Identifying intimate partner violence in different ethnic groups in primary care - a systematic review and secondary data analysis

Abstract

Background Intimate partner violence (IPV), including physical, sexual and emotional violence, causes short and long term ill-health. Brief questions that can identify women from different ethnic groups experiencing IPV who present in clinical settings are a prerequisite for an appropriate response from health services to this substantial public health problem. Aim: To examine the evidence for the validity of questions trying to identify IPV in different ethnic groups and to determine whether their validity varies between ethnic groups. Methods Design: A systematic review and the secondary data analysis of a cross-sectional survey of four questions (HARK) identifying IPV in a primary care sample. Main outcome measures: Systematic review - for each set of index questions identified, diagnostic accuracy indices, correlation coefficients, reliability measures, validity evidence based on response processes and test content were analysed and interpreted. Secondary data analysis - diagnostic indices for IPV and its dimensions in three ethnic groups were calculated for the four HARK questions combined and for the individual HARK questions. 4 Results Systematic review – there is no evidence of questions valid for identifying IPV in specific ethnic groups, including white groups. Secondary data analysis - the optimal HARK cut off score of ≥ 1 was unaffected by the participants‟ ethnicity. The diagnostic indices generated using the HARK cut off of ≥ 1 remained at a high level, in all three ethnic groups. There were no significant ethnic differences in the diagnostic indices of the four combined and individual HARK questions‟ ability at identifying either IPV or its dimensions. Conclusion From the systematic review and secondary data analysis, there is no evidence that questions‟ validity for identifying IPV varies significantly between different ethnic groups. The secondary data analysis does provide evidence that four questions (the HARK) can identify IPV in self-classified UK census categories of African- Caribbean, south Asian, and white groups.