title: Secondary prevention of intimate partner violence: a randomized controlled trial.
abstract: BACKGROUND
  Despite the recognition of intimate partner violence (IPV) against women as a global health issue associated with significant morbidity and mortality, evidence-based treatment strategies for primary care settings are lacking.
  
  
  OBJECTIVE
  To assess the comparative safety behaviors, use of community resources, and extent of violence following two levels of intervention.
  
  
  METHODS
  A randomized, two-arm, clinical trial was completed in urban public primary care clinics with 360 abused women who assessed positive for physical or sexual abuse within the preceding 12 months. Two interventions were tested: a wallet-sized referral card and a 20-minute nurse case management protocol. Outcome measures were differences in the number of threats of abuse, assaults, danger risks for homicide, events of work harassment, safety behaviors adopted, and use of community resources between intervention groups over a 24-month period.
  
  
  RESULTS
  Two years following treatment, both treatment groups of women reported significantly (p <.001) fewer threats of abuse (M = 14.5; 95% CI 12.6, 16.4), assaults (M = 15.5, 95% CI 13.5, 17.4), danger risks for homicide (M = 2.6; 95% CI 2.1, 3.0), and events of work harassment (M = 2.7; 95% CI 2.3, 3.1), but there were no significant differences between groups. Compared to baseline, both groups of women adopted significantly (p <.001) more safety behaviors by 24 months (M = 2.0; 95% CI 1.6, 2.3); however, community resource use declined significantly (p <.001) for both groups (M = -0.2; 95% CI -0.4,-0.2). There were no significant differences between groups.
  
  
  CONCLUSIONS
  Disclosure of abuse, such as what happens with abuse assessment, was associated with the same reduction in violence and increase in safety behaviors as a nurse case management intervention. Simple assessment for abuse and offering of referrals has the potential to interrupt and prevent recurrence of IPV and associated trauma.
authors.affiliation: Texas Woman's University, College of Nursing, Houston, TX 77030, USA. jmcfarlane@twu.edu
authors.forename: Judith M
authors.initials: JM
authors.lastname: McFarlane
authors.forename: Janet Y
authors.initials: JY
authors.lastname: Groff
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: O'Brien
authors.forename: Kathy
authors.initials: K
authors.lastname: Watson
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration; D001294:Attitude to Health; D018585:Battered Women / Q000193:education / Q000523:psychology; D019090:Case Management / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration; D024802:Nurse's Role; D009730:Nursing Assessment / Q000458:organization & administration; D015403:Nursing Evaluation Research; D010353:Patient Education as Topic / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration; D015397:Program Evaluation; D012017:Referral and Consultation / Q000458:organization & administration*; D017751:Safety Management; D012648:Self Care / Q000379:methods / Q000523:psychology; D012944:Social Support; D013179:Spouse Abuse / Q000175:diagnosis / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D019037:Urban Health Services / Q000458:organization & administration