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/SV可导致即刻和长期的不良生理和心理影响， 健康影响。“2020年健康人”的七个目标侧重于降低IPV/SV。国家 医学院和其他国家组织建议，卫生保健提供者（HCP） 对所有妇女进行当前和过去的IPV/SV筛查和咨询。大学健康中心代表着独特的 为女大学生提供筛查机会，减少她们遭受进一步暴力和不良后果的风险。 然而，在所有健康中心中，大学健康中心的IPV/SV筛查率最低（10-20%）。 护理设置。研究表明，科学证据并不能一致或迅速地转化为 临床实践，特别是当建议超出通常认为的范围时 实践为了促进在大学保健中心进行常规IPV/SV筛查， 重要的是进行形成性实施研究，以确定个人、组织和国家， 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），从全国大学HCP样本中收集定量和定性数据， 女大学生具体目标是：（1）（定量）探索多变量之间的关联 个人、组织和州一级变量以及大学HCP的IPV/SV筛查意图， （2）（Quant）检查个体的固定效应和随机效应， 组织和州一级变量对大学HCP的IPV/SV筛查率，使用多水平 （3）（Qual）深入了解大学HCP的信念，组织感知， 具有IPV/SV筛选和实践变更偏好的经验;以及（4）（Qual和Quan）检查 女大学生对IPV/SV筛查和披露的态度/信念和经验， 并与医护人员的感知进行比较。研究结果将通过阐明如何 有效地实施IPV/SV筛选建议，并为制定多层次的 在大学健康中心进行干预以促进筛查。实施常规IPV/SV筛查， 大学健康中心可以利用错过的机会，早期发现，转诊， 减轻暴力的短期和长期后果。

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.