Evaluation of the accuracy of a two-question screening tool in the detection of intimate partner violence in a primary healthcare setting in South Africa

Abstract

Intimate partner violence has been recognised as a global human rights violation. It is universally under-diagnosed and the institution of timeous multi-faceted interventions has been noted to benefit intimate partner violence victims. Currently the concept of using a screening tool to detect intimate partner violence has not been widely explored in a primary healthcare setting in South Africa, and for this reason the current study was undertaken. The objectives of this study were: 1) to determine the operating characteristics of a two-question screening tool for intimate partner violence (Women Abuse Screening Tool-short); and 2) to estimate the prevalence of intimate partner violence among women attending an Out Patient Department, using a validated questionnaire (Women Abuse Screening Tool). Methods: A cross-sectional study was conducted prospectively at the Out Patient Department of a Level 1 Hospital, with systematic sampling of I in 8 women over a period of 3 months. Participants were asked about their experience of intimate partner violence during the past 12 months. The Women Abuse Screening Tool-short, a two-question tool, was used to screen patients for intimate partner violence. To verify the result ofthe screening, women were also asked the remaining questions from the full Women Abuse Screening Tool. Results: Data were collected from 400 participants, with a response rate of99.3%. Based on the results for the Women Abuse Screening Tool, the prevalence of intimate partner violence in the sample was 32%. The Women Abuse Screening Tool-short was shown to have the following operating characteristics: sensitivity 45.2% and specificity 98%. Conclusion: With its high prevalence, intimate partner violence is a health problem of note at this facility. The Women Abuse Screening Tool-short lacks sufficient sensitivity and therefore is not an ideal screening tool for this primary care ambulatory setting. The low sensitivity can be attributed to the participants' understanding of the screening questions, which utilize Eurocentric and nuanced definitions of intimate partner violence. Improvement in the sensitivity of the Women Abuse Screening Tool-short in this setting may be achieved by lowering the threshold for a positive result for intimate partner violence screening, and modification of the screening questions to better reflect intimate partner violence as understood by the local population.