Journal of Family Violence

, Volume 21, Issue 4, pp 245–257 | Cite as

Barriers in Screening Women for Domestic Violence: A Survey of Social Workers, Family Practitioners, and Obstetrician–Gynecologists

  • Leslie E. TowerEmail author
Original Article


Domestic violence (DV) is a pervasive and serious threat to women's lives and well-being. Medical social workers, family practitioners, and obstetrician–gynecologists are in key positions to screen and offer help. Florida NASW members and board certified family practitioners and obstetrician–gynecologists were mailed a psychometrically tested scale. A total of 388 surveys were analyzed. Education (especially the number of in-service hours) and the presence of institutional supports, decreased barriers to screening, increased screening behaviors, and lead to increased victim identification. Only 20.8% of participants always or nearly always routinely screened for DV; 24.0% reported that routine screening did not apply to their role. Self-Efficacy was the strongest predictor of screening behavior with Fear of Offending, Safety Concerns, CEUs/CMEs, and in-service hours contributing approximately equally to the prediction of screening behavior.


Domestic violence Spouse abuse Screening Education Barriers 



The author wishes to thank the following people for their suggestions and support during various stages of this research report: Sharron Singleton, Michael P. Connolly, and Darcy Schiller.


  1. American Association of Social Work Boards (2003). Social Work Continuing Education. Retrieved August 27, 2003 from Scholar
  2. Brown, J. B., Lent, B., & Sas, G. (1993). Identifying and treating wife abuse. Journal of Family Practice, 36(2), 185–191.PubMedGoogle Scholar
  3. Burge, S. K. (1989). Violence against women as a health care issue. Family Medicine, 21(5), 368–373.PubMedGoogle Scholar
  4. Campbell, J., Kub, J. E., & Rose, L. (1996). Depression in battered women. JAMWA, 51(3), 106–110.PubMedGoogle Scholar
  5. Chescheir, N. (1996). Violence against women: Response from clinicians. Annals of Emergency Medicine, 27(6), 766–768.PubMedCrossRefGoogle Scholar
  6. Cohen, S., DeVos, E., & Newberger, E. (1997). Barriers to physician identification and treatment of family violence: Lessons from five communities. Academic Medicine, 72(1)(Suppl. 1), S19–S25.Google Scholar
  7. Council on Ethical and Judicial Affairs. (1992). Physicians and domestic violence: Ethical considerations. JAMA, 267(23), 3190–3193.CrossRefGoogle Scholar
  8. Cullinane, P., Alpert, E., & Freund, K. (1997). First-year medical students’ knowledge of, attitudes toward, and personal histories of family violence. Academic Medicine, 72(1), 48–50.PubMedGoogle Scholar
  9. DeLahunta, E. A., & Tulsky, A. A. (1996). Personal exposure of faculty and medical students to family violence. JAMA, 275(24), 1903–1906.PubMedCrossRefGoogle Scholar
  10. Drossman, D. A., Talley, J. J., Leserman, J., Olden, K. W., & Barreiro, M. A. (1995). Sexual and physical abuse and gastrointestinal illness: Review and recommendations. Annals of Internal Medicine, 123(10), 782–794.PubMedGoogle Scholar
  11. Durant, T., Gilbert, B. C., Slatzman, L. E., Johnson, C. H., & PRAMS Working Group. (2000). Opportunities for intervention. Discussing physical abuse during prenatal care visits. American Journal of Preventive Medicine, 19(4), 238–244.PubMedCrossRefGoogle Scholar
  12. Feldhaus, K. M., Koziol-McLain, J., Amsbury, H. L., Norton, I. M., Lowenstein, S. R., & Abbott, J. T. (1997). Accuracy of three brief screening questions for detecting partner violence in the emergency department. JAMA, 277(17), 1357–1361.PubMedCrossRefGoogle Scholar
  13. Ferris, L. E. (1994). Canadian family physicians’ and general practitioners’ perceptions of their effectiveness in identifying and treating wife abuse. Medical Care, 32(12), 1163–1172.PubMedCrossRefGoogle Scholar
  14. Ferris, L. E., & Tudiver, F. (1992). Family physicians’ approach to wife abuse: A study of Ontario, Canada, Practices. Family Medicine, 24(3), 276–278.PubMedGoogle Scholar
  15. Florida Statute. Ann Statute 456.031.Google Scholar
  16. Fletcher, J. L. (1994). Medicalization of America: Physician, heal thy society [Letter to the editor]? American Family Physician, 49(7), 1595–1598.PubMedGoogle Scholar
  17. Flitcraft, A. H. (1992). Violence, values, and gender [Editorial]. JAMA, 267(23), 3194–3195.PubMedCrossRefGoogle Scholar
  18. Freund, K. M., Bak, S. H., & Blackhall, L. (1996). Identifying domestic violence in primary care practice. Journal of General Internal Medicine, 11(1), 44–46.PubMedGoogle Scholar
  19. Friedman, L. S., Samet, J. H., Roberts, M. S., Hudlin, M., & Hans, P. (1992). Inquiry about victimization experiences: A survey of patient preferences and physician practices. Archives of Internal Medicine, 152(6), 1186–1190.PubMedCrossRefGoogle Scholar
  20. Fullin, K. J., & Cosgrove, A. (1992). Empowering physicians to respond to domestic violence. Wisconsin Medical Journal, 91(6), 280–283.PubMedGoogle Scholar
  21. Ganley, A. L. (1996). Understanding domestic violence. In D. Lee, N. Durborow, & P. R. Salber (Eds.), Improving the health care response to domestic violence: A resource manual for health care providers (pp. 15–18). San Francisco: Family Violence Prevention Fund.Google Scholar
  22. Garimella, R., Plichta, S. B., Houseman, C., & Garzon, L. (2000). Physician beliefs about victims of spouse abuse and about the physician role. Journal of Women's Health and Gender-Based Medicine, 9(4), 405–411.PubMedCrossRefGoogle Scholar
  23. Gerbert, B., Caspers, N., Brownstone, A., Moe, J., & Abercrombie, P. (1999). A qualitative analysis of how physicians with expertise in domestic violence approach the identification of victims. Annals of Internal Medicine, 131(8), 578–584.PubMedGoogle Scholar
  24. Gerbert, B., Johnston, K., Caspers, N. Bleecker, T., Woods, A., & Rosenbaum, A. (1996). Experiences of battered women in health care settings: A qualitative study. Women and Health, 24(3), 1–17.CrossRefGoogle Scholar
  25. Gielen, A. C., O’Campo, P. J., Campbell, J. C., Schollenberger, J., Woods, A. B., Jones, A. S., et al. (2000). Women's opinions about domestic violence screening and mandatory reporting. American Journal of Preventative Medicine, 19(4), 279–285.CrossRefGoogle Scholar
  26. Governor's Task Force (1994). The first report of the Governor's Task Force on Domestic Violence. Tallahassee, Fl: Author.Google Scholar
  27. Grant, D. (1995). US report on violence in medical workplace may hold lessons for Canadian MDs. Canadian Medical Association Journal, 153(11), 1651–1652.PubMedGoogle Scholar
  28. Gremillion, D. H., & Kanof, E. P. (1996). Overcoming barriers to physician involvement in identifying and referring victims of domestic violence. Annals of Emergency Medicine, 27(6), 769–773.PubMedCrossRefGoogle Scholar
  29. Group Health Cooperative and Harborview Injury Prevention and Research Center (1997). Providers’ Knowledge, Attitudes, and Beliefs about Domestic Violence Scale. Unpublished scale.Google Scholar
  30. Gupta, A. R., Wells, C. K., O’Connor, P. G., & Horwitz, R. I. (1998). Prevalence and clinical features of domestic violence among Asian American women in a community based community primary care clinic [Abstract]. Journal of General Internal Medicine, 13(Suppl. 1), 110.Google Scholar
  31. Hamberger, K. L., Ambuel, B., Marbella, A., & Donze, J. (1998). Physician interaction with battered women: The women's perspective. Archives of Family Medicine, 7(6), 575–582.PubMedCrossRefGoogle Scholar
  32. Hamlin, E. R., II. (1991). Community-based spouse abuse protection and family preservation team. Social Work, 36(5), 402–406.PubMedGoogle Scholar
  33. Hathaway, J. E., Mucci, L. A., Silverman, J. G., Brooks, D. R., Mathwes, R., & Pavlos, C. A. (2000). Health status and health care use of Massachusetts women reporting abuse. American Journal of Preventive Medicine, 19(4), 302–307.PubMedCrossRefGoogle Scholar
  34. Hobbs, R. F. D., & Keane, U. M. (1996). Aggression against doctors: A review. Journal of the Royal Society of Medicine, 89(2), 69–72.PubMedGoogle Scholar
  35. Jecker, N. S. (1993). Privacy beliefs and the violent family: Extending the ethical argument for physician intervention. JAMA, 269(6), 776–780.PubMedCrossRefGoogle Scholar
  36. Kheder, S., & VandenBosch, R. (2001). Intimate partner violence: A health system's response—Part 2. Continuum, 10–15.Google Scholar
  37. Koop, G. E., & Lundberg, G. D. (1992). Violence in America: A public health emergency (editorial). JAMA, 267(22), 3075–3076.PubMedCrossRefGoogle Scholar
  38. Koziol-McLain, J., Coates, C. J., Lowenstein, S. R. (2001). Predictive validity of a screen for partner violence against women. American Journal of Preventive Medicine, 21(2), 93–100.PubMedCrossRefGoogle Scholar
  39. Kurtz, D. (1987). Emergency department responses to battered women: Resistance to medicalization. Social Problems, 34(1), 69–81.Google Scholar
  40. Kurtz, D., & Stark, E. (1990). Not-so-benign neglect: The medical response to battering. In K. Yllo & M. Bogard (Eds.), Feminist perspectives on wife abuse (pp. 249–266). Newbury Park, CA: Sage.Google Scholar
  41. LCME (2000). LCME Accreditation Standards: Functions and structure of a medical school (2000 ed.). Chicago, IL: Author.Google Scholar
  42. Macdonald, G., & Sirotich, F. (2001). Reporting client violence. Social Work, 46(2), 107–114.PubMedGoogle Scholar
  43. Maiuro, R. D., Vitaliano, P. P., Sugg, N. K., Thompson, D. C., Rivara, F. P., & Thompson, R. S. (2000). Development of a health care provider survey for domestic violence: Psychometric properties. American Journal of Preventive Medicine, 19(4), 245–252.PubMedCrossRefGoogle Scholar
  44. McCauley, J., Kern, D. E., Kolodner, K., Dill, L., Schroeder, A. F., DeChant, H. K., et al. (1995). The “Battering Syndrome”: Prevalence and clinical characteristics of domestic violence in primary care internal medical practices. Annals of Internal Medicine, 123(10), 737–746.PubMedGoogle Scholar
  45. McCauley, J., Yurk, R. A., Jenckes, M. W., & Ford, D. E. (1998). Inside “Pandora's box.” Abused women's experiences with clinicians and health services. Journal of General Internal Medicine, 13(8), 549–555.PubMedCrossRefGoogle Scholar
  46. McFarlane, J., Greenberg, L., Weltge, A., & Watson, M. (1995). Identification of abuse in emergency departments: Effectiveness of a two-question screening tool. Journal of Emergency Nursing, 21(5), 391–394.PubMedCrossRefGoogle Scholar
  47. McGrath, M. E., Betacchi, A., Duffy, S. J., Peipert, J. F., Becker, B. M., & St Angelo, L. (1997). Violence against women: Provider barriers to intervention in emergency departments. Academic Emergency Medicine, 4(4), 297–300.PubMedCrossRefGoogle Scholar
  48. NASW. (2000). Social work speaks. NASW's policy statements 200–2003 (5th ed.). Washington, DC: Author.Google Scholar
  49. Norton, L. B., Peipert, J. F., Zierler, S., Lima, B., & Hume, L. (1995). Battering in pregnancy: An assessment of two screening methods. Obstetrics and Gynecology, 85(3), 321–325.PubMedCrossRefGoogle Scholar
  50. Paola, F., Malik, R., & Qureshi, A. (1994). Violence against physicians. Journal of General Internal Medicine, 9(9), 503–506.PubMedGoogle Scholar
  51. Parker, B., McFarlane, J., & Soeken, K. (1994). Abuse during pregnancy: Effects on maternal complications and birth weight in adult and teenage women. Obstetrics and Gynecology, 84(3), 323–328.PubMedGoogle Scholar
  52. Parsons, L. H., Zaccaro, D., Wells, B., & Stovall, T. G. (1995). Methods of and attitudes toward screening obstetrics and gynecology patients for domestic violence. American Journal of Obstetrics and Gynecology, 173(2), 381–387.PubMedCrossRefGoogle Scholar
  53. Pease, R. (2001). Domestic violence as a women's health issues—panel discussion. Women's Health Issues, 11(4), 387–390.CrossRefGoogle Scholar
  54. Pinn, V. W., & Chunko, M. T. (1997). The diverse faces of violence: Minority women and domestic violence. Academic Medicine, 72(Suppl. 1), S65–S71.PubMedGoogle Scholar
  55. Plichta, S. B. (1996). Violence and abuse. Implications for women's health. In M. M. Falk & K. S. Collins (Eds.), Women's health: The Commonwealth Fund survey (pp. 237–270). Baltimore: Johns Hopkins University Press.Google Scholar
  56. Plichta, S. B., & Weisman, C. S. (1995). Spouse and partner abuse, use of health services, and unmet need for medical care in US women. Journal of Women's Health, 4(1), 45–53.CrossRefGoogle Scholar
  57. Rey, L. D. (1996). What social workers need to know about client violence. Family in Society, 77(1), 33–39.Google Scholar
  58. Rodriguez, M. A., Bauer, H. M., McLoughlin, E., & Grumbach, K. (1999). Screening and intervention for intimate partner abuse: Practices and attitudes of primary care physicians. JAMA, 282(5), 468–474.PubMedCrossRefGoogle Scholar
  59. Rodriguez, M. A., Quiroga, S. S., & Bauer, H. M. (1996). Breaking the silence: Battered women's perspectives on medical care. Archives of Family Medicine, 5(3), 153–158.PubMedCrossRefGoogle Scholar
  60. Sassetti, M. R. (1993). Domestic violence. Primary Care, 20(2), 289–305.PubMedGoogle Scholar
  61. Sugg, N. K., & Inui, T. (1992). Primary care physician's response to domestic violence—Opening Pandora's box. JAMA, 267(23), 3157–3160.PubMedCrossRefGoogle Scholar
  62. Sugg, N. K., Thompson, R. S., Thompson, D. C., Maiuro, R., & Rivara, F. P. (1999). Domestic violence and primary care. Attitudes, practices, and beliefs. Archives of Family Medicine, 8(4), 301–306.PubMedCrossRefGoogle Scholar
  63. Thompson, R. S., Rivara, F. P., Thompson, D. C., Barlow, W. E., Sugg, N. K., Maiuro, R. D., et al. (2000). Identification and management of domestic violence: A randomized trial. American Journal of Preventive Medicine, 29(4), 253–263.CrossRefGoogle Scholar
  64. Warshaw, C. (1989). Limitations of the medical model in the care of battered women. Gender and Society, 3(4), 506–509.Google Scholar
  65. Warshaw, C. (1996). Domestic violence: Changing theory, changing practice. JAMWA, 51(3), 87–91, 100.PubMedGoogle Scholar
  66. Williams, J. M., Chinnis, A. C., & Gutman, D. (2000). Health promotion practices of emergency physicians. American Journal of Emergency Medicine, 18(1), 17–21.PubMedGoogle Scholar
  67. Women in Distress. (1997). Domestic violence awareness: A training worship for professionals. Ft. Lauderdale, FL: Author.Google Scholar
  68. Webster, J., Chandler, J., & Battistutta, D. (1996). Pregnancy outcomes and health care use: Effects of abuse. American Journal of Obstetrics Gynecology, 174(2), 760–767.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  1. 1.Divisions of Social Work and Public AdministrationEberly College of Arts and Sciences, West Virginia UniversityMorgantownUSA

Personalised recommendations