Validity of the ACTS intimate partner violence screen in antenatal care: a cross sectional study

Abstract Background Intimate partner violence (IPV) is a major public health problem with harmful consequences. In Australia, there is no national standard screening tool and screening practice is variable across states. The objectives of this study were to assess in the antenatal healthcare setting: i) the validity of a new IPV brief screening tool and ii) women’s preference for screening response format, screening frequency and comfort level. Methods One thousand sixty-seven antenatal patients in a major metropolitan Victorian hospital in Australia completed a paper-based, self-administered survey. The survey included four screening items about whether they were Afraid/Controlled/Threatened/Slapped or physically hurt (ACTS) by a partner or ex-partner in the last 12 months; and the Composite Abuse Scale (reference standard). The ACTS screen was presented firstly with a binary yes/no response format and then with a five-point ordinal frequency format from ‘never’ (0) to ‘very frequently’ (4). The main outcome measures were test statistics of the four-item ACTS screening tool (sensitivity, specificity, predictive values, and area under the curve) against the reference standard and women’s screening preferences. Results Twelve-month IPV prevalence varied depending on the ACTS response format with 8% (83) positive on ACTS yes/no format, 12.8% (133) positive on ACTS ordinal frequency format and 10.5% (108) on the reference Composite Abuse Scale. Overall, the ACTS screening tool demonstrated clinical utility for the ordinal frequency format (AUC, 0.80; 95% CI = 0.76 to 0.85) and the binary yes/no format (AUC, 0.74, 95% CI = 0.69 to 0.79). The frequency scale (66%) had greater sensitivity than the yes/no scale (51%). The positive and negative predictive values were 56 and 96% for the frequency scale and 68 and 95% for the yes/no scale. Specificity was high regardless of screening question response options. Half (53%) of the women categorised as abused preferred the yes/no scale. Around half of the women (48%, 472) thought health care providers should ask pregnant women about IPV at every visit. Conclusions The four-item ACTS tool (using the frequency scale and a cut-off of one on any item) is recommended for written self-administered screening of women to identify those experiencing IPV to enable first-line response and follow-up.

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Validity of the ACTS Intimate Partner Violence Screen in Antenatal Care: A Cross Sectional Study

10.21203/rs.3.rs-264487/v1 ◽

2021 ◽

Author(s):

K Hegarty ◽

J Spangaro ◽

M Kyei-Onanjiri ◽

J Valpied ◽

J Walsh ◽

...

Keyword(s):

Intimate Partner Violence ◽

Partner Violence ◽

Screening Tool ◽

Intimate Partner ◽

Comfort Level ◽

National Standard ◽

Response Format ◽

Reference Standard ◽

Predictive Values ◽

Frequency Scale

Abstract Background: Intimate partner violence (IPV) is a major public health problem with harmful consequences. In Australia, there is no national standard screening tool and screening practice is variable across states. The objectives of this study were to assess in the antenatal healthcare setting: i) the validity of a new IPV brief screening tool and ii) women’s preference for screening response format, screening frequency and comfort level.Methods: 1,067 antenatal patients in a major metropolitan Victorian hospital in Australia completed a paper-based, self-administered survey. The survey included four screening items about whether they were Afraid/Controlled/Threatened/ Slapped or physically hurt (ACTS) by a partner or ex-partner in the last 12 months; and the Composite Abuse Scale (reference standard). The ACTS screen was presented firstly with a binary yes/no response format and then with a five-point ordinal frequency format from ‘never’ (0) to ‘very frequently’ (4). The main outcome measures were test statistics of the four-item ACTS screening tool (sensitivity, specificity, predictive values, and area under the curve) against the reference standard and women’s screening preferences.Results: Twelve-month IPV prevalence varied depending on the ACTS response format with 8% (83) positive on ACTS yes/no format, 12.8% (133) positive on ACTS ordinal frequency format and 10.5% (108) on the reference Composite Abuse Scale. Overall, the ACTS screening tool demonstrated clinical utility for the ordinal frequency format (AUC, 0.80; 95% CI = 0.76 to 0.85) and the binary yes/no format (AUC, 0.74, 95% CI = 0.69 to 0.79). The frequency scale (66%) had greater sensitivity than the yes/no scale (51%). The positive and negative predictive values were 56% and 96% for the frequency scale and 68% and 95% for the yes/no scale. Specificity was high regardless of screening question response options. Half (53%) of the women categorised as abused preferred the yes/no scale. Around half of the women (48%, 472) thought health care providers should ask pregnant women about IPV at every visit.Conclusions: The four-item ACTS tool (using the frequency scale and a cut-off of one on any item) is recommended for written self-administered screening of women to identify those experiencing IPV to enable first-line response and follow-up.

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Helping Women Victims of Intimate Partner Violence: Comparing the Approaches of Two Health Care Settings

Violence and Victims ◽

10.1891/0886-6708.24.2.193 ◽

2009 ◽

Vol 24 (2) ◽

pp. 193-203 ◽

Cited By ~ 5

Author(s):

Judy C. Chang ◽

Raquel Buranosky ◽

Diane Dado ◽

Patricia Cluss ◽

Lynn Hawker ◽

...

Keyword(s):

Intimate Partner Violence ◽

Women Victims ◽

Health Professionals ◽

Partner Violence ◽

General Medicine ◽

Intimate Partner ◽

Comfort Level ◽

Clinical Settings ◽

Health Care Settings ◽

Semistructured Interviews

Health professionals from two different clinical settings were asked about their comfort level in dealing with intimate partner violence (IPV). Focus groups and semistructured interviews were used to gather information. Staff in an obstetrics and gynecology setting relatively rich in IPV resources described feeling capable dealing with IPV. The staff in a general medicine setting dedicated to women’s health but without a focus on IPV and with fewer supports described discomfort and difficulty dealing with IPV. Presence of systemic prioritization of and resources for IPV were described as contributing to the confidence in addressing the issue. Other necessary elements identified included (a) on-site resources, (b) adequate time, (c) focused IPV training, and (d) a team or systemic approach.

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Assessing Intimate Partner Violence in South Asian Women Using the Index of Spouse Abuse

Violence Against Women ◽

10.1177/1077801219842945 ◽

2019 ◽

Vol 26 (6-7) ◽

pp. 697-711

Author(s):

Lenore Fitzsimmons Soglin ◽

Maya Ragavan ◽

Supriya Immaneni ◽

David F. Soglin

Keyword(s):

Intimate Partner Violence ◽

South Asian ◽

Partner Violence ◽

Spouse Abuse ◽

Screening Tool ◽

The United States ◽

Intimate Partner ◽

Immigrant Population ◽

Asian Women ◽

South Asian Women

Intimate Partner Violence (IPV) affects 21-40% of South Asian (SA) women in the United States. No screening tool has been validated in this population. This study sought to determine the validity of the Index of Spouse Abuse (ISA) as an IPV screening tool and to determine the prevalence of IPV among a SA immigrant population. Thirty-one percent of women screened positive on one or both ISA scales. The ISA-P and ISA-NP items were highly reliable as was the correlation between the ISA-P and ISA-NP scores. The ISA is a valid and reliable IPV screening tool in the SA immigrant population.

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Predictive value of indicators for identifying child maltreatment and intimate partner violence in coded electronic health records: a systematic review and meta-analysis

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-319027 ◽

2020 ◽

Vol 106 (1) ◽

pp. 44-53

Author(s):

Shabeer Syed ◽

Rachel Ashwick ◽

Marco Schlosser ◽

Arturo Gonzalez-Izquierdo ◽

Leah Li ◽

...

Keyword(s):

Systematic Review ◽

Intimate Partner Violence ◽

Child Maltreatment ◽

Electronic Health Records ◽

Partner Violence ◽

Meta Analysis ◽

Intimate Partner ◽

Health Records ◽

Predictive Values ◽

Electronic Health

ObjectiveElectronic health records (EHRs) are routinely used to identify family violence, yet reliable evidence of their validity remains limited. We conducted a systematic review and meta-analysis to evaluate the positive predictive values (PPVs) of coded indicators in EHRs for identifying intimate partner violence (IPV) and child maltreatment (CM), including prenatal neglect.MethodsWe searched 18 electronic databases between January 1980 and May 2020 for studies comparing any coded indicator of IPV or CM including prenatal neglect defined as neonatal abstinence syndrome (NAS) or fetal alcohol syndrome (FAS), against an independent reference standard. We pooled PPVs for each indicator using random effects meta-analyses.ResultsWe included 88 studies (3 875 183 individuals) involving 15 indicators for identifying CM in the prenatal period and childhood (0–18 years) and five indicators for IPV among women of reproductive age (12–50 years). Based on the International Classification of Disease system, the pooled PPV was over 80% for NAS (16 studies) but lower for FAS (<40%; seven studies). For young children, primary diagnoses of CM, specific injury presentations (eg, rib fractures and retinal haemorrhages) and assaults showed a high PPV for CM (pooled PPVs: 55.9%–87.8%). Indicators of IPV in women had a high PPV, with primary diagnoses correctly identifying IPV in >85% of cases.ConclusionsCoded indicators in EHRs have a high likelihood of correctly classifying types of CM and IPV across the life course, providing a useful tool for assessment, support and monitoring of high-risk groups in health services and research.

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Hands on!!! Infusing intimate partner violence simulation in nursing education

Journal of Nursing Education and Practice ◽

10.5430/jnep.v10n12p76 ◽

2020 ◽

Vol 10 (12) ◽

pp. 76

Author(s):

Camille Burnett ◽

Esha Rawat ◽

Ashley Hudson ◽

Tamia Walker-Atwater ◽

Donna Schminkey

Keyword(s):

Intimate Partner Violence ◽

Nursing Education ◽

Nursing Students ◽

Partner Violence ◽

Intimate Partner ◽

Comfort Level ◽

Safety Planning ◽

Undergraduate Nursing ◽

Hands On ◽

Before And After

Intimate partner violence (IPV) has a 1 in 4 prevalence for women globally. Nursing programs are positioned to prepare students to address IPV screening and brief counselling policy recommendations within curricula. The purpose of this project was to refine the undergraduate nursing curriculum to better facilitate student comfort with and knowledge of IPV screening and intervention using simulation. Methods: We used a 4-item pre/posttest tool to evaluate nursing students’ comfort level with IPV screening and safety planning before and after an IPV simulation with a standardized patient as part of the formative assessment of the simulation. Results: Close to 80% of students (N = 133) reported feeling more comfortable with discussing IPV, screening for IPV, talking to people about IPV, and safety planning after completing the IPV simulation. Conclusion: Infusing IPV screening and intervention simulation into curricula gives students a hands-on opportunity to practice critical trauma-informed skills before encountering a patient exposed to violence. This exposure enhances student comfort with and increases knowledge of screening and intervening with families exposed to IPV and as a result may help to decrease known barriers to IPV screening and intervening post licensure.

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