Study Protocol - Computer Assisted Enquiry for Experiences of Domestic Abuse in Health Care Setting
April 2010
1. Introduction
The term Gender-Based Violence (GBV) describes violence that is directed against a woman because she
is a woman or violence that affects women disproportionately. It includes acts that inflict physical,
mental or sexual harm or suffering, threats of such acts, coercion or other deprivation of liberty (United
Nations 1992). Domestic abuse is one form of gender-based violence. The Scottish Government defines
domestic abuse as “perpetrated by partners or ex-partners [which] can include physical abuse (assault
and physical attack including a range of behaviour), sexual abuse (acts which degrade and humiliate
women and are perpetrated against will, including rape) and mental and emotional abuse (such as
threats, verbal abuse, racial abuse, withholding money and other types of controlling behaviour such as
isolation from family and friends).
The consequences of domestic abuse are well documented and include substantial morbidity and
mortality, physical and psychological health problems (Krug et al 2002). It is a significant public health
problem (WHO). In 2008 the Scottish Government introduced the National Domestic Abuse Delivery Plan
for Children and Young People as part of a strategy to address this. A key component of delivery plan is
the introduction of routine enquiry of domestic abuse in healthcare settings.
The National Gender-based Violence and Health Programme was created to progress this work and aims
to improve identification of and responses to gender-based violence across NHS Scotland. Routine
enquiry will be implemented in priority healthcare settings (maternity, substance misuse, mental health,
sexual health, emergency medicine and community nursing). Routine enquiry means asking every new
person presenting to services specific questions about experiences of abuse. As health care workers are
often the first or only professional contact that people experiencing abuse have, they can offer a lifeline
to safety (DoH 2005) and have a responsibility and opportunity to act (Gunter 2007, Campbell 2003, Sharps et al
2001).
Routine enquiry provides an opportunity for women to disclose experiences of abuse and access
additional supports to address the consequences of abuse (Feder et al 2009, Seng 2008). Disclosure enables
health care workers to incorporate the impact of abuse in making a diagnosis and creating treatment
and care plans (Zink 2004). However, research has shown that even when women choose not to disclose
the act of being asked can in itself be beneficial (Leibshutz 2008). Routine enquiry reduces stigma around
the issue of abuse, informs service users of health consequences of abuse and the role that health care
workers can play in responding to this (Stenson 2005, Chang et al 2004, Zink et al 2004). Routine enquiry may
also help some women to identify the presence of abuse in their lives (Ulrich 2006, Campbell 2004).
Routinely enquiry is acceptable to service users (Feder et al 2009, Gunter 2007, McDonnell 2006) and has been
shown to increase their satisfaction with services (Leibshutz 2008, Rodriguez 1996). Routine enquiry
commonly takes place during face to face assessment interviews. However, computer assisted routine
enquiry has also been shown to be acceptable to service users and to facilitate disclosure to health care
workers (Ahmad et al 2009, Feder et al 2009, Renker 2007, Trautman et al 2007, Rhodes et al 2006, Bacchus et al 2004,
Gerbert et al 1999.) Computer assisted routine enquiry (CARE) provides anonymity for respondents. This
could have particular significance in rural areas where service users have concerns about confidentiality
following disclosures of abuse (McCarry & Williamson 2009).
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As with face to face enquiry if service users choose not to share information with healthcare workers
their experience of abuse and risk of further abuse cannot be incorporated into care planning, however,
computer assisted routine enquiry can still fulfil the role of raising awareness, reducing stigma and
promoting the role of health professionals in responding to abuse.
2. Computer Assisted Routine Enquiry
The Computer Assisted Routine Enquiry (CARE) programme has been developed by Scotland’s Health on
the Web (SHOW) Development Team and the National GBV & Health Team. The full programme
content is available in appendix 1. There are 6 sections and the programme should take no longer than
10 minutes to complete.
1)Introduction to programme and study
2) Learning to use touch screen computer
3) General questions (e.g. age, children etc)
4) Routine enquiry for domestic abuse
5) Questions about abuse and information (This section is only for women who disclose in section 4)
6) Evaluation of CARE
The programme is designed to be as user friendly and accessible as possible. It will be delivered through
a touch screen tablet and will incorporate video clips and audio stream. Each response option will be
highlighted in turn to help users select the most appropriate response for them. Women will also have
the option to exit the programme at any time and move on past questions which they do not wish to
answer.
It is essential that women are left in private to complete the CARE Programme and therefore, CARE is
not appropriate for use in the service user’s home.
3. Aims of this study
This study compares the effectiveness of computer assisted routine enquiry of domestic abuse in
identifying service users’ experience of abuse and facilitating disclosure to healthcare workers with
routine in person, face to face enquiry.
4. Research questions
 Does computer assisted enquiry about domestic abuse overcome barriers to disclosure by
providing anonymity for respondents in rural and urban areas?
 Does computer assisted enquiry about domestic abuse facilitate disclosure to health care
workers?
 Is computer assisted routine enquiry of domestic abuse acceptable to service users in Scotland?
 What are the characteristics of women who choose to disclose following computer assisted
enquiry and / or health care workers? (Age, ethnicity, severity of abuse)
5. Methods
5.1 Study Design
This is an experimental multi site study. Participants will be randomly allocated to two groups: usual
face to face routine enquiry (usual care group) or computer assisted routine enquiry (CARE Group). An
experimental design enables comparison between rates of disclosure in usual care and CARE groups and
random allocation will reduce selection bias.
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5.2 Study sites
This study builds on the work undertaken within each health board area as part of the National GBV &
Health Programme. Implementation of routine enquiry is incremental and each Board has identified
initial sites within maternity and mental health services to implement routine enquiry with all new
patients. Rural and urban study sites have been selected to identify potential differences between these
settings.
The following sites have been identified:
Urban
Ayrshire & Arran
Fife
Highland
Lothian
Orkney
Tayside
Rural
Maternity
Mental Health
X
X
X
X
X
X
Maternity
X
X
X
Mental Health
X
X
X
X
X
X
X
5.3 Study sample
An opportunist sample will be drawn from maternity and mental health services where routine face to
face enquiry of domestic abuse has already been introduced. In rural areas all new female patients will
be invited to participate. Only female patients will be included in this study because at present, the
evidence base does not provide clear direction on helpful responses for men who experience domestic
abuse. However, the study would not preclude workers from asking male service users about domestic
abuse if they thought it appropriate as in usual practice.
In urban areas, researcher resources may limit the ability to invite all new female patients to participate.
A random sample of service users will be selected from clinic lists and invited to participate in this
instance.
Sample sizes are dependant to some extent on the support and participation of study sites. Potentially
data collection in rural areas could run for a period of months. Flexibility of data collection is essential at
this stage to ensure as large a sample as possible. However, it is anticipated that a total sample of at
least 200 service users will be achieved in the data collection period (50 rural maternity service users ,
50 urban maternity service users, 50 rural mental health service users and 50 urban maternity service
users.) As previous studies have compared computer assisted enquiry to selective enquiry or
spontaneous disclosure it has not been possible to do power calculations for this study.
Inclusion criteria: Participants must be female, aged 16 years or older and be considered clinically well to
participate by workers. As the CARE Programme is being developed for this study are limitations on
this version of the programme, requiring participants to be fluent in English language and physically able
to use a mouse / touch screen computer. In addition participants must be able to either hear the
accompanying audio stream and or read the accompanying subtitles.
Studies in the USA (Renker et al) have developed computer assisted self interview specifically for women
with disabilities and translation to other languages could be facilitated. This could be explored in
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subsequent studies if CARE is recommended as part of usual care. Ethnicity and disability data will be
recorded for service users participating in this study, as will reason for exclusion data.
5.4 Procedure
The diagram in Appendix 2 describes the process for data collection in both “usual care” and CARE
groups.
Preparing study sites
The research manager will visit each study site to introduce the study aims, processes and tools. At this
session the workers will agree data collection time scales and plan the most efficient schedule for data
collection (for example where possible arranging for all new patients to attend on one or two days per
week in rural areas).
 Recruitment to study
A healthcare worker will review all new patient records prior to clinic session commencing and identify
any women where it is indicated that discussion of the study would not be appropriate due to health
reasons to the fieldworker. The fieldworker will review the remaining new patient records to ensure
that it is appropriate to discuss the study with the woman. If women meet the inclusion criteria the
fieldworker will provide written information (Appendix 3) and inform them of the following:
o All new female patients are being invited to participate.
o The study is trying to find the best way to ask about things that affect our health.
o Participation is entirely voluntary and the care that women receive will not be affected by their
decision to participate or not.
o To participate women will be required to either answer questions about routine care at the end
of their visit by questionnaire which will take 5 minutes to complete or use a computer to
answer questions which can take around 10 minutes to complete. If women agree to
participate they will be allocated to one of these groups.
o The computer programme has been designed for the public to use and you do not need to be
good with computers to use it.
o Responses are completely confidential unless the women choose to share information with
healthcare workers. If they choose not to share information then no-one will know how they
have responded.
o Women will not be required to become involved in follow up or any other activity.
o They can exit the study at any time.
Data collection
If consent is obtained the fieldworker will:
o Advise the woman that if there is anything they wish to speak about following the assessment
visit the fieldworker will be available in the clinic setting and contact details will be provided on
the written information for women to contact the fieldworker at a later date if necessary
(Appendix 3). Numbers for national services are also provided in the information packs. Unless
contacted by the service user, the fieldworker will have no further contact with the woman
during this visit.
o Obtain written consent from woman (Appendix 4)
o Allocate women to usual care or CARE group alternately.
o Inform the healthcare worker whether usual care or CARE is required during this assessment
and give the healthcare worker data collection form(s) for completion at the end of the
assessment visit.
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o
If allocated to CARE group, set up ready for use.
OR
If women decline to participate or do not meet the inclusion criteria the fieldworker will:
o Thank the woman for taking time to hear about the study.
o
Inform the healthcare worker that face to face routine enquiry is required during this visit as per
“usual care” and give healthcare worker data collection form for completion at the end of
assessment visit. No further action is required for women who decline to participate.
Usual Care Group
In the usual care group, face to face routine enquiry will take place. Health care workers will ask service
users direct questions about domestic abuse during the assessment interview. Data collection in this
group aims to identify if enquiry does routinely occur and if anonymity is an issue for patients and staff.
At the end of the assessment the healthcare worker will again explain the study to women and give the
following information.
o All women attending the clinic for their first visit are being invited to participate.
o Questions are about routine care in this area
o Participation is entirely voluntary.
o The care that women receive will not be affected by their decision to participate or not.
o They are being asked to complete a questionnaire which will take no more than 5
minutes to complete.
o Responses are completely confidential.
o Women will not be required to become involved in follow up or any other activity.
Women who wish to continue will be given the usual care service user data collection form (Appendix 5)
and left in a private space to complete the questionnaire (either consultation room or a separate private
area). Partners or others accompanying the woman will be asked to wait in the waiting area. Envelopes
will be provided for the completed questionnaires and a box will be placed in the private areas for the
collection of envelopes. If women decline to participate at this point the visit will conclude as usual.
 Healthcare worker – usual care
When the consultation is completed, the healthcare worker will complete the data collection form
(Appendix 6) whether women completed data collection forms or not. This will be placed in an
envelope and left for collection in a box with other responses.
Implications for workers providing usual care:
o Health care workers will be advised by fieldworkers about the method of routine enquiry
required.
o Healthcare workers will be required to briefly describe the study to all new patients at the end
of each visit.
o Following each new patient assessment workers will be required to complete the worker data
collection form. This should take approximately 1 minute.
o Areas are required to provide a private space where women can complete the data collection
forms.
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Computer Assisted Routine Enquiry (CARE)
Data collection in the CARE group aims to assess the effectiveness of CARE in facilitating disclosure,
gathering information on characteristics of those who do disclose, measuring the frequency of face to
face enquiry of abuse following CARE and gathering the views of service users and staff on anonymity
and service users’ views of using CARE.
 Introducing Computer Assisted Routine Enquiry
The fieldworker will advise healthcare worker that CARE is required and if necessary set up equipment
prior to assessment commencing. The healthcare worker will introduce themselves to the woman as
usual and take them to the assessment room. When routine enquiry would usually be introduced (for
example during private time or during relationship / family assessment) the healthcare worker will
remind women of the study. They will indicate how to start the programme, advise the woman to open
the room door when the programme ends and leave them alone to complete the CARE programme.
They will return to the room when women have opened the door to indicate that they have finished.
o The CARE Programme – Enquiry and disclosure
The programme content is detailed in Appendix 6. To ensure that all women participating in this study
are asked about domestic abuse and given an opportunity to disclose the following features have been
included in the programme:
 If women exit the programme before routine enquiry has been achieved notification of this will
be printed out in the room stating “Routine enquiry please, exited programme before routine
enquiry achieved.”
 If women do not disclose personal experience of abuse but wish to speak with healthcare
worker about abuse a print out in the room will state “Please discuss domestic abuse – no
disclosure.”
 If women do disclose and choose to share this information with healthcare workers then a print
out in the room will state “Please discuss domestic abuse – disclosure.” This will also provide
any additional information that women provide about the abuse.
 Whether women do or do not disclose during the CARE programme, if they choose not to share
this information with workers no print out will be made.
When the healthcare worker returns to the room they will check to see if there is a print out with
instruction to discuss domestic abuse with the woman. If so, the healthcare worker will open the
discussion on abuse or carry out face to face routine enquiry.
If there is no print out, the healthcare worker will ask women a general question about using the
computer and if there is anything they would like to discuss. Healthcare workers will also remind
women that all of their responses are confidential and that no-one will know how they answered.
o Assessment visit – CARE Group
The assessment will then continue as usual. If indicated later in the assessment the healthcare worker
may provide another opportunity for disclosure by asking direct questions about domestic abuse if they
think it appropriate.
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o Healthcare worker - CARE Group
Once the woman has left the healthcare worker will complete the data form whether or not the woman
used the CARE Programme (Appendix 7). Forms should take a maximum of 2 minutes to complete and
will be collected by the fieldworker at the end of each session.
o






Implications for workers using CARE:
Be advised by fieldworker whether face to face or computer assisted routine enquiry is required.
Introduce CARE at most appropriate part of assessment.
Show women how to start programme (Simply “To begin, press the screen here”).
Leave women to complete CARE
Respond to instructions on print out and disclosures as usual.
If there is no disclosure remind women that all responses are confidential and therefore, no-one
will know how she has responded.
 Completing healthcare worker data collection form (approximately 2 minutes)
5.5 Ethics
Ethics approval will be sought from the West of Scotland Research Ethics Committee. The key issues to
protect participants in this study are obtaining informed consent, ensuring confidentiality, ensuring no
disadvantage to participants and, as domestic abuse is perceived as a sensitive topic, provision of
support for staff and service user participants.
Informed Consent
Informed consent will be obtained on arrival at the clinic. Service users will be given written information
on the study (Appendix 3). A fieldworker will talk through the main points as described previously and
provide an opportunity for participants to ask questions. Participants will be asked to sign two copies of
the consent form. One copy will be retained by the fieldworker and the other by the participant.
This study is investigating methods of routine enquiry about domestic abuse. As written information is
intended to be retained by service users, and may be seen by partners or others, stating this on the
written information may jeopardise the safety of some women. Care has been taken to remove terms
associated with domestic abuse and gender-based violence from written information from this reason
(for example, removing GBV Programme from contact details).
Service users can exit from the study at any point either by not completing the questionnaire in the
usual care group or by exiting the CARE programme.
To remove potential for women who disclose only during the computer programme to expect a
response from healthcare workers, fieldworkers will highlight that health care workers not be aware of
any disclosures and will not be able to offer support unless women choose to share their responses with
them. In cases where women have chosen not to share responses the health care worker will remind
them that they do not have access to any of the information shared by women during the computer
programme.
Confidentiality
A number of actions will be taken to ensure confidentiality for both service user and health care
workers.
Consent forms will be returned to the research manager and retained by them for 3 years.
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Reference numbers will be assigned to participants and to study sites (detailed later in this paper.)
Study site codes will be assigned by the research manager and the code list retained by them.
Participant reference codes will be assigned by fieldworkers. No additional participant data will be
retained.
All data will be stored in locked cupboards or password protected databases. Access will be controlled
by the research manger.
A number of security factors are employed to ensure confidentiality of data collected using the CARE
programme. Data will be protected through an encrypted SSL session and will be held in a TIA942
compliant tier-4 data centre with physical access security and controls. The results will be stored within
a hardened operating system environment, secured in accordance with the Windows Server 2003
Security Guide published as part of Microsoft’s Security Compliance Management Toolkit. The database
that results are stored in is secured in accordance with the Microsoft “Securing SQL Server” guide (Nov
2009). Export of results would be through a controlled encrypted SSH interface with password strength
as specified in NHS Security guidelines. All connections to the system are secured through layered
firewalls from 2 separate suppliers (EAL4 certified) and the application server is accessed through a
reverse proxy rather than directly.
To ensure confidentiality for focus groups participants, data will be anonymised at the time of
transcription. All data will be stored in locked cupboards and in password protected databases.
As anonymity is a key factor in computer assisted routine enquiry, it is essential to consider this in all
aspects of study design. Fieldwork in rural areas will be carried out by workers who have no previous
connections with the study site to address some service user concerns around confidentiality. This will
also provide in person contact for those service users who wish support but do not wish to disclose to
local workers.
Care will be taken when reporting the study findings as the very small numbers of participants and
workers in rural services may jeopardise confidentiality.
 Potential disadvantage
Routine care in the study settings will involve asking every new female patient about domestic abuse as
part of the assessment process. During the study this will continue for those allocated to the usual care
group. For those allocated to the CARE group this question will be asked using a computer and will
provide an opportunity for this information to be disclosed to healthcare workers either by print out or
by women disclosing directly to staff following computer enquiry. Women who exit the programme
before routine enquiry has been achieved will be asked by the healthcare worker in person as will
women who decline to participate.
Workers will continue to use their professional judgement and in situations where they feel that specific
questions about domestic abuse should be asked in person following CARE they will continue to do so.
This will be captured through data collection tools for workers. Therefore, the CARE group will not be
disadvantaged.
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 Support for staff and service users
Study sites will have implemented routine enquiry of domestic abuse as part of usual care through the
National Gender-Based Violence & Health Programme. Prior to this introduction practitioners and
managers will have received training and identified supports for workers and service users. However,
as this study is presenting an alternative method to that routinely used and recognises providing
anonymity as a key factor in enabling disclosure, it is possible that some service users may wish further
support and may not feel able to approach local staff. Each fieldworker will be equipped to respond to
immediate support needs of service users (risk assess and safety plan, be aware of national and local
supports, facilitate referrals, be skilled at dealing with distressed people.) If requested the fieldworker
will maintain contact with women, until appropriate alternative supports are in place. The fieldworker
will also be available to workers in the area who wish to discuss the study, supports for service users or
their own experiences.
5.6 Data
Quantitative data
o Tools for routine enquiry - CARE
A number of screening tools have been validated for gathering data on domestic abuse. In a systematic
review, Feder et al (2009) state that the Women Experience of Battering (WEB) tool was one of the
highest ranked enquiry tools. The WEB tool has been incorporated into computer based intimate
partner violence screening tools in maternity, primary care and emergency medicine (Renker & Tokin 2007;
Rhodes et al 2006 & 2002; McNutt et al 2005). In this study computer assisted routine enquiry questions are
drawn from the tool used by Rhodes et al 2006 which incorporates physical, emotional and sexual
abuse. When women do disclose abuse further questions about the abuse are taken from Dr Campbell’s
Danger Assessment (2004) and the SPECSS assessment (http://www.met.police.uk/csu/pdfs/AppendixIII.pdf).
o Questionnaires
Service users
Questionnaires are a cost effective and efficient method to gather data and can offer anonymity to
participants (Robson 2002). Views of participants in usual care group will be collected using self
completion questionnaires. Completed questionnaires will be placed by the participant in a sealed
envelope and returned to the research manager for collation and analysis using SPSS software.
Service user views on CARE will be collected as part of the CARE programme (Appendix 1) using
questions adapted from Oschwald et al (2009). All responses will be based on multiple choice or Likert
scales to ease both data entry by participants and analysis.
Healthcare workers
Data will be gathered from healthcare workers using post visit questionnaires. As routine enquiry is part
of usual care health care workers in study sites will routinely be recording the frequency of routine
enquiry, disclosures of abuse and equalities monitoring data. In addition, workers providing usual care
will be asked about anonymity (Appendix 6) and if using CARE will be asked if they asked specific
questions about abuse following CARE (Appendix 7)
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o Identification Codes
The following codes will be applied to enable analysis:
Study Site
This code will enable researchers to identify the:
 NHS Board
 Setting (Maternity or Mental Health)
 Rurality of service location
Service User - Rurality
Some women will live in rural areas and travel to more urban settings to receive care. This will not be
captured in the study site code. A service user rurality code will be obtained by the fieldworker using
the woman’s postcode and the Scottish government Rurality Index. Only the index rating will be
entered, the woman’s postcode will not be retained.
Record Number
A record number will be applied to enable pairing of worker and service user data. This number will
incorporate the study code and two additional digits assigned by the fieldworker.
o Analysis of quantitative data
Data will be entered into Microsoft access database for analysis. Data will be analysed according to
setting (mental health or maternity services); rurality (rurality index rating) and method of enquiry (face
to face or CARE). Disclosure, acceptability and importance of anonymity will be compared across
groups. In addition, service user and worker reports on frequency of routine enquiry and importance of
anonymity will be compared.
Qualitative data
In order to gather information about the practical application of CARE, workers will be invited to
participate in a focus group following the completion of quantitative data collection in their area
(Appendix 8). Focus groups are an efficient method of obtaining qualitative data and can generate
dialogue within the group to explore issues (Polit & Hungler 1997). Focus groups will be recorded with
consent and will be transcribed by the group facilitator or by the administrator for the National
Programme Team. Data will be anonymised at the time of transcription. Transcripts will be read
repeatedly by the Research Manager and coded to identify emergent themes. A second researcher will
read a subset of transcripts to ensure that an appropriate coding structure has been developed and that
all potential themes have been identified.
Fieldworkers will keep diaries detailing supports required by service users and / or workers in relation to
the use of technology and to experiences of domestic abuse. In addition, reasons for exclusion from
study and numbers of women declining to participate will also be recorded. Fieldworkers will be invited
to participate in interview or focus group to further explore their experiences of implementing CARE
following the quantitative data collection period.
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6. Timetable
Consultation on proposal
Confirm study sites
Ethics approval
Preparation of study sites
Identify fieldworkers
Data Collection in Health Boards
Collation & Analysis of Data
Reporting
March 2010
April 2010
May / June 2010
From May 2010
June / July 2010
August 2010 to February 2011
March / April 2011
May 2011
7. Dissemination of Findings
Findings will be reported and disseminated by the National GBV & Health Programme Team. Full and
summary reports will be available in hard copy and through the Programme website from May 2011. In
addition, a series of presentations will be delivered to boards and interested groups.
8. Resources
A Study Steering Group and Advisory Group will be established to guide the research. The Steering
Group will have representation from each of the participating health boards. A series of regular
meetings will be established to oversee the implementation of the study. The Advisory Group will have
membership of researchers with experience of working in the healthcare setting and / or in the issue of
GBV. Group members will come from Scottish Government, Health Boards and Academic Institutions
and will advise on technical aspects of the research.
The Research Manager, National GBV & Health Programme will co-ordinate study sites, participate in
data collection, collate, analyse and report on findings. It is anticipated that some health board areas
will be able to support this work by providing a worker to support fieldwork. In addition, funds have
been identified to commission fieldworkers. The Research Manager will provide support to prepare
fieldworkers for data collection, responding to disclosures and providing information to survivors of
abuse. Fieldworkers will attend site preparation sessions with the Research Manager. Additional
resources will be required to fund travel and accommodation for fieldworkers when visiting rural areas.
Where possible, planning of new patients assessments will be co-ordinated to allow most efficient use
of researcher time and financial resources.
An internet enabled computer assisted routine enquiry (CARE) programme will be developed by
Scotland’s Health on the Web (SHOW) Development Team. They will provide ongoing support
throughout the data collection period. There are no costs associated with the development of the
software.
Whilst most clinical areas will already have some IT equipment the purchase of specific equipment for
this study is required. Equipment would be portable, have audio and headphone facilities, internet
access and if possible have touch screen facilities to make CARE as accessible as possible. The purchase
of two laptop / tablet computers would allow data collection in more than one area at any time (either
two separate rural sites or two service users at any time in urban sites.) A third would provide a backup
which is essential in rural areas where there are fewer opportunities to collect data. The SHOW team
have advised on most appropriate IT equipment and the total cost is estimated at £2514.00. This
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equipment will be of use in future research and service development. Costs will be met through the
National GBV & Health Programme.
9. Appendices
1.
2.
3.
4.
5.
6.
7.
8.
Care Programme
Process diagram
Written information – service users
Consent form
Data collection form – usual care service users
Data collection form – usual care workers
Data collection form – CARE workers
Focus group guide – workers
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9. References
Ahmad F, Hogg-Johnson S, Stewart DE, Skinner HA, Glazier RH & Levison W (2009) “Computer assisted screening
for intimate partner violence and control.” Annals of Internal Medicine. 151 pg93-102
Bacchus l et al (2004) “Prevalence of Domestic Violence When Midwives Routinely Enquire in Pregnancy” BJOG
111. 441 – 445
Barron J (2009) The Survivors’ Handbook. Women’s Aid Federation of England
(http://www.womensaid.org.uk/domestic-violence-survivorshandbook.asp?section=000100010008000100310005 )
Campbell JC (2004) “Helping Women to Understand Their Risk in Situations of Intimate Partner Violence.” Journal
of Interpersonal Violence 19 (12) p1464-77
Campbell JC (2004) Danger Assessment. Accessed 17/3/10 at:
(http://www.dangerassessment.org/WebApplication1/pages/da/DAEnglish2010.pdf)
Campbell JC, Webster D, Koziol-McLean J et al (2003) “Risk Factors for Femicide in Abusive Relationships: Findings
from a Multisite case Control Study” Research & Practice 93 (7) p1089-1097
Chang JC, Decker MR, Moracco KE et al (2004) “Asking about intimate partner violence: Advice from female
survivors to health care providers.” Patient Education and Counselling. 59 p141-147
Department of Health (2005) Responding to Domestic Abuse: A Handbook for Health Professionals.
Feder G, Ramsay J, Dunne D et al (2009) “How far does screening women for domestic (partner) violence in
different health-care settings meet the UK National Screening Committee criteria for a screening programme in
terms of condition, screening method and intervention? Systematic reviews of nine UK National Screening
Committee Criteria.” Health Technology Assessment. Vol 13
Gerbert B, Bronstone A, Pantilat S, McPhee S & Allerton M (1999) “When asked, patients tell: Disclosure of
sensitive health risk behaviours.” Medical Care 37 (1)
Gunter J (2007) “Intimate Partner Violence” Obstetrics & Gynaecology Clinics of North America 34 p367-388
Krug EG, Dahlberg LL, Mercy JA et al (2002) World Report on Violence and Health. WHO, Geneva
Leibshultz J et al (2008) “Disclosing Intimate Partner Violence to Health Care Clinicians – What a difference the
setting makes. A qualitative study.” BMC Public Health 8 (229)
McCarry M & Williamson E (2009) Violence Against Women in Rural and Urban Areas. University of Bristol
McDonnell et al (2006) “Acceptability of routine enquiry regarding domestic violence in the ante natal clinic.” Irish
Medical Journal 99 (4) p123-4
McNutt LA, Waltermaurer E, McCauley J, Campbell J, Ford D. (2005) “Rationale for and development of the
computerized intimate partner violence screen for primary care”. Family Violence Prevention and Health Practice.
2005;3:1-12.
Oschwald M, Renker P, Hughes RB et al (2009) “Development of an accessible audio computer assisted self interview
(A CASI) to screen for abuse and provide safety strategies for women with disabilities.” Journal of Interpersonal Violence. 24 (5)
p795 -819
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Polit DF & Hungler BP (1997) Essentials of Nursing Research 3rd Edition. Lippincott London
Renker PR (2008) “Breaking the Barriers: The promise of Computer- Assisted Screening for Intimate Partner
Violence.” Journal of Midwifery & Women’s Health. 53 (6) p 496-503
Renker PR & Tonkin P (2007) “Post Partum Women’s Evaluation of an Audio / Video Computer Assisted Perinatal
Violence Screen.” Computers, Informatics, Nursing 25 (3) p139-147
Rhodes KV, Drum M, Anliker E, Frankel RM, Howes DS, Levinson W (2006) “Lowering the threshold for discussions
of domestic abuse.” Archives of Internal Medicine 166 (May 22) p1107-1114
Robson C (2002) “Real World Research” Blackwell London
Rodriguez MA, Bauer HM, Flores-Ortiz Y & Quiroga SS (1996) “Breaking the Silence: Battered women’s perspectives
on medical care.” Archives of Family medicine. 5 pg 153-158
Scottish Government (2008) National Domestic Abuse Delivery Plan for Children and Young People
Seng JS et al (2008) “Mental Health, Demographic and Risk Behaviour Profiles of Survivors of Childhood and Adult
Abuse” Journal of Midwifery & Women’s Health 53 (6) p512-521
Sharps P et al (2001) “Health Care Providers’ Missed Opportunities for Preventing Femicide.” Preventative
Medicine 33 p373-380
Stenson K, Sidenvall B & Heimer G (2005) “Midwives experiences of routine ante natal questioning relating to
men’s violence against women.” Midwifery 21 (4) p311-21
Trautman DE, McCarthy ML, Miller N, Campbell JC, Kelen GD (2007) “Intimate Partner Violence and Emergency
Department Screening: Computerized screening versus usual care.” Annals of Emergency Medicine. 49 (4) p526534
Ulrich et al (2006) “Postpartum Mothers’ Disclosure of Abuse, Role and Conflict” Health Care for Women
International 27 (4) 324-43
United Nations (1992) General Recommendation No19. 11th Session, Committee on the Elimination of
Discrimination Against Women. www.un.org/womenwatch/daw/cedaw/recommendations/recomm.htm#recom19
WHO http://www.who.int/gender/violence/en/ site accessed 17/3/10
Zink T et al (2004) “Medical Management of Intimate Partner Violence Considering Stages of Change. Precontemplation and Contemplation.” Family Medicine 2 (3) p231-239
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Appendix 1
Computer Assisted Routine Enquiry (CARE) Programme - Draft 4 (29/04/10)
1) Introduction
A short subtitled video clip lasting 1 minute will welcome participants to the CARE programme. The clip
will show a researcher talking to camera. This will be subtitled.
“Thank you for taking part today. We are trying to find the best way to ask women about things that
affect their health. This should take about 10 minutes to complete.
This programme is in 3 parts. The first shows you how to use the computer, the next asks questions
about things that affect your health. The last section asks how you felt about using this computer.
During everyone’s first visit they are asked questions about themselves and their health. We want to
know about these things because we may be able to help in the way that we provide care to you, by
giving information, support or by putting you in touch with other workers. Today this computer will
ask some of these questions.
To make sure that the researchers working on this study do not know who has taken part in the study
none of your personal details are stored on this computer. This means that the workers in the clinic
will not know how you have answered. We hope that you will share your answers with your worker
today and during the programme you will be asked if you are happy to do this. If you answer yes
some information will be printed out in this room. If you answer no, the workers here will not know
how you have answered.
Let’s get started. The next section shows you how to use the computer.”
Video clip ends
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2) Using the computer
This section will take 45 – 60 seconds to complete.
Using touch screen
Throughout the programme text will appear on the screen and the woman will hear the words through
an audio stream. In addition, each response option will be highlighted as the words appear and are
heard. The following questions familiarise women with the touch screen computer.
“We are going to ask some questions to get you used to the computer. To answer, please touch the
answer on the screen that suits you best. Here are some shapes.
CIRCLE
SQUARE
STAR
Please select the CIRCLE”
If woman selects the circle the audio stream will play the words “Thank you” and the programme will
continue to advise on using the programme.
If the woman does not select the circle then the following words will appear on the screen and be read
by the audio stream:
“Let’s try another one. Look at the squares below.
BLACK
GREY
WHITE
Please select the BLACK square”
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If the woman selects the correct response she will hear the words “Thank you” by audio stream and the
programme will continue to advise on using the programme.
If the woman selects the incorrect symbol on the second attempt the following words will appear on
screen and be heard by the woman through the audio stream.
“Thank you for taking part. Please open the door to this room to let your worker know you have
finished”
The programme will then print off a paper for workers stating “Please ask about domestic abuse.
Programme exited before routine enquiry achieved.”
Other instructions
Each of the following instructions will appear on the screen in words with a picture to illustrate the
action. The woman will hear the words through the audio stream.
If, for any reason you want to finish the programme early you can touch the EXIT button at any time.
EXIT
To go back to your last answer touch the BACK button.
< BACK
To move on to the next question touch the NEXT button.
NEXT >
These options will remain on the screen throughout the programme. If women do choose to exit at any
point the screen will clear and they will receive the message
Thank you. Please open the door to this room to let the midwife (or healthcare worker) know that
you have finished.
3) General questions
This section introduces general questions. Again, words will appear on screen, women will hear the
words by audio stream and multiple choice answers will be given and highlighted as women hear each
option.
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“This is the second section of the programme. Please select the answer that suits best by touching the
screen.”
How old are you?
16 to 19
years
20 to 39
years
40 to 59
years
60 years or
older
How many children do you have?
0
1
2
3
4 or
more
These questions could be followed by questions requested by the participating health boards about
health behaviours or health services. Where health board specific questions are included staff will be
aware of the inclusion and prepared to respond to questions or support requests from service users. In
addition, written information on the topics will also be provided.
This section will take between 30 seconds and 2 minutes to complete depending on the number of
additional questions included by boards.
4) Introduction to routine enquiry
A subtitled video clip lasting 15 seconds and showing the researcher talking to camera will introduce the
routine enquiry questions. Different words will be used in maternity and mental health settings:
In maternity setting:
“About a quarter of women in Scotland are affected by domestic abuse at some point in their lives.
Women who experience abuse often have health problems as a result of this. Domestic abuse can
start or increase in pregnancy. Midwives can provide support to women who experience abuse and
so we ask every woman who comes to maternity services if this is a problem for them.”
In mental health services:
“About a quarter of all women in Scotland are affected by domestic abuse at some point in their lives.
Women who experience abuse often have physical and mental health problems as a result such as
depression and anxiety. We ask every woman who comes to this mental health team if this is a
problem for them.”
Video ends.
The following questions will appear one at a time on the screen:
“Is your current (or most recent) partner”
MAN
WOMAN
The following questions will appear one at a time with a yes or no response option:
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“Does your partner try to control your life?
Does your partner try to keep you away from family and friends?
Does your partner insult you or put you down?
Are you afraid to disagree with your partner?
Has your partner ever physically hurt you?
Have you ever been hurt physically by a partner (if current or in past year)?
Have you ever had sex when you didn’t want to?
(If yes) Was this with a current partner?
Do you feel threatened by a current or former partner?”
No Disclosure
If the woman answers No to all questions above the following text will appear on the screen with audio
stream:
“Health care workers can help if you would like to talk about domestic abuse at any time, for yourself
or for someone you know. There are also specialist services that can help whether women choose to
stay or leave their partners like the National Domestic Abuse Helpline and Women’s Aid. You will find
contact details for these groups in the information pack you get today.”
“Would you like to talk to a worker today about domestic abuse?”
Women will be given Yes or No answer options.
If women select “Yes” a document will be printed off in the room for the worker stating “Please discuss
domestic abuse, no disclosure.”
The programme will then move on the Evaluation questions (Section 6).
Disclosure of Abuse
If women answer “Yes” to any of the questions about domestic abuse the programme will move on to
section 5.
This section will take approximately 1 minute and 20 seconds to complete.
5) Women’s experience of abuse.
This section asks women who have disclosed more questions about their abuse. Again words will
appear on the screen and the audio stream will play. Each of these questions will appear separately on
the screen with a yes or no answer option.
“Have you ever told a friend or relative about this?
Have you ever told a health care worker about this?”
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The following questions will be used to identify characteristics of abuse experienced by women who
disclose to workers and those who do not. Questions will appear on the screen one at a time and will
have a yes or no answer option.
“Is the abuse happening more often?
Is the abuse becoming worse?
Has your partner ever used a knife or other weapons?
Has your partner said or done sexual things that made you feel uncomfortable or that hurt you?
Do you have a child from a previous relationship?
Has your partner ever been arrested for domestic violence?
Does your partner have problems with drugs or alcohol?
Does your partner have mental health problems?
Has your partner ever threatened to kill themselves or someone else?”
Questions about children will only appear where women have stated that they have children in the
initial questions.
A subtitled video clip of the researcher will play the following:
“Thank you for telling us about your experiences. You could be at risk of further harm from your
partner and we would encourage you to speak to people who may be able to help you. These include
the nurse or midwife that you see today, any other healthcare workers you see on future visits, health
visitors or your own GP. Groups are also available who may be able to help you such as Women’s Aid
or the National Domestic Abuse Helpline. They can help you to consider all the options that are
available to you. Contact details are given to all women in the information pack you will get today.
No one deserves to live with abuse and help is available. Whether you decide to stay with your
partner or not there are some things that you can do to protect yourself.
The following advice from Women’s Aid (Barron 2009) will appear on screen:
 “If you can tell someone you trust about the abuse.
 Keep emergency numbers such as the police, women’s aid and the National Domestic Abuse
Helpline numbers with you.
 Rehearse an escape plan so you can get out quickly if you have to.
 Pack an emergency bag and keep it somewhere safe such as a friend’s house.
 If you can try to keep a small amount of money on you at all times.”
Video ends and the following words will appear on screen with audio stream:
“We ask every woman who presents to this service about domestic abuse because it can affect your
health and because we may be able to offer some support and information about the options
available to you.
Would you like to speak to a midwife (or healthcare worker) today about domestic abuse?”
A yes or no answer option will be given.
If women select yes she will hear on audio stream
“We will let your midwife know that you wish to talk with her.”
A document will be printed in the room for the worker stating “Please discuss domestic abuse –
disclosure”. This document will also detail yes responses to questions about abuse.
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If the woman selects no the following words and audio stream will run:
“The midwife / nurse that you see today will not know how you have answered these questions. You
can talk a nurse or midwife at any time and they may be able to help you. “
This section will take around 3 minutes to complete. The programme will move on the section 6
6) Evaluation
This section will take approximately 2 minutes to complete. The following words will appear on screen
with audio stream:
“This is the final section and we’d like to ask you some questions about using this computer today.”
The following questions will appear one at a time on screen. The response options are listed below the
questions:
“How did you find using this computer programme?
Very easy
Easy
Difficult
Very difficult
This programme asked about domestic abuse. Do you think you would have preferred to be asked by
a nurse or midwife directly rather than by a computer?
Yes
No
No Difference
Do you know anyone who is working in the clinic today as a friend, relative or neighbour?
Yes
No
If you had known someone do you think this would have made talking about domestic abuse:
A lot easier
Easier
It wouldn’t have made a difference
Difficult
Very difficult
You have chosen whether or not to share your answers with workers here today. Do you think you
would have answered differently if the information was automatically shared with workers?
Yes
No
Did this programme give you any new information about domestic abuse?
Yes
No
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Do you think this programme would be helpful for women who are experiencing domestic abuse?
Yes
No”
7) End Programme
“Thank you for taking part today. Please open the door to indicate that you have finished the
programme.”
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Appendix 2 – Data
collection process
Fieldworker identifies women who meet inclusion criteria and
meet with them in arrival at clinic to describe study and obtain
informed consent.
If the woman consents the fieldworker allocated identifies if
woman allocated to usual or CARE group, informs healthcare
worker which is required in this visit, sets up equipment if
necessary and gives worker appropriate data collection form.
Usual care group
Assessment visit carried out as usual. At
the end of the visit the healthcare worker
will briefly remind the woman about the
study and give the woman a questionnaire
and private space to complete it.
If the woman declines to
participate the fieldworker
notifies the healthcare worker
and usual care is provided.
CARE group
The healthcare worker meets the woman and begins assessment. At the most
appropriate point in the assessment (e.g. private time) the worker will leave the
woman alone to complete the CARE Programme. When the worker returns to
the room they will check if any instruction has been printed out.
If instruction has been printed out the
healthcare worker will respond accordingly:
routine enquiry, discuss domestic abuse or to
begin discussion with women who have
disclosed.
If no instruction, the healthcare
worker will ask the woman if there is
anything they would like to discuss.
If so, respond as usual. If not,
continue visit as usual care.
Once the woman has left, the healthcare worker completes post visit pro
forma
and places
it in a sealed envelope for collection. All envelopes will
REC Ref 10/S0709/30 Methods of Routine Enquiry
– Domestic
Abuse
be collected by the fieldworker at end of session.
24
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Appendix 3
Methods of Enquiry Research Study - Information for Participants
Everyone visiting the clinic for the first time will be asked questions about their health. This helps the
healthcare worker that you see today to get a better understanding of the kind of care you may be
interested in. We are doing this study to find out the best way to ask some of these questions and are
asking every woman who comes to this service for the first time today to take part.
By participating you will be helping us to make services available to as wide a range of people as
possible. Participation is for today only and you will not be asked to take part in this study in the future.
If you agree to participate you will be asked to do one of the following:
At the end of your visit complete a short questionnaire telling us what you think
about some of the questions that the healthcare worker asked you. There are 7
questions with a choice of answers and it should take about 2 minutes to complete.
OR
Use a computer to answer some of the questions during your visit today and then
tell us what you think about this. The programme has been designed for the general
public to use so you do not need to know about computers to take part. It takes
about 10 minutes to complete. You can choose to end the programme at any time.
To make sure that your responses are confidential your personal information is not used in this study.
For people using the computer programme this means that unless you choose to share the answers you
give, healthcare workers will not know how you have responded. You will be asked during the
programme if you are happy to share your answers with workers and we hope you will.
The decision to participate is entirely up to you. If you decide not to take part the service you receive
will not be affected.
This research is part of a Scottish Government programme working across all Health Boards in Scotland.
A report will be produced in May 2011 which will describe the study results. If you would like to know
any more about this study please contact me, Clare McFeely, Research Manager, Scottish Government,
4th Floor The Beacon, 176 St Vincent Street, Glasgow, G2 5SG, call 0141 249 6586 or email
clare.mcfeely@nhs.net
The researcher working here today is called (fieldworker name) and can be contacted in the clinic today
or by telephone on (fieldworker mobile).
If you have any complaints about this study please contact Alastair Pringle, Head of Patient Focus &
Equalities, Directorate of Healthcare Policy & Strategy, 4th Floor Beacon Building, 176 St Vincent Street,
Glasgow, G2 5SG.
Thank you
Clare McFeely, Research Manager.
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Appendix 4
Consent Form - Participants copy
Please tick the appropriate boxes and the sign the form below.
I have read and understood the information about this study
I have been given the opportunity to ask questions
Procedures for confidentiality and anonymity of data have been explained to me
(Ensuring that my personal details are not linked with my responses or shared
with anyone.)
I voluntarily agree to participate
I understand that I can withdraw from the study at any time
Participant Signature:
Date:
Researcher Signature:
Date:
Thank you for taking part in this study.
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Consent Form - Researcher copy
Please tick the appropriate boxes and the sign the form below.
I have read and understood the information about this study
I have been given the opportunity to ask questions
Procedures for confidentiality and anonymity of data have been explained to me
(Ensuring that my personal details are not linked with my responses or shared
with anyone.)
I voluntarily agree to participate
I understand that I can withdraw from the study at any time
Participant Signature:
Date:
Researcher Signature:
Date:
Thank you for taking part in this study.
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Appendix 5
Service User Data Collection Form. Usual Care
Study Site Code: Entered by fieldworker
Record code: Entered by fieldworker
Please tick:
Were you seen alone by a midwife (or mental health worker) today?
Yes
No
Were you asked about domestic abuse today?
Yes
No
Have you ever experienced domestic abuse?
Yes, now
Yes, in the past
No, never
If yes please circle the people below that you have told about this.
The health worker you met today / Other health service workers / Women’s support services
/ The Police / Social workers / Priests, ministers or other religious leaders / Friends or family
Do you know anyone working here as a friend or neighbour or relative?
Yes
No
Do you think knowing someone who works would make talking about domestic abuse:
A lot easier
A bit easier
It wouldn’t make a difference
A bit more difficult
Very difficult
Thank you very much for helping us with this study. Please put this form in an envelope and place it in
the box in this room.
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Appendix 6 - Data Collection for Healthcare Workers – Usual Care
To be completed by workers following completion of visit for Usual Care group.
Study Site Code: Entered by fieldworker
Record code: Entered by fieldworker
Please tick the appropriate boxes.
Did you have any information prior to the assessment that this woman had experienced of domestic
abuse (e.g. on referral information)?
Yes
No
If yes, where did this information come from?
_____________________________________________________________________________________
_____________________________________________________________________________________
Did you see the woman alone during this visit?
Yes
No
Did routine enquiry for domestic abuse take place?
Yes
No
If routine enquiry did not take place, why not? ___________________________________
_______________________________________________________________________
Did the woman disclose? (Please tick all that apply)
Current domestic abuse
Past domestic abuse
Other experiences of abuse?
No disclosure
Did you know this woman as a friend / relative / neighbour?
Yes
No
If yes, did this make a difference to asking about abuse?
It made it easier to ask
It did not make a difference
It made it more difficult to ask
Did the woman complete a questionnaire?
Yes
No
Please complete the monitoring questions over the page.
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Please tick the boxes most appropriate to the woman:
Ethnicity
White
Irish
Scottish
Any other white
British
Mixed
Any mixed background
Asian, Asian Scottish or Asian
Indian
British
Pakistani
Bangladeshi
Any other Asian background
Chinese
Black, Black Scottish or Black
Caribbean
British
African
Any other black
Other
Other Ethic background
Not known
Ethnicity not disclosed
Disabled
Yes
No
Age
16-19
20-29
30-39
40-49
50-59
60 – 65
65+
Thanks you. Please place the completed form in an envelope for collection by ………….
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Appendix 7 – Data collection form workers - CARE group.
Study Site Code: Entered by Fieldworker
Record code: Entered by Fieldworker
Did the woman complete the CARE programme? Yes - Please complete Section 1 only
No – Please complete Section 2 only
Section 1 –When service users complete CARE programme
When you returned to the room which of the following had happened?
Print out containing disclosure
Go to question 1
Print out - no disclosure
Go to question 2
No print out
Go to question 3
Question 1
a) Did you raise the disclosure with the woman?
Yes
No
If yes, what was the outcome? (e.g. referral to services, arranged follow up appointment, service user
declined further supports, service user declined to discuss further?)
______________________________________________________________________________
______________________________________________________________________________
If not, why not? ________________________________________________________________
______________________________________________________________________________
Please go to question 4
Question 2
a) If the print out did not contain a disclosure, did you ask if there was anything they wanted to discuss
with you?
Yes
No
b) Did the woman go on to disclose any of the following to you?
Tick here
Current domestic abuse
Please go to question 4
Past domestic abuse
Please go to question 4
Other experiences of abuse?
Please go to question 4
No disclosure
Please go to question 5
Stated that someone known to her was
Please go to question 5
experiencing abuse
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Question 3
a) If the woman did not choose to print out responses did you ask if there was anything they wished to
discuss?
Yes
No
b) If not, why not? ________________________________________________________________
______________________________________________________________________________
c) During this visit did the woman go on to disclose any of the following to you?
Current domestic abuse
Please go to question 4
Past domestic abuse
Please go to question 4
Other experiences of abuse?
Please go to question 4
No disclosure
Please go to question 5
Question 4
a) If the woman did disclose, did you document this?
Yes
Where? __________________________________________________________________
No
Why not? __________________________________________________________________
b) What was the outcome of this disclosure? (e.g. referral to services, arranged follow up appointment,
service user declined further supports, service user declined further discussion)
_____________________________________________________________________________
_____________________________________________________________________________
Please go to question 5
Question 5
During the course of this visit did you ask specifically if the woman had or was currently experiencing
domestic abuse?
Yes
No
Please go to question 6
Question 6
Did you have any information prior to the assessment that this woman had experienced of domestic
abuse (e.g. on referral information)?
Yes
No
If yes, where did this information come from?
_____________________________________________________________________________________
_____________________________________________________________________________________
Please complete the monitoring data on the back page.
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Section 2 – For completion when service user declined to participate or exited the
programme before routine enquiry was achieved.
1) Please tick appropriate box
Woman declined to participate in study
Woman exited programme before routine enquiry was achieved
Programme not completed due to technical difficulties
2) Did you have any information prior to the assessment that this woman had experienced of domestic
abuse (e.g. on referral information)?
Yes
No
If yes, where did this information come from?
_____________________________________________________________________________________
_____________________________________________________________________________________
3) Did you see the woman alone during this visit?
Yes
No
4) Did routine enquiry for domestic abuse take place?
Yes
No
If routine enquiry did not take place, why not? ___________________________________
_______________________________________________________________________
5) Did the woman disclose? (Please tick all that apply)
Current domestic abuse
Past domestic abuse
Other experiences of abuse?
No disclosure
6) If the woman did disclose what was the outcome of this? (e.g. referral to services, arranged follow up
appointment, service user declined further supports, service user declined to discuss further?)
_____________________________________________________________________________________
______________________ ________________________________________________
7) If the woman disclosed did you record this?
Yes
If yes where? ___________________________________________________________________
No
If no, why not? __________________________________________________________________
Please complete the monitoring data on the next page.
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REC Ref 10/S0709/30 Methods of Routine Enquiry – Domestic Abuse
Please tick the boxes most appropriate to the woman:
Ethnicity
White
Irish
Scottish
Any other white
British
Mixed
Any mixed background
Asian, Asian Scottish or Asian
Indian
British
Pakistani
Bangladeshi
Any other Asian background
Chinese
Black, Black Scottish or Black
Caribbean
British
African
Any other black
Other
Other Ethic background
Not known
Ethnicity not disclosed
Disabled
Yes
No
Age
16-19
20-29
30-39
40-49
50-59
60 – 65
65+
Thank you. Please place this form in one of the envelopes provided and leave at the collection point at
...........
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Appendix 8
Focus Group Guide – Workers in Study Sites
Introduction
Welcome and thanks for coming today.
The purpose of this focus group is to gather your views on using computer assisted routine enquiry.
Explain confidentiality in focus groups.
 General questions
How have you found using CARE?
How do you feel about using CARE with service users?
How does it compare to asking in person?
Did you still do face to face routine enquiry, even when woman had completed CARE?
How do you think patients found using the CARE programme?
Can you give examples of feedback?
 Disclosure
Did many women choose to print off their responses?
When responses were printed did they contain disclosures of abuse? If yes, how did you approach this?
Did you ask if there was anything the women wished to discuss when you returned to the room? Did
this lead to disclosure?
Do you think disclosures increased during the CARE study period?
Are you aware of domestic abuse through other sources e.g. referral letters? If so, how does this affect
your practice?
 Anonymity
Anonymity can be a barrier to disclosure of experiences of abuse.
Do you know the service users presenting here outwith the professional / service user relationship? (E.g
neighbours, friends, families.)
How do you feel about asking women you know about domestic abuse? (Has it / would it stop you from
asking?)
Do you think this could stop women disclosing?
Do you think that CARE addresses anonymity?
What (else) do you think could be done to address this?
In studies in the USA, workers are automatically informed of service user responses. What do you think
about that?
Does CARE address any other barriers to routine enquiry?
 Practicalities
Were there any technical difficulties using care?
How does CARE fit into routine assessments?
Did CARE make a difference to time taken to complete assessments?
 Other
Is there anything that we haven’t covered today that you would like to talk about?
Thank you for taking part.
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REC Ref 10/S0709/30 Methods of Routine Enquiry – Domestic Abuse