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Domestic violence : a tool to increase screening by 76%

25th Nov 2023

This project was carried out as part of the framework agreement with the French Interministerial Directorate for Government Transformation (DITP). We collaborated with their behavioural sciences unit following a solicitation from the French National Authority for Health (HAS).

Sexual assault and domestic violence represent a greater risk to women’s health than cancer, road accidents and malaria combined. Yet doctors find it hard to broach the subject during consultations. How can we encourage them to change their practices to help identify women who are victims of violence?

Doctors: key contacts for women

In 2020, the French National Authority for Health (HAS) published a recommendation to encourage GPs to systematically question new female patients to find out if they are experiencing violence. In fact, women are more inclined to disclose situations of violence if the subject is broached by their doctor, but only a minority of doctors question their patients. We were asked by the HAS to propose solutions to this challenge, and to encourage doctors to speak up if they see signs that their patient may be a victim of violence.

Creating tools to motivate and support doctors in screening and detecting signs of violence

The BIT, HAS and the French Interministerial Directorate for Government Transformation (DITP) have developed two solutions to better inform and equip doctors: a screening tool and a patient questionnaire. 

A simple, attractive and actionable summary

We have summarized nearly 200 pages of information from HAS recommendations into a single page that answers the questions doctors are asking, namely: 

  1. Why screen? This section contains relevant figures for doctors, and helps to correct preconceived ideas about the low prevalence of domestic violence;
  1. When and how to screen? This section contains examples of questions to ask, and reassures doctors that screening is seen as acceptable and even desirable by most women;
  2. What should be done in the event of violence and what support should be offered? This section clearly summarizes how doctors should react and to which specialists they can refer the patient.

Click here to download the summary. 

A questionnaire to normalise the subject

The patient can fill in the questionnaire privately before the consultation and return it to her doctor, who can then quickly identify whether or not she may be experiencing violence and need assistance. It contains a summary of emergency and helpline numbers for female victims. 

Click here to download the questionnaire.

76% increase in screenings thanks to these tools

To carry out this study, we recruited 1,153 GPs via an email campaign sent out by the French National Health Insurance Fund (CNAM).

This large sample size enabled us to rigorously evaluate the solutions through a randomized controlled trial. Half of the doctors participating in the study received our solutions, while the other half received nothing (control group).

Our statistical analyses show that the solutions sent to the doctors have worked, and that they have increased the number of screenings carried out by 76%. This means that doctors who received the solutions questioned two more women per week than those who didn’t receive screening guidance (an average of 4.4 patients versus 2.5 patients for doctors in the control group). 

Number of patients screened for domestic violence during the last week

Not yet a habit

This is a significant and encouraging increase, but the results show that doctors only ask a minority of patients about domestic violence, and that screening is therefore not systematic. There are still many obstacles to be overcome if we are to make screening an automatic habit, even among existing regular patients (and not only among new patients). 

Following the success of the experiment, the HAS has collaborated with the CNAM to send this tool to all general practitioners in France. We hope that this tool will help to lift the taboo surrounding domestic violence and enable women to obtain appropriate support to put an end to the abuse. 

To find out more about the results of the experiment and what worked (and what didn’t), download the evaluation report from the DITP website or contact us!