Development of preparedness to respond to intimate partner violence scale among mental health professionals

INTRODUCTION

Violence against women is a major public health concern. Despite the progressive legislation to prevent violence, around one-third of women aged 15–49 years have undergone physical violence.^[1] Intimate partner violence (IPV) is a major cause of mortality and morbidity among women, resulting in negative health and psychiatric outcomes. IPV has been associated with miscarriages, premature labor, neonatal deaths, vaginal bleeding, urinary tract infections, depression, PTSD, suicides, and substance use.^[2-7] From the gender-vulnerability framework, women with psychiatric illness are at increased risk of IPV and more likely to attempt suicide as a result of partner violence.^[8] The lifetime prevalence of IPV among female and male psychiatric patients is 16–94% and 18–48%, respectively.^[9]

Many women with mental illness experiencing IPV are hesitant to disclose violence to clinicians as they fear retaliation and increased threat of violence by the abusive perpetrators.^[10] Mental health professionals (MHPs) play a key role in addressing IPV in the clinical setting. Despite the WHO’s recommendation for universal IPV screening, MHPs fail to routinely screen for IPV.^[11-13] Various studies have shown that MHPs attribute their reluctance to ask for violence due to inadequate preparedness and training, fear of offending victims, lack of privacy, and personal discomfort in inquiring about IPV.^[14-17] The factor that limits the screening of IPV is a lack of standardized tools to measure the preparedness to respond (PR) to the victims of violence and related practice in clinical settings.

Few available scales measure clinicians’ attitudes and opinions about IPV in health-care settings. The frequently used scales are the Bristol Domestic Violence Study,^[18] DV-related attitude, belief, and self-reported measure,^[19] and the Domestic Violence Health Care Provider Survey,^[20] which measures attitude, opinions, and organizational barriers in the screening of violence in the clinical setting. Moreover, these scales are of Western origin and are appropriate for the Western cultural context. The present research directed toward developing a comprehensive scale to measure MHP PR-IPV in the clinical setting.

MATERIALS AND METHODS

RESULTS

The initial 40 items scale was field-tested to understand the level of measurability of the items and further reduce the items in a meaningful manner. The mean age of the participants was 33.86 ± 6.61. The majority (58%) were females and 66.5% were unmarried. Among 200 participants, 30% were pre-doctoral and doctoral psychiatric social trainees, 21% were psychiatrists and junior residents, 17.5% were pre-doctoral and doctoral clinical psychology trainees, 12.5% were full-time psychiatric social workers, 11.5% were clinical psychologists, and 7.5% were psychiatric nursing trainees.

The factor structure of the scale was analyzed using an exploratory factor analysis (EPA) as the scale was not based pre-determined assumption. From the EPA analysis, certain items may either split or merge with the exiting factor or form a new construct. Hence, principal component analysis using a varimax rotation was performed. Kaiser criterion of factor loading of 0.30 was considered to retain the items.^[26,27] The factor analysis revealed that the main components were regrouped into five factors with 32 final items, constituting 59.2% of the variance among the observed variables. The first factor constituted ten items labeled as “Professionals Preparedness,” Factor 2 consisted six items named as “Victim Blaming,” Factor 3 consisted five items labeled as “Perpetrator Blaming”, fourth factor contained five items labeled as “Knowledge and Opinion (KO),” and the fifth factor included six items named as “Perceived Self-efficacy (PS).” The results of mean scores and the rotated principal component matrix are shown in [Tables 1 and 2]. The total mean score PRIPV scale was 115.64 with an SD = 10.20. The reliability coefficients for the 32-item scale using internal consistency Cronbach Alpha (α) ranged from 0.63 to 0.82. The overall Cronbach α 0.73 indicated a highly reliable coefficient value for the new scale [Table 3].

DISCUSSION

In this research, we have developed and standardized self-reported PR-IPV scale to measure MHPs preparedness and readiness to respond to violence in health settings. The factor analysis of the scale resulted in five factors. Factor 1 emerged as the professional’s preparedness subscale with the maximum number of items loaded significantly under this domain which explained 23.7% of the variance. Factor 2 emerged as the victim-blaming subscale explained 10.9% of the variation, which was part of the knowledge component of the initial scale. The present study’s findings concurred with research by John and Lawoko^[28] and Lawoko et al.^[20] where “victim personality/trait,” “victim disobedience,” and “blame victim” emerged as separate subscales. Factor 3 with five items emerged as “perpetrator blame” constituted 8.8% of the variance. Factor 4 reflected the KO component, with six items explaining 8.9% variance. Factor 5 reflected PS, with six items contributing 6.9% of the total item on the scale. Mathur et al.^[29] and Sugg and Inui^[30] reported a lack of knowledge, training, and PS as core barriers to screening and providing needed support to IPV victims among MHPs. The overall Cronbach alpha value of 0.73 indicates higher reliability for the final scale.^[31]

The scale has potential utility in several different ways: (a) The scale can be used as a pre- and post-test to measure clinicians’ knowledge, opinion, preparedness, and perceived skills to respond to disclosure of IPV and to evaluate the outcome of training or other intervention program over the period and (b) it can also be administered among physicians to measure the level of preparedness and perceived skills to handle IPV in the clinical setting.

Further research needs to be done to assess the stability and utility of the scale with different populations such as physicians, general nurses, family counselors, and ASHA workers working in the community health-care centers. Further, changes in relationship among PR-IPV items, clinician behaviors and patient’s outcomes may be evaluated. Program evaluators and trainees may use the scale to assess the effect of intervention programs.

CONCLUSION

In conclusion, initial validation of 32-items PR-IPV scale found to be an effective tool of measuring level of preparedness among MHPs to respond to IPV in the clinical setting. Further, this tool can be used to measure the effectiveness of training of MHPs and other health care professionals.