Considering the health consequences of IPV, the involvement of the health care system presents a critical opportunity for identifying and helping female survivors of IPV. We found that Colombian clinicians face many barriers to screening for IPV and are interested in interventions in the health care setting to improve screening and management of patients. The lessons learned from this study may elucidate barriers that providers in other health care systems internationally may face in screening for IPV and how they may potentially identify areas for intervention in their particular settings.
We found that many Colombian health care personnel most often asked about IPV when they suspected victimization. By only screening sporadically, health care personnel may lose many opportunities to detect violence when the signs are not obvious. The lack of systematically screening all female patients has been reported in other studies, corroborating that health care personnel may exhibit similar screening behaviors despite the country or health care setting (Elliott, Nerney, Jones, & Friedmann, 2002
; Fikree, Jafarey, Korejo, Khan, & Durocher, 2004
; Rodriguez et al., 1999
; Sagot, 2000
). Yet, unique to our study, we found that respondents felt it was primarily the physician's responsibility to screen for and detect IPV. The importance placed on the role that physicians played in the detection of IPV is one that is not repeatedly found in the literature and may be specific to Colombia, though few studies have included medical and nonmedical personnel in understanding IPV detection within a health care system.
Even though the global medical and public health community acknowledge IPV as a public health problem that should be addressed by the health care setting, health care personnel noted many barriers in detecting IPV in their patient population. Our respondents noted various barriers to detection, such as lack of training, lack of time and effective interventions, personal discomfort, fear of legal involvement, and patient nondisclosure. Many of these barriers to screening for IPV have been reported in studies of providers worldwide (Fikree et al., 2004
; Rodriguez et al., 1999
; Sagot, 2000
). These findings may demonstrate the lack of medical training and systems in place that encourage and facilitate addressing IPV in the health care setting. Since these findings are not uncommon among providers, the potential to replicate and test interventions conducted in other countries to improve IPV screening within the Colombian health care system may be promising (Bonds, Ellis, Weeks, Palla, & Lichstein, 2006
; Snider, Webster, O'Sullivan, & Campbell, 2009
Colombian providers were interested in interventions in the health care setting to improve IPV screening rates. Responders were interested in receiving training in IPV screening and increasing awareness of the importance of screening for IPV among health care staff. Respondents also noted patient-centered solutions including empowering the patient and educating her on the value of reporting the violence to authorities. Organizational changes such as the development of protocols, increasing time for patient visits, embedding IPV screening questions into intake forms and patient histories, and more hospital programs for survivors were noted as ways to support and guide health care personnel in detecting IPV survivors. Considering the multiple barriers that our participants noted in detecting IPV, the respondents offered many feasible provider, patient, and organizational solutions to improve the detection of IPV among their female patients and were interested in implementing these interventions within the health care setting. Translating these individual-aimed solutions may be critical in acceptability of these interventions by providers and ultimately may improve provider screening rates of IPV within the Colombian health care system (Nelson, 2004
Our findings also may inform how to improve IPV detection rates in settings outside of Colombia. We found it was critical to include a wide range of health care providers in understanding the continuum of detection and management of IPV screening. Through conversations with physicians, nurses, psychologists, social workers, and other health care personnel, we were able to understand the process of IPV detection and identify barriers to screening. While many of the barriers to IPV screening that the Colombian providers listed were ones that have been described in other settings internationally, we also found that in Colombia, physicians played a larger role in screening (Elliott et al., 2002
; Rodriguez et al., 1999
; Waalen, Goodwin, Spitz, Petersen, & Saltzman, 2000
). Thus, researchers in other settings may need to delineate the roles that providers have in the detection process in order to effectively improve screening rates. Many barriers to screening may be unique to particular health care systems within a specific community, country or region. Additionally, since these providers are experts in how their system works, they were best prepared to describe potential solutions to mitigate their barriers to IPV screening. Speaking to a variety of personnel, understanding their barriers to IPV detection, and asking them to propose ways to improve screening may best inform the design of interventions that are tailored to address IPV screening in a particular setting.
Although our study has many strengths, we also have some limitations. Our interviews were conducted using a convenience sample, though our participants were key people in the process of identifying and managing IPV survivors and had a high likelihood of contact with female, reproductive age patients. Also, the participants may have been unable to speak freely about a topic that may have been perceived as taboo or perhaps gave socially desirable answers, limiting the variability in our responses to some questions. Yet, we found that the respondents repeated the same stories across institutions and professions, reassuring us that we did capture the most common responses as well as a wide range of beliefs.