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. Author manuscript; available in PMC: 2019 Mar 1.
Published in final edited form as: Health Promot Pract. 2017 Sep 11;19(2):194–202. doi: 10.1177/1524839917728050

Evaluation of an Intimate Partner Violence Training for Home Visitors Using the Theory of Planned Behavior

Christiaan G Abildso 1, Angela Dyer 1, Alfgeir L Kristjansson 1, Michael J Mann 1, Thomas Bias 1, Jessica Coffman 1, Emily Vasile 1, Danielle Davidov 1
PMCID: PMC5824982  NIHMSID: NIHMS942374  PMID: 28893112

Abstract

Introduction

Intimate partner violence (IPV) is a public health issue with recent intervention focus by home visiting programs with at-risk families in the United States. Home visitors are typically required to assess IPV but feel unprepared to do so and desire training. Our aim was to evaluate the impact of a daylong IPV training on the intention to enact three key IPV behaviors (screening, making referrals, and safety planning) using the theory of planned behavior.

Method

Survey of 125 home visitors in West Virginia was conducted before and after a daylong IPV training.

Results

The IPV training had a positive impact on intention to perform the three behaviors of interest, with the greatest impact on the intention to conduct IPV screenings.

Discussion

Results provide important preliminary evidence supporting the effectiveness of professional development as a means of increasing intentions to conduct activities related to IPV. The impact on IPV screening intention is promising because screening is the first step in addressing IPV.

Conclusion

The IPV training proved beneficial in increasing intentions and such trainings should be expanded, but further study is needed to link intentions to subsequent behaviors to address IPV with at-risk families.

Keywords: domestic/intimate partner violence, violence prevention, impact evaluation, training, behavior change theory, theory

Introduction

Intimate partner violence (IPV) is defined by the Division of Violence Prevention at the U.S. Centers for Disease Control and Prevention, Injury Prevention & Control, Division of Violence Prevention (n.d.) as “physical violence, sexual violence, stalking or psychological aggression (including coercive acts) by a current or former intimate partner.” According to the 2010 National Intimate Partner and Sexual Violence Summary Report, an estimated 74.7 million men and women experienced IPV in their lifetime, including 35.6% of women and 28.5% of men (Black et al., 2011). This is comparable to global estimates demonstrating that approximately 30% of women who have been in a relationship have experienced physical or sexual IPV worldwide (World Health Organization, 2013). Furthermore, IPV is associated with significant acute and long-term health consequences; according to the National Crime Victimization Survey, almost half of IPV victims experience physical injury (e.g., gunshot or knife wounds, internal injuries, loss of consciousness, broken bones, cuts, bruises) as a result of violent victimization episodes and over one third require medical treatment for their injuries (Truman & Morgan, 2014).

Background/Literature Review

A number of interventions to assess and respond to IPV among women of childbearing age have been developed and tested due to increased risk for IPV among this population (Bair-Merritt et al., 2014; Wathen & MacMillan, 2003; Institute of Medicine, 2011). The U.S. Preventive Services Task Force recommends that clinicians in health care settings screen all women of childbearing age for IPV and the Affordable Care Act mandates insurance cover for IPV screening and counseling for women (Bair-Merritt et al., 2014; Nelson, Bougatsos, & Blazina, 2012; U.S. Department of Health & Human Services, 2013). While several large randomized controlled trials have failed to demonstrate reductions in exposure to violence or improvements in health or quality of life as a result of universal IPV screening (MacMillan et al., 2009; Klevens et al., 2012; Taft et al., 2013), there is evidence of positive benefit from other brief primary care–based interventions, especially on abused women’s use of community or IPV-related referral resources (Bair-Merritt et al., 2014). Characteristics of these primary care IPV interventions include a focus on empowering women to meet their personal goals, supportive and empathetic discussions, and information sharing surrounding IPV, safety planning, and local referral resources (Bair-Merritt et al., 2014). Still, a variety of factors must be in place within health care organizations to facilitate effective screening and response. O’Campo, Kirst, Tsamis, Chambers, and Ahmad (2011) suggest that comprehensive programs with multiple components and institutional support coupled with adequate provider training and immediate access to referrals and supportive services demonstrate the most promise for increasing provider self-efficacy to assess for and respond to IPV and, in turn, increase the rate of IPV disclosure and identification.

Home visiting programs have been used as a vehicle to assess and respond to IPV because of the tremendous in-home access that these programs have with pregnant women and families, especially among at-risk populations (Bair-Merritt et al., 2010; Jack et al., 2012; Shepard, Elliott, Falk, & Regal, 1999). Evidence-based home visiting programs generally use a psychoeducational approach and provide access to community resources to support families to improve six targeted outcomes for at-risk children, including reduction in crime or domestic violence (U.S. Department of Health & Human Services, Health Resources and Services Administration, 2016). Findings from a randomized controlled trial reported by Bair-Merritt et al. (2010) showed significantly lower incidence rates of IPV victimization and perpetration among mothers in the Hawaii Healthy Start Program receiving early childhood home visiting than a control group in the same program not receiving home visiting services. A recent evaluation of the Domestic Violence Enhanced Perinatal Home Visits trial (Sharps et al., 2016) also demonstrated reductions in IPV over time when using trained home visitors (HVs) to screen for IPV and make appropriate referrals. The Nurse–Family Partnership, the United States’ largest home visitation program, is also engaged in a longitudinal randomized controlled trial to evaluate the impact of addressing IPV during home visits on outcomes for enrolled mothers (Jack et al., 2012).

Rates of IPV vary across the United States, with unique disparities in West Virginia (WV) where the current project took place (Black et al., 2011). According to the 2010 National Intimate Partner and Sexual Violence Summary Report, lifetime prevalence of IPV among women in WV (33.6%) was slightly lower than the national lifetime prevalence (35.6%) but was the highest in the country for men (41.2%; Black et al., 2011). The presence of numerous socioeconomic and health disparities may complicate the nature and consequences of IPV within the highly rural state. Research has demonstrated that rural IPV can be more frequent and severe than IPV perpetrated in nonrural areas (Peek-Asa et al., 2011) and that rural partners are more likely to use weapons, such as knives or guns, against their victims (Logan, Walker, Cole, Ratliff, & Leukefeld, 2003). Rural partners are also more likely to be killed as a result of IPV (Gallup-Black, 2005), and in WV over one third of all homicides have been found to be related to IPV (WV State Police, 2012).

The WV Home Visitation Program (WVHVP) is administered by the Office of Maternal, Child, and Family Health in the WV Department of Health and Human Resources. The WVHVP uses home visiting models that meet evidence-based standards established by the federal Maternal, Infant and Early Childhood Home Visiting Program. These programs include Healthy Families America, Parents as Teachers, and Early Head Start. Other programs offered include Maternal Infant Health Outreach Workers, Right From the Start (Medicaid perinatal case management home visitation program), Healthy Start/Helping Appalachian Parents & Infants Project, and Save the Children. All of the programs above use a home visiting model in which trained professionals visit families in their homes or at neutral locations and have the ability to screen for a variety of issues including IPV. The schedule for IPV screening in these programs varies, though all use the HITS (Hurt, Insult, Threaten, and Scream) tool to screen for IPV (Sherin, Sinacore, Li, Zitter, & Shakil, 1998). Referrals for IPV should be made when a respondent’s score on the four-item, 4- to 20-point scale is 10 or higher. In addition, HVs are encouraged to create a safety plan for clients to help them remain safe while in a violent relationship or if they are planning to leave or have left an abusive relationship.

The theory of planned behavior (TPB) evolved in the late 1970s and early 1980s from its predecessor, the theory of reasoned action (TRA; Ajzen, 1985; Fishbein, 1967). According to the TPB, a behavior is primarily predicted by Behavioral Intention, which is influenced by three main predictive constructs: Attitude Toward the Behavior (ATB), Subjective Norm (SN), and Perceived Behavioral Control (PBC; Ajzen, 2002b; Montaño, Phillips, Kasprzyk, & Greek, 2008). ATB is defined as an individual’s view toward a behavior; SN is an individual’s view of a behavior given his or her perception of his or her social ties; and PBC includes an individual’s assessment of his or her power and ability to carry out the behavior (Ajzen, 2002b; Montaño et al., 2008).

The TPB is a well-researched model of human behavior. It has been used in studies to predict a range of health behaviors including but not limited to eating habits, exercise behaviors, vaccination participation, and cancer screenings/mammography (Gerend & Shepherd, 2012; McEachan, Conner, Taylor, & Lawton, 2011; Roncancio et al., 2015). The TPB has also been used as a framework for a number of behavioral interventions targeting, for example, healthy eating, safe sexual behaviors, safe automobile driving, and food safety interventions (Elliott & Armitage, 2009; Kothe, Mullan, & Butow, 2012; Milton & Mullan, 2012; Montanaro & Bryan, 2014). Furthermore, both the TPB and TRA have been used for evaluation purposes (Calabro, Mackey, & Williams, 2002; Schoening, Greenwood, McNichols, Heermann, & Agrawal, 2004), including a study by Calabro et al. (2002) in which a survey was developed to assess constructs of intention and ATB and analyze changes among psychiatric hospital staff following a training on violence perpetrated by patients. With regard to IPV specifically, studies have shown that the TPB is predictive of IPV behaviors of male perpetrators (Kernsmith, 2005) and the intention of female victims to leave or stay in a violent relationship (Edwards, Gidycz, & Murphy, 2015). While these studies use the TPB to predict behaviors among perpetrators and victims of IPV, Schoening et al. (2004) applied the TPB to assess the changes in attitudes toward IPV following trainings for hospital nurses.

It is important to note that previous studies have demonstrated that although home visiting professionals are typically required to assess IPV among clients, they feel unprepared to do so, report low levels of confidence in addressing IPV with clients, and desire training to enhance IPV knowledge and assessment skills, including how to maintain a nonjudgmental attitude and to initiate conversations about IPV with clients (Bair-Merritt et al., 2010; Duggan et al., 2004; Eddy, Kilburn, Chang, Bullock, & Sharps, 2008; Jack et al., 2012; Jack, Ford-Gilboe, Davidov, & MacMillan, 2017; Jack, Jamieson, Wathen, & MacMillan, 2008; Sharps et al., 2016). HVs also require more information about how to promote safety planning behaviors among clients and encourage follow-through with referrals to IPV-related resources and community agencies (Jack et al., 2017; Tandon, Mercer, Saylor, & Duggan, 2008). In response, professional training opportunities have been developed with the goal of meeting HVs’ needs related to IPV, but little work has been done to evaluate the effectiveness of those approaches. As a result, there is a clear need for evaluation research designed to measure the impact of professional development on HVs’ readiness to implement evidence-based IPV-related services to their clients, specifically screening, safety planning, and making referrals. In accordance with the TPB, providing training that improves HVs’ intentions to screen for IPV, make safety plans, and refer for IPV when warranted is likely to lead to behavior change among home visiting professionals, resulting in more clients being screened and referred for additional services. To date, however, the TPB has not been used to evaluate the impact of professional training on HVs’ intentions toward these key IPV behaviors. In this study we used the TPB to evaluate the impact of a daylong IPV training for HVs in WV. We hypothesized that each of the three main concepts of TPB (ATB, SN, and PBC) would increase during the training, reflecting an improvement in the HVs’ intention to screen for IPV, refer victims to professionals, and create safety plans for their clients.

Method

Sample and Participants

Participants in this study were attendees of a daylong IPV prevention training for HVs in WV provided by a professional trainer using the Futures Without Violence “Healthy Moms, Happy Babies” curriculum on “Domestic Violence, Reproductive Coercion and Children Exposed” (Chamberlain & Levenson, 2014), including PowerPoint slides, training videos, and interactive discussion. The purpose of the training was to familiarize, reinforce, and demonstrate evidence-based techniques for IPV screening, safety planning, and referring through lecture, video demonstrations, and interactive discussion. An IPV victim also spoke at each training to reinforce the importance of addressing IPV by HVs and some suggestions for how to do so from a victim’s perspective. Attendance at the training was required as professional development for all HVs in the state and funded by the WVHVP. In total, 125 HVs attended the training, representing 22 different home visiting agencies that implement at least one of six different home visiting models. The training was held at four different sites in April and May 2015. All attendees were recruited to participate in the study. Participants were given a packet at a registration table at the beginning of the training by a member of the evaluation team, including a cover letter, a consent form, and pre- and posttraining surveys in separate, sealed envelopes. At the start of the training, an evaluation team member reviewed the cover letter and asked for study participation, consent, and completion of the pretraining survey. The post survey was collected from participants at the end of the training. Participation in the survey was voluntary, and participants were not compensated. The West Virginia University Institutional Review Board reviewed and approved the study for the protection of human subjects (Protocol No. 1504668379).

Measures

Pre- and posttraining surveys were developed by the evaluation team and reviewed by key stakeholders at the WVHVP for face validity. Survey items were constructed using TPB item development procedures (Ajzen, 2002a) to assess the intention to perform three behaviors of interest: (a) IPV screening, (b) making referrals for IPV services, and (c) creating safety plans. The final survey included 11 items for each behavior of interest, including 3 items for ATB and 4 items each for SN and PBC. Multiple items were reversed scored. Once reversed, summary scores for each construct and the full instrument were calculated. Higher summary scores represent more positive ATB, SN, and PBC and total intention to perform each behavior.

Attitude Toward Behavior

We assessed attitudes toward each IPV behavior of interest (screening, referring, and safety planning) using a statement for the behavior scored on three 7-point semantic differential scales by the respondent using text anchors: harmful (1) to beneficial (7), good (1) to bad (7), pleasant (1) to unpleasant (7). For example, for IPV screening, the statement read “For my home visitation (HV) clients, me doing an assessment of their experiences of domestic violence is …”

Subjective Norm

Subjective norm for IPV screening, referrals, and safety plans was assessed using four statements pertaining to (a) perceived general expectations, (b) perceived supervisor expectations, (c) what most other HVs do, and (d) what other HVs that the respondent respects are most likely to do. This was followed by four statements scored on a 7-point semantic differential scale: I should (1) to I should not (7), strongly disagree (1) to strongly agree (7), completely true (1) to completely false (7), and completely false (1) to completely true (7).

Perceived Behavioral Control

Similar to SN, we assessed PBC to perform screening, conduct referrals, and create safety plans with four statements pertaining to (a) the possibility of doing the work, (b) the perceived ability to do the work, (c) perceived control over the work, and (d) whether it is up to the HV to do the work or not. This was followed by four statements scored on a 7-point semantic differential scale: impossible (1) to possible (7), definitely true (1) to definitely false (7), complete control (1) to no control (7), and strongly disagree (1) to strongly agree (7).

Analyses

Data were analyzed using two approaches. First we employed principal component analysis on each of the 11-question, behavior-specific measures in the questionnaire: screening, referrals, and safety planning. Items with factor loading of .40 and above were retained for the creation of the final scaled measure within each subcategory. As anticipated, this approach resulted in three behavior-specific scales that corresponded with the three core HV tasks related to IPV. These scales included one related to IPV screening (Screening, 7 items), one related to making IPV-related community referrals (Referrals, 8 items), and one related to developing a collaborative IPV safety plan with home visitation clients when necessary (Safety Planning, 8 items). We then used repeated measures analysis of variance on each of the three measures to test for within-subjects differences in mean scores pre- and posttraining.

Second, the Screening, Referral, and Safety Plan scales were each further divided into three TPB construct- specific subscales related to ATB, SN, and PBC. This step resulted in a total of nine subscales, with three subscales for each behavior-specific scale measure. For example, the Screening scale was divided into three TPB construct-specific subscales: Screening-ATB, Screening-SN, and Screening-PBC. We then used repeated measures analysis of variance to test for within-subjects mean differences pre- and posttraining within each behavior-specific subscale measure. We used Cronbach’s alpha to select/omit items to be used in each analysis.

Results

Nearly all 125 attendees (96.0%, n = 120) of the trainings completed both the pre- and posttraining surveys. In line with overall demographics of HVs in WV, the vast majority of the attendees were female (95.8%, n = 115). The majority were full-time HVs (74.6%, n = 85) and college-educated (60.9%, n = 73). The respondents varied on age (M = 41.8 years, SD = 10.3) and years of experience (M = 8.1 years, SD = 8.1). Full demographic data from the survey respondents are presented in Table 1.

Table 1.

Demographic Characteristics of 120 Home Visitors Who Attended a Daylong Intimate Partner Violence Training, West Virginia, 2015

Characteristic n M ± SD, or n (%)
Age, years 116 41.8 (±10.3)
Experience as a home visitor, years 102 8.1 (±8.1)
Sex 120
 Male 5 (4.2%)
 Female 115 (95.8%)
Highest level of formal education 120
 High school graduate 7 (5.8%)
 Some college 36 (30.0%)
 Undergraduate college graduate 56 (46.7%)
 College graduate degree 17 (14.2%)
 Other 4 (3.3%)
Employment status as home visitor 114
 Full-time 85 (74.6%)
 Part-time 29 (25.4%)
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NOTE: Sample sizes vary due to missing data.

Table 2 outlines the results from analysis Approach 1, based on principal component analysis of intention to perform each of the three IPV behaviors of interest, as well as the distributional properties for the measures. Distributional properties are within acceptable range in all instances for pre- and posttraining assessments. Intention to perform the three IPV behaviors of interest was generally fairly high among the HVs in our study prior to the IPV training (average item scores of 4–5 on scale of 0–6). As hypothesized, and despite this potential ceiling effect, a significant mean difference was observed in the hypothesized direction for the intention to perform all three IPV behaviors of interest (i.e., within-subject analyses) using this statistical approach.

Table 2.

Changes in Behavioral Intention to Conduct Screenings, Make Referrals, and Develop Safety Plans for Intimate Partner Violence Among Home Visitors Undergoing a Daylong Training, West Virginia, 2014

Measure No. of items Range Skew
Kurtosis
α
M (SD)
Difference
Pre Post Pre Post Pre Post Pre Post
Screenings 7 0–42 −0.28 −0.70 −0.58 −0.44 .71 .60 31.14 (6.01) 35.38 (4.41) F(1, 77) = 46.94, p = .001
Referrals 8 0–48 −0.39 −0.78 −0.43 −0.01 .65 .67 37.85 (6.11) 40.27 (5.57) F(1, 77) = 13.38, p = .001
Safety plans 8 0–48 −0.85 −1.22 −0.16 0.93 .71 .66 39.83 (6.71) 41.28 (5.86) F(1, 74) = 4.20, p = .044
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Table 3 includes the results from the analyses that were based on the TPB construct-specific subscales within each of the three behaviors of interest, including the measurement distributional properties. As shown, the majority of analyses on skew and kurtosis (30 of 36) are within the preferred range of ± 1.0, and Cronbach’s alpha ranges from .40 to .77 for all pre- and posttraining assessments. A significant mean difference was observed in the hypothesized direction in three of nine within-subject analyses using this approach to the data (Screening-PBC, Safety Planning-SN, and Safety Planning-PBC subscales), highlighting the impact of the training on improvements in HVs’ belief in their own ability (PBC) to conduct screenings and perform safety plans and their belief that important others (SN) conducted and/or supported conducting safety plans.

Table 3.

Changes in Attitude Toward Behavior (ATB), Subjective Norm (SN), and Perceived Behavioral Control (PBC) to Conduct Screenings, Make Referrals, and Develop Safety Plans for Intimate Partner Violence Among Home Visitors Undergoing a Daylong Training, West Virginia, 2014

Measure No. of items Range Skew
Kurtosis
α
M (SD)
Difference
Pre Post Pre Post Pre Post Pre Post
Screenings
 ATB 3 0–18 −0.10 −0.36 −0.43 −0.05 .62 .51 12.46 (2.54) 12.86 (2.09) F(1, 79) = 4.21, p = .141
 SN 4 0–24 −0.61 −0.52 −0.34 −0.64 .48 .40 14.44 (3.09) 14.69 (2.99) F(1, 100) = 0.73, p = .396
 PBC 3 0–18 −0.20 −.52 −1.05 −0.64 .66 .45 13.30 (3.28) 14.64 (2,91) F(1, 102) = 18.01, p = .001
Referrals
 ATB 3 0–18 0.23 −0.18 −0.31 −0.56 .63 .73 12.43 (2.28) 12.75 (1.95) F(1, 80) = 1.44, p = .234
 SN 4 0–24 −0.65 0.45 −0.44 −0.84 .49 .40 18.56 (4.50) 19.20 (3.95) F(1, 99) = 2.41, p = .124
 PBC 3 0–18 −0.93 −0.10 −1.20 0.59 .63 .68 14.76 (3.13) 15.20 (3.10) F(1, 101) = 2.16, p = .145
Safety plans
 ATB 2 0–12 −1.44 −2.15 0.83 3.85 .77 .46 10.77 (2.00) 11.10 (1.83) F(1, 76) = 1.58, p = .212
 SN 4 0–24 −0.44 −0.66 −0.55 −0.68 .49 .47 19.12 (4.14) 19.96 (3.86) F(1, 96) = 4.78, p = .031
 PBC 3 0–18 −0.66 −1.35 −0.47 1.17 .55 .76 14.13 (3.29) 14.88 (3.31) F(1, 98) = 5.31, p = .023
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Discussion

The results of this work highlight the positive impact the IPV training had on HVs’ intentions to perform three key behaviors that could lead to increased intervention and reduced severity of IPV among clients. Specifically, the IPV training had a positive impact on intention to perform the three behaviors of interest: IPV screening, safety planning, and making referrals. The training included demonstration videos of IPV screening and safety planning, and provided the opportunity to openly share techniques and work through potential barriers. In addition, concerns about making referrals and solutions were discussed with the IPV trainer and WVHVP staff in attendance (e.g., lack of agencies trained to work with male victims of IPV). Table 2 shows that the greatest impact of the IPV training was seen in the intention to conduct IPV screenings. This is a promising finding because the first step to addressing IPV is determining whether a client is experiencing IPV. Removing barriers related to conducting IPV screenings represents a critical first step to helping HVs become comfortable addressing a topic they may perceive as difficult to initiate or a potential negative impact on client rapport. The critical importance of discussing IPV was also stressed by the IPV victims who spoke at each training, who also highlighted their feelings of seclusion and lack of support—all of which HVs are in a unique position to overcome when they visit the home and screen for IPV.

Our more in-depth analysis of each IPV behavior using the TPB construct-specific subscales presented mixed results. Pre- to posttraining changes in intention to screen for IPV were largely a result of significant changes in Screening-PBC. That is, HVs felt significantly more capable of successfully conducting IPV screening after taking part in the daylong training. No single TPB construct changed significantly for making IPV referrals, though each construct changed in the expected direction. Both Safety Planning-SN and Safety Planning-PBC for safety planning increased significantly after the training. This finding suggests that HVs’ perceptions of their colleagues and supervisors improved as did the HVs’ perception of their own ability to successfully develop a safety plan.

These findings are important as they provide preliminary evidence supporting the effectiveness of using professional development to increase the intention of HVs to enact important IPV-specific behaviors (Jack et al., 2012; Sharps et al., 2016). This represents a critical step in evaluating the feasibility of using home visiting programs as a setting for identifying and reducing the severity of IPV, especially considering the current trend of home visiting programs to incorporate goals and activities related to IPV (Bair-Merritt et al., 2010; Jack et al., 2012; Shepard et al., 1999; U.S. Department of Health & Human Services, 2016). Considering that preliminary studies suggest home visiting programs may be able to reduce rates of IPV-related harm (Bair-Merritt et al., 2010; Sharps et al., 2016), identifying ways to reduce barriers to incorporating IPV activities in their programs is imperative. This study provides critical preliminary evidence supporting professional development as a means of reducing these barriers; increasing levels of HVs’ intentions to perform IPV screening, referrals, and safety planning; and increasing the likelihood of successfully incorporating IPV into home visiting programs.

Limitations

Some limitations are worth noting. First, the evaluation survey data were collected during a formal training setting under conditions in which risk of social desirability bias was elevated. We are therefore unable to fully control for potential bias in the data due to the nature of the data collection and setting. Second, although our survey questions were created within a solid theoretical framework (TPB), the instrument was created specifically for this purpose and had limited reliability and validity testing. Despite acceptable psychometric properties, we recommend replicating its use within other IPV trainings. Third, our participants had a somewhat limited period of time to complete the surveys, especially the post survey at the end of the daylong training, which may have further encouraged socially desirable responses. Fourth, this preliminary study provided evidence specific to one group of home visiting professionals in one geographic area during a limited period of time. We recommend replicating this study among a wider range of HVs in a variety of locations and providing additional IPV-specific training. Finally, this study used a self-report pre–post design to assess intentions to perform challenging professional tasks. A logical next step is for researchers to use a study design in which data are collected at multiple time points and linked to rates of actual HV behavior related to IPV screening, referral, and safety planning.

Strengths and Implications for Theory, Policy, and/or Practice

In spite of limitations, the results of this study provide important preliminary evidence supporting the effectiveness of professional development as a means of increasing HVs’ intentions to conduct activities related to IPV. Our study is a unique addition to the expansive TPB literature and highlight the increasing intentions of HVs to conduct IPV screenings, referrals, and safety planning as a result of a daylong training, which should lead to subsequent increases in these behaviors. Further study is necessary to examine the critical link between intentions and actual activities in HVs’ day-to-day practice with at-risk clients in addressing the critical issue of IPV.

Acknowledgments

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health & Human Services (HHS) under Grant No. D89MC23160 and title “Affordable Care Act (ACA) Maternal, Infant and Early Childhood Home Visiting Program Competitive Grant Program” for the amount of $2,242,401. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS, or the U.S. Government. Additionally, for Dr. Davidov, research reported in this article was supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award N0. U54GM104942.

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