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Novel educational program improves readiness to manage intimate partner violence within the fracture clinic: a pretest-posttest study.

ABSTRACT: BACKGROUND:Intimate partner violence (IPV) is prevalent among female patients at fracture clinics; however, previous research suggests health care providers (HCPs) are unprepared to identify victims and provide appropriate support. To address this gap in care, we developed an IPV educational program and conducted a study to measure the impact of this program on HCPs' IPV-related knowledge, attitudes, beliefs and self-reported behaviours. METHODS:We enrolled 140 participants (orthopedic surgeons, surgical trainees, nonphysician HCPs and research and administrative staff) from 7 fracture clinics in North America who completed the 2-hour educational program. We used a pretest-posttest study design to assess knowledge, attitudes, beliefs and self-reported behaviours. We administered the Physician Readiness to Manage IPV Survey before, immediately after and 3 months after training and generated scores for each of the 10 subscales. Our primary outcome was change in score for the actual knowledge subscale from before training to 3 months after training. We used linear regression to conduct all analyses. RESULTS:We found significant improvement on the actual knowledge subscale 3 months after the training (mean difference [MD] 2.44, 95% confidence interval [CI] 1.79 to 3.09). We found statistically significant improvements on 7 additional subscales 3 months after training (perceived preparation [MD 1.96, 95% CI 1.79 to 2.13], perceived knowledge [MD 2.05, 95% CI 1.88 to 2.23], practice issues [MD 6.10, 95% CI 4.98 to 7.23], preparation [MD 1.06, 95% CI 0.89 to 1.22], legal requirements [MD 1.50, 95% CI 1.30 to 1.70], workplace issues [MD 1.11, 95% CI 0.97 to 1.26] and self-efficacy [MD 0.54, 95% CI 0.45 to 0.63]) and on all 10 subscales immediately after training (actual knowledge [MD 3.35, 95% CI 2.77 to 3.94], perceived preparation [MD 2.06, 95% CI 1.88 to 2.23], perceived knowledge [MD 2.14, 95% CI 1.98 to 2.30], practice issues [MD 4.08, 95% CI 3.35 to 4.82], preparation [MD 1.04, 95% CI 0.89 to 1.20], legal requirements [MD 1.66, 95% CI 1.47 to 1.85], workplace issues [MD 1.08, 95% CI 0.96 to 1.20], self-efficacy [MD 0.56, 95% CI 0.49 to 0.63], alcohol/drugs [MD 0.20, 95% CI 0.10 to 0.30] and victim understanding [MD 0.15, 95% CI 0.04 to 0.25]). INTERPRETATION:Our educational program led to significant improvements in participants' readiness to manage IPV. This finding suggests HCPs are better prepared to help patients who experience IPV; however, future research should aim to investigate the impact of this program directly on patients.

SUBMITTER: EDUCATE Investigators

PROVIDER: S-EPMC6298867 | biostudies-other | 2018 Oct-Dec

REPOSITORIES: biostudies-other

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Novel educational program improves readiness to manage intimate partner violence within the fracture clinic: a pretest-posttest study.

CMAJ open 20181001 4

<h4>Background</h4>Intimate partner violence (IPV) is prevalent among female patients at fracture clinics; however, previous research suggests health care providers (HCPs) are unprepared to identify victims and provide appropriate support. To address this gap in care, we developed an IPV educational program and conducted a study to measure the impact of this program on HCPs' IPV-related knowledge, attitudes, beliefs and self-reported behaviours.<h4>Methods</h4>We enrolled 140 participants (ortho ...[more]

PMID: 30563918

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Project description:BackgroundThe aim of the EDUCATE study was to determine whether an intimate partner violence educational program for health care providers working in fracture clinics increased their knowledge about intimate partner violence and their preparedness to discuss this topic with their patients. Here, we present the long-term (12-mo) follow-up data from the EDUCATE study to determine whether improvements in knowledge were maintained.MethodsFor this pretest-posttest study, we enrolled 140 health care providers from 7 academic fracture clinics in Canada and the United States. Training took place between October 2016 and June 2017. We administered the Physician Readiness to Manage Intimate Partner Violence Survey before participants completed the educational program (baseline), immediately after training, and at 3 months and 12 months after training. We used the actual knowledge subscale as the primary outcome for the planned 12-month analyses; we also report on the other subscales of the survey (perceived preparation to manage intimate partner violence, perceived knowledge about the issues, practice issues, preparation, legal requirements, workplace issues, self-efficacy, alcohol or drugs, and victim understanding). We used linear regression models to compare mean 12-month scores with mean baseline scores for each subscale of the survey.ResultsAmong the 109 participating health care providers for whom 12-month assessment data were available, we found statistically significant improvements in the actual knowledge about intimate partner violence subscale of the survey (mean difference [MD] 2.50, 95% confidence interval [CI] 1.69 to 3.32). Statistically significant improvements from baseline to 12 months were also observed for 8 of the 9 other subscales of the survey: perceived preparation (MD 2.06, 95% CI 1.88 to 2.24), perceived knowledge (MD 2.14, 95% CI 1.96 to 2.31), practice issues (MD 6.12, 95% CI 4.97 to 7.27), preparation (MD 1.10, 95% CI 0.94 to 1.26), legal requirements (MD 1.57, 95% CI 1.36 to 1.78), workplace issues (MD 1.19, 95% CI 1.04 to 1.35), self-efficacy (MD 0.56, 95% CI 0.46 to 0.67) and alcohol and drugs (MD 0.11, 95% CI 0.02 to 0.21). Improvements relative to baseline were not observed for the victim understanding subscale.InterpretationThe EDUCATE program led to significant improvements in health care providers' readiness to manage intimate partner violence, with positive changes being observed 12 months after training. These findings indicate that health care providers who receive this training may be better equipped to manage the care of patients who have experienced intimate partner violence.

Project description:ObjectiveThe association between intimate partner violence (IPV) and breastfeeding is unclear. We conducted a systematic review to summarise the evidence of breastfeeding outcomes following exposure to IPV.DesignSystematic review.MethodsWe searched for published studies without study design or language restrictions (up to July 2019) in the following databases: PubMed, Embase, SCOPUS and The Global Health Library. Studies assessing various breastfeeding outcomes (initiation, duration and exclusive breastfeeding) in women exposed to IPV in any form (physical, psychological or sexual) and at any stage (1 year pre-pregnancy, during or post-pregnancy) were included. Two authors independently selected the studies and conducted the quality appraisal by use of the Newcastle-Ottawa Scale. Results were summarised taking precision and quality into account.ResultsA total of 16 studies (participants n=414 393) were included and they adjusted for a total of 48 different confounders. The majority of studies were cross-sectional (n=11) and most studies were judged to be fair/low quality. Four out of seven studies found that IPV exposure shortened breastfeeding duration (adjusted ORs/aORs=0.22 (95% CI: 0.05-0.85), 1.18 (95% CI: 1.01-1.37), 5.92 (95% CI: 1.72-27.98), 1.28 (95% CI: 1.18-1.39)). Further, 5/10 studies found that IPV led to early termination of exclusive breastfeeding (aORs=1.53 (95% CI: 1.01-23.1), 0.83 (95% CI: 0.71-0.96), 1.35 (95% CI: 1.07-1.71), 0.17 (95% CI: 0.07-0.4), 1839 (95% CI: 1.61-2911)) and 2/6 studies found that IPV significantly reduced breastfeeding initiation (aORs=2.00 (95% CI: 1.2-3.3), 0.81 (95% CI: 0.7-0.93)).ConclusionIPV exposure appears to associate negatively with some breastfeeding outcomes. Individual patient data meta-analysis is required to quantify the magnitude of the association for specific IPV-outcome combinations. More high-quality studies and definition of core confounders are warranted.Prospero registration numberCRD42019129353.

Project description:BACKGROUND:Intimate partner violence (IPV) is a significant public health problem with many negative consequences, particularly for pregnant women. This randomized trial investigated the effectiveness of an IPV preventive intervention embedded within the Nurse Family Partnership (NFP) program. MATERIALS AND METHODS:Participants enrolled over a 20-month period and were interviewed at baseline and 1- and 2-year follow-up. Eligibility criteria included first pregnancy, eligible for the nutrition program Women, Infants, and Children (WIC), English or Spanish speaking, and at least 15 years of age. All women initially referred and screened were randomized to either intervention (NFP+) or control (NFP only) condition. The final sample consisted of 238 women completing baseline assessments; retention was 81% at 2-year follow-up. RESULTS:Analyses indicated that there were no main effects: the intervention affected participants differently depending on their baseline experience with IPV. For physical violence victimization, an interaction between baseline victimization and treatment was found; the intervention reduced victimization at 1 year (and approached significance at 2 years), but only among women who had not experienced past-year physical victimization at baseline. For sexual violence victimization, another interaction emerged; women in the intervention group were more likely to report sexual violence victimization at 2-year follow-up, but only among participants who had reported sexual victimization at baseline. The only effect on IPV perpetration was psychological perpetration at 2-year follow-up; again, the treatment effect was moderated by baseline perpetration. The intervention reduced psychological perpetration for participants who were nonperpetrators at baseline, but had no effect on those reporting perpetration. CONCLUSIONS:Overall, findings suggest that the intervention was effective in reducing some forms of violence among those not experiencing IPV at baseline, but was ineffective or potentially harmful for those already experiencing IPV.

Dataset Information

Novel educational program improves readiness to manage intimate partner violence within the fracture clinic: a pretest-posttest study.

Publications

Novel educational program improves readiness to manage intimate partner violence within the fracture clinic: a pretest-posttest study.

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