Changes in health care providers' knowledge, attitudes, beliefs, and behaviors regarding domestic violence, following a multifaceted intervention

Purpose. To improve domestic violence (DV) identification, management, and referral in a not-for-profit rural health network, training for health care professionals was implemented using a train-the-trainer approach, two one- hour training sessions, and dissemination of a clinical protocol. The multi faceted approach also involved modifications of emergency department medica l records, distribution of office enablers, and a local public health campa ign. The authors measured the effectiveness of this campaign. Methods. After implementation of a multifaceted training and public awarene ss campaign, a questionnaire designed by the Centers for Disease Control to measure knowledge, attitudes, beliefs, and intended behaviors (KABB) of he alth care providers relative to DV was administered to 380 health care prof essionals in the fall of 1997, with a follow-up survey completed after the intervention in the fall of 1999. Results. The response rates for the pre- and post-intervention surveys were 67% (n = 380) and 56% (n = 273), respectively. Two scales were correlated in the baseline survey: self-efficacy (related to DV response) and familiar ity with referral resources. Reporting of victim identification in the prec eding year increased from 36% to 39%. Those with training were more likely to have identified a victim within the year (OR = 2.86; 95% CI, 1.73-4.74). Among the 232 respondents with complete data, multiple analysis of varianc e demonstrated statistically significant overall improvement across all sca les. Nine of the 13 KABB scales revealed significant increases from pre- to posttest and included: screening, workplace resources, making referrals, p rovider self-efficacy, victim autonomy, victim understanding, legal require ments, staff preparation, and too busy/can't help. Conclusion: A comprehensive training program for health care providers can increase their self-efficacy in responding to DV victims.