Implementation of an Evidence-based Intimate Partner Violence Toolkit for Women's Health Providers

Intimate partner violence (IPV) affects roughly one of every three women in Utah. The data on IPV prevalence varies widely across states because IPV is not always reported or disclosed due to fear and distrust of healthcare staff and law enforcement agencies. Some providers in Utah believe that domestic violence is not prevalent in their communities. However, survivors of IPV living in rural areas are often isolated by their abusive partner and may only have their healthcare provider as an advocate and resource. Methods After receiving approval for this project, a pre-implementation survey was conducted to assess current practice policies for IPV screening and response to disclosure of IPV, perceived barriers to routine screening, and access and knowledge of referral services for survivors at several rural sites. The information gathered by this survey was used to develop a provider toolkit to help address IPV disclosure in the clinics. The toolkit included Utah Mandatory Reporting Laws, open communication techniques, an emergency plan template, discharge and follow-up considerations, as well as local and national referral services. The toolkit was introduced during a scheduled staff meeting. Using the PDSA model, the toolkit was refined, and the toolkit was shared electronically with the sites. Post-implementation, the feasibility, usability, and sustainability of the intervention were evaluated through a survey that mirrored questions in the pre-implementation survey. Results Pre-implementation survey participants identified the following barriers to screening and offering referral services including lack of time during visits (62.5%), lack of training (50%), lack of knowledge of available resources and belief that IPV is not prevalent within their communities (37.5%). The post-implementation survey respondents reported being likely to use the methods included in the toolkit, found the toolkit to be useful and relevant to their roles, planned to screen and refer using the toolkit as a guide, and reported satisfaction with the toolkit and the educational presentation. Conclusion The implementation of this project at several rural sites proved to be challenging. Future efforts to address IPV in a rural setting could be more successful if a needs assessment is performed prior to implementing a similar tool. Providers at the rural sites expressed readiness for practice change, but the unique barriers related to healthcare in rural areas proved to further limit practice change in addressing IPV disclosure at these sites.