Domestic violence screening in emergency departments and primary healthcare centres : the healthcare professionals’ perspective

Abstract

This dissertation explores the perspectives of health care professionals on domestic violence and on screening for domestic violence, in the Maltese healthcare system. Despite the known health consequences of domestic violence, intimate partner violence screening rate within the emergency and primary care settings is quite low in several countries (e.g. Australia, California and Canada) (Dowd, Kennedy, Knapp, & Stallbaumer-Rouyer 2002;Easteal & Easteal, 1992; Rodriguez, Bauer, McLoughlin, Grumbach, 1999; Thurston, Tutty, Eisener, Lalonde, Belenky, & Osborne, 2007). Klap, Tang, Wells, Starks, & Rodriguez (2007) research in America established that forty-six percent (46%) of screening was held in a primary health care setting while eleven percent (11%) was held in the emergency department of the study setting and the rest forty-three percent (43%) in other settings. Hence, this dissertation study was carried out in the emergency department and the primary healthcare centres of the state institutions and a private hospital. A mixed methodological approach (Reinharz, 1992) was used, with six (6) participants for the qualitative semi structured interviews used for a deeper understanding of the results formulated from the questionnaire Domestic Violence Health Care Provider Survey, which was conducted in the quantitative phase with sixty-one (61) participants. This allows the feminist standpoint researcher to fully understand the concept that other methods of research might neglect or ignore. Although the rate of intimate partner violence screening was not studied directly, the study was consistent with the low rate of screening for violence by intimate partner found elsewhere. The qualitative phase of the study concluded that no screening is conducted in the Maltese healthcare settings, but actions are only taken if the client discloses intimate partner violence. Furthermore, healthcare professionals discussed the barriers encountered in screening for intimate partner violence. Harding (2004) explains that a feminist study is built upon the inquiry of who knows and how their knowledge is utilized. The unheard voices were placed in the centre of the research process to attain real concrete stories for deeper understanding of the society we are living in. Feminist standpoint is considered to be an explanatory and theoretical framework to have a better understanding of the analysis. The sixty-one survey questionnaires were analysed using the statistical analysis program SPSS. The six (6) semi-structured interviews were analysed using the analytic approach of the thematic analysis. This approach resulted in several themes emerging on barriers encountered by healthcare professionals working within a patriarchal health system. Whilst acknowledging the limitations, the research identified that the Maltese healthcare system has gaps, such as lack of intimate partner violence education and training for professionals to enable them to care effectively for the client experiencing intimate partner violence. Finally, health care professionals may overcome intimate partner violence barriers by working as a team and recognize the significance of screening for intimate partner violence, which will decrease the underreporting of domestic violence cases in Malta.