After the questions: the process for and consequences of, routine screening for intimate partner violence in a state-wide health program

Routine screening of women for intimate partner violence (IPV) has been introduced in many health settings to improve identification and response to hidden abuse, yet systematic reviews suggest insufficient evidence exists. This thesis identifies challenges to undertaking research on IPV and to using research to inform policy. This knowledge informed the design of mixed methods evaluative research on the impact of the New South Wales Health routine screening policy for IPV. The research was undertaken in four antenatal, five substance abuse, and one mental health service. It involved three components: cross-sectional surveys with women six months after being asked the screening questions (122 women who said yes to screening questions and 241 who said no); interviews with a sub-group of 20 women who said yes and ten focus groups with health workers. 23% (27/120) women reporting abuse, were revealing this to another person for the first time. Of those who screened negative, 14% (34/240) had experienced abuse, but chose not to disclose. Those who screened positive were more likely than those who screened negative, to report increased agreement with five abuse-related attitudes. The proportion reporting current abuse was significantly lower after six months. 34% (41/120) reported useful effects – most frequently re-evaluating their situation and reduced isolation.6% (7/119) reported negative emotional reactions. Women who had experienced abuse, but elected not to disclose, reported similar effects. The interview findings revealed that women were in diverse situations and challenged formulaic representations of abuse, leading to proposal of a model for understanding decisions to disclose and how valued impacts occurred. These impacts included naming the abuse and establishing a sense of connection. The focus groups found screening has become embedded into practice, particularly through the use of brief, scripted questions enabling workers to build familiarity with the process, reinforced by women's favorable reactions. Screening built worker's awareness of IPV and capacity to respond. The multiple effects associated with screening and the diversity of audiences reached, lead to the conclusion that screening is a complex intervention, reaching women who have not previously disclosed abuse that can influence women whether or not they choose to disclose