2012. Vol.3, No.11, 947-952
Published Online November 2012 in SciRes (
Copyright © 2012 SciRes. 947
Piloting the Domestic Violence Healthcare Providers’ Survey for
Use in Uganda: Testing Factorial Structure and Reliability
Stephen Lawoko1,2*, Milton Mutto3, David Guwattude2
1Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
2Department of Epidemiology, Makerere University, Kampala, Uganda
3Pincer Group International, Kampala, Uganda
Email: *
Received June 5th, 2012; revised August 7th, 2012; accepted September 8th, 2012
Background: A number of instruments to assess healthcare workers readiness to screen for Intimate
Partner Violence (IPV) in healthcare are now available to researchers. Before application in new settings
however, pilot studies assessing their validity are warranted. Aim: In this pilot study, we assessed the
factorial structure and reliability of the Domestic Violence Healthcare Provider Survey Scale (DVHPSS)
for future use in Uganda. Method: A convenient sample of healthcare workers at a referral hospital in
Arua district, Uganda (n = 90) responded to the DVHPSS. Exploratory factor analysis using principle
components and Cronbach’s alphas testing for internal reliability were applied on 86 complete individual
responses to items of the DVHPSS. Bivariate correlations were run to assess scale distinctiveness. Re-
sults: All but one item of the DVHPSS exhibited significant factor loadings. Most subscales emerging
from the factor analysis (i.e. Blame victim, professional role resistance and system support sub-scales)
were congruent with the original scales. A split of the original victim/provider safety scale was however
evident in the current data, forming two distinct scales i.e. victim and provider safety respectively. Items
of the original perceived self-efficacy scale exhibited significant factor loadings but under separate factors,
indicating that they may not be measuring a uni-dimensional concept in the Ugandan healthcare context.
Conclusions: This data confirms the validity and reliability of the DVHSS for use in Uganda. It is how-
ever recommended that items be scored in accordance to the specific sub-scales revealed in this study, to
improve the structural validity of any assessment using the DVHPSS in Uganda.
Keywords: Domestic Violence Survey; Healthcare; Factorial Structure; Reliability; Uganda
Intimate Partner Violence against Women (IPV), defined as
any act in partner relations that results or is likely to result in
physical, sexual or psychological harm or suffering to women
(e.g. threats of violence, coercion, deprivation of liberty) (UN,
1993) has long been recognized as a public health concern
globally. Women experiencing IPV report physical ailments as
a result of physical assaults (Aimakhu, Olayemi, Iwe, Oluyemi,
Ojoko, Shoretire, Adeniji, & Aimakhu, 2004; Koenig, Ahmed,
Hossain, & Khorshed, 2003; Fawole, Aderonmu, & Fawole,
2005), reproductive morbidity in the form of terminated preg-
nancies and still births, child loss within the first years of birth
(Garcia-Morena, Jansen, Ellsberg, Heise, & Watts, 2005;
Kishor & Johnson 2004), and symptoms of depression, anxiety,
post-traumatic stress and suicide dispositions (Koss, 1990;
Heise & Garcia-Moreno, 2002; Tjaden & Thoennes, 2000;
Tolman & Rosen 2001; Petersen, Gazmararian, & Clark, 2001).
Despite the high risk for morbidity, victims of IPV appear to
use and seek sanctuary in formal organisations like health care
to a much lower degree when contrasted with non-abused
women. Recently, the World Health Organisation (WHO) re-
ported that fear of retaliation from the abuser and stigmatizing
attitudes from service providers and community at large to
accounted for discrepancies in health seeking behaviour in this
risk group, with no distinction between low, middle and high
income countries (WHO, 2005), indicating institutional barriers
in detection and management of IPV globally. The healthcare
system thus has in recent years been challenged to get more ac-
tively involved in detection and management of IPV through
systematic screening for the phenomena among women visiting
healthcare settings.
Screening for IPV in healthcare requires the routine in-
volvement of healthcare workers in the detection and manage-
ment of IPV among clients who may or may not present with
direct signs of victimization/abuse (AMA, 1992). The rational
for universal screening is strong. First, anecdotal evidence sug-
gests that merely recognizing and validating women’s situation
with regard to battering may have far-reaching effects on their
responses to treatment options and ultimately their health
(AMA, 1992). Secondly, self-reports from women indicate that
they are comfortable responding to IPV inquiries in healthcare
settings (Stenson, Sidenvall, & Heimer, 2005). Congruent with
this view, healthcare professionals themselves acknowledge
that routine screening is likely to improve female clients satis-
faction with care (John, Lawoko, & Oluwatosin, 2011). A con-
sensus between both stakeholders notwithstanding, evidence
suggests that only 8% - 10% of healthcare personnel routinely
screen for IPV (Erikson, Hill, & Siegal, 2001; Roelens, Ver-
straelen, Van Egmond, & Temmerman, 2006), which suggests
the presence of barriers associated with healthcare providers’
insufficient knowledge and training in screening, professional
roles governing the provider-client relations, (e.g. mutual re-
*Corresponding author.
spect, fear of offending clients, etc.), healthcare providers’ in-
dividual attitudes towards IPV, and cultural values (Erikson,
Hill, & Siegal, 2001; Roelens, Verstraelen, Van Egmond, &
Temmerman, 2006; Waalen, Goodwin, Alison et al., 2000;
John, Lawoko, & Svanstrom, 2011; Maiuro, Vitaliano, Sugg et
al., 2000). A vital question that arises thus with regard to
screening concerns the readiness of healthcare providers to
screen for practices like IPV in healthcare settings and how
such readiness can be measured.
A few instruments have been made available to researchers
for the assessment of readiness to screen for IPV (Short, Alpert,
Harris, & Surprenant, 2006; Rodríguez, Bauer, McLoughlin, &
Grumbach, 1999). Among the most comprehensive of them
however is the Domestic Violence Healthcare Provider Survey
Scales (DVHPSS) (Maiuro, Vitaliano, Sugg, Thompson, Rivara,
& Thompson, 2000). The scale measures healthcare profess-
sionals’ readiness to screen in terms of their perceived knowl-
edge, efficacy in screening, conflicting professional roles,
availability of social support networks to which IPV victims
can be referred, client safety challenges, and health care work-
ers’ general attitudes towards such screening. Though assumed
to be universal, such instruments need to be piloted and vali-
dated before their application in new context. In this study, the
instrument is piloted in Arua district, Uganda, before it is used
in a larger study to assess readiness to screen among healthcare
providers in 3 districts of Uganda. The rationale of testing the
validity of instruments used in healthcare research in general,
before application in explanatory modelling in new populations
deserves some acknowledgement, as an important area of
healthcare research. Healthcare systems vary in their structure,
as do healthcare cadres in their training and attitudes from one
con- text to another. The structure of indicators of readiness to
screen for IPV thus could vary between dissimilar populations.
Validity is an important issue when using abstract measures/
questions to represent theoretical concepts. In general, an in-
strument is said to be valid when it measures what it is pur-
ported to measure (Nunnaly, 1978). Some important aspects of
validity include factorial structure and reliability which together
account for the structural validity of an instrument. Factorial
structure attempts to distinguish underlying concepts a set of
questions/items/variables may be capturing, without imposing a
preconceived structure on what these questions are measuring.
When measuring readiness to screen for IPV based on a set of
questions concerning readiness in general, researchers thus are
interested in understanding the sub-concepts (sub-scales) that
may form parts of readiness as a whole, i.e. the factorial struc-
ture of readiness to screen.
Reliability refers to the accuracy and precision with which an
instrument/subscale captures what it is purported to capture
(Thorndike, Cunningham, Thorndike, & Hagen, 1991). Internal
consistency is one form of reliability measure which assesses
individuals performance from item to item when data is col-
lected using a single form (Cronbach & Meehl, 1995). In this
study, the concepts that emerge from the factor analysis are
tested for reliability.
The objective of this study thus is to assess the structural va-
lidity of the DVHPSS in terms of its factorial structure and
internal reliability. The following research questions are ad-
1) Do the items of the DVHPSS capture adequately the un-
derlying constructs they are purported to measure when applied
in the Uganda healthcare context (i.e. the question of factorial
2) How accurately do the constructs/subscales of the
DVHPSS capture what they are purported to capture in the
Ugandan context (i.e. the question of internal consistent/reli-
Study Setti ng s, Design and P art i ci pants
This cross-sectional study was carried out among healthcare
providers a district referral hospital in Arua district, Uganda.
The healthcare providers at the hospital have not previously
undergone any formal training in screening for IPV among their
female clients. A total of 90 healthcare workers, obtained
through convenient sampling of participated in this pilot study.
The sample size optimal for a structural validity test is depend-
ent on the number of items the instrument in question contains.
Since the domestic violence healthcare survey instrument con-
sists of about 30 items, approximately 3 times as many partici-
pants are needed to run structural validity tests (i.e. 90 partici-
pants). A total of 86 participants had complete responses to all
items and were thus used for this analysis.
The questionnaire was self-administered and was accompa-
nied by an information letter.
Ethical Consideration
Information letters informing participants of the aims of the
study and their role accompanied the questionnaire. Voluntary
participation, confidentiality and informed consent were em-
phasised. This study received ethical approvals from the Mak-
erere University Research Ethics Committee and the Uganda
National Council for Science and Technology, the two bodies
responsible for scientific research in Uganda.
Instrument Measures
The Domestic Violence Health Care Provider Survey Scale
measures healthcare providers’ readiness to screen for IPV as
well as actual screening activity (Maiuro, Vitaliano, Sugg,
Thompson, Rivara, & Thompson, 2000). The instrument has
been previously validated with promising results in some coun-
tries including USA and Nigeria. The questionnaire, in its
original format, is composed of the following 5 subscales:
The perceived self efficacy subscale scale (4 items) assesses
providers own perceived efficacy in inquiring about IPV (de-
tails in Table 1).
The system support sub-scale (4 items) assesses a) healthcare
providers’ access to support networks for referral/management
of IPV victims (details in Table 1).
The professional roles re sistant/fear of offending clients sub-
scale (6 items) assesses whether providers perceive inquiries
about IPV may conflict with ethical issues governing their
communication with clients (details in Table 1).
The blame victim sub-scale (7 items), assesses providers at-
titudes towards victims (details in Table 1).
The victim/provider safety sub-scale (10 items), assesses
whether providers perceive inquiries about IPV from batterers
to further jeopardize safety of victims and/or care provider.
All items require of the respondent to take a position on spe-
cific statements. The response alternatives to each statement
ange from 1 (strongly disagree) to 5 (strongly agree). r
Copyright © 2012 SciRes.
Copyright © 2012 SciRes. 949
Table 1.
Bivariate correlations between subscales: testing for distinctiveness.
Professional role
resistant/fear of offence Victim/provider safety Blame victim Perceived efficacy
Professional role resistant fear of offence
Victim/provider safety 0.31*
Blame victim 0.30* 0.30*
Perceived efficacy 0.14 0.01 0.09
System support 0.25* 0.15 0.05 0.15
Statistical Analysis
Data cleansing: Prior to analyses, certain procedures were
carried out to clean data. First, only participants who had re-
sponded to all items of the DVHSS were included in the analy-
ses to reduce the likelihood of erroneous estimates as a result of
missing data. Second, items were checked for normality using
the skewness statistic and its confidence interval. Skewness
statistic of magnitude zero is an indication of perfect symmetry
(thus, confidence intervals including zero are an indication of
normality). Relevant transformations (e.g. square roots, loga-
rithm, inverse or reflection) were applied to transform skewed
Factor analysis and reliability test: An exploratory factor
analysis (instead of a confirmatory one) was preferred, so as to
avoid taking a preconceived position on which questions should
be included under each sub-scale. It is plausible that certain
sub-scales could in another context merge or split to form new
sub-scales. Thus, exploratory factor analysis using principal
component method was performed to test underlying factors
and their stability as expressed in the factor loadings. Varimax
rotation was applied to limit the number of high loadings under
the same factor. This would enhance clearer identification of
items emerging under each subscale. Criteria for the number of
resulting significant factors was based on Kaiser Criterion and
confirmed with scree plots (Carrol, 1957; Field, Aneja, & Ros-
ner, 2007). Items with factor loading of at least 0.30 were con-
sidered significant; this is based on criteria for significant cor-
relation (Cohen, 1988). The contribution of emerging factors in
explaining the total variation in the item pool was reported.
Significant factors (i.e. those having a highest loading of over
0.30) were tested for internal consistency using Cronbach’s
Alpha. Alpha coefficients of at least 0.60 were considered sig-
nificant, a threshold adequate for research purposes (Streiner &
Norman, 1989; Nunnaly, 1978). Where double loadings were
evident, the item was assigned to the factor under which it
loaded highest.
Scale distinctiveness: Bivariate correlations were run to in-
vestigate scale distinctiveness of the resulting factor solution
(Streiner & Norman, 1989; Nunnaly, 1978) (i.e. though some
sub-scales may be correlated with each other, these correlations
should not be close to one, as this would be an indication that
the sub-scales are measuring an identical concept).
Sample Characteristics
A total of 86 complete responses were received from the
sampled health workers. Fifty five percent (55%) were male.
Mean age of the sample was 38.8 years ( = 8.9, min = 20
& max = 58 years). Majority were married (72%) and of prot-
estant religion (42%). Occupation distribution was as follows:
32% of respondents were Nurses, 15% were mid wives, 10%
were Medical Doctors and 43% were other health professionals.
The average length of time in service was 11.8 years ( =
7.7, min = 1 & max = 35).
Scale Factorial Structure
When subjected to exploratory factor analysis, a five (5) fac-
tor structure emerged (Table 2) and were retained on account
of the Kaiser Criterion (eigen values > 1) and a confirmatory
scree plot. The 5 factors extracted approximately 63% of the
variability in the responses, and mainly reflected the subscales
in their original format. Factor largely reflected the Blame vic-
tim subscale, explaining 24% of the variation in the total re-
sponses. Factor 2 reflected mainly a victim safety subscale
(splitting the original victim/provider safety scale), explaining
12% of the total variation in responses. Factor 3, explaining
10% of variation in the total responses, represented mainly the
System support subscale, though several items of the Perceived
self-efficacy scale loaded high on the same factor. Factor 4
appeared to represent a provider safety scale (splitting the
original victim/provider safety scale) and explained 9% of the
variation in the total response. Finally, factor 5 represented
largely the Professional role resistance/fear of offending clients
subscale, explaining 8% of the variation in the total response.
Item Performance
Except for one item (i.e. “I have ready access to information
detailing the management of IPV”) all other items loaded above
the minimum required threshold of factor loading 0.30 (Table
2). While most items had their highest factor loading under
their original scale, the following observations were made:
Most items of the professional role resistant/fear of offending
clients scale loaded significantly under factor 5, with the excep-
tion of two items, which loaded highest under factor 3 (marked
*” in table). Most items of the “blame victim” subscale loaded
highest under factor 1, with the exception of two items (marked
*” in table), which loaded highest under two separate factors.
Items of the “provider/victim safety” split into two with victim
safety items loading under factor 2 and provider safety under
factor 4. System support items loaded highest under factor 3,
with the exception of 1 items which loaded highest under an-
other factor. The different items of the “perceived self-efficacy”
scale were split between factors 1 - 4. Double loadings were
observed for a number of items. In such cases, the highest
loading was considered.
Table 2.
Full factorial model: original subscales, principal components and cronbach’s alphas.
Sub-scale (cronbach’s alpha in brackets) Principal components
Professional Role Resistance/Fear of offending the Patients (Alpha = 0.674). 1 2 3 4 5
Asking patients about Intimate Partner Violence (IPV) is an invasion of their privacy. 0.264580.224140.10509 0.053590.30597
It is demeaning to patients to question them about abuse. 0.027590.121030.10580 0.120180.66400
If I ask non-abused patients about IPV, they will get very angry. 0.123720.006200.07375 0.293080.61272
I am afraid of offending the patient if I ask about IPV. 0.078920.076400.07834 0.151610.61623
I think that investigating the underlying cause of a patient’s injury is not part of medical care. 0.455600.094490.04960 0.213460.48501
It is not my place to interfere with how a couple chooses to resolve conflicts. 0.294050.12491 0.35109 0.249180.28873
If patients do not reveal abuse to me, then they feel it is none of my business. 0.035260.06605 0.62408 0.043560.12891
Blame victim (Alpha = 0.609).
A victim must be getting something out of the abusive relationship, or else she would leave. 0.34676 0.129060.25072 0.196700.10079
People are only victims if they choose to be. 0.550050.277380.10308 0.388050.04338
When it comes to IPV victimization, it usually “takes two to tango.” 0.73624 0.017760.09615 0.037010.13267
I have patients whose personalities cause them to be abused. 0.796300.020590.09070 0.00036 0.07798
Women who choose to step out of traditional roles are a major cause of IPV. 0.007390.00857 0.12362 0.394570.22963
The victim’s passive-dependent personality often leads to abuse. 0.376240.167210.14302 0.207360.09079
The victim has often done something to bring about violence in the relationship. 0.387870.424180.14463 0.200920.09460
Victim/provider safety (0.600).
There is no way to ask batterers about their behaviours without putting the victims in more
danger. 0.040190.514300.19516 0.321670.11720
I am afraid if I talk to the batterer, I will increase risk for the victim. 0.017430.698190.09535 0.070840.16954
I feel it is best to avoid dealing with the batterer out of fear and concern for the victim’s safety.0.02784 0.664150.22926 0.152110.05638
I feel I can discuss issues of battering and abuse with a battering patient without further
endangering the victim. 0.048490.370130.16097 0.160600.36676
I feel I can effectively discuss issues of battering and abuse with a battering patient. 0.420920.450350.18031 0.333100.04278
I feel there are ways of asking about battering behaviour without placing myself at risk. 0.029290.105810.05781 0.69755 0.14308
I am reluctant to ask batterers about their abusive behaviour out of concern for my
personal safety. 0.272710.347200.04736 0.378050.13946
There is not enough security at my work place to safely permit discussion of IPV with batterers.0.318940.413400.15924 0.33487 0.13521
I am afraid of offending patients if I ask about their abusive behavior. 0.043540.086900.35737 0.344230.11797
When challenged, batterers frequently direct their anger toward health care providers. 0.282910.424650.35432 0.092750.01984
Perceived self efficacy (Alpha = 0.653).
I don’t have the time to ask about IPV in my practice. 0.051150.396040.41394 0.078830.12466
There are strategies I can use to encourage batterers to seek help. 0.429640.278940.36603 0.022230.18061
There are strategies I can use to help victims of IPV change their situation. 0.341680.048610.50922 0.015330.00193
I feel confident that I can make appropriate referrals for batterers. 0.325810.575200.11702 0.321690.00439
I feel confident that I can make the appropriate referrals for abused patients. 0.219330.397400.23915 0.00546 0.28631
I have ready access to information detailing management of IPV. 0.208090.108890.11489 0.219760.02549
There’re ways I can ask batterers about their behaviour that will minimize risk to
the potential victim*. 0.06281 0.051050.40880 0.598730.18511
System support items (Alpha = 0.635).
I have ready access to medical social workers or community advocates to assist in the
management of IPV. 0.30131 0.08761 0.30675 0.072950.00318
I feel that medical social work personnel can help manage IPV patients. 0.144410.335410.00333 0.119110.28585
I have ready access to mental health services should our patients need referrals. 0.077530.048720.78585 0.080130.05002
I feel that the mental health services at my clinic or agency can meet the needs to IPV victims. 0.079300.016210.67083 0.05988 0.08824
Eigenvalues. 5.5888 2.7901 2.3794 2.0543 1.8469
% f variance explained. o24% 12% 10% 9% 8%
Copyright © 2012 SciRes.
Scale Reliability
The reliability coefficients (i.e. Cronbach’s alphas) for the
emerging subscales ranged between 0.60 - 0.67 (Table 2).
Scale Correlations Testing for Scale Distinctiveness
The significant bivariate correlation between the emerging
sub-scales ranged between 0.25 and 0.31 (Table 1).
This paper tested the factorial structure and internal reliabil-
ity of the Domestic Violence Healthcare Provider Survey
Scales (DVHPSS) before its application on a larger sample of
Ugandan healthcare providers. The criteria for statistical scru-
tiny were defined apriori and are in line with recommendations
for assessment of structural validity (Streiner & Norman, 1989;
Nunnaly, 1978; Carrol, 1957; Field, Aneja, & Rosner, 2007;
Cohen, 1988). In general, the study found the instrument appli-
cable to the Ugandan context based on its factorial structure and
scale reliability. A few exceptions incongruent with the original
scale however were found, warranting acknowledgement. First,
the item “I have ready access to information detailing the man-
agement of IPV” did not load significantly under any of the
emerging factors, raising questions as to whether respondents
identified with the issue. In other contexts, e.g. Sweden, USA,
and Nigeria (Lawoko, Sanz, Helstrom, & Castren, 2012; John
& Lawoko, 2010; Mauiro et al., 2000), this item loaded signifi-
cantly under the Perceived self-efficacy scale. It is plausible
that the issue of access to information detailing IPV manage-
ment may have been variedly interpreted by participants in this
context resulting in mixed/random responses and consequently
accounting for the lack of significant correlation with any factor
in general. Further scrutiny of this question will benefit from
in-depth interviews with care personal in the studied context.
Secondly, all other items of the Perceived self-efficacy scale
loaded significantly under separate factors, indicating that they
may not be representing a single-dimensional concept as por-
trayed in other contexts (Lawoko, Sanz, Helstrom, & Castren,
2012; John & Lawoko, 2010; Mauiro et al., 2000). These dis-
crepancies may be a reflection of differences in healthcare pro-
vision and organisation between different societal contexts. For
example, the questions of having strategies to help IPV victims
loaded under the factor system support in our data, instead of
perceived self-efficacy as portrayed in other contexts. The
Ugandan sample may have viewed the issue of strategies in
general as an issue more related to the care system rather than
an issue of self-efficacy. The same could be argued regarding
the issue of lack of time and having strategies to help victims
change their situation.
Another unique observation for our data is the splitting of the
victim/provider safety scale into two separate factors reflecting
a victim and a provider safety scale respectively. Thus, the
Ugandan sample appeared to distinguish self-safety from pa-
tient safety unlike elsewhere where these items clumped under
a single safety factors. Again, plausible explanations for these
discrepancies may lie in differences in the structure, organisation
and provision of healthcare between indifferent societal contexts.
The factor structure of the Blame victim and Professional re-
sistance/fear of offending clients’ sub-scales appeared largely
congruent with observations in some societies e.g. USA and
Nigeria (John & Lawoko, 2010; Mauiro et al., 2000), but at
odds with others e.g. Sweden where a split into two separate
factors was observed (Lawoko et al., 2012). In addition, the
system support scale exhibited similar loadings as the original
scale, congruent with observations in some contexts (John &
Lawoko, 2010; Mauiro et al., 2000) but at odds with others
(Lawoko et al., 2012). These discrepancies thus drum for the
necessity to assess factor structure of existing scales before
their application in new contexts.
The DVHPSS scales exhibited good reliability, as tested with
the internal consistency statistic (Cronbach’s Alpha). In addi-
tion, correlations between the DVHPSS scales were consistent
with theory (i.e. significant for scales where significance was
expected and non-significant for scales where non-significance
was expected). For instance, a significant correlation may from
a theoretical perspective be expected between victim blame and
professional role resistance, i.e. those likely to blame victims
for abuse were also more likely to express conflicting profes-
sional roles in relation to IPV inquiries. Similarly, those likely
to blame the victim were also more likely to express concerns
that IPV inquiries may jeopardize victim/provider safety, indi-
cating some form of resistance/negation towards IPV screening.
These significant correlations were however not too high to
suspect that the concepts measured a uni-dimensional construct.
As such, the significant and non-significant bivariate correla-
tions were an indication that the emerging factors represented
distinct aspects of readiness to screen for IPV.
In summary, this data confirms the validity and reliability of
the DVHSS for use in Uganda. Though scales largely exhibited
similar factorial patterns as observed in other contexts, the
Ugandan sample identified a more detailed breakdown of one
of the initial underlying concepts (i.e. Victim/provider safety)
into two distinct factors victim and provider safety respectively.
In addition, a diffusion of the perceived efficacy items into
separate scales was observed. This suggests that the two scales
may not in the Ugandan healthcare context be measuring a uni-
dimensional construct, and thus need to be scored separately to
improve validity of the results. With regard to reliability on the
other hand, the findings suggest that the scales in their original
form are reliable and represent distinct aspects of readiness to
screen for IPV as indicated by the cronbach’s alphas and inter
scale correlations respectively. In conclusion therefore, the
DVHPSS thus can be applied in its current form in Uganda. It is
however recommended that items be scored in accordance to the
specific sub-scales revealed in this study to improve the structural
validity of any assessment using this questionnaire in Uganda.
This study was designed to serve as a pilot for a larger future
study to understand readiness to screen for IPV among health-
care personal in Uganda (using the DVHPSS). Notwithstanding,
its weaknesses deserve some acknowledgement. Uganda being
a unique context contrasted with USA where the instrument
was developed, the item pool in the questionnaire may not be
exhaustive of challenges to screening for IPV in the Ugandan
context. Qualitative studies could reveal additional crucial chal-
lenges to screening specific to this context. The authors are
currently involved in such studies.
Another word of caution concerns the differences in organi-
sation of healthcare delivery within Uganda. The studied sam-
ple consist only workers at a regional referral hospital in north-
ern Uganda. In the country, healthcare delivery differs hierar-
chically in organisation and capacity between national referral,
regional referral, district hospitals or smaller healthcare units.
The national and regional referral hospitals are better staffed
Copyright © 2012 SciRes. 951
and equipped to deliver health services than the district level
hospitals and smaller health centres. Thus, the current results
may be reflecting what is expected only at regional referral
hospitals in Uganda, and may not be generalised to healthcare
in Uganda as a whole.
We are most grateful to the Swedish institute of Social and
Working life and the Marie-Curie program for funding this
study. We are also grateful to Joseph Duku for data collection
and imputation.
Aimakhu, C. O., Olayemi, O., Iwe, C. A., Oluyemi, F. A., Ojoko, I. E.,
Shoretire, K. A., Adeniji, R. A., & Aimakhu, V. E. (2004). Current
causes and management of violence against women in Nigeria.
Journal of Obstetrics & Gynaecology, 24, 58-63.
Altman, D. G. (1991). Practical statistics for medical research. London,
UK: Chapman & Hall.
Altman, D. G. (1982). How large a sample? In S. M. Gore, & D. G.
Altman (Eds.), Statistics in practice. London: British Medical Asso-
American Medical Association (1992). Diagnostic and treatment guide-
lines on domestic violence. Archives of Family Medine, 1, 39-47.
Brottsförebygande Rådet (BRÅ) (2009). Våld mot kvinnor och män i
nära relationer: Våldets karaktär och offrets erfarenhet av kontakter
och rättsväsendet. BRÅ Rapport, 12.
Carroll, J. B. (1957). Biquartimin criterion for rotation to oblique sim-
ple structure in factor analysis. Science, 126, 1114-1115.
Cohen, J. (1988). Statistical power analysis for behavioral sciences
(2nd ed.). Hillsdale: Lawrence Erlbaum Associates.
Cronbach, L. J., & Meehl, P. C. (1955). Construct validity in psycho-
logical tests. Psychological Bulletin, 52, 281-302.
Erikson, M. J., Hill, T. D., & Siegal, R. M. (2001). Barriers to domestic
violence screening in the padiatric setting. Pediatrics, 108, 98-102.
Fawole, O. I., Aderonmu, A. L., & Fawole, A. O. (2005). Intimate part-
ner abuse: Wife beating among civil servants in Ibadan, Nigeria. Af-
rican Journal of Reprodu c t iv e H e a l t h , 9, 54-64.
Feldhaus, K. M., Kozio-Mclain, J., Amsbury, H. L., Norton, I. M.,
Lowenstein, S. R., & Abbott, J. T. (1997). Accuracy of 3 brief
screening questions for detecting partner violence in the emergency
department. Journal of American Medical Association, 277, 1357-
1361. doi:10.1001/jama.277.17.1357
Field, A. E., Aneja, P., & Rosner, B. (2007). The validity of self-re-
ported weight change among adolescents and young adults. Obesity,
15, 2357-2367. doi:10.1038/oby.2007.279
Garcia-Morena, C., Jansen, H., Ellsberg, M., Heise L., & Watts, C.
(2005). WHO multi-country study on women’s health and domestic
violence against women: Initial results prevalence, health outcomes
and women’s responses. Geneva: WHO.
Golding, J. (1999). Intimate partner violence as a risk factor for mental
disorders: A meta-analysis. Journal of Family Violence, 14, 99-132.
Harris, J. M., Kutob, R. M., Surprenant, Z. J., Maiuro, R. D., & Delate,
T. A. (2002). Can Internet-based education improve physician con-
fidence in dealing with domestic violence? Family Medicine, 34,
Heise, L., & Garcia-Moreno, C. (2002). Violence by intimate partners.
In E. Krug, L. L. Dahlberg, & J. A. Mercy et al. (Eds.), World report
on violence and health. Geneva: WHO.
John, I. A., Lawoko, S., Svanström, L., & Mohammed, A. Z. (2010).
Health care providers readiness to screen for intimate partner vio-
lence in Northern Nigeria. Violence and Victims, 25, 689-704.
John, I. A., & Lawoko, S. (2010). Assessment of the structural validity
of the domestic violence healthcare providers’ survey questionnaire:
Using a Nigerian sample. Journal of Injury and Violence Research, 2,
75-83. doi:10.5249/jivr.v2i2.41
John, I. A., Lawoko, S., & Oluwatosin, A. (2011). Acceptance of
screening for intimate partner violence, actual screening and satisfac-
tion with care amongst female clients visiting a health facility in
Kano, Nigeria. African Journal of Primary Health Care & Family
Medicine, 3, 6.
Kishor, S., & Johnson, K. (2004). Profiling violence: A multi-country
study. Measures DHS, 53-63.
Koenig, M. A., Ahmed, S., Hossain, M. B., & Khorshed, A. B. (2003).
Women’s status and domestic violence in rural Bangladesh: Individ-
ual and community-level effects. Demography, 40, 269-288.
Koss, M. (1990). The women’s mental health research agenda: Vio-
lence against women. American Psychologist, 45, 374-380.
Lawoko, S., Sanz, S., Helstrom, L., & Castren, M. (2012). Assessing
the structural and concurrent validity of a shortened version of the
domestic violence healthcare providers’ survey questionnaire for use
in Sweden. Psychology, 3, 183-191.
Maiuro, R. D., Vitaliano, P. P., Sugg, N. K., Thompson, D. C., Rivara,
F. P., & Thompson, R. S. (2000). Development of a health care pro-
vider survey for domestic violence: psychometric properties. Ameri-
can Journal of Preve n t i v e Me d i c i n e , 19, 245-252.
McFarlane, J., Parker, B., Soeken, K., & Bullock, L. (1992). Assessing
for abuse during pregnancy. Severity and frequency of injuries and
associated entry into prenatal care. Journal of American Medical As-
sociation, 267, 3176-3178. doi:10.1001/jama.267.23.3176
Nunnaly, J. (1978). Psychometric theory. New York: McGraw-Hill.
Petersen, R., Gazmararian, J., & Clark, K. (2001). Partner violence.
Implications for health and community settings. Wome n’s Health Is-
sues, 11, 116-125. doi:10.1016/S1049-3867(00)00093-1
Rodríguez, M. A., Bauer, H. M., McLoughlin, E., & Grumbach, K.
(1999). Screening and intervention for intimate partner abuse: Prac-
tices and attitudes of primary care physicians. Journal of American
Medical Association, 282, 468-474. doi:10.1001/jama.282.5.468
Roelens, K., Verstraelen, H., Van Egmond, K., & Temmerman, M.
(2006). A knowledge, attitudes and practice survey among obstetri-
cian-gynaecologists on intimate partner violence in Flanders, Bel-
gium. BMC Public Health, 6, 238. doi:10.1186/1471-2458-6-238
Short, L. M., Alpert, E., Harris, J. M., & Surprenant, Z. J. (2006). A
tool for measuring physician readiness to manage intimate partner
violence. American Journal of Preventive Medicine, 30, 173-180.
Sohal, H., Eldridge, S., & Feder, G. (2007). The sensitivity and speci-
ficity of four questions (HARK) to identify intimate partner violence:
A diagnostic accuracy study in general practice. BMC Family Prac-
tice, 8, 49.
Streiner, D. L., & Norman, G. R. (1989). Health measurement scales a
practical guide to their development and use. New York: Oxford
University Press, Inc.
Thompson, R. S., Rivara, F. P., Thompson, D. C. et al. (2000). Identi-
fication and management of domestic violence—A randomized trial.
American Journal of Preventive Medicine, 19, 253-263.
Thorndike, R. M., Cunningham, G. K., Thorndike, R. K., & Hagen, E.
P. (1991). Measurement and evaluation in psychology and education
(5th ed.). New York: Macmillan.
Tjaden, P., & Thoennes, N. (2000). Extent, nature, and consequences of
intimate partner violence: Findings from the national violence
against women surv e y. Washington DC: Department of Justice (US).
Tolman, R., & Rosen, D. (2001). Domestic violence in the lives of
women receiving welfare. Violence against Women, 7, 141-158.
World Health Organisation (2005). WHO multi-country study on
women’s health and domestic violence against women. Geneva:
Copyright © 2012 SciRes.