tested on 39 nurses working in PHC in another county who were asked to comment on content, clarity and relevance. These nurses were not included in this study.
Final evaluation produced the final version of the questionnaire which consisted of 29 questions, nine of which aimed at assembling demographic data and personal experiences of IPV. The remaining 20 questions aimed at assessing the nurses' knowledge on IPV. No new questions were added after the second pilot-test, but two questions were divided.
1. The nurses' demographic data and experiences (9 questions): sex, age, birth country, profession, numbers of years working as a nurse, years as a district nurse, years at the current workplace, any personal experience of IPV.
2. The nurses' preparedness to provide nursing care to women exposed to IPV (20 questions):
- conditions at the organisation (7 questions): the nurses' working conditions, working environment and guidelines, special responsibility and interest, cooperation with other professionals and organisations and attitudes towards cooperation.
- personal attitudes (13 questions): the nurses' attitudes and knowledge on IPV, self-rated sufficient preparedness, knowledge and education, ability to identify IPV, attitudes towards asking (including reasons for not asking, if applicable) and frequency of asking (several alternatives could be ticked), preferred intervention implemented when suspicion of IPV was confirmed and also when it was not confirmed (several alternatives could be ticked).
Examples of answering alternatives were: 'yes', 'no' or 'do not know', and 'agree perfectly', 'agree somewhat', 'agree to some degree' and 'do not agree at all'. There was designated space at the end for nurses' to give comments when desirable. Analysis of estimated sample size were performed, using the key question 'If you suspected that a woman was exposed to IPV, would you confirm it by asking her if it was true?', and yielded a power of 90%. In total 125 participants were needed. Estimation of sample size was done to reach a 21% difference between those who could identify women exposed to IPV and those who could not.
Setting and data collection
At the time of the study there were 174 PHCC across urban and rural areas in Stockholm County that employed nearly 1,200 active nurses. Of the 174 PHCC, 40 were randomly selected. During the randomisation process, every PHCC was given a unique number that was written on a paper card and placed in a pot. For transparency, two colleagues independently drew 20 paper cards each, a total of 40. All PHCCs selected were then contacted and were invited to participate in the study. One of the 40 PHCCs declined to participate. The nurses in each PHCC were contacted by telephone and the nurse who replied was asked to act as a contact person for the study. The nurses received verbal and written information about the study. They were asked to distribute the questionnaires and an information letter to their colleagues at their workplace, and to collect the sealed envelopes with the questionnaires after completion and send them to an independent person at the research centres. The questionnaires were coded so that they could be easily traced and reminders were sent to invite participants to follow-up interviews.
The data were analysed using statistical software STATA 9.0. Descriptive statistics in the form of frequency tables were generated to describe the data in terms of number and percentage distribution. The summary and frequency tables were used to examine all variables used in the study. Pearson's chi-square test was used to test the statistical significance of the findings. A p-value of < 0.05 was indicative of statistical significance. Owing to the low number of answers to some answer alternatives, the options always, sometimes and never were dichotomised into two groups, always and sometimes/never.
Are the nurses prepared to identify and provide nursing care to women exposed to IPV who attend primary health care? To address this question, a two-step multivariate logistic regression analysis was performed. In step 1, 'if you suspected that a women was exposed to IPV, would you confirm it by asking her if it was true?' was used as the dependent variable, to assess nurses' ability to identify women exposed to IPV. In step 2, 'do you believe that you are sufficiently prepared to deal with a woman exposed to IPV?' was used as the dependent variable to find predictive factors associated with nurses' preparedness to deal with women exposed to IPV.
Ethical approval was obtained from the Regional Ethical Reviews Board at Karolinska Institutet, Stockholm. All participants were fully informed that their data would not be passed on to any third parties, their participation was voluntary and anonymous and that they could withdraw any time. Furthermore, participants were forewarned that the study could stir up distressing memories of abuse (applicable to those with personal experiences with IPV). A list of centres to seek psychological support was also provided.