Multi-level Influences of Violence Screening in College Health Centers

点击翻译按钮获取中文摘要

Abstract Intimate partner violence (IPV) and sexual violence (SV) are significant public health issues for women, particularly female college students. Twenty percent of women are sexually assaulted in their lifetime and 1.3 to 5 million women experience IPV each year. Female college students experience some of the highest rates of IPV/SV of all groups, including older women and same age women who are not on college campuses. IPV and SV can result in immediate and long-term adverse physical and psychological health effects. Seven “Healthy People 2020” objectives focus on reducing IPV and SV. The National Academy of Medicine and other national organizations recommend that health care providers (HCPs) screen and counsel all women for current and past IPV/SV. College health centers represent unique opportunities to screen college women, and mitigate their risk for further violence and sequelae. However, college health centers have some of the lowest IPV/SV screening rates (10-20%) of all health care settings. Studies demonstrate that scientific evidence does not translate consistently or rapidly into clinical practice, particularly when recommendations go beyond what has been considered usual practice. In order to promote the uptake of routine IPV/SV screening in college health centers, it is vitally important to undertake formative implementation research to identify individual- and organization- level factors that act as facilitators and barriers of screening. The proposed study will use an explanatory sequential mixed-methods (QUAN+qual) design, framed within an organizational expansion of the Theory of Planned Behavior (TPB) and the Consolidated Framework for Implementation Research (CFIR), to survey and conduct in-depth interviews with a national sample of college HCPs. The specific aims are to: (1) (Quant) Explore potential bivariate and multivariate associations between individual- and organization-level variables and college HCPs’ IPV/SV screening rates, using disaggregated data; (2) (Quant) Examine random effects and fixed effects of individual- and organization-level variables on college HCPs’ IPV/SV screening rates, using multi-level modeling; (3) (Qual) Obtain in-depth understanding of college HCPs’ beliefs, organizational perceptions, experiences with IPV/SV screening and intervention preferences; and (4) (Mixed Methods) Integrate qualitative and quantitative findings to elucidate an explanatory model for HCP screening behavior that will aid in the development of a multi- level intervention. The study findings will have high impact by elucidating how to effectively implement IPV/SV screening recommendations and informing the development of a multi-level intervention to promote screening in college health centers. Implementing routine IPV/SV screening in college health centers can capitalize on missed opportunities for early detection, referral and amelioration of the short and long-term sequelae of violence.