Introducing domestic violence assessment in a postpartum clinical setting.

OBJECTIVES: Attempts to introduce assessment for exposure to domestic violence in health care settings have met with limited success, in spite of widespread knowledge of the prevalence of spousal abuse and its implications for women's health. We assessed the utility of Rogers' model of institutional change for the implementation of a universal screening program for domestic violence in postpartum clinical settings. METHODS: We adapted Rogers' innovation-diffusion model to develop and implement a protocol for domestic violence assessment among 300 nurses working in two hospitals that together provide obstetrical care to the City of Vancouver, British Columbia, Canada. Our education sessions introduced new knowledge and addressed attitudes and beliefs. They were followed by "hands-on" demonstration and supervision of assessments. Our "Let's Talk" visual aids program added visibility to our initiative and provided cues as to how to undertake screening and response. Screening rates were monitored along with a process evaluation based on anecdotal reporting by nursing staff. RESULTS: Following the initiation of educational sessions and supervision of assessment, the screening rate was 42%. Within 6 months, the screening rate had climbed to 60% and was sustained at that level. Major barriers to screening include difficulty in finding the opportunity to screen in privacy and overcoming language barriers. CONCLUSIONS: Application of Rogers' principles of diffusion of innovation in the implementation of a universal program for a domestic violence in two obstetrical care settings resulted in a screening rate of 60% which has been sustained for the first 18 months of the program.