Screening for intimate partner violence in healthcare in Kano, Nigeria : barriers and challenges for healthcare professionals

Abstract

Background: Though there has been increased advocacy for screening for Intimate partner violence (IPV) in healthcare over the past decades, data from developed country context suggest that only one in ten healthcare providers routinely screen for this phenomena suggesting barriers. Knowledge on the screening activity, with regard to IPV, and related barriers among healthcare providers in Sub-Saharan Africa is lacking.

Aims: The aim of this dissertation is to scrutinize provider-related as well as client related barriers to screening for Intimate Partner Violence in healthcare in the Sub-Saharan African context, using data from healthcare facility in Kano, Northern Nigeria.

Methods: The cross-sectional studies were based on three questionnaires assessing readiness to screen and screening activity, satisfaction with care and preferences for screening among patients. Domestic Violence Health Care Provider Survey Scale was utilised to measure healthcare providers readiness to screen for IPV as well as actual screening activity (Study I-III).Structured interviews were conducted with women attending the General Out-patient department, maternal and child health clinics of the participating hospital to probe their preference for screening and their satisfaction with care using the pyramid patient questionnaire (Study IV). Data were analysed using relevant univariate and multivariate statistical methods.

Results: The instruments utilised illustrated a stable structural validity (study I) and internal consistency (Studies I, II, III & IV). Barriers to screening were eminent both from the provider and the client perspective. Majority of Health Care Provider (HCP) did not inquire about the possibility/occurrence of IPV from their clients (74%) and scored on average moderately on readiness to screen indicator (i.e. self-efficacy, system support, attitudes towards screening, professional roles and victim/provider safety subscales) suggesting barriers (Study III).

Readiness to screen for IPV as well as screening for IPV was associated with several demographic and occupational characteristics of the healthcare provider (Study II). Social workers perceived a higher self-efficacy and a better support network to refer victims of violence than other professions. Gender and profession were significantly associated with blaming the victim with males and doctors less likely to blame the victim. Age, ethnicity and profession impacted significantly on professional roles related to screening for IPV where younger care providers, of Yoruba ethnicity and social workers were less likely to perceive conflicting professional roles related to screening than older providers, of Hausa ethnicity and doctors respectively. HCP from the Yoruba ethnicity were more likely to inquire about the possibility of IPV among their clients than peers from other ethnic affiliation (Study III).

Majority of Women had a preference for being probed about IPV in healthcare (76%) while 20% regarded such inquiry as unacceptable. However, only 7% of the interviewed women had been probed on the possibility of IPV. Women of Hausa ethnicity (9%) and Islamic religion (8.2%) were more likely to have been screened for IPV during their latest contact. Participants who had been probed on IPV expressed a higher satisfaction with care than peers who had not been probed. (Study IV).

Conclusion: There remain barriers to screening for IPV as expressed in the moderate scores of readiness to screen as well as actual screening statistics. Occupational and socio-demographic characteristics of HCP may account for differences in readiness to screen as well as actual screening activity, warranting interventions e.g. training, education and policy interventions. From the clients perspective, majority preferred being probed about IPV in healthcare. Moreover, women who had been screened expressed a higher satisfaction with care than colleagues who had not. These findings warrant introduction of routine screening in healthcare settings in this region. The ethnic and religious disparities in screening for IPV warrant further investigation.