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.The study contributed toward doctoral and fellowship training of Dr. Ahmad, which was funded by the Canadian Institutes of Health Research (grants IGF 63976 and FOW 68219): Institute of Gender & Health, Ontario Women’s Health Council, and Strategic Training on Health Care, Place & Technology Program. The authors gratefully acknowledge the support of the Ontario Ministry of Health and Long-Term Care. Support from the Centre for Research on Inner City Health, The Keenan Research Centre, in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, is much appreciated