Intimate Partner Violence: A Retrospective Review of Records in Primary Care Settings

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Intimate Partner ViolenceA Retrospective Review
of Records in Primary Care Settings

• Lois Magnussen Ed.D.
• Jan Shoultz, DrPh
• Mary Oneha,PhD
• University of Hawaii at Manoa
• School of Nursing

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Goals of the Study

• The goals of this study were twofold
• to gather data regarding the documentation of
  disclosure of IPV in primary care settings
• to collect demographic data, including ethnicity
  of women who disclose in primary care settings.

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Significance of the Study

• Intimate partner violence (IPV) is pervasive in
  American Society.
• One in five US couples have experienced at least
  one episode of violence.
• It is estimated that 1 in 3 women will be
  assaulted by a partner at some time in their
  lives.

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Cultural Variation

• Reported rates of IPV have a wide range of
  variation from one racial or ethnic group to
  another
• Women of Asian/Pacific Islander background report
  a lower rate of IPV than other ethnic groups.

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Cultural Variation (cont)

• Researchers who work with battered Asian/ Pacific
  Islander (API) women estimate that the prevalence
  of IPV is as great in API populations as in other
  groups.
• Disclosure of IPV may also be hidden in the
  context of other civil and criminal complaints
  such as assault.
• IPV disclosure may also be hidden in the skewed
  proportion of emergency room visits by API
  Americans (18 of all visits) versus European
  American (12 of all visits). NAWHO, 1995.

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IPV in Hawaii

• In the State of Hawaii it is difficult to obtain
  accurate statistics regarding IPV.
• Estimates are that at least 20 of all women in
  Hawaii between the ages of 18 and 64 have been
  victims of domestic violence. DVFCMP, 1996.
• There is no correlation and crossover of data
  from health care providers, criminal justice, or
  courts.

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The Need to Understand IPV in Hawaii

• Few studies documenting disclosure of IPV have
  been done in Community Health Centers.
• Given the unique factors of the multicultural
  population in Hawaii there is a need to further
  investigate disclosure of IPV.

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The Need to Understand IPV in Hawaii (cont)

• While people in Hawaii are influenced by their
  ethnic heritage, these cultural perspectives are
  often modified within the multi-cultural context.
  
• Cultural differences in perspectives related to
  IPV may lead to barriers that prevent women from
  receiving effective screening and care.

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Methodology

• Study Design
• A community-based participatory research design
  was used to gather descriptive data via a
  retrospective chart review at the four primary
  care centers.

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Community based participatory research

• This systematic inquiry was designed with input
  from clinicians and administrators at four
  primary care health centers in diverse
  communities on the island of Oahu.
• The four sites were
• Kalihi Palama Health Center
• Kokua Kalihi Valley Health Center
• Waianae Coast Comprehensive Health Center
• Waikiki Health Center

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Design of the Survey Instrument

• The study was undertaken as a partnership to
  meet the needs of the specific health centers and
  address the purpose of the funded study.
• The following were designed using a collaborative
  process
• development of the survey tool
• collection of the data
• analysis of the data

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Survey InstrumentData were collected on the
following variables

• Ethnicity
• Age of the woman
• Report of IPV
• Pregnancy Status
• Year IPV was reported
• Gender of the provider
• Initiation of the discussion of IPV

• Location of documentation in the chart
• Program in clinic associated with initial
  disclosure
• Documentation of referral

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Data Collection

• Personnel at the health centers participated in
  data collection
• The research assistants assignment changed from
  data collection to data entry.

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Training for Data Collection

• To assure inter-rater reliability, staff who
  collected the data were guided by the the
  investigators from the University of Hawaii in
  data collection and sampling.

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Procedures

• The sample size was computed to determine the
  number of records needed for a descriptive pilot
  study.
• Inclusion criteria
• age between 19 and 64
• seen between 1998 and 2002

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Total Sample

• 351 charts were reviewed
• 14 charts did not fall within the age range or
  were less than 80 complete and were excluded
  from the data analysis.
• 337 charts were included in the retrospective
  chart review.

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Data Analysis

• Data was managed using the Statistical Package
  for the Social Sciences (SPSS).
• Health center staff were involved in the data
  analysis.

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Findings

• Out of a total valid sample of 337 records that
  were reviewed at the four community health
  centers, 31 or 9.1 reported IPV.
• Four of the women who reported violence
• were pregnant.
• Five of these women reported either two or three
  incidents.

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Ethnicity of Sample compared to Ethnicity of
Those Reporting IPV
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Comparison of Age of Sample and of those
Reporting IPV
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Year IPV Reported
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Location of Report of IPV in Chart
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Per Cent of Reports by Program
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Referrals Made
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Implications

• Between ethnic group variation shows nearly
  double the incidence of IPV in some groups.
• The level and depth of resources accessible and
  available to communities may be impacting
  providers interest and desire to provide
  opportunities for disclosure.

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Implications (cont)

• Screening for IPV and documentation within the
  chart varies between and within departments of
  the four primary care centers.
• The ICD Code was not used to document the
  incidents of IPV.

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Future Research

• More specific ethnic categories need to be used
  in data collection.
• Identification of prevalence by specific
  populations will assist community sites in
  directing appropriate resources to those
  populations with the highest prevalence