Multi-level Influences of Violence Screening in College Health Centers

摘要 亲密伴侣暴力（IPV）和性暴力（SV）是妇女的重要公共卫生问题， 尤其是女大学生。20%的女性在一生中遭受过性侵犯， 1.3每年有500万女性经历IPV。女大学生经历了一些 所有群体中IPV/SV的比率最高，包括老年妇女和未服用避孕药的同龄妇女 大学校园IPV和SV可导致即刻和长期不良的身体和 心理健康影响。七个“健康人2020”目标的重点是减少IPV和SV。 美国国家医学院和其他国家组织建议， 医务人员对所有妇女进行当前和过去的IPV/SV筛查和咨询。大学保健中心 代表了筛选大学女性的独特机会，并降低了她们遭受进一步暴力的风险， 后遗症然而，大学健康中心的IPV/SV筛查率最低（10-20%）， 所有医疗机构。研究表明，科学证据并不一致， 迅速进入临床实践，特别是当建议超出了已经考虑的范围时， 惯例为了促进在大学健康中心进行常规IPV/SV筛查， 至关重要的是进行形成性实施研究，以确定个人和组织， 作为筛选的促进因素和障碍的水平因素。拟议的研究将使用解释性的 序贯混合方法（QUAN+QUAL）设计，框架内的组织扩展， 计划行为理论与实施研究的统一框架 （CFIR），调查和进行深入访谈的大学HCP的全国样本。具体 目的是：（1）（定量）探索个体和个体之间潜在的二元和多元关联， 组织层面的变量和大学HCP的IPV/SV筛查率，使用分类数据;（2） （定量）检查个人和组织层面变量的随机效应和固定效应， 大学HCP的IPV/SV筛查率，使用多水平模型;（3）（Qual）获得深入的 了解大学HCP的信念、组织感知、IPV/SV筛查经验 和干预偏好;（4）（混合方法）将定性和定量研究结果结合起来， 阐明HCP筛选行为的解释性模型，这将有助于开发一个多- 水平干预。研究结果将通过阐明如何有效实施 IPV/SV筛查建议，并为制定多层次干预措施提供信息， 在大学健康中心推广筛查。IPV/SV常规筛查在高校卫生工作中的应用 中心可以利用错过的机会，早期发现，转诊和改善短期 和长期的暴力后遗症。

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.