Since the early 199Os, organized nursing and medicine have called upon their providers to address domestic violence as a health problem, beginning with the routine screening of patients. The specific message in prenatal care, for instance, is to screen all pregnant women for domestic violence once per trimester. A comprehensive look at the translation of these professional guidelines into practice has not been undertaken. While considerable research has examined what impedes provider screening for domestic violence, little research has investigated what facilitates provider screening. In fact, as Rodriguez and colleagues (1999) observed in a recent research article, """"""""it is unclear how often and under what circumstances providers screen."""""""" Understanding these circumstances is the prelude to reducing violence and injuries and improving the health of abused women. Through a case study of an urban prenatal clinic that has made domestic violence a priority issue, this proposed dissertation research will examine the institutionalization of a health care response to domestic violence. In particular, the study will address the following research questions: 1) What are the domestic violence screening rates across prenatal care, and how do they vary? 2) What patient factors explain these screening rates throughout prenatal care? and 3) What strategies for addressing domestic violence do providers report, and how did these strategies evolve? The study will employ a mixed methodology design. Qualitative interviews with clinic providers will render thick description of the processes at play in the assessment of and follow-up to domestic violence in patients. Quantitative analysis of medical record data will test hypotheses about patient conditions, both clinical and non clinical, that cue provider screening for domestic violence.
