Dentists’ perceptions and attitudes towards emergency care for women in situations of violence: a scope review

Pereira, Silvilene Giovane Martins; Vargas, Andrea Maria Duarte; Sampaio, Aline Araujo; Silva, Carlos José de Paula; Matoso, Bárbara da Silva Mourthé; Ferreira, Efigênia Ferreira e

doi:10.1590/1413-81232022279.22532021EN

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FREE THEMES • Ciênc. saúde coletiva 27 (09) • Sept 2022 • https://doi.org/10.1590/1413-81232022279.22532021EN copy

Dentists’ perceptions and attitudes towards emergency care for women in situations of violence: a scope review

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Abstract

The purpose of this study was to evaluate, through a scope review, studies that address the perceptions and attitudes of dentists regarding the care of women in situations of violence. Using the descriptors women violence, dentist attendance or dentist care, 473 articles were identified, of which 13 were included at the end of the selection process. Although the need for training was predominant, it was not sufficient. There is a weakness in understanding violence as a health problem, in understanding the role of the professional in solving this problem, and the factors that can contribute to its growth or its control. The results revealed that the dentist had greater difficulty than other professionals in coping with the issue and required extensive training. The recognition of these cases of abuse by the dentist requires the incorporation of educational measures that cause cultural changes, deconstruction of gender norms and the denaturalization of this social phenomenon.

Key words:
Violence against women; Dentist; Scope review

Author/ Country/Year	Objective	Methodological aspects	Results
Love et al. USA (2003)¹¹11 Love C, Gerbert B, Caspers N, Bronstone A, Perry D, Bird W. Dentists' attitudes and behaviors regarding domestic violence. The need for an effective response. J Am Dent Assoc 2001; 132(1):85-93.	To examine the attitudes and behaviours of a national sample of dentists in relation to domestic violence and the barriers that DCs face in intervening and helping women in situations of violence.	Cross-sectional study, online questionnaire, random sample, population 321 CD, (11/1997 to 11/1998). Containing 60 items based on the literature about domestic violence and health care; addressed four areas: identification/protocol, evaluation, barriers to identification and reference. Response rate: 56%.	87% of the DCs never identified violence. Overall, the interventions were minimal, and 94% of the participants reported not having a printed protocol for care. Barriers to identification: presence of partner or children (77%), lack of training (68%), fear of offending patients (66%), embarrassment in bringing violence into the discussion (51%). Education/training on violence facilitated the identification and intervention of cases.
Goff et al. USA (2001)²⁴24 Goff HW, Byrd TL, Shelton AJ, Parcel GS. Health care professionals' skills, beliefs, and expectations about screening for domestic violence in a border community. Fam Community Health 2001; 24(1):39-54.	To verify whether professional training and continuing education on domestic violence is associated with the identification, treatment of cases and professional attitudes.	Cross-sectional Study. Interview by direct mail conducted with 177 dentists, 345 doctors and 84 nurses. Overall response rate was 34.4%. To characterize the population (demographic data and educational history) and evaluate the knowledge, expectations and beliefs about case identification of women in situations of violence. Analysis of the data by SPSS.	Education on domestic violence had a positive association with knowledge and about when to identify and expect results, and a negative association with beliefs. It is possible to train health professionals and increase their skills in dealing with cases of violence.
Goff et al. USA (2003)²³23 Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis [Internet]. JBI; 2020 [cited 2020 mar 18]. Available from: https://jbi-global-wiki.refined.site/space/MANUAL. https://jbi-global-wiki.refined.site/spa...	To investigate personal skills and beliefs about the identification of domestic violence by doctors, dentists and nurses.	Qualitative Study. Individual interviews (May-June/1999), with open questions about the clinician's educational experiences, practices and beliefs about how and when to make the identification, and the expectations of results in cases of domestic violence Population: 15 individuals, equally divided between doctors, dentists and nurses.	The results suggest that there is a relationship between the formal education of the clinician and his or her preparation. Need for improvement of the subject in health curricula to promote awareness, identification and change in personal beliefs about the subject. Of the three groups, dentists reported a greater need for more information on the subject.
Hendler and Sutherland Canada (2007)¹²12 Hendler TJ, Sutherland SE. Domestic violence and its relation to dentistry: a call for change in Canadian dental practice. J Can Dent Assoc 2007; 73(7):617.	The objective of this review is to examine the prevalence and impact of domestic violence, the role of health professionals in dealing with this problem and useful interventions that can be employed to provide assistance to victims.	Literature review, dentist population. Methodology not specified.	The DC is in a strategic position to identify and intervene in cases of violence; however, they are not well trained. Among the health professionals, the DC is the one who feels less responsible to intervene in cases of domestic violence and when they do, they face several barriers, and the intervention is minimal. There is a need for interventions in continuing education in order to foster positive change in the behaviour of the DC.
Plichta USA (2007)⁵5 Plichta SB. Interactions Between Victims of Intimate Partner Violence Against Women and the Health Care System: Policy and Practice Implications. Trauma Violence Abuse 2007; 8(2):226-239.	Analysis of the results of research in official databases conducted in 1996-2006 on the relationship and response of the health system to women in situations of violence.	Document analysis. Population, health professionals. Analyses the results of the survey in the past decade (1996-2006) in relation to victims of intimate partner violence against women.	There is ample evidence that women in situations of intimate partner violence often use the health system. However, they are not identified by health professionals and do not receive the necessary services. Most institutions and health professionals are not prepared to assist women in situations of violence. Almost all studies based on health care environments report much higher identification rates when identification protocols are in place. There have been some pioneering efforts to change the entire system and most seem to be successful in changing knowledge and attitudes; however, studies are limited in scope and quality.
Connor et al. USA (2011)¹⁴14 Connor PD, Nouer SS, Mackey SN, Banet MS, Tipton NG. Dental students and intimate partner violence: measuring knowledge and experience to institute curricular change. J Dent Educ 2011; 75(8):1010-1019.	To evaluate the knowledge and attitudes of health students about interpersonal violence, as well as the extent, content and sufficiency of training to change the institution's curriculum.	Cross-sectional study, validated instrument, 77 items, (between 2007-2008), evaluating self-reported knowledge, attitudes, beliefs and behaviours. Population: 233 dentistry students and 76 dental hygiene students (University of Michigan).	Violence against women was not addressed in undergraduate programs. Graduate students received some type of training on women in situations of violence. It was found that training, exposure or personal experience before or during dental school was effective in increasing confidence and perception. Recommend changes in the undergraduate curriculum to improve the content on the subject and overcome knowledge gaps and improve skills. Note: 20% reported their own experience with interpersonal violence.
McAndrew et al. USA (2014)¹⁸18 McAndrew M, Pierre GC, Kojanis LC. Effectiveness of an online tutorial on intimate partner violence for dental students: a pilot study. J Dent Educ 2014; 78(8):1176-1181.	To test the effectiveness of an online tutorial on domestic violence in the teaching of dentistry students.	Qualitative Study, one-hour online tutorial divided into 10 modules. Recruitment conducted in 2012 enrolled 25 dentistry students in the past year (7% of a class of 358 students) who had not received didactic instruction on domestic violence for more than two years. The modules included an overview of the scope of domestic violence. An objective and validated measure (PREMIS) before and after the tutorial to determine the impact on knowledge, attitudes, beliefs and behaviours of dental students. Statistical analysis of the data.	The tutorial on domestic violence was more effective in causing significant changes in knowledge with short courses than in changing beliefs and attitudes. It was not enough. The perceptions and attitudes of the DCs are flawed in relation to the notification of intrafamilial violence, which hinders the early diagnosis of victims of this type of violence.
Garbin Brazil (2016)²⁶26 Garbin S, Rovida S, Tania Adas TC, Alves AI, Isper GJ. Perceptions and attitudes of public health service dentists in the face of family violence in 24 municipalities in the state of Sao Paulo, Brazil, 2013-2014. Epidemiol Serv Saude 2016; 25(1):179-186.	To describe the perception and attitude towards intrafamily violence among dental surgeons working in basic health units in 24 municipalities, São Paulo.	Cross-sectional, descriptive study (July/2013 to July/2014); questionnaire, semi -structured, composed of 16 subjective and 14 objective questions. Sample, 111 DCs (response rate of 37.8%). Data analysis using the statistical software Epi Info version 3.5.1.	67.5% were unaware of the existing legislation for cases of interpersonal violence; 70.0% did not know how to notify; 55.0% reported not having responsibility for the notification; 85.0% were unaware of the notification form; and 60.0% stated the need to intervene in interpersonal violence. The perceptions and attitudes of dental surgeons are flawed, which hinders the early diagnosis of victims of this type of violence.
Sawyer et al. Australia (2016)⁷7 Sawyer S, Coles J, Williams A, Williams B. A systematic review of intimate partner violence educational interventions delivered to allied health care practitioners. Med Educ 2016; 50(11):1107-1121.	To evaluate the effects of educational interventions on domestic violence on the knowledge, attitudes, skills and behaviours of health professionals (AHCPs).	Study, Systematic Review. Systematic search of multiple databases until the end of May 2015. We selected studies that included educational interventions on interpersonal violence, measuring knowledge, attitudes, skills or behavioural outcomes. Studies were evaluated based on methodological quality, education, context measurement and outcome. Of the 2,757 articles, 18 were included. Population: nurses, dentists, social workers and paramedics.	The results indicate that improvements in some knowledge, attitudes, skills and behaviours are associated with education, although the lack of high quality studies indicates that the conclusions should be treated with caution.
Alalyani and Alshouib Saudi Arabia (2017)¹⁵15 Alalyani WS, Alshouib EN. Dentists awareness and action towards domestic violence patients A cross-sectional study among dentists in Western Saudi Arabia. Saudi Med J 2017; 38(1):82-88.	Identify the potential factors that influence the action of DCs in the face of domestic violence.	Cross-sectional Study-151 DCs. Self-administered and structured questionnaire using a random sample. (January/2016 to February/2016). Data analysis using SPSS22.	The result indicated that the chances of dentists' awareness and actions to care for women in situations of violence were influenced by their education, clinical experience, gender, sector of activity and qualification. The lack of training in the identification of domestic violence and embarrassment in dealing with the issue were the most common barriers. The need for continuing education promotes a change in the personal attitudes of health professionals regarding the cases.
Lea United Kingdom (2016)¹⁶16 Lea SJ, Quinn B, Reynolds PA. The Role and Education of Dental Care Professionals in Identifying Domestic Violence: Report of an Audience Participation Exercise and Round Table Discussion. Tech Know Learn 2017; 22:219-226.	Verify the need to introduce domestic violence education into the dentistry curriculum.	Cross-sectional study; A survey of 10 questions administered to academics, specialists and seniors, in dentistry, from 14 countries, addressing the subject of Dentistry and Domestic Violence. Response rate 52%. After a video on domestic violence, the results are discussed.	Health professionals report professional responsibility in relation to domestic violence. Dental education is not adequately updated in terms of preparation of dental professionals to deal with domestic violence. More research and the development of high quality educational resources in the field are needed. Topic needs continuous discussion.
Zorjan et al. Slovenia (2017)³¹31 Zorjan S, Smrke U, Šprah L. The Role of Attitudes to, and the Frequency of, Domestic Violence Encounters in the Healthcare Professionals’ Handling of Domestic Violence Cases. Zdr Varst 2017; 56(3):166-171.	To evaluate the relationship between the attitudes of health professionals and the actions taken in cases of domestic violence.	Cross-sectional study, convenience sampling (availability) questionnaire, evaluating, attitudes of DCs in relation to domestic violence, experience, behaviour and perceived barriers to recognition and treatment in the health sector. Population: 322 health professionals (doctors, dentists, nursing staff and others).	The results showed the important role of personal attitudes in the actions of health professionals in the face of domestic violence. Findings indicate that health professionals who believe that domestic violence is acceptable tend to respond in less appropriate ways when dealing with women in situations of violence. There is a need for educational interventions aimed at stimulating change in the personal attitudes of health professionals regarding the acceptability of domestic violence.
Parish et al. USA (2018)¹⁷17 Parish CL, Pereyra MR, Abel SN, Siegel K, Pollack HA, Metsch LR. Intimate partner violence screening in the dental setting: Results of a nationally representative survey. J Am Dent Assoc 2018; 149(2):112-121.	To evaluate the practices and attitudes of DCs in the detection of cases of domestic violence.	Cross-sectional study, national survey (November 2010 to November 2011) with 38 questions about DCs’ attitudes, practices and willingness to conduct specific types of medical preventive exams, including interpersonal violence. Population 1,810 DCs. Data analysis: Stata version 12.	Most DCs (53.2%) reported no previous training, and only 2.4% reported having “excellent” knowledge. Most dentists (55.1%) did not believe that the identification of violence should be part of their professional role, and 56.5% did not know where to refer women in situations of violence. Almost none the DCs (92.9%) include a question about violence in patient histories.

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[1] Collaborations

SGM Pereira contributed to the conception and study design, data collection, analysis, and interpretation, to the draft and the critical review of the final version of the manuscript. AA Sampaio, AMD Vargas, BSM Matoso and CJP Silva contributed to data collection, analysis, interpretation, and to critical review of the final version of the manuscript. EF Ferreira guided the study conception, design, and planning, performed data analysis and interpretation, and contributed to drafting and critically reviewing the manuscript.