改变阶段是否能预测在急诊科干预后亲密伴侣暴力结局的改善?
Does stage of change predict improved intimate partner violence outcomes following an emergency department intervention?
机构信息
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.
出版信息
Acad Emerg Med. 2013 Feb;20(2):169-77. doi: 10.1111/acem.12081.
OBJECTIVES
The objective was to assess the effect of an emergency department (ED)-based computer screening and referral intervention on the safety-seeking behaviors of female intimate partner violence (IPV) victims at differing stages of change. The study also aimed to determine which personal and behavioral characteristics were associated with a positive change in safety-seeking behavior. The hypothesis was that women who were in contemplation or action stages of change would be more likely to endorse safety behaviors during follow-up.
METHODS
This was a prospective cohort study of female IPV victims at three urban EDs, using a computer kiosk to deliver targeted education about IPV to provide referrals to local resources. All noncritically ill adult English-speaking women triaged to the ED waiting room during study hours were eligible to participate. Women were screened for IPV using the validated Universal Violence Prevention Screening Protocol (UVPSP), and all IPV-positive women further responded to validated questionnaires for alcohol and drug abuse, depression, and IPV severity. The women were assigned a baseline stage of change using the University of Rhode Island Change Assessment (URICA) scale for readiness to change their IPV behaviors. Study participants were contacted at 1 week and 3 months to assess a variety of predetermined safety behaviors to prevent further IPV during that period. Descriptive analyses were performed to determine if stage of change at enrollment and a variety of specific sociodemographic characteristics were associated with taking protective action during follow-up.
RESULTS
A total of 1,474 women were screened for IPV; 154 (10.4%) disclosed IPV and completed the full survey. Approximately half (47.4%) of the IPV victims were in the precontemplation stage of change, and 50.0% were in the contemplation stage. A total of 110 women returned at 1 week of follow-up (71.4%), and 63 (40.9%) women returned for the 3-month follow-up. Fifty-five percent of those who returned at 1 week and 73% of those who returned at 3 months took protective action against further IPV. Stage of change at enrollment was not significantly associated with taking protective action during follow-up. There was no association between demographic characteristics and taking protective action at 1 week or 3 months.
CONCLUSIONS
Emergency department-based kiosk screening and health information delivery is a feasible method of health information dissemination for women experiencing IPV and was associated with a high proportion of study participants taking protective action. Stage of change was not associated with actual IPV protective measures.
目的
评估基于急诊科(ED)的计算机筛查和转介干预对处于不同改变阶段的女性亲密伴侣暴力(IPV)受害者的安全寻求行为的影响。该研究还旨在确定哪些个人和行为特征与安全寻求行为的积极改变相关。假设是,处于思考或行动阶段的女性在随访期间更有可能支持安全行为。
方法
这是一项针对三家城市 ED 的女性 IPV 受害者的前瞻性队列研究,使用计算机亭向患者提供有关 IPV 的针对性教育,并提供当地资源的转介。在研究期间,所有分诊到 ED 等候室的非危急成年英语患者均符合入组条件。使用经过验证的通用暴力预防筛查协议(UVPSP)对女性进行 IPV 筛查,所有 IPV 阳性女性进一步对酒精和药物滥用、抑郁和 IPV 严重程度进行经过验证的问卷回答。使用罗得岛大学改变评估(URICA)量表对女性进行基线改变阶段评估,以确定其改变 IPV 行为的准备情况。研究参与者在 1 周和 3 个月时接受联系,以评估在此期间预防进一步 IPV 的各种预定安全行为。进行描述性分析以确定入组时的改变阶段和各种特定社会人口学特征是否与随访期间采取保护措施相关。
结果
共有 1474 名女性接受了 IPV 筛查;154 名(10.4%)披露了 IPV 并完成了完整调查。大约一半(47.4%)的 IPV 受害者处于前思考阶段,50.0%处于思考阶段。共有 110 名女性在 1 周随访时返回(71.4%),63 名(40.9%)女性在 3 个月随访时返回。在 1 周时返回的女性中有 55%和在 3 个月时返回的女性中有 73%采取了保护措施以防止进一步的 IPV。入组时的改变阶段与随访期间采取保护措施没有显著关联。人口统计学特征与 1 周或 3 个月时采取保护措施之间没有关联。
结论
基于 ED 的 kiosk 筛查和健康信息传递是为经历 IPV 的女性提供健康信息的一种可行方法,并且与研究参与者采取保护措施的比例较高相关。改变阶段与实际的 IPV 保护措施无关。