An educational intervention study on mandatory reporting of intimate partner violence: changes in knowledge and attitudes among healthcare providers.

BACKGROUND: Intimate partner violence (IPV) is a major public health concern. Healthcare providers can play a crucial role in reporting cases of IPV or suspected IPV injuries to the police or the criminal justice system, commonly referred to as mandatory reporting. However, mandatory reporting of intimate partner violence (MR-IPV) is a debated topic that can pose complex challenges for healthcare providers. This underscores the importance of training programs to ensure that healthcare providers can fulfill their MR-IPV obligations. METHODS: We developed an educational intervention on MR-IPV and assessed its impact on healthcare providers' knowledge and attitudes. The study used a pre- and post-test design with three measurement points: baseline (T0), immediately after the intervention (T1), and six months later (T2). The intervention was conducted at a university college in Norway, with data collected between October 2022 and May 2023. The intervention was delivered to 37 healthcare providers who were currently part-time students in mental healthcare. Changes in knowledge and attitudes between T0 and T1, and T0 and T2 were analyzed through nonparametric tests on related samples using the Marginal homogeneity (Stuart-Maxwell) test. Risk differences (RD), along with their corresponding 95% confidence intervals (CI), were calculated for selected categories. RESULTS: The number of participants knowing the MR law increased from 2.9% at baseline to 62.9% at T1 (RD = 0.60, 95% CI: 0.41-0.79) and to 31.4% at T2 (RD = 0.29, 95% CI: 0.11-0.46). The number of participants reporting knowing relevant criteria increased from 0.0% at baseline to 68.6% at T1 (RD = 0.69, 95% CI: 0.50-0.87) and to 34.3% at T2 (RD = 0.34, 95% CI: 0.16-0.53). We observed several persistent changes in healthcare providers' attitudes towards MR, including finding MR to be a useful instrument and generally complying with MR requirements. CONCLUSIONS: The findings suggest that this educational intervention can have a positive impact on healthcare providers' attitudes and compliance with MR-IPV. Before the intervention, few participants reported knowing the MR law and its application criteria, demonstrating the importance of continuous learning and evidence-based training programs.

Prescription of potentially addictive medications after a multilevel community intervention in general practice.

OBJECTIVE: To evaluate the long-term effects of a multilevel community intervention to improve the quality of prescription practice of potentially addictive medications (PAMs). DESIGN: We conducted a retrospective study, using anonymized data from the Norwegian prescription registry. SETTING: Based on an initiative from the GPs in Molde Municipality in Norway, a multilevel community intervention was initiated by the municipal chief physician in 2018. The intervention targeted GPs, patients, and the public. SUBJECTS: We retrieved prescription data from 26 of 36 GPs. MAIN OUTCOME MEASURES: By using the standardized defined daily dose (DDD), we compared prescription of three groups of PAMs from before the intervention (2017) throughout the intervention in 2018, and through 2020 to determine long-term effects. RESULTS: Three years after the intervention, the GPs in our study sample prescribed 26% less opioids, 38% less benzodiazepines, and 16% less z-hypnotics. Overall prescription of PAMs decreased by 27%. The number of individuals receiving at least 90 DDD of benzodiazepines and z-hypnotics were reduced from 9 to 7 and 34 to 24 per 1000, respectively. Also, the number of individuals receiving two and three PAMs concomitantly were reduced. CONCLUSION: Addressing prescription practice among GPs in a community as a joint intervention, combined with addressing patients and the public may be a feasible method to obtain long-term reduction of PAM prescriptions.Key pointsNon-therapeutic prescriptions of potentially addictive medications (PAMs) are both a public health concern and a frequent challenge in general practice.A multilevel community intervention, targeting general practitioners, patients, and the public, led to 27% reduction in prescription of PAMs.Both the number of daily users and concomitant use of several PAMs were reduced.The reduction in prescription persisted for three years.

Training health care providers to administer VIA as a screening test for cervical cancer: a systematic review of essential training components.

BACKGROUND: Training health care providers to administer visual inspection after application of acetic acid (VIA) is paramount in improving cervical cancer screening services for women in low- and middle-income countries. The objective of this systematic review was to create a framework of essential VIA training components and provide illustrating examples of how VIA training programs can be carried out in different clinical settings. METHODS: A systematic review of PubMed, Embase, and Web of Science (from 2006 to 2021) was undertaken. Our inclusion criteria comprised articles reporting on implemented cervical cancer screening programs using VIA in a screen-and-treat approach. Trained health care providers with any level of health education were included, and the outcome of interest was the reporting of training components. Data were extracted by two reviewers, and a narrative synthesis of the training programs was performed. We developed a framework of seven essential training components and applied it to assess how training courses were conducted in different settings. RESULTS: 13 primary studies were eligible for inclusion, including 2,722 trained health care providers and 342,889 screened women. Most training courses lasted 5-7 days and included theoretical education, practical skill development, and competence assessment. It was unclear how visual aids and training in client counselling and quality assessment were integrated in the training courses. After the training course, nearly all the VIA training programs made provisions for on-job training at the providers' own clinical settings through supervision, feedback, and refresher training. CONCLUSIONS: This study demonstrates the feasibility of implementing international training recommendations for cervical cancer screening in real-world settings and provides valuable examples of training program implementation across various clinical settings. The diverse reporting practices of quality indicators in different studies hinder the establishment of direct links between these data and training program effectiveness. To enhance future reporting, authors should emphasize specific training components, delivery methods, and contextual factors. Standardized reporting of quality indicators for effective evaluation of VIA training programs is recommended, fostering comparability, facilitating research, and enhancing reporting quality in this field.

Does Women's Screening History Have Any Impact on Mammography Screening Attendance After Tailored Education?: A Systematic Review and Meta-analysis.

BACKGROUND: Many ethnic minority women have low attendance at breast cancer screening. OBJECTIVES: This brief report explores whether women's screening histories impact mammography screening attendance after tailored education. RESEARCH DESIGN: Systematic searches were conducted in 5 databases. Randomized controlled trials of educational interventions tailored to ethnic minority women that measured attendance at mammography screening were eligible for inclusion. Data extraction and risk of bias assessment were performed independently. Data were combined in a meta-analysis by using random effects models. Heterogeneity was estimated by using I2 statistics. RESULTS: Six studies with 3521 women were eligible for inclusion. The D+L pooled risk ratio (RR) for mammography attendance for never screened participants was 1.54 (95% confidence interval, 1.24-1.91; P<0.001), with low heterogeneity (I2=27.1%, P=0.231). The D+L pooled risk ratio for attendance for ever screened participants was 1.26 (95% confidence interval, 1.11-1.43; P<0.001), with low heterogeneity (I2=35.5%, P=0.213). CONCLUSIONS: Tailored education increased attendance at mammography by 54% among never screened women and 26% among ever screened women. Although these findings must be interpreted with caution, the findings suggest that women's screening history is an important and ignored variable that affects how effective tailored education is on mammography screening attendance.

Approaching religious fatalism in cancer screening education.

RATIONALE: Religious fatalism has for decades been pointed out as a barrier to cancer screening attendance and several studies suggest interventions to decrease fatalism, given its negative impact on the uptake of cancer screening. AIMS AND OBJECTIVES: Our objective in this interdisciplinary exploration on religious fatalism in the context of cancer screening is to contribute to the increasing academic discussion on religious fatalism and cancer screening as well as the broader context of the intersection of religion and bioethics. METHOD: Through an analysis of religious fatalism in light of the notion of rationality and images of God, we find resources and suggest trajectories for a more seriously and constructively approach to religious fatalism in cancer education. RESULTS AND CONCLUSION: Our main thesis is that interventions do not necessarily have to decrease religious fatalism to increase screening.

Effect of culturally tailored education on attendance at mammography and the Papanicolaou test.

OBJECTIVES: To determine the effectiveness of culturally tailored education on attendance at breast and cervical cancer screening among ethnic minority women. DATA SOURCES: Systematic database searches in Ovid MEDLINE, ProQuest, PubMed, PsycINFO, and Cochrane CENTRAL. STUDY DESIGN: Randomized controlled trials (RCTs) of culturally tailored educational interventions to ethnic minority women in Western countries were investigated for a meta-analysis. RCTs that assessed attendance at mammography or the Papanicolaou test (Pap test) were eligible for inclusion. DATA COLLECTION METHODS: Study characteristics and results were extracted separately. Independent raters assessed risk of bias by using Cochrane Collaboration's tool. PRINCIPAL FINDINGS: Seven RCTs (n = 4246) were included in the meta-analysis of mammography attendance, and four RCTs (n = 1750) were included in the meta-analysis of Pap test attendance. The effect of culturally tailored educational interventions on attendance at mammography was an increase of 18 percent (RR = 1.18, 95% CI, 1.09-1.28, P < .001), with low heterogeneity (I2  = 30.0, P = .237), and a 54 percent increase at the Pap test (RR = 1.54, 95% CI, 1.14-2.09, P = .005), with substantial heterogeneity (I2  = 75.9%, P = .001). CONCLUSIONS: Interpreted within the limitations set by the low number of studies and substantial heterogeneity for the Pap test, findings from the current meta-analyses indicate that culturally tailored educational interventions may increase attendance of ethnic minority women at breast and cervical cancer screenings. There is a need for more studies, in particular RCTs conducted outside the United States, to determine if such findings are similar in other countries.