Testing the woman abuse screening tool in primary health centers in Jakarta, Indonesia

Abstract

Intimate Partner Violence (IPV) is a common occurrence that poses health risks to individuals, especially women, and to families and communities. The Indonesian National Commission on Violence Against Women compile annual reports on reported violence against women, yielding an estimated prevalence of 1%. However, based on IPV studies in other parts of the world, it was hypothesized that IPV is underreported in Indonesia. IPV can be detected through self-administered screening tools or questions posed by primary health providers. However to date, screening has not been implemented in Primary Health Centers (PHC) in Indonesia. The first study involved 240 female patients in two PHC in South Jakarta in a cross-sectional survey to estimate IPV prevalence. We tested the eight-item (24-point) Woman Abuse Screening Tool (WAST) against an in-person diagnostic interview by a trained psychologist following the Domestic Violence Initiative Screening (DVIS) Interview Guide (the gold standard). Although the psychologist interview is the gold standard (yielding an IPV prevalence of 36.25%), it is expensive to use as a screening tool. The WAST proved reliable and valid, using a cutoff score of 10, which would identify most of the IPV cases. The second study gathered qualitative data to gauge the acceptability of the WAST compared to the psychologist interview guided by the DVIS and to gauge method of screening preference of the 240 research participants. Both the WAST and the psychologist interviews were accepted by research participants. Although the preferred method of screening was the psychologist interview, 91% of the women said they would not mind being screened with the WAST on an annual basis. The third study included key informant interviews of PHC heads in the five municipalities of Jakarta on their perceptions of supports and barriers of screening at the PHC level. The majority of PHC heads who agreed to be interviewed were willing to screen for IPV at their PHC, especially if they had screening tools and training, and knew where to refer women for assistance. Combined research findings from the three studies provide support for the institutionalization of routine screening for IPV in Indonesian PHCs.