Our research supports the notion that screening may be helpful in identifying IPV victims who seek care in healthcare settings and provision of interventions in such settings may facilitate increased safety for abused women, thus reducing risk of future harm and additional negative health consequences. Those women seeking care who screened positive for IPV and participated in the clinic-based intervention had engaged in significantly more safety-promoting behaviors at follow-up than women in the control group. This finding is consistent with the recently published results of another study that found an increase in perceived safety and engagement in safety-planning behaviors at follow-up for women who sought care in an emergency department, screened positive for IPV, and participated in an on-site intervention. This intervention followed a similar model of an initial on-site meeting with an IPV advocate, where assessment, safety planning, and goal setting occurred and resource referrals were made, followed by a series of follow-up phone calls at designated intervals.38
These results are also similar to the results of another study that used a telephone intervention with a similar goal of increasing safety-promoting behaviors in abused women. This intervention was based in a legal setting (family violence unit of a district attorney's office) and resulted in an average increase of two safety-promoting behaviors for the intervention group sustained over an 18-month follow-up period.26
These results taken collectively demonstrate that such interventions may be useful in multiple settings where abused women may be seeking assistance.
Routine screening of women entering this clinical setting successfully identified women who recently experienced abuse and who may not have otherwise sought assistance specifically for their abuse experience from a community entity. The provision of on-site intervention services afforded an opportunity for such women to identify and initiate behaviors that help keep them safe from abusive partners. It is conceivable that such service could consequently cause decreased experiences of violence for such women and, relatedly, a decrease in the adverse health consequences that accompany such violent circumstances.
Another strength of this study, besides the helpful findings and the successful provision of safety-enhancing services to IPV survivors, is the 95% retention rate of study participants. This includes those in the control group, who did not receive the same degree of follow-up as intervention participants. This speaks to the rigor of procedures for securing and confirming contact information as well as the rapport developed by the community health worker with the research participants, who looked forward to her phone calls. In addition, the fact that the intervention site was a primary healthcare clinic, where most participants received routine medical care and follow-up, made it slightly easier to track women who may have otherwise been lost. Women often initiated contact with the community health worker or research team members who had a presence in the clinic when they visited for care. This also helped with follow-up.
This study has limitations. First, this was a pilot study and thus involved a relatively small sample. Similar studies should be done on a larger scale, as the results of this study provide evidence of the potential helpfulness of screening and provision of clinic-based IPV services. Such evidence is reinforced by the similar findings from a related study.38
The second potential limitation is selection bias, in that women who agreed to participate in the intervention may have been more ready to act. However, analysis revealed no significant relationship between stage of readiness, as measured by the stages of change scale, and safety-promoting behaviors. In addition, even women who were more ready to act may not have taken the initiative to do so without being given the intervention opportunity or having the abuse acknowledged by an outside person. As identified by Gerbert et al.,14
women may feel validated by a health provider's recognition and acknowledgment of the abuse, that the behavior of the person who abused her was wrong, and that she deserved better treatment. This validation could provide comfort and relief for women and help them recognize the seriousness of their situation and begin to change it. Thus, it is conceivable that providing on-site intervention services may equip women with the educational and psychological tools necessary for her to act.
Lastly, there are some women who may have been reluctant to reveal abuse experiences to strangers (the research team) or may not yet acknowledge their experience as abuse, and we may have missed those women. There will likely always be such women in this type of setting, as this population was not seeking IPV services when recruited. They, therefore, differ from women in settings (e.g., domestic violence shelters, personal protection order offices) where they usually have initiated help-seeking behaviors and are more likely to reveal abuse experience. The results of this study and others, however, indicate that a number of women are reached via the means of screening in a medical setting and benefit from the provision of intervention services, a justification for making them available in such settings.