Changes in Health Care Providersʼ Knowledge, Attitudes, Beliefs, and Behaviors Regarding Domestic Violence, Following a Multifaceted Intervention

TLDR

Domestic violence is a pervasive public health issue that requires effective identification and referral by health care providers. The study aimed to improve domestic violence identification, management, and referral in a rural health network through a train‑the‑trainer program and a clinical protocol. The intervention combined train‑the‑trainer training, two one‑hour sessions, a clinical protocol, modifications to emergency department records, office.

Abstract

To improve domestic violence (DV) identification, management, and referral in a not-for-profit rural health network, training for health care professionals was implemented using a train-the-trainer approach, two one-hour training sessions, and dissemination of a clinical protocol. The multifaceted approach also involved modifications of emergency department medical records, distribution of office enablers, and a local public health campaign. The authors measured the effectiveness of this campaign.After implementation of a multifaceted training and public awareness campaign, a questionnaire designed by the Centers for Disease Control to measure knowledge, attitudes, beliefs, and intended behaviors (KABB) of health care providers relative to DV was administered to 380 health care professionals in the fall of 1997, with a follow-up survey completed after the intervention in the fall of 1999.The response rates for the pre- and post-intervention surveys were 67% (n = 380) and 56% (n = 273), respectively. Two scales were correlated in the base-line survey: self-efficacy (related to DV response) and familiarity with referral resources. Reporting of victim identification in the preceding year increased from 36% to 39%. Those with training were more likely to have identified a victim within the year (OR = 2.86; 95% CI, 1.73-4.74). Among the 232 respondents with complete data, multiple analysis of variance demonstrated statistically significant overall improvement across all scales. Nine of the 13 KABB scales revealed significant increases from pre- to posttest and included: screening, workplace resources, making referrals, provider self-efficacy, victim autonomy, victim understanding, legal requirements, staff preparation, and too busy/can't help.A comprehensive training program for health care providers can increase their self-efficacy in responding to DV victims.