The use of screening tools to identify women attending healthcare settings who have experienced domestic abuse (defined broadly as any behaviour within an intimate relationship that causes physical, psychological or sexual harm). Screening tools range from face-to-face screening by a clinician to self-completed screening forms. All women over the age of 16 attending primary (for example General Practitioner) and secondary healthcare settings (for example antenatal clinics, women’s health/maternity services, emergency departments) are subject to screening. For those women that disclose experiencing domestic violence or abuse, screening results are assessed by the consulting healthcare professional who uses their clinical judgement as to how to respond. Universal screening is intended to increase the identification of violence and abuse and to provide further support and access to services.
This narrative is based on 13 studies covered by the review, 8 of which were included in the meta-analysis. Of those included in the meta-analysis, 4 were conducted in the United States, 3 in Canada, and 1 in Portugal.
Overall, the evidence suggests that universal screening for domestic violence and abuse in healthcare settings has been effective.
A meta-analysis covering 8 studies found that universal screening in healthcare settings led to an increase in the identification of domestic violence and abuse victims compared to healthcare settings where no screening was conducted or where screening was undertaken but results were not passed onto a healthcare practitioner. Women who were screened were almost three times as likely to mention their experience of domestic violence or abuse compared to those who were not screened. The findings were based on a total of 10,074 women across 8 studies.
The review was sufficiently systematic that most forms of bias that could influence the study conclusions can be ruled out.
The evidence is taken from a systematic review covering 13 studies, 8 of which were included in the meta-analyses. The review demonstrated a high quality design in terms of having a transparent and well-designed search strategy, featuring a valid statistical analysis, sufficiently assessing the risk of bias in the analysis, and attention to the validity of the outcome constructs, with only comparable outcomes combined. However, the review did not sufficiently consider unanticipated outcomes.
Biases remain within the included primary studies. All studies were judged to have high or unclear potential for performance bias (blinding of participants and personnel).
The review suggests that the main assumption underpinning the use of universal screening is that routinely asking women in healthcare settings about their experience of domestic abuse from a current or previous partner will increase its identification, improve access to services and support, and ultimately decrease exposure to violence/abuse and detrimental health consequences. These presumed mechanisms were not tested in the review.
The review examined whether the type of screening technique used or the particular healthcare setting affected the impact of universal domestic violence/abuse screening for women in healthcare settings.
The studies included in the review employed different screening methods; screening was either conducted directly by a healthcare professional or indirectly through a self-completion questionnaire with a healthcare professional informed of results. Screening also varied in terms of the approach used; some studies included the use of screening tools or alternatively clinicians may ask one or a range of questions related to domestic violence/abuse either at one point in time or at several points.
No studies included in the Review reported any data on cost-benefit or any other economic evaluation of this intervention.
There is evidence that universal healthcare screening for domestic violence and abuse improves levels of victim identification. The Review is based on the assumption that routinely screening women in healthcare settings will increase the identification of domestic violence and abuse. No difference in impact was detected according to the particular screening technique used (health professional/face-to-face screening or written/computer-based screening). However, healthcare setting did influence the identification of domestic violence and abuse, with the highest level of identification in antenatal settings. Additional evidence is required in relation to cost-effectiveness of universal screening in healthcare settings.
Review 1: O'Doherty, L., Hegarty, K., Ramsay, J., Davidson, L.L., Feder, G. & Taft A. (2015) 'Screening women for intimate partner violence in healthcare settings (Review)', The Cochrane Collaboration