II. violence prevention and intervention in health care and community settings
Development of a health care provider survey for domestic violence: Psychometric properties

https://doi.org/10.1016/S0749-3797(00)00230-0Get rights and content

Abstract

Background: Despite rapid proliferation of descriptive studies of health care providers (HCPs) and protocols for identification and management of domestic violence (DV), few reliable instruments exist for assessing HCPs’ attitudes, beliefs, and behaviors regarding this practice. This study describes the development and psychometric properties of a measure of attitudes, beliefs, and self-reported behaviors related to the identification and management of DV.

Methods: We used a multiphase study design to develop items across eight content domains. We administered an initial pool of 104 items to a pilot sample of 129 primary care providers (physicians, physician assistants, nurse practitioners, and medical assistants) in a large, urban health maintenance organization. Descriptive statistics, principal components, and reliability analyses were performed on each of the eight content domains. The analyses guided the deletion of items and development of additional items, yielding a 56-item pool. The items were then administered and re-analyzed with an independent sample of 246 HCPs.

Results: Six separate and reliable domains were identified: Perceived Self-Efficacy, System Support, Blame Victim, Professional Role Resistance/Fear of Offending Patient, Victim/Provider Safety, and Frequency of DV Inquiry. We found item domain Cronbach α to be acceptable, ranging from 0.73 to 0.91. The final overall measure had 39 items and an α of 0.88. Data are reviewed that support the measure’s sensitivity to change in response to a training intervention.

Conclusion: The measure provides a reliable method for assessing provider characteristics and training needs. It may also serve to evaluate training and policy interventions in DV.

Introduction

In recent years, interest in domestic violence (DV) as a public health problem has increased.1 Surveys suggest that between 1.5% and 6% of American women were assaulted by an intimate partner in 1998 and 1995, respectively.2, 3 Approximately 63% of these suffered physical injuries, and 34% needed medical care.3 Researchers estimate lifetime prevalence of such assault at between one third and one half of all married or cohabiting women.3, 4 Clinical studies indicate that 12% to 25% of female patients in primary health care settings report assault by a partner “in the past year,”5, 6 as do 12% to 22% of patients in emergency departments7, 8 and 4% to 17% examined during pregnancy.9, 10, 11

A variety of professional organizations have called for greater efforts to involve health care workers in the identification and management of DV.12, 13, 14 Despite a rapid proliferation of descriptive studies of providers and intervention protocols, lack of reliable instruments to assess the attitudes, beliefs, and behaviors of health care providers (HCPs) regarding DV-related practice limits these efforts.

Attitudes and beliefs about DV have long been identified as a barrier to effective clinical response,15, 16 but few measures have been developed to assess them systematically. Easteal and Easteal17 reported that doctors’ attitudes regarding etiology (e.g., attributing DV to a victim’s personality) and professional role resistance (e.g., limiting the focus of care to injuries only) militate against effective intervention. Rose and Saunders18 suggested that female providers may have more empathic attitudes toward DV. Reid and Glasser19 found that most primary care physicians believed that DV was rare and that they were not well prepared to manage it. Unfortunately, these studies have employed single items or a series of items that lack reliability and validity data.20, 21

Finn22 developed a five-item scale for “sex role attitudes and the acceptance of DV” but provided no reliability/validity data. Saunders et al.23 performed reliability and validity studies to develop an “inventory of beliefs about wife beating.” Although the analyses yielded five subscales, these assessed general attitudes about DV rather than practice-specific attitudes. Moreover, reliabilities for three of the five subscales were only marginally acceptable.

Little work has been done to develop psychometrically sound, multidomain measures of DV-related attitudes, beliefs, and behaviors specifically geared to HCPs. Consequently, it is difficult to interpret the reliability, meaning, and practical implications of many studies performed to date.

This study describes the development and psychometric properties of a measure of attitudes, beliefs, and self-reported behaviors related to the identification and management of DV, based on both theoretic and empiric methods. Our goals were to demonstrate content validity and internal consistency reliability and to explore the instrument’s utility for identifying training needs and evaluating DV interventions.

Section snippets

Overview of study

In Phase I, we assembled an expert panel that developed 104 items within eight domains of DV-related content and processes for HCPs. Phase II involved factor identification, scale development, and reliability assessment through (1) administration of the 104 items to 129 HCPs; (2) elimination of 13 items with limited variability; (3) principal components analyses (PCAs) on each of the eight content domains, reducing items from 91 to 63; and (4) a PCA on 63 items. This yielded 45 items loading on

Discussion

The current measure of DV-related attitudes, beliefs, and self-reported behaviors can be used to profile training needs and to evaluate training programs and policy interventions for HCPs. The resulting six domains not only capture much of Sugg and Inui’s34 prior conceptual framework for common attitudinal barriers to DV (perceived self-efficacy in addressing DV, tendency to blame the victim, professional role resistance/fear of offending the patient), but also include empirically derived

Acknowledgements

The authors would like to thank Ellen Setteducati, Gayle Schneider, and Yuriko Kawakatsu for their assistance in manuscript preparation. The authors also thank the DV project study team for their support and hard work: Barbara Meyer, Kathy Smith-DiJulio, Madlen Caplow, Ben Givens, and Lori Fleming.

This project was funded, in part, by the Agency for Health Care Policy and Research (Grant #HS07568-02, AHCPR) and the Group Health/Kaiser Permanente Community Foundation.

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