Appendix F
Summary of Evaluation Studies on Training of Health Care Professionals on Intimate Partner Violence



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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Appendix F Summary of Evaluation Studies on Training of Health Care Professionals on Intimate Partner Violence

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Knowledge, Attitudes, and Beliefs Outcome   Nature of Training Provided Expected Outcomes and Measure Target Population (study citation) Intervention Group Comparison Group (if applicable) Study Design Major Outcomes Measure Medical students (Ernst et al., 1998, 2000) Type: Didactic Length: 3 hrs. Clinical aids: None   One group Knowledge re IPV Self-report (14 items) Medical students (Haase et al., 1999) Type: Mixed Length: 9 hrs. over 6 weeks Clinical aids: None None Two groups (one comparison group) Perceived comfort, preparedness, questioning habits, and knowledge of resources re IPV Self-report (five items, a = 0.70

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Timing Sample Size and Attrition from Measurement Results I = Intervention Group C = Comparison Group Pre = Baseline or Pretest Post = Posttest FU = Follow-up Baseline Posttest (months) Follow-ups (months) Intervention Comparison Within-Group Change Relative Group Difference Comment Yes 1 24 Eligible = 148 Pre = 144 Post = 141 (98%) FU = 104 (72%)   Ipost>Ipre* (6 items) IFU >Ipre* (5 items) IFU <Ipost* (2 items) IFU =Ipost (8 items)   Within-group comparisons were not based on matched groups (e.g., those with complete data and on all measurement waves) due to the Institutional Review Board’s requirement that participants be anonymous. Thus, the comparisons should be interpreted with caution. No 24   Eligible = Not reported Post = 29 Eligible = Not reported Post = 86   Ipost>Cpost* Although the training was a formal elective course, groups were created by self-report on the posttest rather than known course enrollment. The analysis controlled for gender. Analyses of individual items indicated that group differences were in knowledge and reported questioning habits rather than comfort and preparedness.

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Knowledge, Attitudes, and Beliefs Outcome   Nature of Training Provided Expected Outcomes and Measure Target Population (study citation) Intervention Group Comparison Group (if applicable) Study Design Major Outcomes Measure Medical students (Jonassen et al., 1999) Type: Mixed Length: 2-3.5 days   One group Knowledge re IPV Self-report (10 items) Clinical aids: Materials on local resources; screening algorithm Attitudes re IPV Self-report (26 items) Clinical skills and experience Self-report (10 items) Medical students (Short et al., 2000) Type: Mixed Length: 4-week module Clinical aids: None One lecture Two groups (one comparison group) Knowledge, attitudes, and behavioral intentions about IPV Self-report (37 items, a = 0.80, test-retest = 0.87)   Appropriateness of intervening Self-report (3-item subscale, a = 0.51, test-retest = 0.64) Physician responsibility for IPV Self-report (8-item subscale, a = 0.69, test-retest = 0.82) Victim autonomy for decisions Self-report (3-item subscale, a = 0.54, test-retest = 0.69)

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Timing Sample Size and Attrition from Measurement Results I = Intervention Group C = Comparison Group Pre = Baseline or Pretest Post = Posttest FU = Follow-up Baseline Posttest (months) Follow-ups (months) Intervention Comparison Within-Group Change Relative Group Difference Comment Yes Immediately after training 6 Eligible = 205 Pre, Post, and FU = 144 (70%)   Ipost >Ipre* IFU >Ipre*   Test reliability was reported as adequate. Ipost >Ipre* IFU >Ipre* Ipost >Ipre* IFU >Ipre* Results pertain to comparisons for two separate cohorts. Yes 1   Eligible = 149 Pre = 124 Post = 87 (70%) Eligible = 97 Pre = 88 Post = 66 (75%) Ipost >Ipre* Ipost >Cpost*   Ipost < Ipre Ipost <Cpost Ipost >Ipre Ipost >Cpost Ipost >Ipre Ipost >Cpost

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Knowledge, Attitudes, and Beliefs Outcome   Nature of Training Provided Expected Outcomes and Measure Target Population (study citation) Intervention Group Comparison Group (if applicable) Study Design Major Outcomes Measure   Self-efficacy for detecting IPV Self-report (6-item subscale, a = 0.72, test-retest = 0.72) Behavioral intentions to screen Self-report (6-item subscale, a = 0.66, test-retest = 0.83) Residents in all specialties (Coonrod et al., 2000) Type: Mixed Length: 20 min. Clinical aids: Articles and pocket information cards Didactic educational session on unrelated topic Length: 20 min. Clinical aids: Articles and pocket information cards on topic Two groups (randomized) Knowledge of IPV Self-report (5-item subscale)

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Timing Sample Size and Attrition from Measurement Results I = Intervention Group C = Comparison Group Pre = Baseline or Pretest Post = Posttest FU = Follow-up Baseline Posttest (months) Follow-ups (months) Intervention Comparison Within-Group Change Relative Group Difference Comment   Ipost >Ipre* Ipost >Cpost*   Ipost >Ipre* Ipost >Cpost*   Yes 9-10   Eligible = 24 Pre = 24 Post = 12 (50%) Eligible = 22 Pre = 22 Post = 11 (50%)   Ipost >Cpost* Analysis controlled for pretest score. Results

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Knowledge, Attitudes, and Beliefs Outcome   Nature of Training Provided Expected Outcomes and Measure Target Population (study citation) Intervention Group Comparison Group (if applicable) Study Design Major Outcomes Measure Residents in internal medicine (Knight et al., 2000) Type: Didactic Length: 105 min. Clinical aids: Local resource list; laminated card of screening questions and resource contacts   One group Beliefs re IPV (including selfefficacy of victims) Self-report (31 items) Residents in internal medicine (Kripke et al., 1998) Type: Mixed Length: 4 hrs. Clinical aids: None One group Knowledge re IPV Self-report (10 items) Attitudes re IPV Self-report (25 items) Perceptions re skills Self-report (10 items)

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Timing Sample Size and Attrition from Measurement Results I = Intervention Group C = Comparison Group Pre = Baseline or Pretest Post = Posttest FU = Follow-up Baseline Posttest (months) Follow-ups (months) Intervention Comparison Within-Group Change Relative Group Difference Comment Yes Immediately after training   Eligible = 45 Pre = 45 Post = 45 (100%)   Ipost =Ipre   Measures used were those developed by Varvaro et al. (1997), who reported internal consistencies ranging from 0.62 to 0.90, depending on the subscale of interest. Results were affected by residents = complaints about the lengthiness of the survey and their careless responding. Yes Immediately after training 6 Eligible = 55 Pre = 55 Post = 55 (100%) FU = 55 (100%) Ipost >Ipre* IFU >Ipre* Ipost >Ipre* IFU >Ipre* Ipost >Ipre* IFU =Ipre The differences would have been statistically significant if a one-tailed test had been used.

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Knowledge, Attitudes, and Beliefs Outcome   Nature of Training Provided Expected Outcomes and Measure Target Population (study citation) Intervention Group Comparison Group (if applicable) Study Design Major Outcomes Measure ED staff and emergency medical technicians (Allert et al., 1997) Type: Didactic Length: 90 min. Clinical aids: Copy of care guidelines; list of local resources   One group Knowledge of written protocol, reporting requirements, and documentation Self-report (4 items) ED nurses (Bokunewicz & Copel, 1992) Type: Didactic Length: 60 min. Clinical aids: None One group Beliefs re IPV Self-report (questions on a scenario, a = 0.79) ED staff, including physicians, nurses, and social workers (Campbell et al., in press) Type: Mixed Length: 2 days Clinical aids: Technical assistance if requested Usual or available training Two groups (group randomized) Knowledge and attitudes about IPV Self-report (23 items, a = 0.73)

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Timing Sample Size and Attrition from Measurement Results I = Intervention Group C = Comparison Group Pre = Baseline or Pretest Post = Posttest FU = Follow-up Baseline Posttest (months) Follow-ups (months) Intervention Comparison Within-Group Change Relative Group Difference Comment Yes Immediately after training 3 Eligible = 329 Pre = 266 Post = 266 (100%) FU = 213 (80%)   Ipost >Ipre* (6 items) IFU >Ipre* (6 items)   Total number of items in the instrument was not specified. The follow-up was done by telephone to a random sample, but the response rate was not reported. It is unclear whether the statistical tests took into account repeated measures. Yes Immediately after training   Eligible = 42 Pre = 18 Post = 18 (100%) Ipost >Ipre*   Yes 18-24   3 EDs Eligible = Not reported Pre = Not reported Post = 330 3 EDs Eligible = Not reported Pre = Not reported Post = 319 Ipost >Ipre* Ipost >Cpost* An overall response rate for the posttest was 75%, but no information was provided regarding differential response rates for the two groups. The analyses controlled for gender, state, and pretest standing.

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Screening, Identification, and Detection of Intimate Partner Violence   Nature of Training Provided Expected Outcomes and Measure Target Population (study citation) Intervention Group Comparison Group (if applicable) Study Design Major Outcomes Measure ED staff (Fanslow et al., 1998, 1999) Type: Didactic Length: 1 or 4 hrs. Clinical aids: Protocols; forms; body map; checklist; contact cards Number of participants: 33 nurses and 11 medical staff   Cohort % of all cases identified as IPV victims Chart review % of possible IPV cases that were confirmed Chart review % of possible IPV cases with documentation Chart review ED staff (McLeer et al., 1989) Type: Unclear Length: Unclear Clinical aids: Protocol Number of participants: Not clear   Cohort % of all cases identified as IPV Chart review ED physicians (Olson et al., 1996) Type: Didactic Length: 1 hr. Clinical aids: Stamped query on patient form Number of participants: Unclear   Cohort % of all cases identified as IPV Chart review

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Timing Sample Size and Attrition from Measurement Results I = Intervention Group C = Comparison Group Pre = Baseline or Pretest Post = Posttest FU = Follow-up Baseline Posttest (months) Follow-ups (months) Intervention Comparison Within-Group Change Relative Group Difference Comment Yes 1-3 12-15 Pre = 2276 Post = 2287 FU = 1598 Pre = 1768 Post = 1720 FU = 1312 Ipost =Ipre Ipost =Cpost IFU =CFU The analyses did not incorporate additional variables (e.g., patient characteristics). Pre = 57 Post = 53 FU = 17 Pre = 54 Post = 45 FU = 30 Ipost >Ipre* Ipost > Cpost* IFU =CFU Pre = 57 Post = 53 FU = 17 Pre = 54 Post = 45 FU = 17 Ipost >Ipre*I post >Cpost* IFU =CFU Routine screening not adopted by ED staff. Yes 12 96 Pre = 359 Post = 412 FU2 = 470   Ipost >Ipre* IFU >Ipre IFU < Ipost*   At follow-up, the protocol was no longer in use nor any other formal assessment procedure.   1 mo. prior 1 Pre = 1,272 Stamp-only = 1,444 Stamp & training = 1,356   Ipost >Ipre* IFU >Ipost   A significant increase in identification rates occurred after introduction of the stamp, but there was no change when education was added.

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Screening, Identification, and Detection of Intimate Partner Violence   Nature of Training Provided Expected Outcomes and Measure Target Population (study citation) Intervention Group Comparison Group (if applicable) Study Design Major Outcomes Measure ED staff, including physicians, residents, interns, and nurses (Roberts et al., 1997a) Type: Unclear (workshops and case presentations) Length: Unclear Clinical aids: None Number of participants: Unclear   Cohort % of self-reported IPV victims who were noted as such on chart within 24 hours after presentation Chart review ED, critical care, and perinatal hospital staff (Short et al., in press) Type: Length: Clinical aids: Protocol Usual and available Two groups (one comparison group) % of cases with documentation of definite IPV Chart review % of cases with documentation of suspected IPV Chart review ED nurses (Tilden & Shepherd, 1987) Type: Didactic Length: 4 hrs. Clinical aids: Protocol and forms Number of participants: 22   Cohort % of all cases identified as IPV Chart review

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Timing Sample Size and Attrition from Measurement Results I = Intervention Group C = Comparison Group Pre = Baseline or Pretest Post = Posttest FU = Follow-up Baseline Posttest (months) Follow-ups (months) Intervention Comparison Within-Group Change Relative Group Difference Comment Yes 12   Pre = 141 Post = 183   Ipost =Cpost Low attendance at training and lack of social work referral services at times when victims showed in the emergency room may have contributed to the lack of differences.   15 18 21 24 Post = FU1 = FU2 = FU3 = Post = FU1 = FU2 = FU3 =   IFU3 > CFU3* A total of 2,531 charts were reviewed, but the numbers were not reported for each data collection wave. IFU3 > CFU3* Yes 4   Pre = 447 Post = 445   Ipost >Ipre*  

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Screening, Identification, and Detection of Intimate Partner Violence   Nature of Training Provided Expected Outcomes and Measure Target Population (study citation) Intervention Group Comparison Group (if applicable) Study Design Major Outcomes Measure Maternity care coordinators in county health departments (Covington et al., 1997a) Type: Didactic Length: Unclear Clinical aids: Protocol Number of participants:   Cohort % of pregnant adolescents reporting IPV at first visit Self-report of adolescent patients % of pregnant adolescents reporting IPV at any visit Self-report of adolescent patients Maternity care coordinators in county health departments (Covington et al., 1997b) Type: Didactic Length: Unclear Clinical aids: Protocol Number of partcipants: Unclear   Cohort % of pregnant adult clients reporting IPV at first visit Self-report of pregnant patients % of pregnant adult clients reporting IPV at any visit Self-report of pregnant patients

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Timing Sample Size and Attrition from Measurement Results I = Intervention Group C = Comparison Group Pre = Baseline or Pretest Post = Posttest FU = Follow-up Baseline Posttest (months) Follow-ups (months) Intervention Comparison Within-Group Change Relative Group Difference Comment Yes 12   Pre = 129 Post = 117   Ipost >Ipre   Analyses controlled for differences in race/ethnicity between the two patient cohorts. Although the rate of identification at the first visit doubled between baseline and the posttest, this was not a statistically reliable difference due to the small sample size. Ipost >Ipre* Yes 12 Pre = 1,056 Post = 384 Ipost >Ipre* Analyses controlled for differences in race/ethnicity and age between the two patient cohorts. The baseline review of charts covered a 36-month time span, and no differences were found in identification rates among the three years. Ipost >Ipre*

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Screening, Identification, and Detection of Intimate Partner Violence   Nature of Training Provided Expected Outcomes and Measure Target Population (study citation) Intervention Group Comparison Group (if applicable) Study Design Major Outcomes Measure Community health center staff, including physicians, mid-level practitioners, social workers, and psychologists (Harwell et al., 1998) Type: Mixed Length: 3-6 hrs. Clinical aids: IPV screening pocket card; IPV assessment form; stamp to indicate screening and suspected or confirmed abuse; patient card of resources and safety tips; additional tailored followup training to some CHCs Number of participants: 108   Cohort % of cases screened for IPV Chart review % of cases where IPV was suspected Chart review % of cases where IPV was confirmed Chart review Public health nurses (Shepard et al., 1999) Type: Mixed Length: 4 hrs. Clinical aids: Protocol Follow-ups Number of participants:12 Cohort % of cases identified as IPV Chart review

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Timing Sample Size and Attrition from Measurement Results I = Intervention Group C = Comparison Group Pre = Baseline or Pretest Post = Posttest FU = Follow-up Baseline Posttest (months) Follow-ups (months) Intervention Comparison Within-Group Change Relative Group Difference Comment Yes 6   Pre = 251 Post = 255   Ipost >Ipre*   There was no significant change in positive identification of IPV victims in the chart. Ipost >Ipre* Ipost >Ipre   Yes 12 24 Pre = 546 Post = 442 FU = 372   Ipost >Ipre IFU1 >Ipre   Differences in identification rates were not significant when age was controlled (although they were marginally significant).

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Screening, Identification, and Detection of Intimate Partner Violence   Nature of Training Provided Expected Outcomes and Measure Target Population (study citation) Intervention Group Comparison Group (if applicable) Study Design Major Outcomes Measure Primary care team members (Thompson et al., 2000) Type: Mixed Length: 2 half-day sessions over 12 months Clinical aids: Posters; provider cue cards; routine exam forms; feedback Usual and available training (e.g., manual) Two groups (group randomized) % asking about IPV Provider self-report (one item) % of patients who were asked about IPV Chart review % of patients who were victims of IPV Chart review Prenatal health clinic staff, including physicians, nurses, nutritionists, counselors, and clerical staff (Wist & McFarlane, 1999) Type: Didactic Length: 90 min. Clinical aids: Protocol; follow-up No protocol in one clinic Two groups (one comparison group) % of patients identified as IPV Chart review

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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence Timing Sample Size and Attrition from Measurement Results I = Intervention Group C = Comparison Group Pre = Baseline or Pretest Post = Posttest FU = Follow-up Baseline Posttest (months) Follow-ups (months) Intervention Comparison Within-Group Change Relative Group Difference Comment Yes 9   2 clinics Eligible = ? Pre = Post = 91 3 clinics Eligible = ? Pre = Post = 88 Ipost >Ipre* Ipost > Cpost* IFU >CFU Ipost > Cpost* Differences in recorded asking occurred among those who had physical exams and screening questionnaire. Ipost >Ipre* Yes   Pre = 1,590 Post = 1,372 Same Pre = 2,205 Post = 2,020 Same   Yes   Ipost >Ipre Ipost >Cpost   Yes 3 15 Pre = 360 Post = 110 FU2 = 250 Pre = 180 Post = 55 FU2 = 125 I(post+FU) > IFU >CFU* Ipost > Cpost* The percent of charts at the intervention site that contained an abuse screen declined from 95% at the 3-month posttest to 85% at the 15-month follow-up.

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