DOMESTIC VIOLENCE EDUCATION

Educating Healthcare Professionals on Evidence-Based Domestic Violence Interventions

Kayla Day Krug
Edson College of Nursing and Health Innovation, Arizona State University

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Abstract

Purpose: The purpose of this quality improvement project was to train healthcare professionals
(HCP) on evidence-based interventions for domestic violence (DV).
Background: DV occurs at high rates and negatively impacts physical and mental health.
Intermittently screening patients for DV is healthcare’s current response and this is inadequate.
Evidence shows the most effective way to assist DV victims is through active psychoeducation.
Active psychoeducation involves a conversation between the HCP and patient about relationship
safety, the sharing of local resources, and a referral to a local DV agency if warranted.
Methods: A virtual educational intervention was recorded and made available to members of a
professional nursing organization in the Western United States. The educational intervention
provided instruction on the Confidentiality, Universal education, Empowerment, Support
(CUES) method, an active psychoeducation technique. The post-education survey was a
modified version of Project Catalyst’s Post-Training Survey for Community Health Centers with
twenty-one questions pertaining to understanding of the training and intention to incorporate
CUES into clinical practice.
Results: Eleven participants completed the educational intervention and post-education survey.
Descriptive statistics demonstrated that participants strongly agreed (73%) and agreed (27%) that
the training improved their ability to provide active psychoeducation on DV. All participants
reported an intention to incorporate CUES into their clinical practice.
Conclusion: Training HCP to provide active psychoeducation on DV to their patients increases
professionals’ ability to incorporate this evidence-based method into clinical practice.
Keywords: domestic violence, psychoeducation, healthcare professionals, intervention

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Educating Healthcare Professionals on Evidence-Based Domestic Violence Interventions
Domestic violence (DV) involves the physical battery, financial manipulation, stalking,
emotional abuse, or sexual violence an individual experiences at the hands of their intimate
partner. DV is a healthcare issue that negatively impacts the physical and mental health of
individuals, the financial health of institutions, and the social health of communities across the
globe. An informed, effective response to DV by healthcare professionals (HCP) will reduce the
devastating consequences resulting from this phenomenon.
Problem Statement
According to the Centers for Disease Control and Prevention (2021), DV is experienced
by an estimated one in four women and one in ten men in the United States. DV costs the United
States’ economy $103,767 per female victim and $23,414 per male victim after calculating
reduced occupational productivity, criminal costs, and healthcare costs. Walsh et al. (2015) note
that DV is associated with chronic cardiac disorders, reproductive disorders, metabolic disorders,
substance use disorders, and mental health disorders in victims. DV has a devastating impact
globally, not just nationally. Thirty percent of women around the world will be victims of DV in
their lifetime (Yakubovich et al., 2018). This extensive problem impacts the health of
populations and individuals and requires an evidence-based response from HCP.
Purpose and Rationale
DV harms victims, their children, healthcare institutions, and the economy. The purpose
of this review is to provide an overview of who is impacted by DV, summarize the growing
evidence supporting the need for HCP to provide educational interventions to their patients about
DV and available resources, discuss the minimal impact that the current practice of universally

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screening for DV has on victims, and describe a desired outcome of the healthcare industry
implementing the alternative intervention of patient education to address DV.
Background and Significance
Population Affected by DV
Although DV is not limited to a specific demographic, some individuals are at higher risk
of DV victimization than others. Yakubovich et al. (2018) report that risk factors for
experiencing DV include low socioeconomic status, limited education, minimal social support,
growing up with parents who had less than a high school education, or experiencing an
unplanned pregnancy. Walsh et al. (2015) report that an additional risk factor for experiencing
DV is a strong adherence to rigid, outdated gender norms. Protective factors against DV include
older age and marriage (Yakubovich et al., 2018). More research is needed to better understand
the risk factors for becoming a perpetrator of DV. One known risk factor for DV perpetration is
witnessing DV as a child (Kimber et al., 2018). Although DV victimization is oftentimes
associated with lower socioeconomic status, heterosexual, cisgender females, it is important to
remember that DV can occur in any relationship.
One in ten men in the United States is a victim of DV in their lifetime (Centers for
Disease Control and Prevention, 2021). Shelton (2018) notes that lesbian, gay, bisexual,
transgender, and queer (LGBTQ) populations are also impacted by DV and oftentimes excluded
from the rhetoric. LGBTQ individuals may be faced with threats of outing and bias from police
and HCP, making DV more likely to go undetected. Messing et al. (2015) report that immigrant
and refugee DV victims face their own unique challenges preventing help-seeking behaviors,
including language barriers and perpetrators who threaten deportation.
Education Provision Intervention

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It is vital that those suffering from DV be aware that their experience is not normal
relationship conflict and understand that resources exist and can be accessed if the victim feels it
is in their best interest to do so. HCP can best support victims of DV by providing an
educational intervention and list of available resources to all patients, regardless of whether or
not the HCP thinks that patient may be a DV victim. HCP need to avoid assumptions about
victim profiles and remember that anyone can be a DV victim. Bridges et al. (2015) note that
psychoeducation has shown efficacy in the treatment of depression, cancer, and diabetes. The
researchers also found efficacy in the use of psychoeducation to increase understanding of DV in
college students. Spangaro (2017) notes that providing universal patient education on DV is an
efficacious first-line response to the treatment of DV in healthcare settings.
Universal Screening for DV
Healthcare’s current response to the DV epidemic is universal screening. Lee et al.
(2019) note the Joint Commission includes universal screening for DV as an accreditation
requirement for hospitals. However, screening is far from universal. Depending on the provider,
hospital, or unit culture, screening is typically given to females only, is limited to certain age
ranges, or occurs only when a patient has specific risk factors for DV (Lee et al., 2019).
Approximately ten percent of DV victims report being screened for DV when encountering
healthcare settings (Riedl, 2019). O'Doherty et al. (2015) report that screening for DV in
healthcare settings has no significant impact on victim outcomes. Phares et al. (2019), note that
HCP encounter significant barriers to screening, often resulting in screening not occurring.
Barriers include HCP attitudes, lack of education on the topic of DV, HCP’s lack of knowledge
in evidence-based DV interventions, time constraints, lack of privacy, and providers’ discomfort

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and avoidance of uncomfortable conversations (Phares et al., 2019). Simply screening for the
presence of DV does little to help those suffering from DV, yet this remains current practice.
Desired Outcome of DV Education Provision
HCP often fail to properly identify DV and appropriately intervene due to ineffective
screening protocols. This practice negatively impacts people and systems. Victims of DV
continue to be harmed both physically and mentally, children reared in violent homes continue to
be exposed to trauma, and healthcare systems experience financial burdens by continually
intervening in cases of acute physical injury, suicide attempts, or substance abuse associated with
DV. A desired outcome for this significant problem would be a future state where HCP are
educated on the importance of giving all patients DV education and resources. This simple, costeffective intervention has the ability to reach more DV victims and promote positive outcomes
compared to the ineffective current practice of universal screening. Positive outcomes for DV
victims would include promoting safety and increasing resource utilization rates.
Summary of Background and Significance
DV victims are not limited to a singular demographic. Due to the high prevalence of DV
and harsh reality that victimhood can be experienced by anyone, HCP must employ the most
effective, evidence-based interventions to support DV victims. The current practice of screening
is ineffective. Although the intention is for screening to be universal, barriers often prevent
screening from occurring. DV victims are left undetected and uncared for by the healthcare
system. Evidence supports an alternative approach to caring for DV victims. Universal active
psychoeducation, in the form of conversations about DV and the provision of DV information
and local resources, is a more effective treatment option. HCP must be educated on this much
needed practice change.

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Internal Evidence

A nonprofit coalition of DV organizations in the Western United States is seeing firsthand the negative consequences associated with the current practice of screening for DV in
healthcare settings. DV victims encounter healthcare settings, but are rarely screened for DV.
HCP miss opportunities to provide these victims with education and resources. Although this
nonprofit coalition of DV organizations does not collect hard data on DV screening or education
rates, soft data is available. Through close contact with member organizations, this coalition
organization continually learns of inconsistencies in HCP’s screening practices and
understanding of the importance of patient education and resource provision.
PICO Question
This inquiry has led to the clinically significant PICO question, “In healthcare
professionals, how does providing patient education and referral, compared to treatment as usual,
impact feelings of competence in the ability to care for domestic violence victims?”
Search Strategy
A review of the current literature was completed in order to answer the PICO question.
Four databases with information relevant to the topic of DV interventions were extensively
searched – Cochrane, PubMed, PsycINFO, and CINAHL. Keywords generated from all
components of the PICO were utilized in the search process. Keywords for the population
included domestic violence, intimate partner violence, spousal abuse, domestic abuse, healthcare
workers, healthcare providers, healthcare professionals, clinicians, doctor, nurse, and allied
health. Keywords for the intervention included resources, information, education intervention,
pamphlets, and handouts. Keywords for comparison intervention included screen, inquire, and
question.

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The initial search of the Cochrane Library database included the keywords domestic
violence, patient education, and screening. This yielded five results. Article titles and abstracts
were screened for relevance to the PICO question. No exclusions were added to the search due
to the low volume of studies yielded.
The initial search of the PubMed database included the keywords domestic violence,
intimate partner violence, patient education, and screening. This yielded 4,711,320 articles.
Exclusions were utilized to narrow down to more relevant results and included publication
within the past five years and English language. Key words were changed to domestic violence,
healthcare, and intervention and this yielded a more manageable 135 results. Article titles and
abstracts were reviewed and selected based on applicability to the PICO question.
The initial search of the PsycINFO database included the keywords domestic violence,
patient education, intervention, and screening. This yielded 484,599 results. Exclusions were
applied and included limiting to peer-reviewed articles only, articles published within the past
five years, and the keyword domestic violence appearing in publication title. This yielded
119,137. Keywords were changed to domestic violence, handout, pamphlet, and patient
education materials which yielded 254 results and domestic violence and healthcare intervention
which yielded 36 results. Results were screened for relevance to the PICO question.
The initial search of the CINAHL database included the keywords domestic violence,
domestic abuse, intimate partner violence, screening, and patient education. This yielded 394
articles. Exclusions were applied to narrow down to the most relevant articles and included
publications within the last five years, peer-reviewed articles, and English language. This
yielded 112 results. Article titles and abstracts were read and selected for inclusion based on
relevance to the PICO question.

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After searching the four databases described above, 31 articles were deemed to be highly
relevant to the PICO question. A rapid critical appraisal of all 31 articles was completed in order
to narrow down to the 10 most relevant, highest quality studies. The highest quality studies are
outlined in Appendix A.
Critical Appraisal and Synthesis of Evidence
Melnyk and Fineout-Overholt’s (2019) rapid critical appraisal was completed on the 10
studies selected for inclusion in the evaluation table. The 10 studies were comprised of largely
high-quality evidence, including three systematic reviews and five randomized controlled trials.
Two pretest-posttest intervention studies were also utilized due to their high applicability to the
PICO question (see Appendix A, Table 1). Bias was not observed in any of the 10 studies and all
studies reported their funding sources. Funding sources primarily consisted of research grants
from the education, non-profit, and international health institution sectors. All studies were
current evidence, generated within the last five years. Although studies gathered evidence from
across the globe, more research was generated in high-income countries. Low-income countries
are underrepresented in the 10 studies included in the evaluation table (see Appendix A, Table
A1).
Noteworthy heterogeneity is present across studies’ measurement tools and
demographics. In four studies, measurement tools were generated by researchers for the specific
purpose of completing that particular study. Although developed by a team of experts, these
measurement tools have unknown validity and reliability, weakening the evidence. Study
demographics also showed significant differences. Two of the 10 studies focused on HCP
practices when screening or educating patients on DV. The remaining eight studies mainly
focused on women of childbearing age, however, significant differences existed within this

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population. For example, studies gathered evidence on rural, urban, English speaking, nonEnglish speaking, Medicaid recipients, and a wide-variety of education levels and socioeconomic
statuses.
Despite the heterogeneity present between the 10 studies, many similarities were also
observed. All studies focused on DV interventions in the healthcare setting. Seven out of 10
studies focused on outpatient interventions and two out of 10 studies focused on online
interventions. The interventions utilized in the 10 studies focused on screening for DV or DV
education. DV education focused on either passive psychoeducation, typically the provision of
written information without a discussion about DV between HCP and patient, or on active
psychoeducation, which typically included a discussion about DV between HCP and patient
along with a written resource list and referral to a DV agency when appropriate. Active
psychoeducation demonstrated the greatest efficacy in impacting outcomes, although studies
varied in how active psychoeducation was delivered. Some studies utilized brief interventions
with written resources and referrals, whereas other studies utilized intensive interventions with
repeated follow-up. The 10 studies examined similar outcomes, including DV knowledge,
awareness of DV resources, and confidence that HCP was equipped to assist with DV (see
Appendix A, Table A2).
Discussion
DV is a serious public health issue that negatively affects the physical, mental, and
financial well-being of people across the globe. The healthcare setting is an optimal place to
implement interventions to combat DV because DV victims often present to inpatient and
outpatient locations with complaints such as fractures, reproductive disorders, post-traumatic
stress disorders, substance use disorders, and suicidal ideation or suicide attempts that occur

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secondary to DV. The current healthcare response of selectively screening less than half of
patients about DV concerns is not effective. This literature review shows the efficacy of brief,
active psychoeducation in promoting patients’ understanding of DV, awareness of DV resources,
and belief that an HCP can help with DV safety planning or referrals to DV agencies (see
Appendix A, Table A2). Brief, active psychoeducation consists of a short conversation between
HCP and patient about DV coupled with a provision of DV resources and potentially a referral to
a DV agency that can provide further assistance if so desired by the patient. This literature
review highlights the training HCP need in caring for DV victims (see Appendix A, Table A2).
HCP would benefit greatly from education on the importance of brief, active DV
psychoeducation and how to universally incorporate this intervention into their patient
encounters.
Theory Application
Theoretical frameworks and conceptual models support a grounded understanding of
complex ideas. This challenging task is completed by providing a systematic view of
relationships between variables (Butts & Rich, 2018). The Health Belief Model was developed
in the 1950s by the United States Public Health Service to guide understanding of the
complexities influencing individual’s health-promoting behaviors or lack thereof. This model
shows that health-promoting behaviors are influenced by an individual’s understanding of the
risks and benefits of making a change, an individual’s understanding of the perceived threat, and
an individual’s self-efficacy. Self-efficacy, perception of a threat, and understanding of risks and
benefits are all modifiable variables. By modifying these variables, health-promoting behaviors
can be influenced (Butts & Rich, 2018).

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The Health Belief Model was utilized to methodically view the phenomenon of HCP
delivery of DV education (see Appendix B, Figure 1). This model was selected because
relationships where DV is occurring are complex and DV victims often need to weigh conflicting
interests when making decisions about health-promoting behaviors. It is important for HCP to
understand that health-promoting behaviors are influenced by an individual’s weighing of pros
and cons, their understanding of the dangers, and their belief in their ability to make a change.
By providing brief, active psychoeducation, HCP can modify some of the variables influencing
an individual’s DV experience. HCP can increase understanding of the health risks associated
with DV and impact an individual’s self-efficacy through empathic conversation and resource
provision.
Implementation Framework
Implementation frameworks offer a roadmap in the evolution of an evidence-based
project (Davidson et al., 2017). The Academic Center for Evidence-based Practice Star Model
of Knowledge Transformation (ACE Star) was selected as the implementation framework for
this project (see Appendix B, Figure 2). The ACE Star model consists of a circle surrounding a
five-pointed star. The circle represents the infinite, cyclical nature of change and the fivepointed star represents five repeated tasks in project implementation. These tasks include
discovery of quality evidence, summary of evidence, translation of evidence into plans for
practice, integration into practice, and critical evaluation of the process and outcomes (Davidson
et al., 2017). The ACE Star model aligns well with a DV education evidence-based project.
This project requires a gathering and synthesizing of quality evidence on the topic of DV, a
translation of this evidence into an evidence-based intervention, intervention implementation,
and critical evaluation of this entire process.

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Implications for Practice Change
The high prevalence of DV and the negative physical, mental, and financial sequalae
associated with DV demonstrate the importance of implementing an evidence-based practice
change in healthcare’s response to DV. The far-reaching impact of DV means that stakeholders
in the fight against DV will come from a variety of backgrounds. These stakeholders will include
DV victims, DV survivors, children growing up in homes with DV, HCP, insurance companies,
DV agencies, healthcare systems, employers of DV victims, economists, and advocacy groups
for females, immigrants, and LGBTQ individuals.
Stakeholders invested in DV outcomes will hope to see improvements in the following
areas: an increase in patients’ understanding of DV, an increase in awareness of DV resources,
and an increase in patients’ confidence that HCP can help with DV. A standardized tool
measuring these outcomes would be beneficial in streamlining the tracking and later the
dissemination of intervention outcomes. However, before these outcomes can be tracked, HCP
must first receive training on DV and appropriate interventions. The evidence shows that the
most effective intervention is a brief, active psychoeducation-based conversation between HCP
and patient, along with resource provision and potential referral to a DV agency. HCP must be
educated on why this change is necessary and how to incorporate this change into their daily
practice. An intervention educating HCP in DV education is the first step in reaching improved
outcomes on DV knowledge, resource awareness, and patients’ perception of HCP role in DV.
A post-intervention survey administered to HCP who received education on evidence-based DV
interventions along with a validated confidence scale would be the first step in invoking positive
DV outcomes.
Potential Outcomes

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Providing HCP with education on how to implement a brief, active psychoeducation
intervention for DV would have a significant impact on DV victims, their families, the healthcare
system, and other key stakeholders. Adequately addressing DV in the healthcare setting would
improve the physical, mental, and financial health of DV victims by increasing awareness of
what constitutes abusive behavior and increasing awareness of local DV resources, including
advocacy groups and shelters. Educating HCP in an informed, evidence-based DV response
would empower victims and potentially turn a DV victim into a DV survivor.
Methods
Ethical Considerations
Consent Process
Quality-improvement project participants were provided with a consent letter prior to
receiving the educational intervention or post-intervention survey. The consent letter made
participants aware that the educational intervention and post-intervention survey were voluntary
activities that did not carry risks greater than the completion of ordinary daily tasks.
Institutional Review Board Approval
Permission to complete the educational intervention and to evaluate the efficacy of
education through a post-intervention survey was obtained through Arizona State University’s
Institutional Review Board (IRB). The application submitted to the IRB included the prerecorded virtual education, a link to the online survey, a copy of the participant consent letter,
and letters from the involved organizations demonstrating support for the project.
Project Purpose
The purpose of this evidence-based project was to promote HCP’s understanding of DV
and ability to provide effective DV interventions. The expected impact of the educational

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intervention was to increase HCP’s knowledge of DV prevalence, understanding of DV health
consequences, and familiarity with DV interventions so that HCP would be better equipped to
aid DV victims encountered in healthcare settings.
Description of Population and Setting
The educational intervention and post-intervention survey were administered to members
of a professional nursing organization based in the Western United States. Eligibility criteria for
participation included voluntary consent, age 18 years or older, English speaking, and
membership in the professional organization. No financial incentive was provided to
participants. Participants were primarily registered nurses, student nurses, and advanced practice
nurses. The majority of participants held a bachelor’s degree and worked in inpatient healthcare
settings.
Project Description and Timeline
The educational intervention was delivered virtually through a recorded presentation
uploaded to the website of the professional nursing organization. The education provided was an
abbreviated version of Project Catalyst’s Confidentiality, Universal education, Empowerment,
and Support (CUES) training. The CUES method is a brief, active DV psychoeducation
intervention that HCP can learn and incorporate into their clinical encounters. Project Catalyst is
a national initiative focused on reducing human trafficking, DV, and reproductive coercion.
Project Catalyst is sponsored by multiple agencies within the United States Department of Health
and Human Services. The abbreviated form of CUES training utilized in this project focused
only on DV, excluding information on human trafficking and reproductive coercion.
Project implementation was completed in the Fall of 2020. The participant consent letter,
recorded education intervention, and post-intervention survey were accessible to members of the

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professional organization for a ten-week period. Data analysis of survey results was completed
in November 2020.
Instrumentation
A post-intervention survey was utilized to measure the impact of the educational
intervention. The survey was a modified version of Project Catalyst’s Post-Training Survey for
Community Health Centers. Written authorization for utilization of the survey was obtained from
the creator of the survey. Modifications were made to the original survey to exclude references to
reproductive coercion and human trafficking as these topics were not covered in this project.
Psychometric properties of the modified survey are unknown. The survey consisted of 5
questions regarding participant demographic information, 9 questions regarding DV knowledge,
trauma informed care, impacts of DV on health outcomes, knowledge of DV resources, and other
elements of CUES training, and 7 questions regarding the intent to incorporate CUES training
into clinical practice.
Data Collection and Data Analysis
The online post-intervention survey was administered through SurveyMonkey. Data was
collected through SurveyMonkey and then translated to an Excel document. Data was inputted
into Intellectus statistical software program for descriptive statistical analysis.
Budget
The proposed budget for this project included a SurveyMonkey account for $384.00.
Resources available to students at Arizona State University for no cost included access to a
Zoom account for recording of the educational intervention, access to Intellectus statistical
software, and access to statistics tutors. Others completing similar projects could anticipate

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spending $125.00 for these resources. Project costs were minimal, so no outside funding was
sought or received.
Results
Participant Demographics
Eleven participants completed the post-educational intervention survey. Participants were
primarily registered nurses (36%), students (27%), and advanced practice nurses (18%). Eightyone percent of participants held a bachelor’s degree or higher level of education. The majority of
participants had been practicing in the field of nursing for five years or less (73%).
Survey Responses
The educational intervention increased participants’ understanding of DV and the CUES
method. Participants strongly agreed (64%) and agreed (36%) that the CUES training increased
their understanding of the impact of DV on health. Participants strongly agreed (82%) and
agreed (18%) that the education improved their understanding of the components of the CUES
method. Participants strongly agreed (73%) and agreed (27%) that the training improved their
ability to provide brief, active psychoeducation on DV. In addition to increasing participants’
understanding of DV and CUES, the training also increased participants’ intent to provide
universal, active psychoeducation on DV to patients. Participants strongly agreed (64%) and
agreed (36%) that after the educational intervention, they were more likely to universally educate
their patients on DV. Participants strongly agreed (55%) and agreed (45%) that following the
training they were more likely to refer patients to DV community programs and advocacy
services when appropriate.
Project Impact

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This project demonstrated the improvement DV education has on HCP’s understanding
of DV and its connection to physical and mental health. The project also shows the positive
impact DV education for HCP has on HCP’s intent to educate their patients on DV, provide DV
resources, and make referrals to DV agencies when appropriate. This project does not convey
statistical significance because the modified version of Project Catalyst’s Post-Training Survey
for Community Health Centers had unknown validity and reliability. However, the project’s
descriptive statistics demonstrated that all participants were positively influenced by the
educational intervention. When HCP are better informed on DV and evidence-based DV
interventions, patients will see better outcomes.
Discussion
Project Summary
This project utilized the ACE Star model to guide meaningful change. A thorough review
of the available literature demonstrated the efficacy of HCP provision of brief, active
psychoeducation on DV in DV outcomes. This evidence guided the project’s intervention of
training HCP how to provide brief, active DV psychoeducation. Descriptive statistics obtained
from the post-educational intervention survey showed that HCP who received training on the
CUES method were better able to implement evidence-based DV interventions.
Project Limitations and Strengths
A significant strength of this project was the implementation of the educational
intervention in a virtual format during the COVID-19 global pandemic. The virtual education
allowed HCP to receive the CUES training in a safe, remote location. Another strength of this
project was the availability of quality, current research related to the problem being addressed.
Weaknesses of this project included the measurement instrument’s unknown validity and

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reliability and small sample size. Obtaining IRB approval for advertising and creating an
advertising strategy for the virtual education and survey may have generated a larger sample
size.
Conclusion
DV is prevalent and results in poor physical and mental health outcomes while draining
limited healthcare resources. Healthcare’s current response of selectively screening for DV is
inadequate and HCP must be informed of evidence-based interventions. This project illustrated
the positive impact that training HCP on evidence-based DV interventions has on HCP’s
understanding of DV and intent to educate their patients on DV. HCP play a vital role in
decreasing the impact of DV on individuals and communities.

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school health center intervention for abusive adolescent relationships: A cluster RCT.
Pediatrics, 135(1), 76-85. https://doi.org/ 10.1542/peds.2014-2471
O'Doherty, L., Hegarty, K., Ramsay, J., Davidson, L., Feder, G., & Taft, A. (2015). Screening
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Intimate partner violence screening and intervention: The American college of preventive
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https://doi.org/10.1016/j.amepre.2019.07.003
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DOMESTIC VIOLENCE EDUCATION

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Appendix A
Evaluation and Synthesis Tables

Table A1
Evaluation Table of Quantitative Studies
Citation

Theory/
Conceptual
Framework

Alvarez et al.
(2017). Provider
screening and
counseling
for intimate partner
violence: A
systematic review of
practices and
influencing factors

Neuman’s
System Model
(secondary
prevention) Inferred

Funding: NIH
grant, Johns
Hopkins research
grant
Bias: none
Country: 25 studies
from USA, studies

Design/
Method

Design: SR
and MA
Purpose:
understand
HCP DV
practices

Sample/ Setting

N: 35
DS: Embase,
PubMed,
CINAHL,
Scopus, Web of
Science,
Cochrane
Inclusion
Criteria: SP
were HCP
reporting on
screening and
counseling
women about
DV, studies in
either English
or Spanish

Major
Variables &
Definitions

Measurement/
Instrumentatio
n

Data
Analysis

Findings/
Results

IV: DV
screening and
intervention

Preferred
Reporting
Items for
Systematic
Reviews and
Meta-Analyses

Data
systematicall
y recorded in
database,
reviewed by
authors for
themes

DV1: <50%
of HCP
routinely
screen, wide
variety of
questions
used to ask
about DV,
some are
vague, some
HCP ask
about DV in
private, many
do not,
responding
with empathy
and resource
provision are
underutilized

DV1: HCP
practices
DV2: barriers
to screening
DV3:
facilitators to
screening

Quality of
Evidence;
Application
to practice
LOE: I
Strengths:
examined
many types
of HCP and
healthcare
settings
Weaknesses
: included
studies with
low LOE,
many studies
looked
solely at
screening
and not at
intervention,

Key: ANOVA – analysis of variance; APE – active psychoeducation; CG- control group; CI – confidence interval; DS – databases
searched; DV# – dependent variable; DV – domestic violence; EG – experimental group; GRADES - Grading of Recommendations
Assessment Development, and Evaluation tool; HCP – healthcare professional; IV – independent variable; LOE – level of evidence;
MA – meta-analysis; N – number of studies in SR or number of participant in a study; n – number of participants in a systematic
review or number of participants in a subset of a study; PPE – passive psychoeducation; RCT – randomized controlled trial; SD –
standard deviation; SMD – standardized mean differences; SP – study participants; SR – systematic review; UE – universal
education; α – Cronbach’s alpha

DOMESTIC VIOLENCE EDUCATION

25

Table A1
Evaluation Table of Quantitative Studies
Citation

also from Belgium,
Canada, Colombia,
Finland, England,
Sweden, Nicaragua,
and India

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

Exclusion
Criteria:
studies without
details on HCP
practice habits,
studies that
included
patients as
participants

Major
Variables &
Definitions

Measurement/
Instrumentatio
n

Data
Analysis

Findings/
Results

although
some HCP
make
appropriate
referrals
DV2: lack of
reimbursemen
t for
screening,
challenge to
see patient
privately, lack
of time
DV3: clear
screening
protocol and
referral
guidelines
outlined by
clinic, HCP
education on
DV and
available
resources

Quality of
Evidence;
Application
to practice
excluded
studies
where HCP
screened or
counseled
men on DV
Conclusions
: HCP need
education on
how to care
for DV
victims,
HCP need
clear clinic
protocols
Feasibility
to PICO:
HCP and
their patients
would
benefit from
HCP

Key: ANOVA – analysis of variance; APE – active psychoeducation; CG- control group; CI – confidence interval; DS – databases
searched; DV# – dependent variable; DV – domestic violence; EG – experimental group; GRADES - Grading of Recommendations
Assessment Development, and Evaluation tool; HCP – healthcare professional; IV – independent variable; LOE – level of evidence;
MA – meta-analysis; N – number of studies in SR or number of participant in a study; n – number of participants in a systematic
review or number of participants in a subset of a study; PPE – passive psychoeducation; RCT – randomized controlled trial; SD –
standard deviation; SMD – standardized mean differences; SP – study participants; SR – systematic review; UE – universal
education; α – Cronbach’s alpha

DOMESTIC VIOLENCE EDUCATION

26

Table A1
Evaluation Table of Quantitative Studies
Citation

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

Major
Variables &
Definitions

Measurement/
Instrumentatio
n

Data
Analysis

Findings/
Results

Quality of
Evidence;
Application
to practice
receiving
DV
education

Bridges et al.
(2015). The effect of
brief, passive
psychoeducation on
knowledge and
ratings of intimate
partner violence in
the United States
and Argentina
Funding: Arkansas
Department of
Higher Education
Grant
Bias: none
Country: USA and
Argentina

Learning
Theory Inferred

Design: RCT
Purpose:
Evaluate
effect of PPE
on DV
knowledge
and abuse
recognition

N: 100
n: 51 (EG)
n: 49 (CG)
Demographics
: No significant
difference
between EG
and CG.
College
students,
average age 20
years, 72 %
female, 38%
white, 56%
Latinx, 68%
reside USA,
32% reside
Argentina

IV: PPE
DV1: DV
knowledge
DV2: ability
to identify
type of DV in
vignettes
DV3: impact
of culture on
DV
understanding
, compare
USA to
Argentina

8-item test
created by
researchers;
unknown
validity,
reliability

DV1:
independent
samples t-test

6 vignettes
describing
non-abusive
conflict and
different types
of DV
(economic,
social,
physical,
sexual, and
emotional)
created by

DV3: twoway
ANOVA

DV2:
ANOVA

EG had better
DV
knowledge
scores. EG
better able to
identify subtle
forms of DV
in vignettes
than CG.
DV1:
p = .003
(medium
effect)
DV2: EG
mean 3.96,
CG mean
3.68

LOE: II
Strengths:
RCT design,
detailed
explanation
of test and
vignettes
Weaknesses
: sample was
college
students,
potentially
higher SES,
primarily
white or
Latinx, and
female;

Key: ANOVA – analysis of variance; APE – active psychoeducation; CG- control group; CI – confidence interval; DS – databases
searched; DV# – dependent variable; DV – domestic violence; EG – experimental group; GRADES - Grading of Recommendations
Assessment Development, and Evaluation tool; HCP – healthcare professional; IV – independent variable; LOE – level of evidence;
MA – meta-analysis; N – number of studies in SR or number of participant in a study; n – number of participants in a systematic
review or number of participants in a subset of a study; PPE – passive psychoeducation; RCT – randomized controlled trial; SD –
standard deviation; SMD – standardized mean differences; SP – study participants; SR – systematic review; UE – universal
education; α – Cronbach’s alpha

DOMESTIC VIOLENCE EDUCATION

27

Table A1
Evaluation Table of Quantitative Studies
Citation

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

Setting: testing
conducted
online in either
Spanish or
English

Major
Variables &
Definitions

Measurement/
Instrumentatio
n
researchers;
unknown
validity,
reliability

Data
Analysis

Findings/
Results

Quality of
Evidence;
Application
to practice

(mediumlarge effect)

materials
with
unknown
validity and
reliability,
no long-term
follow up

DV3: EG p=
0.86, CG
p=0.17 (no
significant
difference
between
groups)

Conclusions
: PPE can
educate
public about
DV and
available
resources
Feasibility
to PICO:
PPE shows
efficacy in
improving
DV
outcomes,
especially if

Key: ANOVA – analysis of variance; APE – active psychoeducation; CG- control group; CI – confidence interval; DS – databases
searched; DV# – dependent variable; DV – domestic violence; EG – experimental group; GRADES - Grading of Recommendations
Assessment Development, and Evaluation tool; HCP – healthcare professional; IV – independent variable; LOE – level of evidence;
MA – meta-analysis; N – number of studies in SR or number of participant in a study; n – number of participants in a systematic
review or number of participants in a subset of a study; PPE – passive psychoeducation; RCT – randomized controlled trial; SD –
standard deviation; SMD – standardized mean differences; SP – study participants; SR – systematic review; UE – universal
education; α – Cronbach’s alpha

DOMESTIC VIOLENCE EDUCATION

28

Table A1
Evaluation Table of Quantitative Studies
Citation

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

Major
Variables &
Definitions

Measurement/
Instrumentatio
n

Data
Analysis

Findings/
Results

Quality of
Evidence;
Application
to practice
paired with
APE

Decker et al.
(2017). Implementin
g trauma-informed
partner violence
assessment in family
planning clinics
Funding: Maryland
Department of
Health and Mental
Hygiene, Futures
Without Violence,
and Office of
Women’s Health
Bias: none
Country: USA

Theory of
Planned
Behavior –
Inferred

Design:
single group
pre-test,
post-test
Purpose:
learn about
impact of an
APE
intervention
on DV

N: 132
Demographics
: English
speaking
women ages
18-35
Setting: two
family planning
clinics in
Maryland, one
urban, one
suburban

IV:
ARCHES, an
APE DV
intervention,
takes 3-5
minutes to
complete,
focuses on
UE with
small
brochure,
empathy, and
real-time
referrals to
resources
DV1: patient
belief that
HCP cares
about DV

Computer
based survey
assessing
lifetime
exposure to
DV; 3-month
follow up
assessed
understanding
of DV
resources
Unknown
validity and
reliability

Logistic
regression
models to
obtain p
values

DV1: p=0.04

LOE: III

DV2: p=0.04

Strengths:
3-month
follow up,
intervention
is brief and
structured
Weaknesses
: low
retention
rate, nonrandomized
study design,
little
information
on data
analysis

Key: ANOVA – analysis of variance; APE – active psychoeducation; CG- control group; CI – confidence interval; DS – databases
searched; DV# – dependent variable; DV – domestic violence; EG – experimental group; GRADES - Grading of Recommendations
Assessment Development, and Evaluation tool; HCP – healthcare professional; IV – independent variable; LOE – level of evidence;
MA – meta-analysis; N – number of studies in SR or number of participant in a study; n – number of participants in a systematic
review or number of participants in a subset of a study; PPE – passive psychoeducation; RCT – randomized controlled trial; SD –
standard deviation; SMD – standardized mean differences; SP – study participants; SR – systematic review; UE – universal
education; α – Cronbach’s alpha

DOMESTIC VIOLENCE EDUCATION

29

Table A1
Evaluation Table of Quantitative Studies
Citation

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

Major
Variables &
Definitions

Measurement/
Instrumentatio
n

Data
Analysis

Findings/
Results

DV2: patient
belief that
HCP can help
with DV

Quality of
Evidence;
Application
to practice
Conclusions
: APE on
DV helps
patients see
HCP as DV
supports
with ability
to arrange
help
Feasibility
to PICO:
HCP can
provide
better
quality care
to patients
through APE
on DV

Divakar et al.
(2019).
Digital education of
health professionals

Learning
Theory –
Inferred

Design: SR
and MA

N: 6
n: 631

IV: digital
DV education

GRADES

Postintervention
SMD

DV1: SMD
0.67, 95% CI,
p=0.05

LOE: I
Strengths:
rigorous

Key: ANOVA – analysis of variance; APE – active psychoeducation; CG- control group; CI – confidence interval; DS – databases
searched; DV# – dependent variable; DV – domestic violence; EG – experimental group; GRADES - Grading of Recommendations
Assessment Development, and Evaluation tool; HCP – healthcare professional; IV – independent variable; LOE – level of evidence;
MA – meta-analysis; N – number of studies in SR or number of participant in a study; n – number of participants in a systematic
review or number of participants in a subset of a study; PPE – passive psychoeducation; RCT – randomized controlled trial; SD –
standard deviation; SMD – standardized mean differences; SP – study participants; SR – systematic review; UE – universal
education; α – Cronbach’s alpha

DOMESTIC VIOLENCE EDUCATION

30

Table A1
Evaluation Table of Quantitative Studies
Citation

on the management
of domestic
violence: Systematic
review and metaanalysis by the
digital health
education
collaboration
Funding: World
Health Organization,
Nanyang University
grant
Bias: none
Country: 5 studies
from USA, 1 study
from Netherlands

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

Purpose:
understand
efficacy of
DV digital
education for
HCP

DS: EMBASE,
Medline,
Cochrane,
PsycINFO,
Web of
Science,
Educational
Resource
Information
Centre,
Cumulative
Index of
Nursing and
Allied Health
Literature
Inclusion
Criteria:
studies that
examined
efficacy of
digital DV
education for

Major
Variables &
Definitions
DV1: DV
knowledge
DV2: HCP
attitude
toward DV
DV3: HCP
self-efficacy
in caring for
DV patients

Measurement/
Instrumentatio
n

Data
Analysis

Findings/
Results

DV2: SMD
0.67, 95% CI,
p=0.04
DV3: SMD
0.47, 95% CI,
p=0.71
5 out of 6
studies
demonstrate
that digital
education
improves DV
knowledge in
HCP

Quality of
Evidence;
Application
to practice
study
grading
criteria,
focused on
variety of
HCP
Weaknesses
: studies
utilized nonvalidated
instruments,
few studies
found on
topic
Conclusions
: digital
education
may be a
useful way
to train HCP
on DV and

Key: ANOVA – analysis of variance; APE – active psychoeducation; CG- control group; CI – confidence interval; DS – databases
searched; DV# – dependent variable; DV – domestic violence; EG – experimental group; GRADES - Grading of Recommendations
Assessment Development, and Evaluation tool; HCP – healthcare professional; IV – independent variable; LOE – level of evidence;
MA – meta-analysis; N – number of studies in SR or number of participant in a study; n – number of participants in a systematic
review or number of participants in a subset of a study; PPE – passive psychoeducation; RCT – randomized controlled trial; SD –
standard deviation; SMD – standardized mean differences; SP – study participants; SR – systematic review; UE – universal
education; α – Cronbach’s alpha

DOMESTIC VIOLENCE EDUCATION

31

Table A1
Evaluation Table of Quantitative Studies
Citation

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

Major
Variables &
Definitions

Measurement/
Instrumentatio
n

Data
Analysis

Findings/
Results

HCP, RCT,
cluster RCT

Quality of
Evidence;
Application
to practice
appropriate
response
Feasibility
to PICO:
HCP can
learn about
APE and DV
through
online
learning

Gupta et al. (2017).
A
nurse-delivered,
clinic-based
intervention to
address intimate
partner violence
among low-income
women in Mexico
City: Findings from

Transtheoretica
l Model of
Health
Behavior
Change –
Inferred

Design:
cluster RCT
Purpose:
learn if APE
delivered by
nurses
improved
levels of DV,
safety
planning,

N: 950
n: 470 EG
n: 480 CG
Demographics
: heterosexual
women
between ages
18-44 who had
experienced
DV in the past

IV: nurse
safety
planning
intervention
DV1:
experiencing
DV over next
12-months

11-question
research
assistant
delivered
screening tool
Unknown
validity and
reliability

GLIMMIX
procedure

DV1: p=0.01

LOE: II

DV2: p=0.01

Strengths:
large sample
size, low
attrition, 15month
follow up

Both EG and
CG saw
statistically
significant
improvement
in safety

Weaknesses
: only

Key: ANOVA – analysis of variance; APE – active psychoeducation; CG- control group; CI – confidence interval; DS – databases
searched; DV# – dependent variable; DV – domestic violence; EG – experimental group; GRADES - Grading of Recommendations
Assessment Development, and Evaluation tool; HCP – healthcare professional; IV – independent variable; LOE – level of evidence;
MA – meta-analysis; N – number of studies in SR or number of participant in a study; n – number of participants in a systematic
review or number of participants in a subset of a study; PPE – passive psychoeducation; RCT – randomized controlled trial; SD –
standard deviation; SMD – standardized mean differences; SP – study participants; SR – systematic review; UE – universal
education; α – Cronbach’s alpha

DOMESTIC VIOLENCE EDUCATION

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Table A1
Evaluation Table of Quantitative Studies
Citation

a cluster randomized
controlled trial
Funding: Vanguard
Charitable
Endowment
Program, National
Institute of Mental
Health grant
Bias: none
Country: Mexico

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

resource
utilization, or
quality of life
in DV
victims

year, average
age 30, 90%
married or
partnered, 63%
less than high
school
education, 81%
Catholic
Setting: 42
public health
clinics in
Mexico City

Major
Variables &
Definitions
DV2: safety
planning
behaviors
EG received
screening,
nurse assisted
referrals,
counseling,
and safety
planning
CG received
screening and
referral card

Measurement/
Instrumentatio
n

Data
Analysis

Findings/
Results

Quality of
Evidence;
Application
to practice

planning and
DV reduction

examined
heterosexual
women,
unknown
details about
screening
tools
Conclusions
: in-depth
counseling is
not more
effective
than
screening
and referral
in reducing
DV and
improving
safety
planning
Feasibility
to PICO:

Key: ANOVA – analysis of variance; APE – active psychoeducation; CG- control group; CI – confidence interval; DS – databases
searched; DV# – dependent variable; DV – domestic violence; EG – experimental group; GRADES - Grading of Recommendations
Assessment Development, and Evaluation tool; HCP – healthcare professional; IV – independent variable; LOE – level of evidence;
MA – meta-analysis; N – number of studies in SR or number of participant in a study; n – number of participants in a systematic
review or number of participants in a subset of a study; PPE – passive psychoeducation; RCT – randomized controlled trial; SD –
standard deviation; SMD – standardized mean differences; SP – study participants; SR – systematic review; UE – universal
education; α – Cronbach’s alpha

DOMESTIC VIOLENCE EDUCATION

33

Table A1
Evaluation Table of Quantitative Studies
Citation

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

Major
Variables &
Definitions

Measurement/
Instrumentatio
n

Data
Analysis

Findings/
Results

Quality of
Evidence;
Application
to practice
HCP often
lack time for
in-depth
counseling,
training
HCP in
brief, APE is
more
feasible

Klevens et al.
(2015). Does
screening or
providing
information on
resources for
intimate partner
violence increase
women's
knowledge?
Findings from a
randomized
controlled trial

Transtheoretica
l Model of
Health
Behavior
Change

Design: RCT
Purpose: to
understand
the role of
screening
and resource
provision in
women’s
understandin
g of DV and
DV
resources

N: 2,708
n: 909 digital
screen and refer
(EG)
n: 893 no
screen, resource
provision only
(EG)
n: 898 no
screen, no
resource
provision (CG)

IV: digital
screen and
refer, or
resource
provision
without
screening

Partner
Violence
Screen (α =
0.80)

Chi square
tests

DV1: p=0.58

LOE: II

DV2: p=0.52

Strengths:
RCT design,
12-month
follow up

DV1:
understanding
of DV

Weaknesses
: 13%
attrition rate,
females only

DV2:
understanding

Conclusions
: resource

Key: ANOVA – analysis of variance; APE – active psychoeducation; CG- control group; CI – confidence interval; DS – databases
searched; DV# – dependent variable; DV – domestic violence; EG – experimental group; GRADES - Grading of Recommendations
Assessment Development, and Evaluation tool; HCP – healthcare professional; IV – independent variable; LOE – level of evidence;
MA – meta-analysis; N – number of studies in SR or number of participant in a study; n – number of participants in a systematic
review or number of participants in a subset of a study; PPE – passive psychoeducation; RCT – randomized controlled trial; SD –
standard deviation; SMD – standardized mean differences; SP – study participants; SR – systematic review; UE – universal
education; α – Cronbach’s alpha

DOMESTIC VIOLENCE EDUCATION

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Table A1
Evaluation Table of Quantitative Studies
Citation

Funding: Centers
for Disease Control
and Prevention
Bias: none
Country: USA

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

Demographics
: average age
39 years, 100%
women, 48%
white, 60%
uninsured, 30%
Medicaid
Setting: 10
primary care
clinics in
Chicago

Major
Variables &
Definitions
of DV
resources
Digital
screening
occurred by
women
watching a
video on DV
then
answering
questions on
computer
about DV
status

Measurement/
Instrumentatio
n

Data
Analysis

Findings/
Results

Quality of
Evidence;
Application
to practice
provision
alone does
not assist
DV victims,
no
significant
benefit from
digital
screening
(screening
not done by
HCP)
Feasibility
to PICO:
HCP need to
be trained in
providing an
empathic
response and
APE

Key: ANOVA – analysis of variance; APE – active psychoeducation; CG- control group; CI – confidence interval; DS – databases
searched; DV# – dependent variable; DV – domestic violence; EG – experimental group; GRADES - Grading of Recommendations
Assessment Development, and Evaluation tool; HCP – healthcare professional; IV – independent variable; LOE – level of evidence;
MA – meta-analysis; N – number of studies in SR or number of participant in a study; n – number of participants in a systematic
review or number of participants in a subset of a study; PPE – passive psychoeducation; RCT – randomized controlled trial; SD –
standard deviation; SMD – standardized mean differences; SP – study participants; SR – systematic review; UE – universal
education; α – Cronbach’s alpha

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Table A1
Evaluation Table of Quantitative Studies
Citation

Madden, K. (2017).
An intimate partner
violence
informational
program in a
hospital fracture
clinic: A pre-test
post-test
intervention study
Funding: Canadian
Institutes of Health
Research
Bias: none
Country: Canada

Theory/
Conceptual
Framework
Learning
Theory –
Inferred

Design/
Method

Design: pretest, post-test
intervention
study
Purpose:
determine
efficacy of
PPE in
changing
patient
perceptions
about
discussing
DV

Sample/ Setting

N: 160
n: 80 (CG)
n: 80 (EG)
Demographics
: 78%
Caucasian, 37%
married, 63%
with children,
mean age 46,
53% female,
73% with bone
fracture
Setting:
orthopedics
clinic in
Canadian
hospital

Major
Variables &
Definitions
IV: PPE on
DV
DV1: patient
willingness to
discuss DV
DV2: patient
belief that
staff had DV
resources

Measurement/
Instrumentatio
n

Data
Analysis

Findings/
Results

16-question
survey
regarding view
of clinic as a
place to
discuss DV
and receive
resources for
DV

Independent
t-test

DV1: p=0.99

LOE: III

DV2: p=0.29

Strengths:
controlled
experiment

Survey
developed by
orthopedic and
DV experts,
modeled after
previous
research, but
unknown
validity and
reliability

Quality of
Evidence;
Application
to practice

Weaknesses
: results
clinically
significant,
but not
statistically
significant,
severe pain
may limit
patient’s
exposure to
PPE
Conclusions
:
PPE
supports
active APE

Key: ANOVA – analysis of variance; APE – active psychoeducation; CG- control group; CI – confidence interval; DS – databases
searched; DV# – dependent variable; DV – domestic violence; EG – experimental group; GRADES - Grading of Recommendations
Assessment Development, and Evaluation tool; HCP – healthcare professional; IV – independent variable; LOE – level of evidence;
MA – meta-analysis; N – number of studies in SR or number of participant in a study; n – number of participants in a systematic
review or number of participants in a subset of a study; PPE – passive psychoeducation; RCT – randomized controlled trial; SD –
standard deviation; SMD – standardized mean differences; SP – study participants; SR – systematic review; UE – universal
education; α – Cronbach’s alpha

DOMESTIC VIOLENCE EDUCATION

36

Table A1
Evaluation Table of Quantitative Studies
Citation

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

Major
Variables &
Definitions

Measurement/
Instrumentatio
n

Data
Analysis

Findings/
Results

Quality of
Evidence;
Application
to practice
in caring for
DV victims
Feasibility
to PICO:
PPE from
HCP is not
enough,
HCP need to
be trained in
APE

Miller et al. (2015).
A
school health center
intervention for
abusive adolescent
relationships: A
cluster RCT
Funding: Futures
Without Violence
Bias: none

Learning
Theory –
Inferred

Design:
cluster RCT
Purpose:
evaluate
efficacy of
APE on DV
knowledge

N: 7 school /
939 students
n: 4 schools /
447 students
(EG)
n: 3 schools /
492 students
(CG)
Demographics
: 76% female,
5% white, 95%

IV: School
Health Center
Healthy
Adolescent
Relationships
Program
(SHARP)
DV1:
recognition of
DV

Recognition of
Adolescent
Relationship
Abuse Scale
(α= 0.85)
Generalized
Self-Efficacy
Scale (α=0.89)

Wald Log –
linear chisquare test
Post-hoc
intensity
adjustment
analysis
completed
based on
whether
student

Before
adjustment,
no statistical
significance.
After
intervention
intensity
adjustment,
EG showed
greater DV
knowledge
and DV

LOE: II
Strengths:
RCT design,
93%
participant
retention
Weaknesses
: lack of
diversity in
sample,

Key: ANOVA – analysis of variance; APE – active psychoeducation; CG- control group; CI – confidence interval; DS – databases
searched; DV# – dependent variable; DV – domestic violence; EG – experimental group; GRADES - Grading of Recommendations
Assessment Development, and Evaluation tool; HCP – healthcare professional; IV – independent variable; LOE – level of evidence;
MA – meta-analysis; N – number of studies in SR or number of participant in a study; n – number of participants in a systematic
review or number of participants in a subset of a study; PPE – passive psychoeducation; RCT – randomized controlled trial; SD –
standard deviation; SMD – standardized mean differences; SP – study participants; SR – systematic review; UE – universal
education; α – Cronbach’s alpha

DOMESTIC VIOLENCE EDUCATION

37

Table A1
Evaluation Table of Quantitative Studies
Citation

Country: USA

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

Major
Variables &
Definitions

non-white, high
school students
age 13-18 years

DV2:
intention to
change
violent
relationships

Setting: 7 high
school health
centers in
California

DV3:
knowledge of
DV resources
SHARP is an
APE
intervention
administered
by HCP
during routine
health visits

Measurement/
Instrumentatio
n
Conflict
Tactics Scale
and Sexual
Experiences
Survey
(α=0.49)

Data
Analysis

reported
provider
utilized
SHARP
method

Findings/
Results

resource
understanding
than CG.
CI: 95%
DV1: p=0.11
DV2: p=0.62
DV3: p=0.14

Quality of
Evidence;
Application
to practice
small
number of
clusters,
short
duration
follow up
Conclusions
: APE shows
some
efficacy in
the treatment
of DV
Feasibility
to PICO:
HCP and
their patients
will benefit
from HCP
learning
APE

Key: ANOVA – analysis of variance; APE – active psychoeducation; CG- control group; CI – confidence interval; DS – databases
searched; DV# – dependent variable; DV – domestic violence; EG – experimental group; GRADES - Grading of Recommendations
Assessment Development, and Evaluation tool; HCP – healthcare professional; IV – independent variable; LOE – level of evidence;
MA – meta-analysis; N – number of studies in SR or number of participant in a study; n – number of participants in a systematic
review or number of participants in a subset of a study; PPE – passive psychoeducation; RCT – randomized controlled trial; SD –
standard deviation; SMD – standardized mean differences; SP – study participants; SR – systematic review; UE – universal
education; α – Cronbach’s alpha

DOMESTIC VIOLENCE EDUCATION

38

Table A1
Evaluation Table of Quantitative Studies
Citation

Theory/
Conceptual
Framework

O'Doherty et al.
(2015). Screening
women for intimate
partner violence in
healthcare settings

Neuman’s
System Model
(secondary
prevention) Inferred

Funding: World
Health Organization,
Cochrane
Collaboration, and
UNICEF
Bias: none
Country: Canada,
USA, Japan,
Portugal, New
Zealand

Design/
Method

Design:
SR and MA
Purpose:
understand
efficacy of
screening for
DV in
healthcare
settings

Sample/ Setting

N: 13 studies
n: 4,959
women
DS: Cochrane,
OVID Medline,
Embase,
CINAHL
PLUS,
PsycINFO,
ProQuest,
Conference
Proceedings
Citations Index,
DARE, WHO
ICTRP,
clinicaltrials.go
v
Inclusion
Criteria: RCT
or quasi-RCT
studies that
compared

Major
Variables &
Definitions

Measurement/
Instrumentatio
n

IV: screening
for DV

Instruments
not specified

DV1:
identification
of DV

Measurements
of DV
identification
and referral
rates

DV2: DV
referrals

Data
Analysis

GRADES

Findings/
Results

DV1:
minimal
effect
considering
high
prevalence of
DV
DV2: no
difference in
number of
referrals
compared to
alternative
intervention
of no
screening

Quality of
Evidence;
Application
to practice
LOE: I
Strengths:
studies
examined
women in
diverse
healthcare
settings and
countries,
thorough
examination
of the
literature
Weaknesses
: excluded
studies that
examined
males,
mostly highincome
countries

Key: ANOVA – analysis of variance; APE – active psychoeducation; CG- control group; CI – confidence interval; DS – databases
searched; DV# – dependent variable; DV – domestic violence; EG – experimental group; GRADES - Grading of Recommendations
Assessment Development, and Evaluation tool; HCP – healthcare professional; IV – independent variable; LOE – level of evidence;
MA – meta-analysis; N – number of studies in SR or number of participant in a study; n – number of participants in a systematic
review or number of participants in a subset of a study; PPE – passive psychoeducation; RCT – randomized controlled trial; SD –
standard deviation; SMD – standardized mean differences; SP – study participants; SR – systematic review; UE – universal
education; α – Cronbach’s alpha

DOMESTIC VIOLENCE EDUCATION

39

Table A1
Evaluation Table of Quantitative Studies
Citation

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

screening to
treatment as
usual,
participants
were female
only and age 16
or above,
participants
went to a
healthcare
setting or had a
home visit
Exclusion
Criteria:
studies that had
APE or PPE,
targeted males
or women
under age 16,
studies not
completed in
healthcare
setting

Major
Variables &
Definitions

Measurement/
Instrumentatio
n

Data
Analysis

Findings/
Results

Quality of
Evidence;
Application
to practice
Conclusions
: screening
for DV has a
small,
minimal
impact on
DV
identificatio
n and no
impact on
DV resource
allocation or
women’s
health
outcomes
Feasibility
to PICO:
screening, or
treatment as
usual, is not
enough,
HCP need to
learn APE

Key: ANOVA – analysis of variance; APE – active psychoeducation; CG- control group; CI – confidence interval; DS – databases
searched; DV# – dependent variable; DV – domestic violence; EG – experimental group; GRADES - Grading of Recommendations
Assessment Development, and Evaluation tool; HCP – healthcare professional; IV – independent variable; LOE – level of evidence;
MA – meta-analysis; N – number of studies in SR or number of participant in a study; n – number of participants in a systematic
review or number of participants in a subset of a study; PPE – passive psychoeducation; RCT – randomized controlled trial; SD –
standard deviation; SMD – standardized mean differences; SP – study participants; SR – systematic review; UE – universal
education; α – Cronbach’s alpha

DOMESTIC VIOLENCE EDUCATION

40

Table A1
Evaluation Table of Quantitative Studies
Citation

Theory/
Conceptual
Framework

Design/
Method

Sharps et al. (2016).
Domestic violence
enhanced perinatal
home visits: The
DOVE randomized
clinical trial

Dutton’s
Empowerment
Model

Design: RCT

Funding:
NIH/NINR grant
Bias: none
Country: USA

Purpose:
evaluate
efficacy of
APE in
reducing DV
in perinatal
period

Sample/ Setting

N: 239
n: 124 (EG)
n: 115 (CG)
Demographics
: no significant
difference
between
groups, rural
and urban
women, age 14
or above, low
income,
experiencing
DV, pregnant,
< 32 weeks’
gestation
Setting: multilocation, rural
and urban home
settings

Major
Variables &
Definitions

Measurement/
Instrumentatio
n

Data
Analysis

Findings/
Results

IV: Domestic
Violence
Enhanced
Home
Visitation
Program
(DOVE) –
APE focusing
on
empowerment
, autonomy,
resource
awareness,
and safety
planning

Conflict
Tactics Scale 2
(α=0.94)

Independent
sample t-tests

DV1: p=0.01
at 1, 3, 6, 12,
18, and 24month followup

DV1:
reduction in
DV

Quality of
Evidence;
Application
to practice
LOE: II
Strengths:
followed
women over
24 months,
large sample
size
Weaknesses
: 18.8% of
recruits
refused to
participate,
high attrition
rate after 12month
follow-up
Conclusions
: APE is
effective in
reducing DV
against high-

Key: ANOVA – analysis of variance; APE – active psychoeducation; CG- control group; CI – confidence interval; DS – databases
searched; DV# – dependent variable; DV – domestic violence; EG – experimental group; GRADES - Grading of Recommendations
Assessment Development, and Evaluation tool; HCP – healthcare professional; IV – independent variable; LOE – level of evidence;
MA – meta-analysis; N – number of studies in SR or number of participant in a study; n – number of participants in a systematic
review or number of participants in a subset of a study; PPE – passive psychoeducation; RCT – randomized controlled trial; SD –
standard deviation; SMD – standardized mean differences; SP – study participants; SR – systematic review; UE – universal
education; α – Cronbach’s alpha

DOMESTIC VIOLENCE EDUCATION

41

Table A1
Evaluation Table of Quantitative Studies
Citation

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

Major
Variables &
Definitions

Measurement/
Instrumentatio
n

Data
Analysis

Findings/
Results

Quality of
Evidence;
Application
to practice
risk women
in both rural
and urban
areas
Feasibility
to PICO:
HCP and
their patients
will benefit
from HCP
learning
about DV
APE

Key: ANOVA – analysis of variance; APE – active psychoeducation; CG- control group; CI – confidence interval; DS – databases
searched; DV# – dependent variable; DV – domestic violence; EG – experimental group; GRADES - Grading of Recommendations
Assessment Development, and Evaluation tool; HCP – healthcare professional; IV – independent variable; LOE – level of evidence;
MA – meta-analysis; N – number of studies in SR or number of participant in a study; n – number of participants in a systematic
review or number of participants in a subset of a study; PPE – passive psychoeducation; RCT – randomized controlled trial; SD –
standard deviation; SMD – standardized mean differences; SP – study participants; SR – systematic review; UE – universal
education; α – Cronbach’s alpha

DOMESTIC VIOLENCE EDUCATION

42

Table A2
Synthesis Table
Author
Year
LOE
Design
Setting
Inpatient
Outpatient
Home
Online
Sample
Size/Number
of Studies
SP = HCP
SP = Patients
Screening
Resource
Provision
PPE
APE
DV
Knowledge
DV Resource
Awareness
Confidence in
HCP to help
with DV

Alvarez et
al.
2017
I
SR & MA

Bridges et
al.
2015
II
RCT

X
X
35 studies
X

Divakar et
Gupta et
Klevens et
al.
al.
al.
2019
2017
2015
I
II
II
SR & MA
C-RTC
RCT
Study Characteristics

Madden

X

X
950

X
100

132

X

X

Rarely
done

X
6 studies
X

X
X
X

≠

Decker et
al.
2017
III
Pre/post

X

⇑

X
Interventions
X

X
⇑

X
Outcomes
⇑

≠

⇑

⇑

2017
III
Pre/post

Miller et
al.
2015
II
C-RCT

O’Doherty
et al.
2015
I
SR & MA

Sharps et
al.
2016
II
RCT

X

X

X

X
X
X

X

2,708

160

939

13 studies

239

X

X

X

X

X

X

X

X

X
X

X

X

≠

⇑

≠

⇑

≠

⇑

≠

⇑

⇑

⇑

Key: APE – active psychoeducation; C-RCT – cluster randomized controlled trial; HCP – healthcare professional; LOE – level of
evidence; PPE – passive psychoeducation or online education; RCT – randomized controlled trial; SP – study participants; SR & MA
– systematic review and meta-analysis; X – study exhibited this phenomenon; ⇑- increased; ⇓- decreased; ≠ - no change

DOMESTIC VIOLENCE EDUCATION

43
Appendix B

Models and Frameworks
Figure 1
The Health Belief Model

U.S. Public Health Service (1952).

DOMESTIC VIOLENCE EDUCATION
Figure 2
ACE Star Model of Knowledge Transformation

Stevens, K.R. (2004).

44