Review and special article
Intimate Partner Violence Screening Tools: A Systematic Review

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Context

Intimate partner violence (IPV) screening remains controversial. Major medical organizations mandate screening, whereas the U.S. Preventive Services Task Force (USPSTF) cautions that there is insufficient evidence to recommend for or against screening. An effective IPV screening program must include a screening tool with sound psychometric properties. A systematic review was conducted to summarize IPV screening tools tested in healthcare settings, providing a discussion of existing psychometric data and an assessment of study quality.

Evidence acquisition

From the end of 2007 through 2008, three published literature databases were searched from their start through December 2007; this search was augmented with a bibliography search and expert consultation. Eligible studies included English-language publications describing the psychometric testing of an IPV screening tool in a healthcare setting. Study quality was judged using USPSTF criteria for diagnostic studies.

Evidence synthesis

Of 210 potentially eligible studies, 33 met inclusion criteria. The most studied tools were the Hurt, Insult, Threaten, and Scream (HITS, sensitivity 30%–100%, specificity 86%–99%); the Woman Abuse Screening Tool (WAST, sensitivity 47%, specificity 96%); the Partner Violence Screen (PVS, sensitivity 35%–71%, specificity 80%–94%); and the Abuse Assessment Screen (AAS, sensitivity 93%–94%, specificity 55%–99%). Internal reliability (HITS, WAST); test–retest reliability (AAS); concurrent validity (HITS, WAST); discriminant validity (WAST); and predictive validity (PVS) were also assessed. Overall study quality was fair to good.

Conclusions

No single IPV screening tool had well-established psychometric properties. Even the most common tools were evaluated in only a small number of studies. Sensitivities and specificities varied widely within and between screening tools. Further testing and validation are critically needed.

Section snippets

Context

Intimate partner violence (IPV) is a major public health problem associated with adverse health consequences for victims.1, 2, 3 Healthcare settings represent important sites for IPV screening and intervention. In 2004, however, the U.S. Preventive Services Task Force (USPSTF) concluded that there was “insufficient evidence to recommend for or against routine screening of women for IPV.”4 This recommendation reflects limited empirical data about the potential harms of screening and about

Study Eligibility Criteria

For the current review, IPV was defined as physical, sexual, or emotional abuse or battering (including fear and coercive control) between intimate partners. For inclusion, studies had to (1) determine the psychometric properties of IPV screening questions; (2) test the IPV screening tool in a medical setting such as internal medicine, family practice, obstetrics–gynecology, the emergency department, or pediatrics; (3) be written in English, and (4) be published in a peer-reviewed journal. The

Common IPV Screening Tools

The most studied IPV screening tools were the Hurt, Insult, Threaten, and Scream (HITS),13, 14, 15, 24, 43 the Woman Abuse Screening Tool/Woman Abuse Screening Tool-Short Form (WAST/WAST-SF),15, 16, 17, 25, 26, 44 the Partner Violence Screen (PVS),22, 23, 24, 25, 26, 44 and the AAS.30, 35, 36, 37 These screening instruments are summarized in Table 1, which includes the specific questions and scoring for each screening tool, demographics of the populations on whom the screening tool has been

Comments

Authors of a 1968 WHO report, The Principles and Practice of Screening for Disease, commented that “in theory, screening is an admirable method of combating disease…in practice, there are snags.”48 The current review highlights a number of “snags” that preclude drawing definitive conclusions about the effectiveness of IPV screening tools tested in healthcare settings. First, even the most common screening tools (the HITS, the WAST, the PVS, and the AAS) were evaluated in only a small number of

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