What is the prevalence of intimate partner violence disclosed during routine screening in a large general practice in provincial New Zealand?
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Supplementary material
Other Title
Authors
Higgins, Deborah
Author ORCID Profiles (clickable)
Degree
Master of Nursing
Grantor
Eastern Institute of Technology
Date
2013
Supervisors
Marshall, Bob
Manhire, Kathy
Manhire, Kathy
Type
Masters Thesis
Ngā Upoko Tukutuku (Māori subject headings)
Keyword
New Zealand
intimate partner violence (IPV)
disclosure
prevalence
screening
intimate partner violence (IPV)
disclosure
prevalence
screening
ANZSRC Field of Research Code (2020)
Citation
Higgins, D. M. (2013). What is the prevalence of intimate partner violence disclosed during routine screening in a large general practice in provincial New Zealand? (Unpublished document submitted in partial fulfilment of the requirements for the degree of Master of Nursing). Eastern Institute of Technology (EIT), New Zealand.
Abstract
Domestic Violence in its’ myriad shapes and forms is a pervasive, insidious crime affecting every level of society. It is most often perpetrated behind closed doors by the ones who are meant to love and protect us. Gaining a true understanding of Intimate Partner Violence (IPV) victimology in terms of age, ethnicity, gender, willingness to disclose and the level of danger posed by each situation allows for the meaningful provision of intervention services such as women’s refuge or the police.
This research aimed to explore the prevalence of IPV disclosure during routine screening in a large general practice in provincial New Zealand (NZ). A statistical analysis was applied to four and a half years’ of screening data taken from 5668 individuals who were screened on 7818 occasions. Doctors and nurses at the health centre were encouraged to routinely screen females over the age of 16 years or younger if they showed signs of abuse, were sexually active or pregnant and men on suspicion for past and present IPV. There were some 15 year olds recorded in the database, they have been included in this study to allow a comparison with the WHO study data. Data were recorded in terms of name, age, date of screening, screener identity, enrolled doctor, ethnicity, clinical indicator, National Health Index number and gender. A monthly auditing cycle of the health centre programme extracted these descriptive statistics from the electronic patient management system, then screening rates and outcomes were analysed and fed back to frontline staff. The maintenance of strong links to service provider agencies in the community for the purposes of information sharing was encouraged by the health centre. Screening for IPV in General Practice is not routinely done in New Zealand and these data have not been used for any other research purposes, and as such are a unique resource in New Zealand.
For the purposes of this study the data were extracted for the four and half year period using a similar auditing process then calculated for the entire group known as the Total group (using all the data for those aged 15 years and older) and a subgroup known as the WHO group (using the data for those aged over 15 years up to 64 years). Anonymity was ensured with all identifiable features removed from the data immediately, the NHI was used to establish a unique count of individuals then removed. Pearson’s Chi-squared tests were used to explore the univariate association between sub groups and screening outcomes. All statistical analyses were performed using SPSS Version 21.
Analysis indicated an overall ever-positive disclosure rate of 5%, which is lower than New Zealand population studies that place ever-positive prevalence as high as 35% (Fanslow & Robinson, 2004) or higher at 78% (Koziol-Mclain, Rameka, Giddings, Fyfe, & Gardiner, 2007). Even though the ever-positive rates were lower than in other studies a higher rate of positive disclosure from New Zealand Māori and Pasifika women prevailed. NZ Māori women disclosed an ever-positive rate of 8.7% to 9.3% over the two groups, Pasifika women 5.3% to 5.8% compared to 3.8% to 4.2% for NZ European women and 1.4% to 1.6% for those who identified as Other. While there was a larger proportion of enrolled patients screened than those presenting casually (80% vs. 20%), casual patients positively disclosed in 13.1% to 13.8% of instances as opposed to enrolled patients in 9.3% to 10.6%. Positive disclosure of past abuse was made 1.3 times more often than that of a current abusive situation, and this ratio is considerably lower than in other studies. Those aged between 35 - 44 years positively disclosed abusive situations most frequently, followed by 45 – 54 year olds and 25 – 34 year olds. Nurses screened 4.3 to 4.7 times more often than doctors however the doctors facilitated 8% to 10% more positive disclosures than the nurses, and disclosures to doctors had a higher degree of severity than those disclosed to nurses.
It is difficult to definitively state why the rates of disclosure are higher for NZ Māori and Pasifika women. It may be that women from these ethnicities were abused more often, or perhaps, alternatively, was there a heightened public awareness of the existence of abuse in these ethnicities that allowed these women to disclose more readily. The anonymity of a health centre where a patient was not enrolled, with staff not known to them may have contributed to the higher disclosure rate for casual patients. In addition the health centre may be seen as a safe place to discuss IPV and purposely chosen.
Past abuse was the most common disclosure type, which was is not surprising due to the high prevalence rates in our communities as found in population studies. This study found patients disclosing past abuse 1.3 times more often than current abuse. The ratio from this study is lower than that found in population studies (5.7 times in the Fanslow and Robinson (2004) study and 3.4 times in the Koziol – McLain et al. (2007) study. This may be due to patients wanting to deal with the health issue they have presented for, deeming a past abusive situation as having been dealt with and therefore of less importance for the 15 minute consultation timeframe. Younger women tended to disclose more readily, which may be due to an increased awareness in younger people that IPV does not have to be tolerated coupled with generational influences of indoctrination that may be inherent to older women. Doctors screened less often than nurses but patients disclosed more readily to a doctor and more often with situations of current abuse. The lower doctor screening rates may be indicative of time pressure or personal attitudes leading to questioning mainly when there are suspicions rather than routinely screening. The higher rates of severity disclosed could be due to a patient perception that doctors have more power than nurses to help, or that a patient is more open with a doctor.
Recommendations include: Using standardised screening questions for all practitioners coupled with regular ongoing IPV education updates; the maintenance of current community networks while building others, and a closer analysis of individual screening rates taken from the monthly audits to allow for targeted education and encouragement of those with lower rates. It would be unlikely that disclosure rates from a general practice setting would mirror that of population studies due to the vast differences in data collection methods, however, the purposes of the general practice programme is not data collection but to provide immediate support to the victims of IPV through appropriate and timely recognition, response and onward referral.
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