Novel educational program improves readiness to manage intimate partner violence within the fracture clinic: a pretest-posttest study

CMAJ Open. 2018 Dec 18;6(4):E628-E636. doi: 10.9778/cmajo.20180150. Print 2018 Oct-Dec.


Background: Intimate partner violence (IPV) is prevalent among female patients at fracture clinics; however, previous research suggests health care providers (HCPs) are unprepared to identify victims and provide appropriate support. To address this gap in care, we developed an IPV educational program and conducted a study to measure the impact of this program on HCPs' IPV-related knowledge, attitudes, beliefs and self-reported behaviours.

Methods: We enrolled 140 participants (orthopedic surgeons, surgical trainees, nonphysician HCPs and research and administrative staff) from 7 fracture clinics in North America who completed the 2-hour educational program. We used a pretest-posttest study design to assess knowledge, attitudes, beliefs and self-reported behaviours. We administered the Physician Readiness to Manage IPV Survey before, immediately after and 3 months after training and generated scores for each of the 10 subscales. Our primary outcome was change in score for the actual knowledge subscale from before training to 3 months after training. We used linear regression to conduct all analyses.

Results: We found significant improvement on the actual knowledge subscale 3 months after the training (mean difference [MD] 2.44, 95% confidence interval [CI] 1.79 to 3.09). We found statistically significant improvements on 7 additional subscales 3 months after training (perceived preparation [MD 1.96, 95% CI 1.79 to 2.13], perceived knowledge [MD 2.05, 95% CI 1.88 to 2.23], practice issues [MD 6.10, 95% CI 4.98 to 7.23], preparation [MD 1.06, 95% CI 0.89 to 1.22], legal requirements [MD 1.50, 95% CI 1.30 to 1.70], workplace issues [MD 1.11, 95% CI 0.97 to 1.26] and self-efficacy [MD 0.54, 95% CI 0.45 to 0.63]) and on all 10 subscales immediately after training (actual knowledge [MD 3.35, 95% CI 2.77 to 3.94], perceived preparation [MD 2.06, 95% CI 1.88 to 2.23], perceived knowledge [MD 2.14, 95% CI 1.98 to 2.30], practice issues [MD 4.08, 95% CI 3.35 to 4.82], preparation [MD 1.04, 95% CI 0.89 to 1.20], legal requirements [MD 1.66, 95% CI 1.47 to 1.85], workplace issues [MD 1.08, 95% CI 0.96 to 1.20], self-efficacy [MD 0.56, 95% CI 0.49 to 0.63], alcohol/drugs [MD 0.20, 95% CI 0.10 to 0.30] and victim understanding [MD 0.15, 95% CI 0.04 to 0.25]).

Interpretation: Our educational program led to significant improvements in participants' readiness to manage IPV. This finding suggests HCPs are better prepared to help patients who experience IPV; however, future research should aim to investigate the impact of this program directly on patients.