Community Health Workers Managing Intimate Partner Violence: Current Practice and Promise

Abstract

Intimate partner violence (IPV) is a significant public health problem that affects more women than men, both nationally and globally. According to the Health Resource and Service Administration (HRSA), the top priority is to train the nation’s healthcare and public health workforce in addressing IPV at community and health systems levels. Community health workers (CHWs) are trusted frontline public health workers that serve as liaisons between the healthcare system and the communities they serve, and therefore play a unique role in providing care to clients with various chronic diseases. Despite their effectiveness, there is a dearth of literature examining the provision of care to victims of IPV by CHWs.The following study utilized a multiple methods design to determine the current practice and promise of CHWs managing clients who are victims of IPV. This dissertation research occurred in multiple phases. The preparation phase consisted of modifying the PREMIS survey, a validated tool that has been used to assess physician readiness to manage IPV, and subsequently making it more appropriate for CHWs using expert feedback. Study 1 involved the administration of the modified PREMIS survey to a sample of currently practicing CHWs (n=152), followed by psychometric analyses. Study 2 utilized semi-structured interviews with a panel of experts (i.e., experienced CHWs, CHW trainers, CHW supervisors, CHW Advisory Committee members) (n=10) to determine appropriate roles of CHWs in addressing IPV. Most sub-scales in study 1 yielded moderate to high reliability (0.70<α’s<0.97), some sub-scales had low reliability (0.57<α’s<0.64), and construct validity was established for several of the subscales. On average, many CHWs had low scores on objective knowledge of IPV (mean=15.4 out of 26), perceived preparation to manage IPV (mean=3.8 out of 7), and perceived knowledge of IPV (mean=3.7 out of 7). Adjusted regression models indicated that staff capabilities and staff preparation were significant predictors of perceived preparedness to manage IPV (all p’s<.05). Study 2 identified eight themes and five sub-themes on potential roles that CHWs can take in managing clients who are victims of IPV. Results of this study provide valuable insight on IPV training and credentialing opportunities for CHWs.