2. An Education Program for Prenatal Patients Aimed Toward Primary Prevention of Domestic Violence Peter Vasilenko, PhD Professor of Obstetrics and Gynecology Michigan State University College of Human Medicine

3. While much attention has been paid to the secondary prevention of domestic violence and the treatment of abused women, relatively little has been focused on primary prevention.

4. Pregnancy as an Appropriate Time for Primary Prevention Women regularly visit their providers for prenatal care Usually motivated by the pregnancy toward health and education. Prenatal care education program already in place

5. Domestic Violence During Pregnancy Violence can begin or escalate during pregnancy DV can affect the health of women/mothers DV can affect pregnancy outcome Late entry / missed appointments Miscarriage / stillbirth Prematurity / low birth weight Fetal injury and death

6. Our own work has shown 30% of pregnant women screen positive for abuse (majority is physical abuse) Women with abuse have increased rates of prematurity and low birth weight Among mothers with infant deaths, ~half have been in recent violent encounters

7. Description and evaluation of an education program for prenatal patents aimed at primary prevention of domestic violence

8. Methods Women were enrolled at first prenatal visit Entry to care was 30 weeks or less Screen negative for physical abuse Intervention consisted of four 20 minute sessions at four subsequent visits Evaluation preformed by a pre-test, post-test (completion, 6 weeks, 6 months postpartum) Interviews for qualitative feedback

9. Intervention Education Subsets DV statistics and definitions Victim behavior How to get help / Community resources

10. Pre-test / Post-test Evaluation 39 questions Reliability analysis (Cronbach’s alpha) Entire test = 0.7000 Subsets=0.5121 – 0.5881 Content Knowledge questions Locus of control Self esteem Attitudes toward DV (Dodge and Green) Women’s Experiencing with Battering (WEB)

11. Sample 773 women screened for abuse Final enrollment was 282 150 controls / 132 intervention No important demographic or characteristics differences between Study and non-study patients Control and education groups

12. Results - Total Score P<0.001

13. Results – Subset Scores (Post-1) P<0.001 StatisticsHelpBehavior

14. Results – Scales Scores (Post-1) P=0.017P<0.001 P=0.474 P=0.074 **

15. Follow-up Interviews Overall women were pleased with the education program They commented that even if the content was not immediately relevant to their personal situation, the knowledge was useful to pass along to family members and friends who were in more difficult situations and relationships.

16. Summary Women’s knowledge about DV was significantly improved through a simple prenatal education program The increase in knowledge was immediately apparent, and maintained through 6 months post-partum The improvement in knowledge occurred in all three subsets There was also a moderate effect on self-esteem and attitudes

17. Conclusions A simple prenatal care program can increase women’s knowledge about DV The program can easily be duplicated in other clinics. The program can be adapted for use in clinics with non-pregnant women

18. Conclusions The increased knowledge may empower women to make better decisions about current and future relationships, utilize community resources, and share this knowledge with other women, all of which could serve to directly or indirectly reduce DV in the community.

19. Peter Vasilenko, PhD Professor of Obstetrics and Gynecology Director of Research Michigan State University College of Human Medicine A209 East Fee Hall East Lansing, Michigan 48824 Phone:517-432-4791 Fax:517-432-8021 Email:vasilenk@msu.edu