Application of the Woman Abuse Screening Tool (WAST) and WAST-Short in the Family Practice Setting
Women are often reluctant to disclose abuse to their family physicians for numerous reasons, including shame, denial, fear of reprisal by their partner, a tendency to minimize or normalize the abuse, fear of a negative or punitive response by their physician, or assignment of power and control to the physician.6,24-26 However, studies have shown that when women feel understood, listened to, and validated by their physicians they are more inclined to discuss the abuse.27-29 Also, previous studies with abused women22,23,27-29 have found that they want their physicians to take responsibility for asking questions about abuse and to do so in a manner that is caring, respectful, and supportive. Thus, determining the comfort of women being asked the WAST questions by their family physicians was viewed as essential to our study.
Therefore, the objectives of field testing the WAST were to assess its validity and reliability in the general population within the context of the family practice setting; to determine the comfort levels of family physicians administering the WAST, their perceptions of its ability to help them identify abused women, and their willingness to continue using it in their practices; and to determine the self-reported comfort of patients with being asked the WAST questions by their family physicians.
Our study was approved by the Review Board for Health Sciences Research Involving Human Subjects at the University of Western Ontario.
Methods
Setting
Our study was conducted in the offices of family physicians located in London, Ontario, Canada, and the surrounding area. The recruitment and data collection took place from March 1997 to August 1998.
Instruments
The WAST. Although the original version of the WAST consisted of 7 questions, an eighth question (“Has your partner ever abused you sexually?”) was added for our study (Figure). This question was thought to be clinically important when assessing women who screen positive on the WAST-Short. The 2 questions that make up the WAST-Short assess the degree of relationship tension and the amount of difficulty that the woman and her partner have in working out arguments on a scale of 1 to 3.
Scores on the WAST-Short are computed on the basis of a criterion cutoff score of 1, which involves assigning a score of 1 to the most extreme positive responses for each of the 2 items (ie, “a lot of tension” and “great difficulty”) and a score of 0 to the other response options.18 The remaining 6 questions are used to gain a more complete assessment of the abuse by asking the respondent to rate the frequency of various feelings and experiences on a scale from 1 (often) to 3 (never). The WAST items are recoded and summed to calculate the overall score.
The Abuse Risk Inventory. The Abuse Risk Inventory (ARI) is a 25-item self-report measure used in the identification of woman abuse and is also described as being useful in the assessment process.30 Respondents rate 25 items on the basis of frequency of occurrence using a 4-point scale ranging from “rarely or never” to “always.” A score of 50 or higher suggests that the respondent may be in an abusive situation or at risk for abuse.30 The ARI has demonstrated reliability (a=.91).30
Physician and Patient Comfort with the WAST Questionnaires. These self-report questionnaires were used to determine the level of comfort of physicians and patients with asking or being asked each of the WAST questions. Responses were given using a 4-point scale ranging from 1 (not at all comfortable) to 4 (very comfortable).
Prior Knowledge Questionnaire. This questionnaire assessed a physician’s previous or concurrent relationships with the patient and her partner by identifying various contexts (eg, workplace, leisure) through which the physician is connected with the patient and her partner in the role other than as the family physician. This questionnaire was included because of the potential influence of the physician’s personal relationship with the patient and her partner on both the patient’s willingness to disclose abuse and the physician’s comfort in inquiring about it.
The Perceived Usefulness Questionnaire. This questionnaire asked physicians to respond to the following statements using a 5-point Likert scale ranging from 1 (strongly agree) to 5 (strongly disagree): “The wording of the WAST was clear”; “The WAST helped me to identify women who are abused”; “I feel better able to identify women who are abused using the WAST”; and “I felt comfortable asking questions on the WAST.” Physicians were also asked to indicate whether they would continue to use the WAST in their practice using the same 5-point scale.
