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Evaluating a health care provider delivered intervention to reduce intimate partner violence and mitigate associated health risks: study protocol for a randomized controlled trial in Mexico City.

Falb KL, Diaz-Olavarrieta C, Campos PA, Valades J, Cardenas R, Carino G, Gupta J - BMC Public Health (2014)

Bottom Line: Nurses meeting eligibility criteria in treatment groups received an intensive training on screening for IPV, providing supportive referrals, and assessing for health and safety risks.In treatment clinics, women received the nurse delivered session at baseline and received a follow-up counseling session after three months.This study will provide important insight into whether a nurse-delivered program can assist women currently experiencing abuse in a Latin American context.

View Article: PubMed Central - PubMed

Affiliation: Chronic Disease Epidemiology and Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA. jhumka.gupta@yale.edu.

ABSTRACT

Background: Intimate partner violence (IPV) victimization is a prevalent issue among women residing in Mexico City. Comprehensive and integrated health care provider (HCP) delivered programs in clinic-settings are needed, yet few have been evaluated in Latin America, including Mexico. In addition, there has been minimal attention to interventions among lower income women presenting at settings outside of antenatal care clinics. The current randomized controlled trial seeks to increase midlevel HCPs' capacity, specifically nurses, who are often the first point of contact in this setting, to identify women presenting at health clinics with experiences of IPV and to assist these women with health risk mitigation. Specific outcomes include changes in past-year IPV (physical and/or sexual), reproductive coercion, safety planning, use of community resources, and quality of life.

Methods/design: Forty-two public health clinics in Mexico City were randomized to treatment or control clinics. Nurses meeting eligibility criteria in treatment groups received an intensive training on screening for IPV, providing supportive referrals, and assessing for health and safety risks. Nurses meeting eligibility criteria at control clinics received the standard of care which included a one-day training focused on sensitizing staff to IPV as a health issue and referral cards to give to women. Women were screened for eligibility (currently experiencing abuse in a heterosexual relationship, 18-44 years of age, non-pregnant or in first trimester) by research assistants in private areas of waiting rooms in health clinics. Consenting women completed a baseline survey and received the study protocol for that clinic. In treatment clinics, women received the nurse delivered session at baseline and received a follow-up counseling session after three months. Surveys are conducted at baseline, three months, and fifteen months from baseline.

Discussion: This study will provide important insight into whether a nurse-delivered program can assist women currently experiencing abuse in a Latin American context. Findings can be used to inform IPV programs and policies in Mexico City's public health clinics.

Trial registration: NCT01661504.

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Related in: MedlinePlus

Abuse assessment screening.
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Fig1: Abuse assessment screening.

Mentions: Women were eligible to participate in the study if they were between the ages of 18-44 years, currently in a heterosexual relationship with a male partner, responded in affirmative to past year sexual or physical IPV, and was not pregnant or pregnant in their first trimester. Study exclusion criteria included cognitive impairment (e.g. slurred speech), seeking treatment for life threatening emergency care, and intending to relocate within two years. Research assistants approached women in the waiting rooms of participating clinics, verified eligibility for the study, and asked women to take an assessment screening that contained items from an abuse assessment screen that is widely used by International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) in Latin American and Caribbean countries and has been previously used in studies occurring in Mexico City[38–40]. Based on feedback from piloting the assessment, the final tool consisted of eleven questions in order to build rapport between the research assistant and participant. The first nine questions were in regards to the woman’s health and relationship with her partner, including emotional abuse, as directly asking about physical or sexual IPV at the very beginning of the assessment was rendered as too sensitive during our piloting phase. Based on feedback from focus groups carried out with IPV survivors at a community domestic violence agency, concrete examples of physical and sexual IPV were included in the questions (see Figure 1). If a woman answered at least one affirmative response to the validated screening items on physical and sexual IPV contained in the assessment, they were invited to participate in the study; those interested completed written and/or verbal informed consent. Both the assessment and the informed consent process took place within a private area of the clinic.Figure 1


Evaluating a health care provider delivered intervention to reduce intimate partner violence and mitigate associated health risks: study protocol for a randomized controlled trial in Mexico City.

Falb KL, Diaz-Olavarrieta C, Campos PA, Valades J, Cardenas R, Carino G, Gupta J - BMC Public Health (2014)

Abuse assessment screening.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4127193&req=5

Fig1: Abuse assessment screening.
Mentions: Women were eligible to participate in the study if they were between the ages of 18-44 years, currently in a heterosexual relationship with a male partner, responded in affirmative to past year sexual or physical IPV, and was not pregnant or pregnant in their first trimester. Study exclusion criteria included cognitive impairment (e.g. slurred speech), seeking treatment for life threatening emergency care, and intending to relocate within two years. Research assistants approached women in the waiting rooms of participating clinics, verified eligibility for the study, and asked women to take an assessment screening that contained items from an abuse assessment screen that is widely used by International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) in Latin American and Caribbean countries and has been previously used in studies occurring in Mexico City[38–40]. Based on feedback from piloting the assessment, the final tool consisted of eleven questions in order to build rapport between the research assistant and participant. The first nine questions were in regards to the woman’s health and relationship with her partner, including emotional abuse, as directly asking about physical or sexual IPV at the very beginning of the assessment was rendered as too sensitive during our piloting phase. Based on feedback from focus groups carried out with IPV survivors at a community domestic violence agency, concrete examples of physical and sexual IPV were included in the questions (see Figure 1). If a woman answered at least one affirmative response to the validated screening items on physical and sexual IPV contained in the assessment, they were invited to participate in the study; those interested completed written and/or verbal informed consent. Both the assessment and the informed consent process took place within a private area of the clinic.Figure 1

Bottom Line: Nurses meeting eligibility criteria in treatment groups received an intensive training on screening for IPV, providing supportive referrals, and assessing for health and safety risks.In treatment clinics, women received the nurse delivered session at baseline and received a follow-up counseling session after three months.This study will provide important insight into whether a nurse-delivered program can assist women currently experiencing abuse in a Latin American context.

View Article: PubMed Central - PubMed

Affiliation: Chronic Disease Epidemiology and Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA. jhumka.gupta@yale.edu.

ABSTRACT

Background: Intimate partner violence (IPV) victimization is a prevalent issue among women residing in Mexico City. Comprehensive and integrated health care provider (HCP) delivered programs in clinic-settings are needed, yet few have been evaluated in Latin America, including Mexico. In addition, there has been minimal attention to interventions among lower income women presenting at settings outside of antenatal care clinics. The current randomized controlled trial seeks to increase midlevel HCPs' capacity, specifically nurses, who are often the first point of contact in this setting, to identify women presenting at health clinics with experiences of IPV and to assist these women with health risk mitigation. Specific outcomes include changes in past-year IPV (physical and/or sexual), reproductive coercion, safety planning, use of community resources, and quality of life.

Methods/design: Forty-two public health clinics in Mexico City were randomized to treatment or control clinics. Nurses meeting eligibility criteria in treatment groups received an intensive training on screening for IPV, providing supportive referrals, and assessing for health and safety risks. Nurses meeting eligibility criteria at control clinics received the standard of care which included a one-day training focused on sensitizing staff to IPV as a health issue and referral cards to give to women. Women were screened for eligibility (currently experiencing abuse in a heterosexual relationship, 18-44 years of age, non-pregnant or in first trimester) by research assistants in private areas of waiting rooms in health clinics. Consenting women completed a baseline survey and received the study protocol for that clinic. In treatment clinics, women received the nurse delivered session at baseline and received a follow-up counseling session after three months. Surveys are conducted at baseline, three months, and fifteen months from baseline.

Discussion: This study will provide important insight into whether a nurse-delivered program can assist women currently experiencing abuse in a Latin American context. Findings can be used to inform IPV programs and policies in Mexico City's public health clinics.

Trial registration: NCT01661504.

Show MeSH
Related in: MedlinePlus