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Mentions: The questions and survey statements were principally developed to fit a conceptual framework (see figure 1). This behavioural construct was developed by Woolf  and subsequently modified by Cabana et al.  in a systematic review of barriers to physician adherence to clinical practice guidelines. We modified the model, which was derived from a retrospective literature review  and applied it as a conceptual framework to model expected barriers to future guideline implementation with regard to screening for intimate partner abuse.
A knowledge, attitudes, and practice survey among obstetrician-gynaecologists on intimate partner violence in Flanders, Belgium
Bottom Line: They do consider screening for IPV as an issue of medical liability and therefore do not suffer from a lack of motivation to screen.Finally, physician education was found to be the strongest predictor of a positive attitude towards screening and of current screening practices.Endorsement of physician training on IPV is an important first step towards successful implementation of screening guidelines for IPV.
Affiliation: Department of Obstetrics & Gynaecology, Faculty of Medicine & Health Sciences, Ghent University, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium. kristien.roelens@UGent.be
Background: Intimate partner violence (IPV) has consistently been found to afflict one in twenty pregnant women and is therefore considered a leading cause of physical injury, mental illness and adverse pregnancy outcome. A general antenatal screening policy has been advocated, though compliance with such guidelines tends to be low. We therefore attempted to identify potential barriers to IPV screening in a context where no guidelines have been instigated yet.
Methods: Questionnaire-based Knowledge, Attitude, and Practice survey among obstetrician-gynaecologists in Flanders, Belgium (n = 478).
Results: The response rate was 52.1% (249/478). Gynaecologists prove rather unfamiliar with IPV and therefore largely underestimate the extent of the problem. Merely 6.8% (17/249) of the respondents ever received or pursued any kind of education on IPV. Accordingly they do feel insufficiently skilled to deal with IPV, yet sufficiently capable of recognizing IPV among their patients. Survey participants largely refute the incentive of universal screening in favour of opportunistic screening and do not consider pregnancy as a window of opportunity for routine screening. They do consider screening for IPV as an issue of medical liability and therefore do not suffer from a lack of motivation to screen. In addition, obstetrician-gynaecologists do believe that screening for IPV may be an effective means to counteract abusive behaviours. Yet, their outcome expectancy is weighed down by their perceived lack of self-efficacy in dealing with IPV, by lack of familiarity with referral procedures and by their perceived lack of available referral services. Major external or patient-related barriers to IPV screening included a perceived lack of time and fear of offending or insulting patients. Overall, merely 8.4 % (21/245) of gynaecologists in this survey performed some kind of IPV questioning on a regular basis. Finally, physician education was found to be the strongest predictor of a positive attitude towards screening and of current screening practices.
Conclusion: Endorsement of physician training on IPV is an important first step towards successful implementation of screening guidelines for IPV. Additional introduction of enabling and reinforcement strategies such as screening tools, patient leaflets, formal referral pathways, and physician feedback may further enhance compliance with screening recommendations and guidelines.
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