Barriers and Facilitators to Screening for Anxiety and Intimate Partner Violence

Article Figures & Data

Table 1.

Clinic and Participant Characteristics

Clinic type	n = 12
Health system	7
Independent	2
FQHC or RHC*	3
Clinic specialty
Family medicine	11
Other, mixed practice	1
Clinic location
Rural	8
Urban	4
Participant role	n = 27
Primary care clinician	7
Medical director	3
Behavioral health consultant/social worker	5
Medical assistant	2
Administrative staff/practice manager	5
Quality/compliance manager	3
Other	2

Abbreviations: FQHC, federally qualified health center; RHC, rural health center.
*Included in the total number of clinics.

Table 2.

Selection of Structured Interview Questions for Primary Care Clinicians and Staff (n = 27 Participant Interviews)

I will ask you to tell me a little bit about yourself and your thoughts and experiences with screening women and adolescent female patients for IPV and anxiety
Can you discuss how your clinic is involved in screening for IPV?*
Do you have standing protocols available to guide IPV screening in your clinic?*
Outside of your standing protocols, what symptoms in a patient or family would prompt you to screen for IPV?*
Can you walk me through how you document a screening for IPV in your EHR?*
Who else is involved in the screening or documentation? (prompts: MA, behavioral health, social worker, PCP)
What happens at the clinic if a patient screens positive? Who / which roles are involved?
Do you have any concerns about universal screening for IPV?*
What are facilitators and barriers to adopting a new screening tool?
What are your clinics protocols for establishing new screening tools?
How do you typically learn about new guidelines and recommendations? What about changes to existing guidelines and recommendations?
Do have any final thoughts or suggestions for improving the screening of women patients for IPV and/or anxiety?

*A parallel question format was used for anxiety screening, in place of IPV as above.
Abbreviations: EHR, electronic health record; IPV, intimate partner violence; MA, medical assistant; PCP, primary care physician.

Table 3.

Rapid Qualitative Analysis Matrix Domains

Participant Information	Anxiety Screening	IPV Screening
ID #	Clinic	Clinic
Role	ID	ID
Age	Role	Role
Gender	Description of clinic	Description of clinic
Race/Ethnicity	Are there standing protocols for anxiety	Are there standing protocols for IPV
Years at current practice	Anxiety Tool(s) used	IPV Tool(s) used
Years in profession	Anxiety Protocol and Workflow	IPV Protocol and Workflow
	Realities on the ground	Realities on the ground
	Symptoms that would trigger further questions	Symptoms that would trigger further questions
	Training	Training
	Documenting	Documenting
	What happens when someone screens positive?	What happens when someone screens positive?
	Telehealth piece	Telehealth piece
	Barriers	Barriers
	Facilitators	Facilitators
	Protocols for implementing new procedures
	How do you stay up-to-date?

Table 4.

Summary of Screening Barriers and Facilitators

Barriers	Facilitators
Both IPV and Anxiety: Screening fatigue No required health maintenance metric	Both IPV and Anxiety: Leveraging existing screening practices Built-in EHR screening tools Universal screening of all adult populations
Primarily IPV: Documentation and reporting Highly sensitive topic Low prevalence in daily practice Inadequate follow-up and resources	Primarily IPV Special training for sensitive topics Clear protocols for follow-up
	Primarily Anxiety: Increasing prevalence means increased awareness of need to screen Age- appropriate tool for adolescents