title: Assessing for violence during pregnancy using a systematic approach.
abstract: OBJECTIVE
  The purpose of this study was to determine whether a systematic, multiple assessment protocol could increase reporting of prenatal violence compared with a one-time routine assessment.
  
  
  METHODS
  In 1994, the Maternity Care Coordination (MCC) program in a health department prenatal clinic in North Carolina implemented a concise, systematic assessment protocol on all 384 women who enrolled in the program from April 1994 to April 1995. The protocol assessed for violence at three times during pregnancy using the direct question, "Have you been hit, slapped, kicked, or hurt during this pregnancy?" To determine the effectiveness of the system, we retrospectively examined the 1991-1993 MCC records (n = 1056) in which the care coordinators routinely screened all clients for violence at their first visit only.
  
  
  RESULTS
  Compared with the routine assessment approach, the new systematic assessment protocol increased reporting of prenatal violence at the initial prenatal visit from 6.3% to 10.9% (relative risk = 1.7, 95% confidence interval = 1.2, 2.5), and the multiple assessments increased reporting of prenatal violence to 14.1% (relative risk = 2.2, 95% confidence interval = 1.6, 3.1).
  
  
  CONCLUSIONS
  Our study suggests that a concise and systematic screening technique using direct questions combined with multiple assessments increased reporting of prenatal violence compared with a single routine assessment.
authors.affiliation: Coastal Area Health Education Center, Wilmington, North Carolina 28402-9025, USA. covi@med.unc.edu
authors.forename: D L
authors.initials: DL
authors.lastname: Covington
authors.forename: S J
authors.initials: SJ
authors.lastname: Diehl
authors.forename: B D
authors.initials: BD
authors.lastname: Wright
authors.forename: M
authors.initials: M
authors.lastname: Piner
mesh_terms: D016001:Confidence Intervals; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008429:Maternal Welfare; D015999:Multivariate Analysis; D009657:North Carolina / Q000453:epidemiology; D011159:Population Surveillance; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000517:prevention & control; D012307:Risk Factors; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D013179:Spouse Abuse / Q000517:prevention & control* / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology / Q000517:prevention & control