Multi-level Influences of Violence Screening in College Health Centers

摘要 亲密伴侣暴力(IPV)和性暴力(SV)是妇女的重大公共卫生问题， 尤其是女大学生。20%的女性在有生之年遭受过性侵 每年有130万至500万妇女经历IPV。女大学生经历了一些 所有人群中IPV/SV的比率最高，包括老年妇女和同龄妇女 大学校园。IPV/SV可立即和长期造成身体和心理上的不良影响 对健康的影响。《健康人2020》的七个目标重点是降低肺活量/舒张压。《国家报》 医学科学院和其他国家组织建议医疗保健提供者(HCP) 对所有女性进行目前和过去的IPV/SV筛查和咨询。大学健康中心代表着独特的 有机会对大学女生进行筛查，减少她们遭受进一步暴力和不良后遗症的风险。 然而，大学健康中心的IPV/SV筛查率是所有健康中心中最低的(10%-20%) 护理设置。研究表明，科学证据不会始终如一地或迅速转化为 临床实践，特别是当建议超出通常认为的范围时 练习一下。为了促进大学卫生中心常规的IPV/SV筛查，至关重要的是 重要的是进行形成性实施研究，以确定个人、组织和国家- 作为筛选的促进者和障碍的水平因素。拟议的研究将使用一种解释性的 顺序混合方法(Quan+QUAL)设计，在组织扩展范围内 计划行为理论(TPB)及其实施研究的综合框架 (CFIR)，从全国大学HCP样本中收集定量和定性数据，并 女大学生。具体目标是：(1)(量化)探索多变量之间的联系 个人、组织和国家层面的变量和大学HCP的IPV/SV筛查意图和 利率，使用分类数据；(2)(定量)检查个人--的固定效应和随机效应， 使用多水平的组织、州和州水平变量对大学HCP的IPV/SV筛查率的影响 建模；(3)(Qual)深入了解大学HCP的信念、组织观念、 有IPV/SV筛选和实践更改偏好的经验；和(4)(QAU和QUE)检查 女大学生对IPV/SV筛查和披露的态度/信念和经历， 并与HCP的看法进行比较。研究结果将产生很大的影响，因为它阐明了如何 有效落实IPV/SV筛查建议，通报多层次发展 促进大学卫生中心筛查的干预措施。实施常规的IPV/SV筛查 大学健康中心可以利用错过的机会进行早期发现、转诊和 改善暴力的短期和长期后遗症。

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/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.