Assignment task:
Exploring the uptake and framing of research evidence on universal screening for intimate partner violence against women: a knowledge translation case study
- C Nadine Wathen,
- Jennifer CD MacGregor,
- Shannon L Sibbald &
- Harriet L MacMillan
Health Research Policy and Systems volume 11, Article number: 13 (2013) Cite this article
- 9017 Accesses
- 23 Citations
- 2 Altmetric
Metricsdetails
Abstract
Background
Significant emphasis is currently placed on the need to enhance health care decision-making with research-derived evidence. While much has been written on specific strategies to enable these "knowledge-to-action" processes, there is less empirical evidence regarding what happens when knowledge translation (KT) processes do not proceed as planned. The present paper provides a KT case study using the area of health care screening for intimate partner violence (IPV).
Methods
A modified citation analysis method was used, beginning with a comprehensive search (August 2009 to October 2012) to capture scholarly and grey literature, and news reports citing a specific randomized controlled trial published in a major medical journal on the effectiveness of screening women, in health care settings, for exposure to IPV. Results of the searches were extracted, coded and analysed using a multi-step mixed qualitative and quantitative content analysis process.
Results
The trial was cited in 147 citations from 112 different sources in journal articles, commentaries, books, and government and news reports. The trial also formed part of the evidence base for several national-level practice guidelines and policy statements. The most common interpretations of the trial were "no benefit of screening", "no harms of screening", or both. Variation existed in how these findings were represented, ranging from summaries of the findings, to privileging one outcome over others, and to critical qualifications, especially with regard to methodological rigour of the trial. Of note, interpretations were not always internally consistent, with the same evidence used in sometimes contradictory ways within the same source.
Conclusions
Our findings provide empirical data on the malleability of "evidence" in knowledge translation processes, and its potential for multiple, often unanticipated, uses. They have implications for understanding how research evidence is used and interpreted in policy and practice, particularly in contested knowledge areas.
Peer Review reports
Background
It has been over 20 years since intimate partner violence (IPV) was declared to be a major public health problem [1], and while data on the prevalence [2-5], consequences [6-10], and costs [11-14] are well-established, many gaps remain in the knowledge base regarding how the health care sector can best detect and respond to IPV. These gaps have led to debates in the field and conflicting advice to health and social service providers, and policy decision-makers [15, 16].
One of the most contested areas is whether or not all women should be routinely screened by a health care provider for exposure to IPV. Proponents argue that IPV's burden of suffering necessitates universal screening of all women presenting to healthcare settings [17, 18] with the hope that this will lead women on a path of help-seeking, with eventual reductions in violence and its health consequences. A number of evidence-based reviews and guidelines have concluded that the lack of evidence regarding the benefits, and potential harms and costs, of such screening on women's health and well-being favours a case-finding approach (assessment of a patient based on risks for, and/or clinical signs or symptoms of, exposure) [19-21]. A recent updated systematic review for the US Preventive Services Task Force concluded that, while there may not be evidence from screening trials indicating benefit to women, the fact that screening can identify women, and that some intervention studies show promise for some women, warrants inclusion of universal screening protocols in health care settings [22].
This situation is typical of many health topics, where there is imperfect yet evolving research evidence, and a variety of interested and invested stakeholders who develop, promote and/or enact specific policies or practices, and who may or may not wish these options to be informed by "evidence" [23]. What makes this case interesting for empirical analysis is the increased policy activity in the field in 2011-12, especially in, but not limited to, the USA.
The "case" - a randomized controlled trial of IPV screening
In 2009, in the Journal of the American Medical Association (JAMA), the results of a multi-site Canadian randomized controlled trial (RCT) were published indicating that universal screening for IPV did not significantly reduce women's exposure to violence, or improve health outcomes or quality of life [24] (hereafter referred to as 'the IPV screening trial' or 'the trial'). This was accompanied by an editorial recommending that until screening is shown to have measurable benefits for abused women, a case-finding approach, as defined above, is the best clinical response [25]. The key messages arising from the trial are outlined below. During the course of the current analysis, a second large RCT, conducted in the USA and also addressing IPV screening in health care settings, was published in JAMA, with very similar findings [26]; it too had an accompanying editorial re-emphasizing the need for clinical case-finding [27].
Given the debate surrounding this issue, we sought to examine how the evidence from the initial trial, published in a widely-read medical journal, has become represented in the literature, and to what extent it has influenced practice guidelines and policies. The trial - the largest of its kind at the time providing direct evidence regarding the effectiveness of screening in health care settings - also came at a significant moment in the evolution of the debate regarding the health care response to IPV, especially in the USA, where, as we will describe, recent clinical and legislative bodies have taken a position on this issue.
In just a paragraph answer this question
Explain whether or not the author's credentials show they could be an authority on the topic. Need Assignment Help?