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Impact of Domestic Violence Screening Services on Domestic Violence Identification among Women Attending Primary Healthcare Centres in Nigeria

Abstract

Domestic violence is an important public health and social concern that can affect women's physical health, mental wellbeing, reproductive health, safety, and quality of life. Women who experience domestic violence may present to primary healthcare centres with injuries, reproductive health problems, chronic health conditions, psychological distress, or other health concerns without disclosing the underlying violence. Routine domestic violence screening in primary healthcare settings provides an opportunity for healthcare professionals to identify women experiencing abuse who might otherwise remain undetected. However, limited screening protocols, inadequate training of healthcare workers, concerns about privacy and confidentiality, lack of referral services, fear of retaliation, stigma, and limited availability of appropriate support services may affect the effectiveness of screening programmes in Nigeria. Against this background, this study investigates the impact of domestic violence screening services on domestic violence identification among women attending primary healthcare centres in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Andersen's Behavioral Model of Health Services Use. The Health Belief Model explains how women's perceptions of the risks and consequences of domestic violence, perceived benefits of disclosure and screening, perceived barriers, and cues to action may influence identification and disclosure of abuse. The Social Ecological Model emphasizes the interaction of individual, relationship, community, healthcare, and broader societal factors in shaping women's experiences of domestic violence and access to support services. Andersen's Behavioral Model explains how predisposing characteristics, enabling resources, and healthcare needs influence women's utilization of healthcare services, including domestic violence screening. Collectively, these theoretical perspectives provide a suitable framework for explaining how domestic violence screening services may influence identification of domestic violence among women attending primary healthcare centres in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise women aged 18 years and above attending selected primary healthcare centres across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, primary healthcare centres, and eligible women. Domestic violence screening services will be assessed using indicators such as availability of screening protocols, routine screening practices, frequency of screening, healthcare-worker training, availability of private screening spaces, confidentiality procedures, screening tools, informed consent procedures, referral arrangements, documentation practices, and availability of psychosocial and protective support services. Domestic violence identification will be assessed using indicators such as identification of women experiencing physical, sexual, psychological, or controlling forms of abuse, disclosure during screening, newly identified cases, documentation of identified cases, referral for appropriate support, and linkage to relevant health, psychosocial, social, legal, or protective services. Data will be collected using structured questionnaires, validated domestic violence screening instruments where appropriate, healthcare records, screening registers, referral records, and primary healthcare programme documents. Descriptive statistics will be used to summarize participants' characteristics, screening availability, screening practices, and patterns of domestic violence identification. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of domestic violence screening services on domestic violence identification. Where a quasi-experimental design is adopted, identification rates before and after implementation of structured domestic violence screening may be compared, while relevant demographic, socioeconomic, healthcare, and contextual factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that domestic violence screening services have a significant positive impact on domestic violence identification among women attending primary healthcare centres in Nigeria. Women attending facilities with systematic and confidential screening services are expected to have a higher likelihood of having experiences of domestic violence identified than women attending facilities without routine screening. Screening may provide women with a safe opportunity to disclose abuse, particularly when healthcare providers use appropriate, confidential, non-judgmental, and culturally sensitive approaches. Early identification may facilitate referral for medical care, psychosocial support, safety planning, social services, legal assistance, and other appropriate interventions. However, fear of disclosure, stigma, concerns about confidentiality, presence of partners or family members, inadequate healthcare-worker training, limited consultation time, and weak referral networks may reduce the effectiveness of screening services. The study therefore expects confidential, systematic, survivor-centred, and adequately supported domestic violence screening services to contribute significantly to improved identification of domestic violence among women attending primary healthcare centres in Nigeria. The study is expected to contribute to the literature on domestic violence screening, domestic violence identification, intimate partner violence, women's health, primary healthcare, gender-based violence, reproductive health, psychosocial healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare centres, healthcare workers, women's health organizations, social welfare agencies, development partners, and policymakers regarding strategies for strengthening the healthcare response to domestic violence. The study will also provide evidence-based recommendations for integrating confidential domestic violence screening into appropriate primary healthcare services, training healthcare workers in survivor-centred screening and response, improving privacy and confidentiality, strengthening referral and support networks, improving documentation systems, and linking identified women to appropriate medical, psychosocial, social, legal, and protective services across Nigeria.

Keywords: Domestic violence screening services, domestic violence identification, women, primary healthcare centres, intimate partner violence, gender-based violence, women's health, survivor-centred care, healthcare screening, Nigeria, public health.