Intervention to Identify Battering in Ambulatory Care

Ambulatory care settings provide what may be the first opportunity for a battered woman to find support, assistance, or protection, but they are usually not identified as such or given appropriate services. It has become the standard of care over the past few years to identify abused women in emergency departments, but the potential role of primary care in preventing further abuse has only begun to be examined. Serious women's health problems such as depression, chronic pain, chronic irritable bowel syndrome, and pelvic inflammatory disease have been associated with woman abuse. Battered women and their children use significantly more ambulatory clinics than control families. This proposal seeks funding to evaluate the effectiveness of a training intervention to improve staff and institutional responses to battered women. The aims of this research are to: (a) evaluate a comprehensive intervention designed to improve the response of health care providers to battered women in primary care settings, (b) determine the prevalence of currently and formerly abused women in military primary care settings, (c) demonstrate significantly more positive attitudes toward battered women by trained staff, and (d) determine the most frequent correlated medical and mental health diagnosis associated with abuse. The proposed research uses an experimental pre- and post-intervention design. Six Naval Ambulatory care settings have been selected, three randomly assigned as test sites and three randomly assigned as comparison sites. The intervention consists of a six hour training, protocol, and manual for ongoing reference and planning for system changes. Data collection includes pre-intervention and post-intervention measures of identification and documentation of battering in the medical record. As part of the post-intervention data collection, women patients will be asked to complete questionnaires concerning physical and emotional abuse and their general physical and mental health: (a) Abuse Screen, (b) Index of Spouse Abuse, (c) Symptom Checklist 90, (d) Duke Health Profile and (e) Patient Satisfaction Survey. In addition, attitudes of Naval health care providers in the research settings will be surveyed using the Staff Attitudes Scale. In depth interviews will be held with nursing staff from comparison and test sites to determine barriers and facilitators of optimal response to abused women and unique to military primary care settings.