Computer-assisted screening for intimate partner violence and control: a randomized trial

BACKGROUND: Intimate partner violence and control (IPVC) is prevalent and can be a serious health risk to women. OBJECTIVE: To assess whether computer-assisted screening can improve detection of women at risk for IPVC in a family practice setting. DESIGN: Randomized trial. Randomization was computer-generated. Allocation was concealed by using opaque envelopes that recruiters opened after patient consent. Patients and providers, but not outcome assessors, were blinded to the study intervention. SETTING: An urban, academic, hospital-affiliated family practice clinic in Toronto, Ontario, Canada. PARTICIPANTS: Adult women in a current or recent relationship. INTERVENTION: Computer-based multirisk assessment report attached to the medical chart. The report was generated from information provided by participants before the physician visit (n = 144). Control participants received standard medical care (n = 149). MEASUREMENTS: Initiation of discussion about risk for IPVC (discussion opportunity) and detection of women at risk based on review of audiotaped medical visits. RESULTS: The overall prevalence of any type of violence or control was 22% (95% CI, 17% to 27%). In adjusted analyses based on complete cases (n = 282), the intervention increased opportunities to discuss IPVC (adjusted relative risk, 1.4 [CI, 1.1 to 1.9]) and increased detection of IPVC (adjusted relative risk, 2.0 [CI, 0.9 to 4.1]). Participants recognized the benefits of computer screening but had some concerns about privacy and interference with physician interactions. LIMITATION: The study was done at 1 clinic, and no measures of women's use of services or health outcomes were used. CONCLUSION: Computer screening effectively detected IPVC in a busy family medicine practice, and it was acceptable to patients. PRIMARY FUNDING SOURCE: Canadian Institutes of Health Research and Ontario Women's Health Council