Randomized Comparison of 3 Methods to Screen for Domestic Violence in Family Practice

Ping-Hsin Chen, PhD; Sue Rovi, PhD; Judy Washington, MD; Abbie Jacobs, MD; Marielos Vega, BSN, RN; Ko-Yu Pan, PhD; Mark S. Johnson, MD, MPH


Ann Fam Med. 2007;5(5):430-435. 

In This Article

Abstract and Introduction


Purpose: We undertook a study to compare 3 ways of administering brief domestic violence screening questionnaires: self-administered questionnaire, medical staff interview, and physician interview.
Methods: We conducted a randomized trial of 3 screening protocols for domestic violence in 4 urban family medicine practices with mostly minority patients. We randomly assigned 523 female patients, aged 18 years or older and currently involved with a partner, to 1 of 3 screening protocols. Each included 2 brief screening tools: HITS and WAST-Short. Outcome measures were domestic violence disclosure, patient and clinician comfort with the screening, and time spent screening.
Results: Overall prevalence of domestic violence was 14%. Most patients (93.4%) and clinicians (84.5%) were comfortable with the screening questions and method of administering them. Average time spent screening was 4.4 minutes. Disclosure rates, patient and clinician comfort with screening, and time spent screening were similar among the 3 protocols. In addition, WAST-Short was validated in this sample of minority women by comparison with HITS and with the 8-item WAST.
Conclusions: Domestic violence is common, and we found that most patients and clinicians are comfortable with domestic violence screening in urban family medicine settings. Patient self-administered domestic violence screening is as effective as clinician interview in terms of disclosure, comfort, and time spent screening.


The prevalence of current victims of domestic violence among patients in primary care settings ranges from 7% to 50%,[1] even though studies show that only 1% to 15% of women in primary care settings were asked about domestic violence by their clinician.[2,3,4] Lack of office protocols and limited time are perceived as common barriers by medical clinicians.[5,6,7,8] In one study, battered women perceived clinician reluctance to ask about abuse as a major barrier to their domestic violence disclosure.[9]

Although studies have found that brief screening questionnaires increase identification of domestic violence,[10,11] research findings are inconsistent on the optimum method of administering screening tests. In a recent randomized study, MacMillan et al found no significant difference in the proportion of patients who disclosed domestic violence using a self-administered questionnaire compared with patients who were interviewed by a clinician; the patients, however, preferred self-administered screening.[12] McFarlane and colleagues found that a medical staff interview identified more abused women than a written history form,[13] whereas another study reported opposite findings.[14] With few notable exceptions,[10,12,13,14,15,16,17] previous studies have not examined clinician and patient comfort with different screening protocols. One study of a brief screening tool indicated that 91% of women felt comfortable when screened by their clinicians.[10]

The purpose of this study was to identify an optimal screening protocol to help overcome barriers to domestic violence screening. We compared the rate of domestic violence disclosure, comfort level with screening, and time spent screening for self-administered, medical staff interview, and physician interview screening protocols.


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