title: Domestic violence is a leading risk factor in default from colposcopy services.
abstract: OBJECTIVE
  Domestic violence is common in women and is associated with poorer health-care outcomes. However, no causal pathway has been identified to explain this observation. We have followed a cohort of women to determine whether poorer outcomes can be explained by high rates of default and loss to follow-up.
  
  
  METHODS
  A prospective cohort study was performed. Institutional ethics approval was obtained. Participants were consecutive patients attending colposcopy clinics at a major metropolitan hospital in Australia. Following ascertainment of domestic violence status, appointment outcomes for colposcopy services were tracked for a 3-year period. Multivariate analysis was undertaken to determine demographic factors associated with default from care and loss to follow-up.
  
  
  RESULTS
  Of 581 women approached, consent was obtained from 574 women (99%). Domestic violence status was obtained from 566 women, of whom 187 (33%) had a recent history of exposure. Women exposed to violence were more likely to default from colposcopy once (26.2% vs 7.4%; P < 0.0001), twice (11.2% vs 3.2%, P = 0.0001), or thrice (10.7% vs 2.4%, P < 0.0001). They were more likely to be lost to follow-up (8.0% vs 1.1%, P < 0.0001). In multivariate analysis, exposure to domestic violence remained significantly associated with default and loss to follow-up.
  
  
  CONCLUSIONS
  Domestic violence is a risk factor for default from attendance and loss to follow-up at colposcopy services. This may explain the mechanism behind adverse health-care outcomes seen. Screening and targeted appointment intervention programs may improve clinical compliance.
authors.affiliation: Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia.
authors.forename: Rachael
authors.initials: R
authors.lastname: Collier
authors.forename: Julie A
authors.initials: JA
authors.lastname: Quinlivan
mesh_terms: D000328:Adult; D003127:Colposcopy; D017579:Domestic Violence; D005260:Female; D006801:Humans; D059012:Lost to Follow-Up; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
keywords: colposcopy; default; domestic violence; loss to follow-up; non-compliance