Evaluation of a two-question screening tool in the detection of intimate partner violence in a primary healthcare setting in South Africa

Abstract

Intimate partner violence has been recognised globally as a human rights violation. It is universally underdiagnosed and the institution of timeous multi-faceted interventions has been noted to benefit intimate partner violence victims. Currently the concept of using a screening tool to detect intimate partner violence has not been widely explored in a primary healthcare setting in South Africa, and for this reason the current study was undertaken. The objectives of this study were: (1) to determine the operating characteristics of a two-question screening tool for intimate partner violence (Women Abuse Screening Tool-short); and (2) to estimate the prevalence of intimate partner violence among women attending an outpatient department, using a validated questionnaire (Women Abuse Screening Tool). Methods: A cross-sectional study was conducted prospectively at the outpatient department of a primary care hospital, with systematic sampling of one in eight women over a period of three months. Participants were asked about their experience of intimate partner violence during the past 12 months. The Women Abuse Screening Tool-short was used to screen patients for intimate partner violence. To verify the result of the screening, women were also asked the remaining questions from the full Women Abuse Screening Tool. Results: Data were collected from 400 participants, with a response rate of 99.3%. Based on the results for the Women Abuse Screening Tool, the prevalence of intimate partner violence in the sample was 32%. The Women Abuse Screening Tool-short was shown to have a sensitivity of 45.2% and specificity of 98%. Conclusion: With its high prevalence, intimate partner violence is a health problem at this facility. The Women Abuse Screening Tool-short lacks sufficient sensitivity and therefore is not an ideal screening tool for this primary care ambulatory setting. The low sensitivity can be attributed to the participants' understanding of the screening questions, which utilise Eurocentric definitions of intimate partner violence. Improvement in the sensitivity of the Women Abuse Screening Tool-short in this setting may be achieved by lowering the threshold for a positive result.

Análisis y validación de los resultados del servicio de cribado de violencia de género en Castilla y León a los 4 años de su puesta en marcha

“…Hay estudios que han presentado tasas de respuestas más elevadas aunque con metodologías diferentes en la fase de captación y con contraprestaciones económicas o de otro tipo en alguno de ellos: un 96% en Indonesia (Iskandar, L., Braun, K.L. y Katz, A.R., 2015) y un 99,3% en Sudáfrica (Saimen, A. et. al., 2016) Nuestra muestra incluyó un 6,9% de mujeres extranjeras, superando el porcentaje de las residentes en nuestro área, que no llega al 3% en Burgos para mujeres en ese rango de edad.…”

“…Aunque los autores del instrumento obtuvieron en sus primeros estudios alta Sensibilidad y Especificidad, en otros estudios posteriores para el punto de corte aconsejado, la Sensibilidad fue más baja (Rabin, R.F. et al, 2009;Saimen, A. et. al., 2016;MacMillan, H.L.…”

“…En algunos estudios se sugieren puntos de corte diferentes por responder mejor a los criterios de Sensibilidad y Especificidad adecuados, teniendo en cuenta el punto que aporta los mejores valores psicométricos (el área máxima bajo la curva de ROC) (Chen, P.-H. et al, 2007;Iskandar, L., Braun, K.L. y Katz, A.R., 2015;Saimen, A. et. al., 2016).…”

“…Otros hallazgos similares que cuestionan la idoneidad del punto de corte en 13 se han encontrado en otros estudios (Chen, P.-H. et al, 2007;Rabin, R.F. et al, 2009;Saimen, A. et. al., 2016;MacMillan, H.L.…”

“…y Katz, A.R., 2015). Un estudio con mujeres en Sudáfrica con el WAST (corto y largo) obtuvo una prevalencia de violencia de pareja en la muestra del 32% (Saimen, A. et. al., 2016 Tras muchos años de utilización del WAST y diversas validaciones, al aplicarle en entornos culturales más diversos se ha observado que el comportamiento de la herramienta puede tener variaciones que limiten su validez y sugieran cambios en los criterios de valoración (Sprague, S., 2016;Iskandar, L., Braun, K.L.…”