What is the feasibility of using WAST-Short domestic abuse screening tool in primary care? An exploratory cross-sectional study in Northwest London

Abstract

Background Domestic abuse (DA) is underdiagnosed in general practice. The primary care workforce plays a key role in the healthcare response to DA. Screening increases the early detection of DA in primary care, but such tools are not routinely used in primary care. We conducted a cross-sectional study of NHS patients across general practices in Northwest London to explore the use of a short DA screening tool in primary care. We explored the association of history of abuse with the WAST-short score after controlling for demographic characteristics. Methods An open, easily accessible anonymous 29-item e-Survey translated into 18 languages and including information on accessible support services was sent to eligible NHS patients (18 years and over) via SMS by general practices in Northwest London. Data was collected from 6,967 NHS patients between 3 March and 7 October 2022. Participants were asked about their personal experiences of DA. The WAST-short screening questionnaire was used to assess the degree of tension in the respondent's relationship of concern and their perceived difficulty in working out arguments within that relationship. The WAST-Short score was calculated by adding the points allocated to the answers to these two questions. Regression analysis explored the association between WAST-short score and a history of abuse. Results Data from 4,253 respondents to the anonymous survey were analysed. Almost half of the respondents confirmed having experienced DA, whereas 6.1% declined disclosure. After adjusting for a priori confounders (age, gender and ethnicity), the multivariable logistic regression model showed that those who disclosed a history of abuse and those who 'would rather not say' had significantly higher odds of having tension in their relationship and higher odds of having difficulty in working out arguments compared to those with no history of abuse. Conclusions Screening identifies victims, in particular, the cohort who may be struggling to disclose their experiences of abuse. The use of the validated non-obtrusive two-item WAST-short tool could help with the early identification of DA survivors in primary care. Upskilling health and social care professionals in administering this brief non-threatening screening tool would help raise awareness, identify and support victims.