Aim: Domestic violence is common in women and is associated with poorer healthcare outcomes. However, no causal pathway has been identified to explain this observation. We have followed a cohort of women to determine whether poorer outcomes can be explained by high rates of default and lost to follow up.

Methods: A prospective cohort study was performed. Institutional ethics approval was obtained. Participants were consecutive patients attending colposcopy clinics at a major metropolitan hospital in Australia. Following ascertainment of domestic violence status, appointment outcomes for colposcopy services were tracked for a three-year period. Multivariate analysis was undertaken to determine demographic factors associated with default from care and loss to follow up.

Results: Of 581 women approached, consent was obtained from 574 women (99%). Domestic violence status was obtained from 566 women, of whom 187 (33%) had a recent history of exposure. Women exposed to violence were more likely to default from colposcopy once (26.2% vs 7.4%; p<0.0001), twice (11.2% vs 3.2%, p=0.0001), or thrice (10.7% vs 2.4%, p<0.0001). They were more likely to be lost to follow up (8.0% vs 1.1%, P<0.0001). In multivariate analysis exposure to domestic violence remained significantly associated with default and loss to follow up.

Conclusion: Domestic violence is a risk factor for default from attendance and lost to follow up at colposcopy services. This may explain the mechanism behind adverse healthcare outcomes seen. Screening and targeted appointment intervention programs may improve clinical compliance.


domestic violence, colposcopy, default, noncompliance, loss to follow up

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