Computer-assisted screening for intimate partner violence and control: a randomized trial.

BACKGROUND

Intimate partner violence and control (IPVC) is prevalent and can be a serious health risk to women.

OBJECTIVE

To assess whether computer-assisted screening can improve detection of women at risk for IPVC in a family practice setting.

DESIGN

Randomized trial. Randomization was computer-generated. Allocation was concealed by using opaque envelopes that recruiters opened after patient consent. Patients and providers, but not outcome assessors, were blinded to the study intervention.

SETTING

An urban, academic, hospital-affiliated family practice clinic in Toronto, Ontario, Canada.

PARTICIPANTS

Adult women in a current or recent relationship.

INTERVENTION

Computer-based multirisk assessment report attached to the medical chart. The report was generated from information provided by participants before the physician visit (n = 144). Control participants received standard medical care (n = 149).

MEASUREMENTS

Initiation of discussion about risk for IPVC (discussion opportunity) and detection of women at risk based on review of audiotaped medical visits.

RESULTS

The overall prevalence of any type of violence or control was 22% (95% CI, 17% to 27%). In adjusted analyses based on complete cases (n = 282), the intervention increased opportunities to discuss IPVC (adjusted relative risk, 1.4 [CI, 1.1 to 1.9]) and increased detection of IPVC (adjusted relative risk, 2.0 [CI, 0.9 to 4.1]). Participants recognized the benefits of computer screening but had some concerns about privacy and interference with physician interactions.

LIMITATION

The study was done at 1 clinic, and no measures of women's use of services or health outcomes were used.

CONCLUSION

Computer screening effectively detected IPVC in a busy family medicine practice, and it was acceptable to patients.

PRIMARY FUNDING SOURCE

Canadian Institutes of Health Research and Ontario Women's Health Council.