Addressing Intimate Partner Violence Among Women Veterans

NCT04106193 | Completed

• 2 other identifiers: SDR 18-150Iverson Miller SDR
• Study Type: interventional
• Target: 7,421
• Locations: 1 country
• Sites: 10

Brief Summary

Up to 20% of women Veterans (WV) using VHA primary care experience past-year intimate partner violence (IPV), which contributes to numerous physical and mental health conditions, including suicidality. Despite national recommendations to screen WVs for IPV, there is low adoption of IPV screening programs in primary care. In response, VHA is spreading IPV screening programs in Women's Health Model 1 and Model 2 primary care clinics, where the majority of WV VHA primary care patients receive care. The systematic and effective implementation of IPV screening programs within primary care clinics is expected to enhance care for WVs as well as improve access to, and timeliness of, IPV-related care. Given the high prevalence of IPV among WVs and its significant negative health effects, successful implementation of IPV screening programs is expected to reduce morbidity among WV VHA patients. This stepped wedge hybrid II implementation/effectiveness study will assess efforts to implement routine IPV screening for WV VHA patients.

Conditions

Intimate Partner Violence

Keywords

intimate partner violence; women Veterans; screening; primary care

Outcome Measures

Primary Outcomes (2)

• Change in Reach (primary implementation outcome)

  Change in proportion of WVs seen in Model 1 and 2 clinics during the last three months of each study phase who receive IPV screening

  For each site, the proportion calculated at baseline (months 1-3) will be compared to the proportion calculated for the latter half of the facilitation period (months 7-9).

• Change in Disclosure Rate (primary clinical effectiveness outcome)

  Change in proportion of eligible WVs who screen positive for IPV

  For each site, the proportion calculated at baseline (months 1-3) will be compared to the proportion calculated for the latter half of the facilitation period (months 7-9).

Secondary Outcomes (5)

• Change in Psychosocial Service Use (secondary clinical effectiveness outcome)

  For each site, the proportion calculated at baseline (months 1-3) will be compared to the proportion calculated for the latter half of the facilitation period (months 7-9).

• Adoption of Screening (secondary implementation outcome)

  For each site, the proportion calculated at baseline (months 1-3) will be compared to the proportion calculated for the latter half of the facilitation period (months 7-9).

• Change in Adoption of Referrals / Resource Provision (secondary implementation outcome)

  For each site, the proportion calculated at baseline (months 1-3) will be compared to the proportion calculated for the latter half of the facilitation period (months 7-9).

• Change in Implementation Fidelity (secondary implementation outcome)

  For each site, the proportion calculated at baseline (months 1-3) will be compared to the proportion calculated for the latter half of the facilitation period (months 7-9).

• Maintenance (secondary implementation outcome)

  For each site, the proportion calculated in the latter half of the facilitation phase (months 7-9) will be compared to the proportion calculated for the last three months of the maintenance phase (months 19-21)

Study Arms (2)

Toolkit + Implementation as Usual

EXPERIMENTAL

Participating clinics assigned to this arm will receive a guiding toolkit and implementation as usual regarding IPV screening practices.

Other: Implementation as usual; Other: Toolkit

Toolkit + Blended Facilitation

EXPERIMENTAL

Participating clinics assigned to this arm will receive a guiding toolkit and blended facilitation to support IPV screening practices.

Other: Blended Facilitation; Other: Toolkit

Interventions

Blended Facilitation OTHER

Blended facilitation consists of an External Facilitator and Internal Facilitator to support adoption of intimate partner violence screening practices for WVs treated in primary care.

Toolkit + Blended Facilitation

Implementation as usual OTHER

Implementation as usual refers to traditional, site-initiated support for screening practices to detect intimate partner violence among WVs treated in primary care.

Toolkit + Implementation as Usual

Toolkit OTHER

All study arms will feature a toolkit meant to guide sites' adoption of intimate partner violence screening among WVs treated in primary care.

Toolkit + Blended Facilitation; Toolkit + Implementation as Usual

Eligibility Criteria

• Age: 18 Years - 100 Years
• Gender Eligibility Details: Patient population is limited to Women Veterans (WVs) eligible for screening for intimate partner violence (IPV) in primary care.
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Women Veterans age 18+
• Presenting for care at participating VA-based primary care clinics.
• Due to be screened for intimate partner violence (IPV)

You may not qualify if:

• IPV screen completed in past year.

Sponsors & Collaborators

• VA Office of Research and Development: lead
• VA Boston Healthcare System: collaborator

Study Sites (10)

Southern Arizona VA Health Care System, Tucson, AZ

Tucson, Arizona, 85723, United States

Location

VA Long Beach Healthcare System, Long Beach, CA

Long Beach, California, 90822, United States

Location

VA Northern California Health Care System, Mather, CA

Sacramento, California, 95655, United States

Location

VA San Diego Healthcare System, San Diego, CA

San Diego, California, 92161, United States

Location

VA Greater Los Angeles Healthcare System, West Los Angeles, CA

West Los Angeles, California, 90073, United States

Location

Orlando VA Medical Center, Orlando, FL

Orlando, Florida, 32803, United States

Location

VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA

Boston, Massachusetts, 02130-4817, United States

Location

VA Gulf Coast Veterans Health Care System, Biloxi, MS

Biloxi, Mississippi, 39531, United States

Location

Hunter Holmes McGuire VA Medical Center, Richmond, VA

Richmond, Virginia, 23249, United States

Location

Jonathan M. Wainwright Memorial VA Medical Center, Walla Walla, WA

Walla Walla, Washington, 99362, United States

Location

Related Publications (4)

• Iverson KM, Dichter ME, Stolzmann K, Adjognon OL, Lew RA, Bruce LE, Gerber MR, Portnoy GA, Miller CJ. Assessing the Veterans Health Administration's response to intimate partner violence among women: protocol for a randomized hybrid type 2 implementation-effectiveness trial. Implement Sci. 2020 May 7;15(1):29. doi: 10.1186/s13012-020-0969-0.

  PMID: 32381013 RESULT

• Ogden SN, Dichter ME, Bazzi AR. Intimate partner violence as a predictor of substance use outcomes among women: A systematic review. Addict Behav. 2022 Apr;127:107214. doi: 10.1016/j.addbeh.2021.107214. Epub 2021 Dec 18.

  PMID: 34933089 RESULT

• Adjognon OL, Brady JE, Iverson KM, Stolzmann K, Dichter ME, Lew RA, Gerber MR, Portnoy GA, Iqbal S, Haskell SG, Bruce LAE, Miller CJ. Using the Matrixed Multiple Case Study approach to identify factors affecting the uptake of IPV screening programs following the use of implementation facilitation. Implement Sci Commun. 2023 Nov 21;4(1):145. doi: 10.1186/s43058-023-00528-x.

  PMID: 37990345 DERIVED

• Iverson KM, Stolzmann KL, Brady JE, Adjognon OL, Dichter ME, Lew RA, Gerber MR, Portnoy GA, Iqbal S, Haskell SG, Bruce LE, Miller CJ. Integrating Intimate Partner Violence Screening Programs in Primary Care: Results from a Hybrid-II Implementation-Effectiveness RCT. Am J Prev Med. 2023 Aug;65(2):251-260. doi: 10.1016/j.amepre.2023.02.013. Epub 2023 Apr 7.

  PMID: 37031032 DERIVED

Study Officials

• Katherine M. Iverson, PhD MA BA

  VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: SCREENING
• Intervention Model: CROSSOVER
• Sponsor Type: FED
• Responsible Party: SPONSOR

Model Details: Hybrid type II implementation-effectiveness design; stepped wedge

Study Record Dates

• First Submitted: September 23, 2019
• First Posted: September 26, 2019
• Study Start: November 1, 2020
• Primary Completion: September 30, 2023
• Study Completion: September 30, 2023
• Last Updated: October 5, 2023

Record last verified: 2023-10

Data Sharing

• IPD Sharing: Will not share

Locations

US (10)