Healthcare worker knowledge and opinion regarding intimate partner violence screening in an academic dermatology clinic: a survey study : International Journal of Women's Dermatology

Secondary Logo

Journal Logo

Research Letters

Healthcare worker knowledge and opinion regarding intimate partner violence screening in an academic dermatology clinic: a survey study

Carr, Christian L. MD, MPH; Rivera, Sydney MPH; Jetelina, Katelyn K. MPH, PhD; Mauskar, Melissa MD*

Author Information
International Journal of Women’s Dermatology: October 2022 - Volume 8 - Issue 3 - p e025
doi: 10.1097/JW9.0000000000000025
  • Open

What is known about this subject in regard to women and their families?

  • As many as 1 in 3 women are/will be victims of intimate partner violence in their lifetime.
  • Multiple negative physical and mental health outcomes have been linked to intimate partner violence.
  • The majority of screening for intimate partner violence occurs in primary care, obstetrics and gynecology, and emergency department settings.

What is new from this article as messages for women and their families?

  • 68% of female healthcare workers reported current or prior relationships concerning for intimate partner violence.
  • Confidence among healthcare workers regarding screening and management of patients with victimization is low.
  • A majority of healthcare workers at our site are interested in receiving training and introducing screening for intimate partner violence in dermatology clinics.

Dear Editors,

Intimate partner violence (IPV) is a major public health problem involving physical, psychological, or sexual violence, which may result in physical and mental health consequences for victims.1 One in 3 women worldwide will experience physical and sexual IPV in their lifetime. The US Preventive Services Task Force recommends that all females of childbearing age be screened for IPV in primary care settings.2 Little is known regarding interest and baseline knowledge of IPV screening among providers in specialty care, such as dermatology.3 As dermatologists often see patients multiple times a year and frequently perform examinations of sensitive areas, patients may be willing to disclose IPV to their dermatologist.4 The purpose of this study is to assess IPV opinions and knowledge among dermatologic healthcare workers.

A cross-sectional survey was distributed to healthcare workers with direct patient interaction in the Department of Dermatology at an academic teaching hospital. The questionnaire was developed and stored in REDCap. An invitation to complete the survey was emailed to 90 workers’ institutional email addresses, with response rate of 60% (n = 54). Two participants were removed for failure to complete over 80% of analyzed items, for final sample size of 52. A modified version of the HITS screening tool (Hurt, Insulted, Threatened, Screamed at) with added items screening for sexual violence was utilized to prevent varied personal definitions/interpretations of IPV from influencing results. In our study, history of any of the items on HITS was considered positive for victimization. Univariate analyses (eg, mean) described demographics, victimization history, opinions, and knowledge. Bivariate tests (eg, Chi-square) evaluated differences by provider sex. All analyses were conducted using SAS 9.4 (SAS Institute, Inc., Cary, NC).

Table 1 displays sample characteristics. Mean age was 40.0 years (SD = 10), 44% identified as White, and 73% as female. Personal history of victimization was reported by 68% of females and 64% of males, with 21% currently experiencing victimization.

Table 1. - Sample description, stratified by sex (N = 52)
Total sample Sex
n = 52
N (%)
Female
n = 38
N (%)
Male
n = 14
N (%)
t test/Chi-square/Fishers Exact Test
Age (Mean, [SD]) 40 [10] 40 [10] 39 [8] 0.6
Clinic role 2
 Physician/APP 28 (54) 18 (47) 10 (71)
 Nurse/MA/staff 24 (46) 20 (53) 4 (29)
Race/ethnicity 11*
 NH White 23(44) 19 (50) 4 (29)
 NH Black 4 (7) 2 (5) 2 (14)
 Hispanic 16(31) 14 (37) 2 (14)
 NH Other 9 (17) 3 (8) 6 (43)
History of victimization 0.08
 Yes 35 (67) 26 (68) 9 (64)
 No 17 (33) 12 (32) 5 (36)
Victimization timing 0.09
 Current 11 (21) 8 (21) 3 (21)
 Ever (but not current) 24 (46) 18 (47) 6 (43)
 Never 17 (33) 12 (32) 5 (36)
APP, advanced practice provider; MA, medical assistant; NH, non-Hispanic; SD, standard deviation.
*P < 0.05.
History of victimization was assessed using answers to questions based on the e-HITS questionnaire.

The majority (73%) of participants voiced interest in IPV training and agreed that dermatology clinics should screen for IPV (65%) (Table 2). More females supported IPV screening in dermatology settings than males, although the difference was not statistically significant. About half of the participants were not aware of legal reporting requirements and nearly three-quarters felt they did not have sufficient training. Only 1 (3%) healthcare worker asks their patients about abuse regularly.

Table 2. - Knowledge and opinions compared by sex (N = 52)
Total sample
n = 52
N (%)
Female
n = 38
N (%)
Male
n = 14
N (%)
Fisher’s Exact Test
Opinions of screening in clinic
 I would like (additional) training on proper ways to identify, treat,  and refer patients for IPV. Agree: 38 (73) Agree: 27 (71) Agree: 11 (79) 3.7
Neutral: 13 (25) Neutral: 11 (29) Neutral: 2 (14)
Disagree: 1 (2) Disagree: 0 (0) Disagree: 1 (7)
If proper referral pathways are set in place, dermatology clinics  should systematically screen for IPV. Agree: 34 (65) Agree: 27 (71) Agree: 7 (50) 3.4
Neutral: 15 (29) Neutral: 10 (26) Neutral: 5 (36)
Disagree: 3 (6) Disagree: 1 (3) Disagree: 2 (14)
Dermatology clinics are uniquely situated to identify signs of IPV. b Agree: 31 (60) Agree: 24 (65) Agree: 7 (50) 1.7
Neutral: 15 (29) Neutral: 9 (24) Neutral: 6 (43)
Disagree: 5 (10) Disagree: 4 (11) Disagree: 1 (7)
Healthcare providers do not have the time to assist patients in  addressing IPV. a , b Agree: 8 (18) Agree: 6 (19) Agree: 2 (15) 0.1
Neutral: 3 (7) Neutral: 2 (6) Neutral: 1 (8)
Disagree: 33 (75) Disagree: 23 (74) Disagree: 10 (77)
Knowledge
I am aware of legal requirements in this state regarding reporting  of suspected cases of IPV. a Agree: 13 (38) Agree: 9 (38) Agree: 4 (40) 1.1
Neutral: 4 (12) Neutral: 2 (8) Neutral: 2 (20)
Disagree: 17 (50) Disagree: 13 (54) Disagree: 4 (40)
If victims of abuse remain in the relationship after repeated episodes  of violence, they must accept responsibility for that violence. Agree: 3 (6) Agree: 3 (8) Agree: 0 (0) 6.6
Neutral: 2 (4) Neutral: 0 (0) Neutral: 2 (14)
Disagree: 47 (90) Disagree: 35 (92) Disagree: 12 (86)
I do not have sufficient training to assist individuals in addressing  situations of IPV. Agree: 38 (73) Agree: 28 (74) Agree: 10 (71) 0.08
Neutral: 3 (6) Neutral: 2 (5) Neutral: 1 (7)
Disagree: 11 (21) Disagree: 8 (21) Disagree: 3 (21)
Capability and practices
I am capable of identifying IPV without asking my patient about it. a Agree: 6 (18) Agree: 5 (21) Agree: 1 (10) 0.9
Neutral: 2 (6) Neutral: 1 (4) Neutral: 1 (10)
Disagree: 26 (76) Disagree: 18 (75) Disagree: 8 (80)
I can make appropriate referrals to services within the community  for IPV victims. a Agree: 18 (53) Agree: 13 (54) Agree: 5 (50) 0.3
Neutral: 5 (15) Neutral: 3 (13) Neutral: 2 (20)
Disagree: 11 (32) Disagree: 8 (33) Disagree: 3 (30)
I ask all new patients about abuse in their relationships. a Agree: 1 (3) Agree: 1 (4) Agree: 0 (0) 0.8
Neutral: 2 (6) Neutral: 1 (4) Neutral: 1 (10)
Disagree: 31 (91) Disagree: 22 (92) Disagree: 9 (90)
If an IPV victim does not acknowledge the abuse, there is very little  that I can do to help. Agree: 14 (27) Agree: 11 (29) Agree: 3 (27) 1.7
Neutral: 3 (6) Neutral: 3 (8) Neutral: 0 (0)
Disagree: 35 (67) Disagree: 24 (63) Disagree: 11 (79)
aResponses obtained only from nurses, not medical assistants or staff.
bNot answered by all participants.
Agree, strongly agree, agree, and somewhat agree; disagree, strongly disagree, disagree, and somewhat disagree.

This preliminary study assesses healthcare workers’ opinions, knowledge, and personal history of IPV within a dermatology practice. Although this is a single-institution study, results indicate interest in further education among both male and female dermatology providers. There is a high rate of personal IPV history among participants in our study, which may contribute to interest in screening implementation.5 This higher rate may be due to response bias (people with personal history may have been more likely to respond) or to increased sensitivity of the screening mechanism. There may also be a truly higher rate of IPV in either the local community, where the survey was completed or among healthcare workers in general. Further work should investigate whether healthcare workers are at increased risk. In addition to supporting patients experiencing IPV, improved training and increased recognition may also facilitate a more supportive environment for healthcare workers who have been victimized.

Our study demonstrates that dermatology providers have interest in conducting IPV screening but desire increased education and support to do so confidently. Implementation of provider training in trauma-informed care (a system to integrate trauma knowledge and sensitivity into existing models of care to avoid retraumatization) and electronic medical record screening tools will allow the dermatology community to serve as another point of support for patients experiencing IPV and ultimately improve access to care for this vulnerable population.

Conflicts of interest

None

Funding

None.

Patient consent

Consent for publication from all authors.

References

1. Bonomi AE, Anderson ML, Reid RJ, et al. Medical and psychosocial diagnoses in women with a history of intimate partner violence. Arch Intern Med 2009;169:1692–1697.
2. Curry SJ, Krist AH, Owens DK, et al.; US Preventive Services Task Force. Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: US preventive services task force final recommendation statement. JAMA 2018;320:1678–1687.
3. Sprague S, Madden K, Simunovic N, et al. Barriers to screening for intimate partner violence. Women Health 2012;52:587–605.
4. Gurnee EA, Stoff BK. Confronting abusive injuries in dermatology: Ethical and legal considerations. J Am Acad Dermatol 2017;76:573–576.
5. McLindon E, Humphreys C, Hegarty K. Is a clinician’s personal history of domestic violence associated with their clinical care of patients: a cross-sectional study. BMJ Open 2019;9:e029276.
Keywords:

intimate partner violence; dermatology; healthcare workers; screening

Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of Women’s Dermatologic Society.