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Domestic violence is a leading risk factor in default from colposcopy services
Author(s) -
Collier Rachael,
Quinlivan Julie A.
Publication year - 2014
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.12413
Subject(s) - medicine , domestic violence , colposcopy , multivariate analysis , cohort , demography , cohort study , poison control , obstetrics , injury prevention , gynecology , environmental health , cancer , cervical cancer , sociology
Aim Domestic violence is common in women and is associated with poorer health‐care outcomes. However, no causal pathway has been identified to explain this observation. We have followed a cohort of women to determine whether poorer outcomes can be explained by high rates of default and loss to follow‐up. Material and Methods A prospective cohort study was performed. Institutional ethics approval was obtained. Participants were consecutive patients attending colposcopy clinics at a major metropolitan hospital in A ustralia. Following ascertainment of domestic violence status, appointment outcomes for colposcopy services were tracked for a 3‐year period. Multivariate analysis was undertaken to determine demographic factors associated with default from care and loss to follow‐up. Results Of 581 women approached, consent was obtained from 574 women (99%). Domestic violence status was obtained from 566 women, of whom 187 (33%) had a recent history of exposure. Women exposed to violence were more likely to default from colposcopy once (26.2% vs 7.4%; P < 0.0001), twice (11.2% vs 3.2%, P = 0.0001), or thrice (10.7% vs 2.4%, P < 0.0001). They were more likely to be lost to follow‐up (8.0% vs 1.1%, P < 0.0001). In multivariate analysis, exposure to domestic violence remained significantly associated with default and loss to follow‐up. Conclusion Domestic violence is a risk factor for default from attendance and loss to follow‐up at colposcopy services. This may explain the mechanism behind adverse health‐care outcomes seen. Screening and targeted appointment intervention programs may improve clinical compliance.