Development of a quality index tool to assess the completion of J88 forms for rape survivors in South Africa
Date
2016
Authors
Mathews, Moushumi Ann
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Abstract
Background
The J88 form is important as a legal document that presents the recorded findings of the healthcare worker during the medical examination after rape has been reported through either the medical or justice system. The quality of how these forms are completed therefore becomes pertinent. There are many anecdotal references to poorly completed J88 forms in South Africa; although assumptions are made by the healthcare sector on what comprises a well completed J88 form, the measure of quality is not completely clear.
Aim
This study aims to develop and assess a Quality Index Tool for completed J88 forms.
Methodology
In the first part of the study, a Delphi process used semi-structured telephonic interviews explore the views of eight medical and eight legal experts on what factors they thought contributed to the quality of the completed J88 form. Sixty-three criteria were identified. These were ranked and refined through three rounds where the experts engaged with these issues to come to a level of agreement about what key issues affected the quality of completed J88 forms. These issues were then to be compiled into a tool to assess the quality of J88 forms.
In the second part of the study a simple random sample of 160 J88 forms gathered in a larger study from cases reported to the police in 2012 were used. The forms were scored using the Quality Index Tool created in the first part of the study and inter-rater agreement was assessed. These scores were then entered into STATA 13 with province, provider and patient information like sex of the patient, nurse/doctor to determine what the general quality of the J88 forms. T-tests and ANOVAs, were performed to compare the mean score which had been standardised between different groups e.g. child vs. adult patients. A multiple regression model was built to identify patient and provider factors associated with poorer and higher quality of completion of the J88 forms and a logistic regression model was used to assess whether higher quality was associated with writing better conclusions.
Results
During the first round of the Delphi process, sixty three Quality Statements were identified from the in-depth interviews conducted with the experts. Experts agreed that there was substantial variation in how well the J88 was completed. They identified some factors that were relevant to the completion of the form overall like how legibly the form was completed, and identified specific criteria for different parts of the form like whether an explanation was given if a diagram was not completed. In the subsequent two rounds, consensus on these Quality Statements was sought between the experts. Only two statements achieved perfect consensus (100% agreement). Another twenty two statements achieved a level of agreement above 80%, which was the level of agreement sought in the final round. These twenty four Quality Statements were compiled to form the Quality Index Tool.
In the second part of the study, the mean Quality Index Score percentage achieved for the 160 J88 forms scored was 72.1% (range from 65 to 79.2%). Of the 160 J88 forms scored, 6 (3.8%) were completed for male patients and 66 (41.25%) were completed for children (<18 years of age); 36 (22.5%) were completed by nurses. Factors associated with a better score were the patient being an adult, the healthcare worker being a nurse and performing an anal examination. It was also found that a higher score was predictive of a better conclusion in the logistic regression analysis.
Conclusion
Care of a rape survivor comprises counselling, clinical management and collecting evidence which can be used in the investigation and prosecution of the case. The J88 plays an important role in the latter. Overall, the quality of completion of J88s was variable. Since the Quality Index Tool predicted higher quality in the completion of conclusions it is important to ensure that provider training is intensified. The Quality Index Tool can be used by auditors and researchers who are interested in quality of medico-legal services.
Description
A research report submitted to the
Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
in partial fulfilment of the requirements for the degree of
Master of Medicine in the branch of Public Health Medicine
Johannesburg
November 2016