Evaluating the effectiveness of a mobile application to improve the quality, collection, and usability of forensic documentation of sexual violence.

BACKGROUND: Survivors of sexual violence deserve timely and high-quality forensic examination, evidence collection, and documentation as part of comprehensive care. However, in many countries, the quality of medical-legal documentation is severely limited. MediCapt is an innovative digital application that enables clinicians to document forensic medical evidence as well as capture and securely store forensic photographs of injuries. This study evaluated the effectiveness and usability of MediCapt to document forensic medical evidence of sexual violence. METHODS: This mixed-methods evaluation involved key-informant interviews, usability questionnaires, and forensic record reviews. Participants included clinicians, medical records personnel, information technology personnel, and health facility administrators, as well as law enforcement and legal professionals in Kenya. RESULTS: The Physicians for Human Rights (PHR) data quality checklist found that using MediCapt led to significantly higher data-quality scores compared to paper-based forms. MediCapt forms scored higher on 23 of 26 checklist items. While a wide difference in quality was seen among paper-based forms, MediCapt appeared to both standardize and improve quality of documentation across sites. MediCapt strengths included data security and confidentiality, accuracy and efficiency, and supplemental documentation with photography. Weaknesses included infrastructure challenges, required technological proficiencies, and time to learn the new system. Although it is early to assess the impact of MediCapt on prosecutions, providers and law and justice sector professionals were optimistic about its usefulness. They identified MediCapt as appropriate for use with survivors of sexual violence and reported MediCapt's legibility and photography features had already been commended by the court. CONCLUSION: MediCapt was well-received across all sectors, its use was perceived as feasible and sustainable, and it significantly improved the quality of collected forensic data. It is anticipated this improvement in forensic documentation will increase successful prosecutions, strengthen accountability for perpetrators, and improve justice for survivors.

Development and validation of a data quality index for forensic documentation of sexual and gender-based violence in Kenya.

INTRODUCTION: High-quality forensic documentation can improve justice outcomes for survivors of sexual and gender-based violence, but there are limited tools to assess documentation data quality. This study aimed to develop and validate a data quality assessment index to objectively assess clinician documentation across the 26 key elements of the standardized forensic evidence forms used in Kenya. METHODS: Informed by prior quality assessment tools, an initial draft of the index was developed. Feedback from Kenya- and U.S.-based clinicians and human rights experts was solicited and incorporated into the draft index in an iterative fashion. Two raters independently employed the finalized Physicians for Human Rights Data Quality Index to assess and score the quality of documentation across 31 clinician-completed forms. Inter-rater reliability was determined using Cohen kappa (к) coefficients. RESULTS: The Index was found to have substantial overall reliability. Of the 26 documentation items, the Index had a perfect (к = 1.0) and almost perfect (к = 0.81-0.99) level of inter-rater agreement across 17 (65.4%) and 5 (19.2%) items, respectively. On a low-to-high documentation quality scale of 0 to 2, the majority of items (n = 19, 73.1%) had a mean documentation quality score >1.5-2. CONCLUSION: Quality assurance of forensic documentation is an essential component of post-sexual assault care. To our knowledge, this is the first validated quality-assessment tool in the peer-reviewed literature for sexual assault documentation and may be a promising strategy to enhance the quality of sexual assault documentation in other settings, locally, regionally, and internationally.