Literature Collection

BACKGROUND: Women veterans, compared to civilian women, are especially at risk of experiencing intimate partner violence (IPV), pointing to the critical need for IPV screening and intervention in the Veterans Health Administration (VHA). However, implementing paper-based IPV screening and intervention in the VHA has revealed substantial barriers, including health care providers' inadequate IPV training, competing demands, time constraints, and discomfort addressing IPV and making decisions about the appropriate type or level of intervention. OBJECTIVE: This study aimed to address IPV screening implementation barriers and hence developed and tested a novel IPV clinical decision support (CDS) tool for physicians in the Women's Health Clinic (WHC), a primary care clinic within the Veterans Affairs Palo Alto Health Care System. This tool provides intelligent, evidence-based, step-by-step guidance on how to conduct IPV screening and intervention. METHODS: Informed by existing CDS development frameworks, developing the IPV CDS tool prototype involved six steps: (1) identifying the scope of the tool, (2) identifying IPV screening and intervention content, (3) incorporating IPV-related VHA and clinic resources, (4) identifying the tool's components, (5) designing the tool, and (6) conducting initial tool revisions. We obtained preliminary physician feedback on user experience and clinical utility of the CDS tool via the System Usability Scale (SUS) and semistructured interviews with 6 WHC physicians. SUS scores were examined using descriptive statistics. Interviews were analyzed using rapid qualitative analysis to extract actionable feedback to inform design updates and improvements. RESULTS: This study includes a detailed description of the IPV CDS tool. Findings indicated that the tool was generally well received by physicians, who indicated good tool usability (SUS score: mean 77.5, SD 12.75). They found the tool clinically useful, needed in their practice, and feasible to implement in primary care. They emphasized that it increased their confidence in managing patients reporting IPV but expressed concerns regarding its length, workflow integration, flexibility, and specificity of information. Several physicians, for example, found the tool too time consuming when encountering patients at high risk; they suggested multiple uses of the tool (eg, an educational tool for less-experienced health care providers and a checklist for more-experienced health care providers) and including more detailed information (eg, a list of local shelters). CONCLUSIONS: Physician feedback on the IPV CDS tool is encouraging and will be used to improve the tool. This study offers an example of an IPV CDS tool that clinics can adapt to potentially enhance the quality and efficiency of their IPV screening and intervention process. Additional research is needed to determine the tool's clinical utility in improving IPV screening and intervention rates and patient outcomes (eg, increased patient safety, reduced IPV risk, and increased referrals to mental health treatment).

INTRODUCTION: The MELD-B project is a multidisciplinary research consortium with one of its aims focused on identifying childhood targets for the prevention of multiple long-term conditions (MLTCs). Drawing upon the expertise of policy and practice stakeholders can inform research questions, data analysis, and contribute to meaningful and practical outputs. In pursuit of this collaborative approach, a stakeholder workshop, co-designed with people with lived experience, was conducted to inform the next steps of the early prevention workstream of the MELD-B project. METHODS: The research team worked with four public contributors to co-design the workshop in terms of its aims and structure. This involved utilising a project-specific animation and developing an imaginary persona to illustrate the life-course concepts of MLTCs, with an emphasis on how early life factors can influence outcomes later in life. Stakeholders were divided into three groups, each with a mix of professions and facilitated by two team members. Jamboard (an online interactive whiteboard) was used to collate ideas, and overarching themes were identified. A poll was administered at the end of the workshop giving choices to prioritise time points for interventions. RESULTS: 25 stakeholders with policy and practice expertise of childhood attended the workshop. Stakeholders were from backgrounds including integrated care boards (n = 5), healthcare practitioners (n = 3), academics (n = 4), council employees (n = 9) and not-for-profit organisations (n = 4). The workshop aimed to identify critical time points and targets in the early life-course for feasible and practical interventions to prevent or delay MLTCs. Themes discussed included: mental health, educational attainment, early identification of health conditions and neurodiversity, nutritional choices, transitional periods, the virtual world, and intermediate outcomes on the pathway to future ill health. Stakeholders suggested that family-targeted interventions were important to prioritise in early childhood; however, at secondary school age individual-focused interventions may become more significant. A poll identified birth and ages 5-7 and 10-11 as the most important time points for interventions. CONCLUSIONS: People with lived experience should have central roles in shaping research questions, prioritising problems and engaging with stakeholders. Our workshop identified priority themes to inform prevention interventions using routinely collected and national cohort data. PATIENT OR PUBLIC CONTRIBUTION: The research team worked with four public contributors to co-design the workshop in terms of its aims and structure. Public contributions helped to identify stakeholders to invite to the workshop and co-produced PowerPoint slides to guide the workshop. In addition, the workshop utilised a co-produced project-specific animation and imaginary persona to help frame our research. Public contributors attended the workshop and helped to facilitate discussions by providing their own lived experience. Following the workshop, public contributors reviewed the themes identified by the research team from the discussions within the workshop. Finally, public contributors have also been involved in dissemination of the findings from this study, including this paper. Two of the public contributors are named co-authors on this paper, and two did not wish to be named as co-authors.