Multi-level Influences of Violence Screening in College Health Centers

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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/SV can result in immediate and long-term adverse physical and psychological health effects. Seven “Healthy People 2020” objectives focus on reducing IPV/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 adverse 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-, organization-, and state- 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 collect and quantitative and qualitative data from a national sample of college HCPs and female college students. The specific aims are to: (1) (Quant) Explore multivariate associations between individual-, organization-, and state-level variables and college HCPs’ IPV/SV screening intentions and rates, using disaggregated data; (2) (Quant) Examine fixed effects and random effects of individual-, organization-, and state-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 practice change preferences; and (4) (Qual and Quan) Examine female college students’ attitudes/beliefs and experiences related to IPV/SV screening and disclosure, and compare to HCPs’ perceptions. 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.