Development of Verbal HITS for Intimate Partner Violence Screening in Family Medicine

摘要

Background and Objectives: Researchers in intimate partner violence (IPV) screening have developed a short written tool called HITS. The acronym corresponds to questions that elicit information about how often a woman’s male partner physically Hurts, Insults, Threatens harm, and Screams at her. The purpose of this study was to develop a verbal form of the HITS and to compare it to the published written version.Methods: A secondary analysis of data from prior HITS research was conducted. From this, the screening questions were modified for oral presentation so that patients could respond with a yes or no answer. To test the comparability of the two screening formats, 103 adult female patients completed both forms of the HITS during routine office visits. Phase one of this study used Optimal Data Analysis (ODA) on 210 cases from prior HITS research to create a cut score that differentiates clinic patients from self-identified victims of abuse. From this, written HITS questions were modified for verbal administration. Phase two of this study used t test, ANOVA, and classification of two screening formats to compare the written and verbal HITS administered to 103 adult female family medicine patients.Results: Responses to both types of screening were related. The mean score on the written HITS was statistically higher for respondents who reported “yes” to a Verbal HITS question. This was consistent across all four questions. Also, the mean written HITS score increased linearly as a function of the number of yes answers on the Verbal HITS. The screening classification (positive, negative) from both forms of the HITS was the same for 83% of the respondents.Conclusions: The verbal and written HITS comprise two ways that clinicians can screen for domestic violence.(Fam Med 2014;46(3):180-5.)Intimate Partner Violence (IPV) is a major public health problem affecting over 12 million women and men in the United States each year at risk from current or former partners.1 IPV is related to serious morbidities, including physical injury, psychological distress, and death from physical or sexual assault.2 Significant numbers of women appear to be abused physically by their partners, yet physicians under-recognize IPV by a large margin. Often, physicians identify only a small percent of victims in their practice,3,4 commonly after significant adverse health events, or physicians order costly work-ups for complaints associated with or possibly even caused by the abuse. The poor recognition of IPV may be due to several factors5,6 and a lack of consensus of universal screening practices in the medical profession. In 2004, the US Preventive Services Task Force (USPSTF) concluded that evidence was insufficient to recommend for or against screening women for IPV (I Statement).7 In 2012, the USPSTF updated the recommended screening for IPV to category B.8 Under the new recommendation, clinicians are advised to screen all women of childbearing age for IPV and provide services (referral or intervention) for those who screen positive.8 This new recommendation, along with provisions in the Affordable Care Act that require insurance coverage for screening and counseling at no extra costs to women, put forth a call to action for health care professionals to take a more active role in recognizing and preventing IPV.9Despite the new recommendation, screening for IPV by health care professionals may still be done infrequently for a variety of reasons. Potential barriers to recognition of IPV include lack of knowledge and experiential training, time constraints associated with daily practice, and general discomfort.5,6 Specifically, a physician’s lack of knowledge of short, time-efficient, and validated IPV identification tools can decrease IPV screening. Several standardized screening instruments are available for outpatient settings, such as the 40-item Wife Abuse Inventory10 and the Conflict Tactics Scale.11 However, these lengthy questionnaires are primaril