Question

 

The healthcare providers at the Glenville County Health Department pregnancy clinic have been using the same survey to screen patients for risk of family violence for several years. Only a small percentage of the women who take the survey obtain a score that would indicate that they are at risk for family violence. However, during the course of prenatal visits, when healthcare providers inquire if the women feel safe at home, it is not uncommon for women to disclose living with fear of violence. Because the survey results do not appear to be accurate, the clinic administrators decided it was time for a change. With a limited budget, the administrators decided to conduct an evaluation. A team of four staff members was formed and led by Michael Williams, PhD, MPH, Director of Quality Management for Glenville County Health Department. Fortunately, Dr. Williams has a background in public health and evaluation methods. Let's review the steps used by the team.

Complete the following case questions.

1. This case assumes the original family-violence survey was not very reliable or valid. What may other reasons that women were disclosing fear of violence to their health care providers but not on the survey?

2. How would you begin to modify the survey questions now that they have been used for a while in the clinic?

3. When the team started looking at questions in the original survey, they felt they reflected issues of neighborhood and community safety rather than interpersonal violence. Do you think that this information is still valuable? How so? What would you do with the information gathered from these old surveys?

4. What are some of the threats to internal validity that need to be considered? List each threat and decide why and how it needs to be considered. Internal validity threats include: History Maturation Testing Instrumentation Statistical regression to the mean Selection Mortality Diffusion of treatment Compensatory equalization or rivalry Resentful demoralization Interactions with selection ( history, instrumentation, differential attrition)

 

Answer 1

Question 1. Women were disclosing fear to health care providers but not during the survey may be due to the following issues:

(a)They thought the surveys have lesser credibility while compared to prenatal checkups.

(b) They questions asked by health care providers might have seemed to be more assuring as they know these are health care providers who are trying to solve the issues they have got while surveys are just some data collection by some random individuals.

(c) The women in the prenatal period may have felt more vulnerable compared to when they were not pregnant.

(d) May be they were not comfortable enough to report there issues in surveys due to it's sexual factors(like sexual abuse) which may have felt easireto discuss with health care providers.

(e) Women finds it important to address every issues for the sake of their children in their womb.

2. Modify the survey questions in a way that will help the women in understanding the importance of ever questions asked, and how these questions would help them and their family and why these questions are vital in such surveys. And also make the question a lot easier to be expressed by the survey in a way that it reaches clearly and neatly as it is to the subject. Make the questions a lot more personal than general. As questions in the surveys were used for a while, address the issues with those questions to begin with and make the people working behind the surveys and also the subject about how these new changes could bring the essence of more success in the survey.

3. Yes they are valuable. Issues of neighborhood and community gives us a blunt idea about how each family unit in the community or neighborhood works and about the problems each family may be facong. Community problems mostly influences the families in those communities. It also gives an idea of the environment where new kids are going to grow up and about possible threats they are going to face in their childhood. And also about the safety of a women in that society and about the helping hands she may be receiving in time of difficulty. It also helps in understanding about any potential negative effect on the mental health of the women by the community or neighborhood.

5. Yes, the survey need to be re-validated so as to include every person above 18 years to be included in the survey because it will give us a more detail oriented view of the problems faced by the women and individuals in the family. And also if the woman tends to hide their opinions or facts about violence due to any aforementioned reasons in the first question, the truth or actual problems can be deduced from the opinions or answers of the other members of the house. And also famiy violence is something that can have a negative impact on any member and each member will have unique experiences which needs to be addressed and helped.