PURPOSE We undertook a study to compare 3 ways of administering brief domestic violence screening questionnaires: self-administered questionnaire, medical staff interview, and physician interview.
METHODSWe conducted a randomized trial of 3 screening protocols for domestic violence in 4 urban family medicine practices with mostly minority patients. We randomly assigned 523 female patients, aged 18 years or older and currently involved with a partner, to 1 of 3 screening protocols. Each included 2 brief screening tools: HITS and WAST-Short. Outcome measures were domestic violence disclosure, patient and clinician comfort with the screening, and time spent screening.
RESULTSOverall prevalence of domestic violence was 14%. Most patients (93.4%) and clinicians (84.5%) were comfortable with the screening questions and method of administering them. Average time spent screening was 4.4 minutes. Disclosure rates, patient and clinician comfort with screening, and time spent screening were similar among the 3 protocols. In addition, WAST-Short was validated in this sample of minority women by comparison with HITS and with the 8-item WAST.CONCLUSIONS Domestic violence is common, and we found that most patients and clinicians are comfortable with domestic violence screening in urban family medicine settings. Patient self-administered domestic violence screening is as effective as clinician interview in terms of disclosure, comfort, and time spent screening.
INTRODUCTIONT he prevalence of current victims of domestic violence among patients in primary care settings ranges from 7% to 50%, 1 even though studies show that only 1% to 15% of women in primary care settings were asked about domestic violence by their clinician.2-4 Lack of offi ce protocols and limited time are perceived as common barriers by medical clinicians. [5][6][7][8] In one study, battered women perceived clinician reluctance to ask about abuse as a major barrier to their domestic violence disclosure.
9Although studies have found that brief screening questionnaires increase identifi cation of domestic violence, 10,11 research fi ndings are inconsistent on the optimum method of administering screening tests. In a recent randomized study, MacMillan et al found no signifi cant difference in the proportion of patients who disclosed domestic violence using a selfadministered questionnaire compared with patients who were interviewed by a clinician; the patients, however, preferred self-administered screening. 12 McFarlane and colleagues found that a medical staff interview identifi ed more abused women than a written history form, 13 whereas another study reported opposite fi ndings.14 With few notable exceptions, The purpose of this study was to identify an optimal screening protocol to help overcome barriers to domestic violence screening. We compared the rate of domestic violence disclosure, comfort level with screening, and time spent screening for self-administered, medical staff interview, and physician interview screening protocols.
METHODS
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