Screening, Sensitivity, Specificity, and So Forth: A Second, Somewhat Skeptical, Sequel

Trevethan, Robert

doi:10.30560/mhs.v2n1p60

Cited by 6 publications

(5 citation statements)

References 73 publications

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“…This is consistent with the knowledge that for IPV screening tools to be effective, they need to be repeated during the antenatal period and postnatally, with an ability to document clearly previous answers so women are not repeatedly asked for the same information [47]. Indeed, screening metrics aside, it is vital that screening tools do not dominate decision making but rather complement professional judgement of trained clinicians who are supported by their workplaces [48]. Addressing the sensitive topic of IPV requires trained clinicians knowledgeable about dynamics of IPV, structural entrapment, impacts on families and available specialist resources.…”

Section: Discussionsupporting

confidence: 61%

Validity of the ACTS intimate partner violence screen in antenatal care: a cross sectional study

et al. 2021

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Background Intimate partner violence (IPV) is a major public health problem with harmful consequences. In Australia, there is no national standard screening tool and screening practice is variable across states. The objectives of this study were to assess in the antenatal healthcare setting: i) the validity of a new IPV brief screening tool and ii) women’s preference for screening response format, screening frequency and comfort level. Methods One thousand sixty-seven antenatal patients in a major metropolitan Victorian hospital in Australia completed a paper-based, self-administered survey. The survey included four screening items about whether they were Afraid/Controlled/Threatened/Slapped or physically hurt (ACTS) by a partner or ex-partner in the last 12 months; and the Composite Abuse Scale (reference standard). The ACTS screen was presented firstly with a binary yes/no response format and then with a five-point ordinal frequency format from ‘never’ (0) to ‘very frequently’ (4). The main outcome measures were test statistics of the four-item ACTS screening tool (sensitivity, specificity, predictive values, and area under the curve) against the reference standard and women’s screening preferences. Results Twelve-month IPV prevalence varied depending on the ACTS response format with 8% (83) positive on ACTS yes/no format, 12.8% (133) positive on ACTS ordinal frequency format and 10.5% (108) on the reference Composite Abuse Scale. Overall, the ACTS screening tool demonstrated clinical utility for the ordinal frequency format (AUC, 0.80; 95% CI = 0.76 to 0.85) and the binary yes/no format (AUC, 0.74, 95% CI = 0.69 to 0.79). The frequency scale (66%) had greater sensitivity than the yes/no scale (51%). The positive and negative predictive values were 56 and 96% for the frequency scale and 68 and 95% for the yes/no scale. Specificity was high regardless of screening question response options. Half (53%) of the women categorised as abused preferred the yes/no scale. Around half of the women (48%, 472) thought health care providers should ask pregnant women about IPV at every visit. Conclusions The four-item ACTS tool (using the frequency scale and a cut-off of one on any item) is recommended for written self-administered screening of women to identify those experiencing IPV to enable first-line response and follow-up.

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Section: Discussionsupporting

confidence: 61%

Validity of the ACTS intimate partner violence screen in antenatal care: a cross sectional study

et al. 2021

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“…(47) Indeed, screening metrics aside, it is vital that screening tools do not dominate, decision making but rather complement professional judgement of clinicians. (48) Addressing the sensitive topic of IPV requires clinicians knowledgeable about dynamics of IPV, structural entrapment, impacts on family and available specialist resources.…”

Section: Discussionmentioning

confidence: 99%

Validity of the ACTS Intimate Partner Violence Screen in Antenatal Care: A Cross Sectional Study

Hegarty

Spangaro

Kyei-Onanjiri

et al. 2021

Preprint

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Background: Intimate partner violence (IPV) is a major public health problem with harmful consequences. In Australia, there is no national standard screening tool and screening practice is variable across states. The objectives of this study were to assess in the antenatal healthcare setting: i) the validity of a new IPV brief screening tool and ii) women’s preference for screening response format, screening frequency and comfort level.Methods: 1,067 antenatal patients in a major metropolitan Victorian hospital in Australia completed a paper-based, self-administered survey. The survey included four screening items about whether they were Afraid/Controlled/Threatened/ Slapped or physically hurt (ACTS) by a partner or ex-partner in the last 12 months; and the Composite Abuse Scale (reference standard). The ACTS screen was presented firstly with a binary yes/no response format and then with a five-point ordinal frequency format from ‘never’ (0) to ‘very frequently’ (4). The main outcome measures were test statistics of the four-item ACTS screening tool (sensitivity, specificity, predictive values, and area under the curve) against the reference standard and women’s screening preferences.Results: Twelve-month IPV prevalence varied depending on the ACTS response format with 8% (83) positive on ACTS yes/no format, 12.8% (133) positive on ACTS ordinal frequency format and 10.5% (108) on the reference Composite Abuse Scale. Overall, the ACTS screening tool demonstrated clinical utility for the ordinal frequency format (AUC, 0.80; 95% CI = 0.76 to 0.85) and the binary yes/no format (AUC, 0.74, 95% CI = 0.69 to 0.79). The frequency scale (66%) had greater sensitivity than the yes/no scale (51%). The positive and negative predictive values were 56% and 96% for the frequency scale and 68% and 95% for the yes/no scale. Specificity was high regardless of screening question response options. Half (53%) of the women categorised as abused preferred the yes/no scale. Around half of the women (48%, 472) thought health care providers should ask pregnant women about IPV at every visit.Conclusions: The four-item ACTS tool (using the frequency scale and a cut-off of one on any item) is recommended for written self-administered screening of women to identify those experiencing IPV to enable first-line response and follow-up.

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“…However, the term "gold standard" implies credibility even if the validity and accuracy of the reference itself is uncertain. Thus, we emulate others in using the more neutral "reference standard" terminology instead (99). We have chosen to label the census racial categories our reference standard, not because we believe it to be theoretically more valid than a surname match, but because an explicit racial classification in a data source is generally used as the default unless it is unavailable.…”

Section: Discussionmentioning

confidence: 99%

Operationalizing racialized exposures in historical research on anti-Asian racism and health: a comparison of two methods

Kaniecki

Novak

Gao

et al. 2023

Front. Public Health

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BackgroundAddressing contemporary anti-Asian racism and its impacts on health requires understanding its historical roots, including discriminatory restrictions on immigration, citizenship, and land ownership. Archival secondary data such as historical census records provide opportunities to quantitatively analyze structural dynamics that affect the health of Asian immigrants and Asian Americans. Census data overcome weaknesses of other data sources, such as small sample size and aggregation of Asian subgroups. This article explores the strengths and limitations of early twentieth-century census data for understanding Asian Americans and structural racism.MethodsWe used California census data from three decennial census spanning 1920–1940 to compare two criteria for identifying Asian Americans: census racial categories and Asian surname lists (Chinese, Indian, Japanese, Korean, and Filipino) that have been validated in contemporary population data. This paper examines the sensitivity and specificity of surname classification compared to census-designated “color or race” at the population level.ResultsSurname criteria were found to be highly specific, with each of the five surname lists having a specificity of over 99% for all three census years. The Chinese surname list had the highest sensitivity (ranging from 0.60–0.67 across census years), followed by the Indian (0.54–0.61) and Japanese (0.51–0.62) surname lists. Sensitivity was much lower for Korean (0.40–0.45) and Filipino (0.10–0.21) surnames. With the exception of Indian surnames, the sensitivity values of surname criteria were lower for the 1920–1940 census data than those reported for the 1990 census. The extent of the difference in sensitivity and trends across census years vary by subgroup.DiscussionSurname criteria may have lower sensitivity in detecting Asian subgroups in historical data as opposed to contemporary data as enumeration procedures for Asians have changed across time. We examine how the conflation of race, ethnicity, and nationality in the census could contribute to low sensitivity of surname classification compared to census-designated “color or race.” These results can guide decisions when operationalizing race in the context of specific research questions, thus promoting historical quantitative study of Asian American experiences. Furthermore, these results stress the need to situate measures of race and racism in their specific historical context.

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Screening, Sensitivity, Specificity, and So Forth: A Second, Somewhat Skeptical, Sequel

Cited by 6 publications

References 73 publications

Validity of the ACTS intimate partner violence screen in antenatal care: a cross sectional study

Validity of the ACTS intimate partner violence screen in antenatal care: a cross sectional study

Validity of the ACTS Intimate Partner Violence Screen in Antenatal Care: A Cross Sectional Study

Operationalizing racialized exposures in historical research on anti-Asian racism and health: a comparison of two methods

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