Awareness,Knowledge,and Screening for Intimate Partner Violence Among Orthopedic Surgeons in Israel

Abstract

This study examines factors associated with screening of female patients for intimate partner violence (IPV) by orthosurgeons in a sample of 100 Israeli orthosurgeons. Findings reveal positive attitudes toward screening female patients but a significant lack of knowledge. Arab orthosurgeons held slightly more negative attitudes toward screening for IPV and had a more prominent lack of knowledge regarding screening for IPV, compared to their Jewish counterparts. Nationality and feeling uncomfortable asking female patients about IPV predicted screening for IPV. The importance of training orthosurgeons on the assessment and treatment of IPV cannot be overemphasized, especially among Arab orthosurgeons.

Keywords

screening intimate partner violence orthopedic surgeons Israel

Introduction

Violence is an act carried out with the intention of harming another person or an act that is perceived as such (Procentese et al., 2020). Intimate partner violence (IPV) is one of the most common forms of violence against women. IPV refers to any behavior within an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship. This includes acts of physical and sexual violence, psychological abuse, and controlling behaviors including isolating a person from family and friends, monitoring their movements, and restricting access to financial resources, employment, education, or medical care (World Health Organization, 2012).

IPV has far-reaching negative consequences for women's physical and mental health. Women subjected to IPV complain more about poor health and take more days of sick leave. IPV is also associated with mental problems including depression, anxiety, phobias, posttraumatic stress disorder, suicide, and substance abuse (Kapiga et al., 2017).

IPV is a multifaceted problem across cultures, religions, socioeconomic statuses, and levels of education (World Health Organization, 2012). According to data provided by the United Nations, 243 million women and girls aged 15–49 years have been subjected to sexual and/or physical violence perpetrated by an intimate partner in the previous 12 months, or one-in-three women have experienced such violence at some point in their lives (Deuba et al., 2016). There are no exact data on the extent of IPV in Israel, but the common assumption is that the number of women subjected to IPV is much higher than the number of cases reported to the police, since most women avoid filing a complaint for various reasons. According to data provided by the Israel Police Statistical Abstract for the year 2018, in that year about 18,100 files were opened for physical violence offenses and threats between spouses, of which about 13,000 cases were opened for physical violence offenses between spouses, mostly against women (Avgar, 2019).

Women who are subjected to physical violence and who are injured most often sustain muscle and skeletal injuries. These injuries require referral to an orthopedic surgeon (hereafter “orthosurgeon”). Skeletal injuries, often seen by orthosurgeons, are the second most common manifestation of IPV. A PRAISE team of 80 researchers conducted a cross-sectional study of a consecutive sample of 2,945 female participants in orthopedic fracture clinics in Canada, the United States, the Netherlands, Denmark, and India. The research results reveal that one in six women had been subjected to IPV within the past year. Moreover, almost 50 women had attended the clinic as a direct consequence of IPV (PRAISE Investigators, 2013). These statistics prompt that orthosurgeons take an active role in the detection of women who have been subjected to IPV.

One of the most significant problems that make it hard to detect and intervene among IPV victims is the fact that women are unlikely to disclose the abuse. The reason is that women often do not believe that their physicians have knowledge of IPV or have the possibility or even the concern to help the victims (World Health Organization, 2013). Moreover, studies reveal that women are unlikely to disclose the abuse unless openly asked by a healthcare provider (Dagher et al., 2014; Fanslow & Robinson, 2010). Furthermore, it has been shown that women are in favor of routine screening, as long as the healthcare professionals are compassionate, supportive, respectful, and demonstrate knowledge of IPV (Feder et al., 2006; Iverson et al., 2014; Williams et al., 2017).

On the other hand, the literature also reveals many barriers that prevent physicians in various healthcare settings from asking female patients about IPV. One of the leading reasons noted by physicians is the lack of effective interventions for female patients who are detected as IPV victims (Beynon et al., 2012). The lack of knowledge and training of physicians regarding IPV is another common barrier. In studies conducted among physicians, the lack of knowledge was very prominent, especially among orthosurgeons. Conn et al. (2014) found that many orthosurgeons believed that their female patients were rarely victims of IPV, and estimated the prevalence of IPV at <1%. Moreover, orthosurgeons report that they received little information on screening for IPV during their training and often were not familiar with the obligation of screening for IPV (Conn et al., 2014).

Additional barriers that prevent physicians from screening female patients about IPV are limited resources, including time constraints. A randomized controlled trial study found that reducing barriers by means of training and provision of support for clinicians and administrative staff could significantly increase referrals to support services for IPV victims (Abbasi, 2011).

The literature reveals that a large proportion of medical staff do not routinely screen female patients for IPV (Sims et al., 2011). In a study conducted by Conn et al. (2014), orthopedic surgery residents did not feel it was part of their job to ask female patients about IPV. In contrast, in a study conducted by Downie et al. (2019), 74% of physicians reported that they do screen for IPV and believe that orthosurgeons, who encounter trauma cases, have an obligation to screen for IPV.

In 2003, the Israeli Ministry of Health issued a circular which mandates screening female patients for IPV as an integral part of the work routine of various healthcare professions, including orthosurgeons, in all healthcare settings, in light of the proven harm to women's health associated with this phenomenon. Hospital administrators and department heads were declared responsible for imparting to the staff knowledge regarding IPV detection and management, by means of training programs. In addition, tools for detection of IPV victims were implemented, and procedures for intervention and referral of the women to appropriate community services were formulated. Moreover, documentation and reporting methods were established (Daoud et al., 2019; Ministry of Health, 2003). The aim of the present study is to examine the extent to which orthosurgeons in Israel screen female patients for IPV and associated factors.

Method

Research Design

This study is a quantitative correlational study.

Participants

A convenience sample of 100 orthosurgeons took part in the study.

Research Instrument

Participants completed a questionnaire adapted from Della Rocca et al. (2013). The questionnaire was shortened to 31 items for the present study. The questionnaire examined the following variables: screening for IPV, barriers to screening, and knowledge regarding IPV screening.

The first part of the questionnaire examined the sociodemographic and professional characteristics of the respondents (eight items). The second part of the questionnaire included a question regarding the level of difficulty experienced when asking a female patient who is a suspected IPV victim about IPV. The respondent was asked to provide answers on a Likert scale ranging from 1 (no difficulty) to 4 (great difficulty). The third part of the questionnaire consisted of 15 statements representing beliefs, attitudes, and barriers to screening for IPV. The respondent was asked to indicate his/her level of agreement with the statements, on a Likert scale ranging from 1 (completely disagree) to 4 (completely agree). To facilitate analysis of the responses, scores “1” and “2” were combined into “disagree,” while scores “3” and “4” were combined into “agree.”

The fourth part of the questionnaire included knowledge questions regarding screening for IPV, questions regarding screening for IPV, and questions regarding training on IPV (seven items). Any score other than “0” in response to the question, “How many women did you ask during the last year if they were victims of IPV?” identified the respondent as having performed IPV screening.

Data Collection

The study was approved by the institutional Helsinki Committee. The questionnaire contained an introduction that explains the purpose of the study and the anonymity of the data. Completion of the questionnaire was viewed as consent to participate in the study. The questionnaire was distributed among orthosurgeons in Israel. One hundred twenty questionnaires were distributed, while 100 were returned completed (for a response rate of 83%).

Statistical Analysis

Statistical analysis was performed using SPSS software for Windows, version 25 (SPSS, Chicago, IL, USA). Descriptive statistics—percentages, means, and standard deviations (SDs)—were used to describe the research data. Chi-square tests and t tests were conducted to identify significant differences between orthosurgeons. Chi-square tests were used to compare categorical data, while Pearson correlations and t tests for independent samples were used for continuous variables. Logistic analysis was performed to identify predictors of screening for IPV. For all analyses, a level of significance of p < .05 was considered statistically significant.

Results

Characteristics of the Sample

The characteristics of the sample are presented in Table 1. The mean age of the respondents was 39.5 years, with an age range of 28–68 years. Most of them were men (80%), married (79%), and they had 1.8 children on average. Most of the respondents were Jewish (70%), and most of them defined themselves as secular (75%). Most of the respondents were residents (64%), while the rest were senior physicians (36%), with an average of 9.8 years of experience.

Table 1.

Characteristics of the Sample.

		M (SD)	Range	%
Age		39.5 (8.8)	28–68
Gender	Male			88
	Female			12
Marital status	Single			16
	Married			79
	Divorced			5
Number of children		1.8 (1.4)	0–5
Nationality	Jewish			70
	Muslim Arab			20
	Christian Arab			10
Religiosity	Secular			75
	Traditional			18
	Religious			7
Seniority	Resident			64
	Senior			36
Experience (years)		9.8 (9.3)	1–45

Descriptive Statistics

Beliefs and Attitudes Regarding Screening Female Patients for IPV

Most of the respondents reported having a slight (43%) or moderate difficulty (26%) asking a female patient who is a suspected IPV victim about IPV. Few respondents reported no difficulty (20%) and a minority reported great difficulty (11%).

The vast majority of the respondents expressed positive attitudes toward screening female patients for IPV. Thus, most of them disagreed with statements claiming that it is not possible to help an IPV victim, that IPV is a private issue, and that it is useless to screen for IPV as IPV victims usually deny it when asked. In addition, the vast majority of the respondents disagreed that screening for IPV is not the duty of an orthopedic surgeon. However, barriers to screening were prevalent as well. In descending order of frequency, the barriers were: time constraints (40%), lack of knowledge regarding IPV (38%), feeling uncomfortable asking patients about IPV (36%), lack of knowledge regarding how to ask about the possibility of IPV (29%), and personal safety concerns (11%) (Table 2).

Table 2.

Orthosurgeons’ Beliefs and Attitudes Regarding Screening Female Patients for Intimate Partner Violence (IPV).

Statement	Disagree (%)	Agree (%)
It is useless to ask about IPV, as IPV victims usually deny it when asked	82	18
Asking about IPV is an invasion of privacy	86	14
I do not believe it is possible to help an IPV victim	91	9
IPV is a private issue	96	4
The system's intervention programs for IPV victims are not effective, therefore there is no need to ask about IPV	87	13
I am afraid of offending patients if I ask about IPV	61	39
I do not feel comfortable asking patients about IPV	64	36
Non abused patients will be offended if asked about IPV	62	38
I lack knowledge regarding IPV	62	38
I do not have time to ask about IPV	60	40
I am reluctant to ask about IPV, due to personal safety concerns	89	11
I do not know how to ask about the possibility of IPV	71	29
Asking about IPV is not part of my duty as an orthopedic surgeon	90	10
Identifying IPV victims is not relevant for my practice	90	10
As an orthopedic surgeon, my role is limited to treating illness and injuries, and nothing else	94	6

Knowledge Regarding Screening for IPV

Most of the respondents (79%) knew that reporting IPV in the case of a female patient legally defined as an incapacitated person is mandated by law. In contrast, only a minority of the respondents (12%) knew that asking all female patients who present at the healthcare facility about IPV is mandated by a circular issued by the Ministry of Health. Moreover, only a minority of the respondents (19%) knew that their workplace has written guidelines for detecting and managing IPV victims. Notably, the vast majority of the respondents (93%) had not attended a training program on IPV. However, only 57% of them expressed interest in receiving training on the assessment and treatment of IPV.

Screening Female Patients for IPV

During the last year, each respondent screened an average 2.2 female patients for IPV (SD = 4.8, range 0–30) and identified an average of one female patient as an IPV victim (SD = 0.6, range 0–10).

Inferential Statistics

Differences were found between Jewish and Arab orthosurgeons in certain attitudes toward screening female patients for IPV and in certain knowledge questions. Arab orthosurgeons were more inclined to agree that intervention among IPV victims is not effective (M = 1.57, SD = 0.77) compared to Jewish orthosurgeons (M = 1.40, SD = 0.49, t = −1.262 [df = 98], p < .05). In addition, Arab orthosurgeons were more inclined to agree that screening for IPV is not part of an orthosurgeon's duties (M = 1.55, SD = 0.73) compared to Jewish orthosurgeons (M = 1.21, SD = 0.53, t = −1.51 [df = 98], p < .05).

In addition, it was found that 30% of Arab orthosurgeons did not know that reporting IPV in the case of a female patient legally defined as an incapacitated person is mandated by law, compared to 12% of Jewish orthosurgeons who did not know this (χ² = 7.53 [df = 2], p < .05). Moreover, 70% of Arab orthosurgeons did not know that their workplace has written guidelines for detecting and managing IPV victims, compared to only 20% of Jewish orthosurgeons who did not know this (χ² = 6.06 [df = 2], p < .05).

The age variable was grouped into categories of 28–34, 35–39, and 40–68 years. Differences were found between the age groups in the level of difficulty involved in asking a woman who is a suspected IPV victim about IPV and in the level of agreement that they do not have time to ask about IPV. Thus, ∼70% of orthosurgeons aged 35–68 years reported having no difficulty or having slight difficulty asking a female patient who is a suspected IPV victim about IPV, compared to 45% of orthosurgeons aged 28–34 years who reported having no difficulty or having slight difficulty (χ² [df = 6, N = 100] = 14.64, p < .05). Moreover, it was found that 52% of orthosurgeons aged 28–39 years agreed that they do not have time to ask about IPV, compared to 19% of orthosurgeons aged 40–68 years who agreed with this claim (χ² [df = 6, N = 100] = 12.66, p < .05). In addition, a positive association was found between the orthosurgeon’s experience and his/her knowledge regarding screening for IPV (r = 0.24, p < .05). Namely, orthosurgeons with more experience had more knowledge.

The results of the regression analysis indicate that nationality and feeling uncomfortable asking female patients about IPV predict screening female patients for IPV by orthosurgeons. Thus, Jewish orthosurgeons were 2.86 times more likely to screen female patients for IPV than Arab orthosurgeons. Moreover, the more uncomfortable an orthosurgeon feels asking female patients about IPV, the less likely it is that he/she will screen for IPV (Table 3).

Table 3.

Multivariate Analysis of Factors Associated with Screening Female Patients for Intimate Partner Violence (IPV) by Orthosurgeons.

Factor	Odds ratio	95% CI	P-value
Age	0.894	0.513–1.558	.694
Nationality (reference: Arabs)	2.861	0.983–3.326	.044
Belief that screening for IPV is not the duty of an orthopedic surgeon	1.003	0.456–2.207	.994
Feeling uncomfortable asking female patients about IPV	0.482	0.262–0.886	.019
Level of knowledge regarding IPV screening	0.785	0.418–1.471	.450

Discussion

The present study examined the extent to which orthosurgeons in Israel screen female patients for IPV and associated factors. The research results reveal that during the last year, each orthosurgeon screened an average of 2.2 female patients for IPV. This finding suggests a low rate of screening for IPV by Israeli orthosurgeons, consistent with previous studies in other countries (Downie et al., 2019; Sims et al., 2011).

In this study, most orthosurgeons reported experiencing slight or moderate difficulty with asking a female patient who is a suspected IPV victim about IPV, while only a minority reported great difficulty. The study reveals that this difficulty may be due to several possible barriers, with a similar prevalence: time constraints, lack of knowledge regarding IPV, feeling uncomfortable asking patients about IPV, and lack of knowledge regarding how to ask about the possibility of IPV. These barriers were identified as barriers in previous studies at a similar frequency (Abbasi, 2011; Beynon et al., 2012). Notably, only feeling uncomfortable was found to predict screening for IPV.

Although according to the orthosurgeons’ reports in this study, lack of knowledge regarding IPV was not a common barrier, the results of the knowledge questions reveal a significant lack of knowledge. Thus, only a minority of the orthosurgeons knew that asking all female patients present at the healthcare facility about IPV is mandated by a circular issued by the Ministry of Health. In addition, only a minority of the respondents knew that their workplace has written guidelines for detecting and managing IPV victims. Thus, it seems that the majority of the orthosurgeons were unaware of the duty to screen female patients for IPV. Moreover, it seems that they are also unfamiliar with the procedures for detection and treatment. That is, it is likely that the orthosurgeons do not truly know how and what to ask when performing the screening or what to do if the woman reports that she is a victim of IPV. It can also be assumed that orthosurgeons that do screen, do so as they see right. A finding that emerged in the present study and which supports this hypothesis is that during the last year each orthosurgeon screened an average of 2.2 female patients for IPV, while identifying an average of one female patient as an IPV victim. The proximity of the two means suggests that orthosurgeons tend to screen for IPV those patients whom they believe should be screened, according to their own considerations.

The present study reveals that the vast majority of orthosurgeons did not attend a training program on IPV. Lack of knowledge and lack of training is a common problem, which has also emerged in previous studies (Conn et al., 2014; Della Rocca et al., 2013; Downie et al., 2019). Moreover, the research findings indicate that orthosurgeons with more experience had more knowledge regarding IPV. That is, it seems that the source of orthosurgeons’ knowledge is their professional experience rather than formal training. The present study also indicates that many orthosurgeons were unaware of their need for training: one-third of them expressed no interest in receiving training on the assessment and treatment of IPV.

Notably, in this study, negative attitudes toward screening female patients for IPV were not prevalent among the orthosurgeons. That is, the orthosurgeons did believe that it is possible to help an IPV victim, and that it is important to screen female patients for IPV. This finding reflects the high awareness of Israeli society to the problem of IPV as a social problem that must be addressed (Ritblatt & Rosental, 2018).

Moreover, the research findings suggest that the orthosurgeons did not object to screening for IPV as part of their role. It should be noted that previous studies provide inconsistent findings regarding orthosurgeons’ opinion whether screening for IPV should be part of an orthosurgeon's duties. Thus, while in one study orthosurgeons believed that screening for IPV should not be part of their duties (Conn et al., 2014), in another study orthosurgeons believed that it is their duty to screen (Downie et al., 2019). This inconsistency may be related to orthosurgeons’ awareness of the role of the healthcare system in managing IPV and to the local organizational culture. In a metasynthesis of qualitative studies, five themes were identified as enhancing the readiness of health practitioners to address IPV: having a commitment; adopting an advocacy approach; trusting the relationship; collaborating with a team; and being supported by the health system (Hegarty et al., 2020).

The findings of the present study indicate that negative attitudes toward screening for IPV were slightly more common among Arab orthosurgeons than among Jewish orthosurgeons. Thus, Arab orthosurgeons were more inclined to agree that intervention among IPV victims is not effective and that screening for IPV is not part of the orthosurgeon's role. These findings may reflect attitudes toward IPV in Arab society. Studies show that Arabs are more likely to believe that IPV is a private issue that should be resolved within the family (Ben-Porat, 2020; Daoud et al., 2019; Meler, 2020).

In addition, the research findings reveal a more prominent lack of knowledge regarding screening for IPV among Arab orthosurgeons compared to Jewish orthosurgeons. Thus, a higher percent of Arab orthosurgeons did not know that reporting IPV in the case of a female patient legally defined as an incapacitated person, is mandated by law, and most of them did not know that their workplace has written guidelines for detecting and managing IPV victims. A lack of interest regarding IPV may have led to a lack of interest in seeking information about the management of IPV, which in turn led to a lack of knowledge regarding the procedures of screening for IPV. It should be noted that in this study, belonging to the Arab sector was found to be a risk factor for not screening for IPV. This may be associated with more negative attitudes and a more severe lack of knowledge among Arab orthosurgeons.

In the present study, younger orthosurgeons tended to report more difficulty with asking a female patient who is a suspected IPV victim about IPV, compared to older orthosurgeons. Moreover, younger orthosurgeons were more inclined to agree that they do not have time to ask about IPV. This suggests that younger orthosurgeons have more difficulty with screening for IPV, due to their higher workload. It should be noted that in the present study, the experience of having difficulty was not found to be associated with the actual performance of screening. That is, it seems that having difficulty is more of a subjective experience in performing the action and not necessarily a barrier.

The present study has several limitations. The study employed convenience sampling, which is prone to self-selection and desirability biases. Therefore, the generalizability of the findings to all orthopedic surgeons in Israel is limited. In addition, most of the research participants were male orthosurgeons, thus limiting the generalizability of the findings to the entire population of orthosurgeons. Moreover, the research design does not allow for establishing cause and effect.

Conclusion and Recommendations

It seems that the reason for the low rate of screening for IPV in the present study can be ascribed to several barriers such as feeling uncomfortable performing screening, including a lack of knowledge of which the orthosurgeons are unaware. The research findings reveal that the importance of training orthosurgeons on the assessment and treatment of IPV cannot be overemphasized. This is especially noticeable among Arab orthosurgeons. Moreover, in light of the fact that the research findings indicate that orthosurgeons are unaware of their lack of knowledge and that many of them do not express interest in such training, it seems that training should be mandatory for all orthosurgeons. The training should address the procedures for screening for IPV by orthosurgeons. In addition, it is important that the training program includes simulations that may help orthosurgeons cope with feelings of discomfort while performing screening.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Merav Ben Natan

Author Biographies

Rawan Masarwa is an orthopedic surgeon in the Orthopedics B Department in Hillel Yaffe Medical Center. She is involved in numerous research projects conducted in the Department, especially those relating to the role of orthopedic surgeons in detection of domestic violence.

Merav Ben Natan is the Director of the Pat Matthews Academic School of Nursing located at the Hillel Yaffe Medical Center in Hadera, Israel. She is also an instructor at the Department of Nursing at Tel Aviv University. In addition, she serves as the Chairman of the Committee on Elder Abuse and Violence of the Israel Ministry of Health.

Yaniv Yonai is an orthopedic surgeon in the Orthopedics B Department in Hillel Yaffe Medical Center. He is involved in numerous research projects conducted in the Department, including those relating to the role of orthopedic surgeons in detection of domestic violence.

Yaniv Steinfeld is an orthopedic surgeon in the Orthopedics B Department in Hillel Yaffe Medical Center. He is involved in numerous research projects conducted in the Department, including those relating to the role of orthopedic surgeons in detection of domestic violence.

Yaron Berkovich is the Head of the Orthopedics B Department in Hillel Yaffe Medical Center and an orthopedic surgeon. He is involved in numerous research projects conducted in the Department. Domestic violence is among his preferred fields of interest.

References

Abbasi

. (2011). Improvement in practice: The IRIS case study. The Health Foundation.

Avgar

. (2019). Domestic violence: Interventions in domestically violent men in Israel. Knesset. Retrieved January 3, 2020, from https://fs.knesset.gov.il/globaldocs/MMM/d8631f68-d1b2-e911-80ff-00155d0a754a/2_d8631f68-d1b2-e911-80ff-00155d0a754a_11_13646.pdf (in Hebrew)

Ben-Porat

. (2020). Patterns of service utilization among women who are victims of domestic violence: The contribution of cultural background, characteristics of violence, and psychological distress. Journal of Interpersonal Violence, 35(17–18), 3167–3187. https://doi.org/10.1177/0886260517707308

Beynon

C. E.

Gutmanis

I. A.

Tutty

L. M.

Wathen

C. N.

MacMillan

H. L

. (2012). Why physicians and nurses ask (or don’t) about partner violence: A qualitative analysis. BMC Public Health, 12(1), 473. https://doi.org/10.1186/1471-2458-12-473

Conn

L. G.

Young

Rotstein

O. D.

Schemitsch

. (2014) “I’ve never asked one question.” Understanding the barriers among orthopedic surgery residents to screening female patients for intimate partner violence. Canadian Journal of Surgery, 57(6), 371. https://doi.org/10.1503/cjs.000714

Dagher

R. K.

Garza

M. A.

Kozhimannil

K. B

. (2014). Policymaking under uncertainty: Routine screening for intimate partner violence. Violence Against Women, 20(6), 730–749. https://doi.org/10.1177/1077801214540540

Daoud

Berger-Polsky

Sergienko

O’Campo

Leff

Shoham-Vardi

. (2019). Screening and receiving information for intimate partner violence in healthcare settings: A cross-sectional study of Arab and Jewish women of childbearing age in Israel. BMJ Open, 9(2), e022996. https://doi.org/10.1136/bmjopen-2018-022996

Della Rocca

G. J.

Sprague

Dosanjh

Schemitsch

E. H.

Bhandari

. (2013). Orthopaedic surgeons’ knowledge and misconceptions in the identification of intimate partner violence against women. Clinical Orthopaedics and Related Research, 471(4), 1074–1080. https://doi.org/10.1007/s11999-012-2749-x

Deuba

Mainali

Alvesson

H. M.

Karki

D. K

. (2016). Experience of intimate partner violence among young pregnant women in urban slums of Kathmandu valley, Nepal: A qualitative study. BMC Women’s Health, 16(1), 11. https://doi.org/10.1186/s12905-016-0293-7

10.

Downie

Madden

Bhandari

Jariwala

. (2019). A prospective questionnaire-based study on staff awareness of intimate partner violence (IPV) in orthopaedic trauma patients. The Surgeon, 17(4), 207–214. https://doi.org/10.1016/j.surge.2018.07.003

11.

Fanslow

J. L.

Robinson

E. M

. (2010). Help-seeking behaviors and reasons for help seeking reported by a representative sample of women victims of intimate partner violence in New Zealand. Journal of Interpersonal Violence, 25(5), 929–951. https://doi.org/10.1177/0886260509336963

12.

Feder

G. S.

Hutson

Ramsay

Taket

A. R

. (2006). Women exposed to intimate partner violence: Expectations and experiences when they encounter health care professionals: A meta-analysis of qualitative studies. Archives of Internal Medicine, 166(1), 22–37. https://doi.org/10.1001/archinte.166.1.22

13.

Hegarty

McKibbin

Hameed

Koziol-McLain

Feder

Tarzia

Hooker

. (2020). Health practitioners’ readiness to address domestic violence and abuse: A qualitative meta-synthesis. PLoS One, 15(6), e0234067. https://doi.org/10.1371/journal.pone.0234067

14.

Iverson

K. M.

Huang

Wells

S. Y.

Wright

J. D.

Gerber

M. R.

Wiltsey-Stirman

. (2014). Women veterans’ preferences for intimate partner violence screening and response procedures within the veterans health administration. Research in Nursing & Health, 37(4), 302–311. https://doi.org/10.1002/nur.21602

15.

Kapiga

Harvey

Muhammad

A. K.

Stöckl

Mshana

Hashim

Hansen

Lees

Watts

. (2017). Prevalence of intimate partner violence and abuse and associated factors among women enrolled into a cluster randomised trial in northwestern Tanzania. BMC Public Health, 17(1), 190. https://doi.org/10.1186/s12889-017-4119-9

16.

Meler

. (2020). Money, power, and inequality within marriage among Palestinian families in Israel. Sociological Review, 68(3), 623–640. https://doi.org/10.1177/0038026119881093

17.

Ministry of Health. (2003). Detection and management of women victims of IPV in healthcare settings—hospitals and community. Retrieved January 3, 2020 from https://www.health.gov.il/hozer/mk23_2003.pdf (in Hebrew)

18.

PRAISE Investigators. (2013). Prevalence of abuse and intimate partner violence surgical evaluation (PRAISE) in orthopaedic fracture clinics: A multinational prevalence study. Lancet, 382(9895), 866–876. https://doi.org/10.1016/S0140-6736(13)61205-2

19.

Procentese

Fasanelli

Carnevale

Esposito

Pisapia

Arcidiacono

Napoli

I. D

. (2020). Downside: The perpetrator of violence in the representations of social and health professionals. International Journal of Environmental Research and Public Health, 17(19), 7061. https://doi.org/10.3390/ijerph17197061

20.

Ritblatt

S. N.

Rosental

. (2018). Socioeconomic, historical, and cultural context of Israel and impact on the families. In M. Robila & A. C. Taylor (Eds.). Global perspectives on family life education (pp. 363–379). Springer.

21.

Sims

Sabra

Bergey

M. R.

Grill

Sarani

Pascual

Kim

Datner

. (2011). Detecting intimate partner violence: More than trauma team education is needed. Journal of the American College of Surgeons, 212(5), 867–872. https://doi.org/10.1016/j.jamcollsurg.2011.01.003

22.

Williams

J. R.

Halstead

Salani

Koermer

. (2017). An exploration of screening protocols for intimate partner violence in healthcare facilities: A qualitative study. Journal of Clinical Nursing, 26(15–16), 2192–2201. https://doi.org/10.1111/jocn.13353

23.

World Health Organization. (2012). Understanding and addressing violence against women. World Health Organization. Retrieved January 3, 2020, from https://apps.who.int/iris/bitstream/handle/10665/77432/WHO_RHR_12.36_eng.pdf

24.

World Health Organization. (2013). Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines. World Health Organization. Retrieved January 3, 2020, from https://www.who.int/reproductivehealth/publications/violence/9789241548595/en/