Application of the Woman Abuse Screening Tool (WAST) and WAST-Short in the Family Practice Setting

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Original Research

Application of the Woman Abuse Screening Tool (WAST) and WAST-Short in the Family Practice Setting

J Fam Pract. 2000 October;49(10):896-903

References

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Patient Characteristics

A total of 456 patients were asked to participate in our study. Fifty-seven women were deemed ineligible on the basis of the inclusion criteria, resulting in 399 eligible patients. Ninety-two (23.1%) of these refused, giving lack of time, degree of sickness, and discomfort in discussing personal issues as their reasons. Thus the final sample included 307 women.

The average age of these patients was 46.2 years (range=18-86 years). The majority (87.6%) were married or in a common-law relationship. The patients were primarily white (97.6%), and 44.7% reported having postsecondary education. More than half of the subjects (58.9%) were employed, and 58.7% reported an annual household income of more than $30,000 (Table 1).

Of the 307 patients screened, 26 (8.5%) were identified by the WAST-Short as experiencing abuse. The demographics of the sample for those who screened positive and negative for abuse are provided in Table 1. No significant differences were found. However, the 26 women who screened positive for abuse reported a wide range of income levels, with 9 women (34.6%) indicating an annual income of more than $50,000.

Table 2 shows the individual WAST item responses and overall scores for the total sample divided into 2 groups: those who screened positive for experiencing abuse and those who screened negative. Significant differences were found between the 2 groups for each item and for the overall WAST scores.

Physician Perceptions of and Comfort with the WAST

The majority of the physicians (85%) thought the wording of the WAST was clear. Sixty-five percent indicated that it assisted them in identifying women who were abused, and 70% felt more confident in identifying abused women when using the WAST. Also, 75% of physicians reported that they would continue to use the WAST in their practice. We did not systematically inquire about a physician’s previous knowledge of a patient’s experience with abuse. However, this information was often reported to the research assistant anecdotally, who then recorded these conversations in her logbook. According to the logbook entries, 6 of the physicians had been aware of previous abuse experienced by some of the women participating in the study.

All the physicians were comfortable with the items on the WAST, as indicated by a mean score of 3.6 on the question “How comfortable were you in asking your patients the WAST questions?” (1=not at all comfortable; 4=very comfortable).

There was a significant association between the number of years since graduation and the reported comfort level of physicians with asking each of the WAST questions; those who had been in practice for a greater length of time were more comfortable than more recent graduates. For example, 85.7% and 100% of physicians who graduated in the 1950s and 1960s, respectively, reported feeling very comfortable asking question 8, compared with 62.1% and 0% of graduates from the 1980s and 1990s, respectively (P <.001). This trend was consistent for each of the WAST items. No significant differences were found in the level of comfort of the physicians on 6 of the WAST questions on the basis of certification status. However, this was not the case when asking the 2 items related to physical abuse, which had smaller proportions of physicians with CFPC certification feeling very comfortable compared with the noncertificants (57.4% vs 76.7% and 60.6% vs 78.1% on questions 4 and 6, respectively; P <.05). Higher proportions of women physicians than men reported being very comfortable when asking the WAST questions addressing physical, emotional, and sexual abuse (77.9% vs 54.9%; 74.8% vs 52.0%; and 77.9% vs 53.8%, respectively; P <.001). There was no association found between the comfort level of physicians and their previous knowledge of their patients.

Patient Comfort with the WAST

For all the WAST items, a minimum of 91% of the women reported being comfortable or very comfortable when asked the questions by their family physician. The average comfort level score across all items was 3.6 (Table 3). However, the abused women were significantly less comfortable than the nonabused women with the questions that addressed physical and sexual abuse (including the question asking whether arguments resulted in a violent outcome) with all 3 questions achieving a significance level of P <.05.

Discussion

The 8-item WAST was found to be a reliable and valid measure in the family practice context among the general population. The WAST-Short identified 26 women (8.5% of the sample) as experiencing abuse, and there was a significant difference between the abused and nonabused women on their total WAST scores. Although not directly transferable, these findings are noteworthy when compared with a 1993 survey of 12,300 Canadian women older than 18 years reporting that 10% of women had experienced violence in the 12 months before the survey.³³