Barriers to screening for intimate partner violence: a mixed-methods study of providers in family planning clinics.

CONTEXT Universal screening for intimate partner violence has been recommended for health care settings. However, provider adherence to this recommendation is low, and little research has explored perspectives on relevant policies and procedures among providers in family planning centers. METHODS In 2009, a sample of 75 health care staff from a large, urban family planning organization that has a protocol for screening for partner violence participated in focus group discussions about their attitudes toward, perceptions of barriers to and preparedness for such screening; 64 of them also completed a brief survey. Multiple analysis of variance was used to assess differences between licensed practitioners (advanced practice clinicians and social workers) and unlicensed health care assistants; findings were analyzed for congruence with and divergence from the focus group data. RESULTS Barriers included lack of time, training and referral resources, but were reported less by licensed than by unlicensed providers. Overall, participants rated screening as helpful to clients, but licensed providers had more positive attitudes toward and felt more prepared for it than unlicensed ones. In the focus groups, some providers expressed frustration with clients' responses to referrals, concern about taking too much time away from other health care matters and opinions that it was more appropriate for licensed professionals than for unlicensed practitioners to conduct screening. Both licensed and unlicensed staff wanted more training on responding to disclosures of violence. CONCLUSIONS Family planning providers who are working under an institutional protocol continue to perceive barriers to screening and may benefit from ongoing professional development.