Developing a Contextual Framework to Understand Provider Bias When Delivering Intimate Partner Violence Universal Education in a Pediatric Emergency Department

Provider bias can create inequities in the response to intimate partner violence (IPV) within healthcare settings, negatively impacting the health of IPV survivors and their families. In our pediatric emergency department (ED), it is recommended that universal IPV education be offered to all adult caregivers presenting alone with a pediatric patient. Despite the program's standardization, quality improvement data have identified disparities in the delivery of IPV universal education and electronic medical record documentation. In a previous study, significant disparities in offering IPV universal education and documentation were found and linked to both explicit and implicit provider biases. This paper aims to apply theoretical frameworks, such as the Social Ecological Model (SEM) and the Theory of Reasoned Action/Theory of Planned Behavior, to develop a contextual framework that examines macro- and micro-level factors influencing a provider's decision to offer IPV education. Interviews with ED providers from a prior study, focusing on the role of race in addressing IPV, were analyzed to uncover specific biases that inform providers' decisions on offering IPV universal education to a caregiver. The contextual framework was used to explore the root causes of biases and how they influence a provider's behavior, leading to inequities in IPV universal education. To conclude, the contextual framework is used to identify potential interventions at various SEM levels to reduce biases in our IPV universal education program by improving IPV universal education training, increasing provider knowledge of IPV experience across diverse populations, and providing a method for providers to self-evaluate their own biases. Further studies can explore how this contextual framework can be adapted through a cross-disciplinary approach to examine other behaviors that contribute to disparities in IPV care delivery, with a goal of increasing equitable access to IPV interventions across multiple healthcare settings.