Intimate Partner Violence Screening Tools: Are They Valid for Rural Pregnant Women?

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Introduction: More than 324,000 women per year are identified as having experienced intimate partner violence (IPV) during pregnancy. Correctly identifying women experiencing all forms of IPV is necessary to inform the development and implementation of interventions to prevent and address IPV. The Abuse Assessment Screen (AAS) and Women Abuse Screening Tool (WAST) were designed to quickly identify violence against women, but clinical practice and research are hindered by the lack of validity date for these and other similar screening tools. The purpose of the current study was to compare and validate the brief AAS and WAST against the longer well-validated Revised Conflict Tactics Scale (CTS2) in a rural pregnant population. Methods: Participants in the Tennessee Intervention for Pregnant Smokers (TIPS) program (N=540) completed several questionnaires during a prenatal visit,including the AAS, WAST, and CTS2. The AAS questions: “within the last year have you been hit slapped or physically hurt by someone?” was used for physical violence comparison with the corresponding CTS2 subscale, and “within the last year has anyone forced you to have sexual activities” was used for sexual violence comparison with the corresponding CTS2 subscale. The WAST was compared to the CTS2 subscales using the two questions “has your partner ever abused you physically” and “has your partner ever abused you sexually?” In addition, a third comparison was made between the CTS2 psychological abuse subscale and the WAST question, “Has your partner ever abused you emotionally?” There are no questions on the AAS that specifically addresses psychological abuse to use for comparison to the WAST and CTS2. Results: Prevalence of any form of IPV, as indicated by answering “yes” to any of the IPV assessment questions, was 45% for the AAS, 74% for the WAST, and 80% for the CTS2. According to the CTS2 subscales, the prevalence of physical, sexual, and psychological violence within the last year was 21%, 19%, and 76% respectively. Taking the CTS2 results as standard, sensitivity on the AAS for physical violence was 35%, and for sexual violence was 2%. Sensitivity on the WAST for physical violence was 46%, for sexual violence was 1%, and for psychological violence was 29%. Conclusions and Implications: The WAST performed better at identifying cases of physical violence than the AAS, while the two screening tools performed similarly in identifying cases of sexual violence. However, neither IPV screen identified a large number of sexual violence victims. Because the WAST includes questions regarding psychological abuse in addition to physical and sexual abuse, the WAST captured more cases of any form of IPV compared to the AAS. These results suggest that the WAST should be used with caution as a stand-alone assessment of IPV, and that the AAS should not be used as a stand-alone assessment for physical or sexual violence in this pregnant population.


Johnson City, TN

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