Screening for intimate partner violence in healthcare in Kano, Nigeria : barriers and challenges for healthcare professionals

Background: Though there has been increased advocacy for screening for Intimate partner violence (IPV) in healthcare over the past decades, data from developed country context suggest that only one in ten healthcare providers routinely screen for this phenomena suggesting barriers. Knowledge on the screening activity, with regard to IPV, and related barriers among healthcare providers in Sub-Saharan Africa is lacking. Aims: The aim of this dissertation is to scrutinize provider-related as well as client related barriers to screening for Intimate Partner Violence in healthcare in the Sub-Saharan African context, using data from healthcare facility in Kano, Northern Nigeria. Methods: The cross-sectional studies were based on three questionnaires assessing readiness to screen and screening activity, satisfaction with care and preferences for screening among patients. Domestic Violence Health Care Provider Survey Scale was utilised to measure healthcare providers readiness to screen for IPV as well as actual screening activity (Study I-III).Structured interviews were conducted with women attending the General Out-patient department, maternal and child health clinics of the participating hospital to probe their preference for screening and their satisfaction with care using the pyramid patient questionnaire (Study IV). Data were analysed using relevant univariate and multivariate statistical methods. Results: The instruments utilised illustrated a stable structural validity (study I) and internal consistency (Studies I, II, III & IV). Barriers to screening were eminent both from the provider and the client perspective. Majority of Health Care Provider (HCP) did not inquire about the possibility/occurrence of IPV from their clients (74%) and scored on average moderately on readiness to screen indicator (i.e. self-efficacy, system support, attitudes towards screening, professional roles and victim/provider safety subscales) suggesting barriers (Study III). Readiness to screen for IPV as well as screening for IPV was associated with several demographic and occupational characteristics of the healthcare provider (Study II). Social workers perceived a higher self-efficacy and a better support network to refer victims of violence than other professions. Gender and profession were significantly associated with blaming the victim with males and doctors less likely to blame the victim. Age, ethnicity and profession impacted significantly on professional roles related to