HITS (Hurt, Insult, Threaten, Scream) Tool (HITS)

Assessment Rating:
A
A – Psychometrics Well-Demonstrated
See entire scale
Developer(s):

Kevin Sherin, MD, MPH

Description / Purpose:

Intimate partner violence (IPV) occurrence and frequency. 

A four-item questionnaire that asks respondents how often their partner physically Hurt, Insulted, Threatened with harm, and Screamed at them. These four items make the acronym HITS. Each question is answered on a 5-point scale: 1 = never, 2 = rarely, 3 = sometimes, 4 = fairly often, 5 = frequently.  The scores range from 4 to a maximum of 20.

Target Population: Adults

Time to Administer: Less than 5 minutes

Completed By: Self-report or interview format

Modalities Available: Pen and paper

Scoring Information: Hand scored by summing the responses

Languages Available:

Training Requirements for Intended Users: None

Availability: The HITS tool normally has a copyright fee of $25. Larger organizations will be charged based on the number of copies needed.  Use the Contact form on the website to get specific information: http://thehitstool.com/contact-us 

Contact Information

Website: thehitstool.com
Name: Kevin M. Sherin, MD
Email:
Phone: (407) 325-0433

Summary of Relevant Psychometric Research

This tool has received the Measurement Tools Rating of "A – Psychometrics Well-Demonstrated" based on the published, peer-reviewed research available. The tool must have 2 or more published, peer-reviewed studies that have established the measure’s psychometrics (e.g., reliability and validity, sensitivity and specificity, etc.). Please see the Measurement Tools Rating Scale for more information.

Show relevant research...

Sherin KM, Sinacore JM, Li XQ, Zitter RE, Shakil A. (1998). HITS: A short domestic violence screening tool for use in a family practice setting. Family Medicine, 30, 508-12. 

Sample:

Participants — 160 adult female family practice office patients living with a partner for at least 12 months

Race/Ethnicity — Not Specified

Summary:

Cronbach’s alpha was 0.80 for the HITS scale. The correlation of HITS and CTS scores was 0.85. For phase two, the mean HITS scores for office patients and abuse victims were 6.13 and 15.15, respectively. Optimal data analysis revealed that a cut score of 10.5 on the HITS reliably differentiated respondents in the two groups. Using this cut score, 91% of patients and 96% of abuse victims were accurately classified. Overall, the HITS scale showed good internal consistency and concurrent validity with the CTS verbal and physical aggression items. The HITS scale also showed good construct validity in its ability to differentiate family practice patients from abuse victims.

Shakil A, Donald S, Sinacore JM, Krepcho M. (2005). Validation of the HITS domestic violence screening tool with males. Family Medicine, 37, 193-98. 

Sample:

Participants — 78 male subjects from an ambulatory clinic, a Human Immunodeficiency Virus (HIV) clinic, or emergency room

Race/Ethnicity — 59% White, 22% African American, 17% Hispanic, 3% Other

Summary:

Concurrent validity of the HITS was good. Optimal Data Analysis (ODA) found that the score of 11 on the HITS differentiated between non-victims and victims. Sensitivity and specificity were 88% and 97%, respectively. Predictive values were 97% for non-victims and 88% for victims. The positive and negative likelihood ratios were 34.41 and 0.12, respectively.  HITS differentiated between male victimized respondents from non-victims in clinical settings.

Chen PH, Rovi S, Vega M, Jacobs A, Johnson MS. (2005). Screening for domestic violence in predominantly Hispanic clinical settings, Family Practice, 22, 617-23.

Sample:

Participants — 202 women in an urban clinical setting

Race/Ethnicity — 72.3% Hispanic

Summary:

Reliability and validity of HITS were compared with the Index of Spouse Abuse - Physical Scale (ISA-P) and Woman Abuse Screening Tool (WAST). Performance measures of HITS were compared with the ISA-P or WAST as a criterion standard.  Cronbach’s alphas were 0.76 and 0.61 for the English version and Spanish version of HITS, respectively. When administered first and analyzed alone, the Spanish version of HITS had a reliability of 0.71. For both English and Spanish versions HITS was significantly correlated to ISA-P and WAST. The English HITS version had a sensitivity of 86% and a specificity of 99%.A cut-off score of 5.5 for Spanish HITS version achieved a sensitivity of 100% and a specificity of 86%. HITS demonstrated good reliability and validity with ISA-P in English speaking patients. The Spanish version of HITS showed moderate reliability and good validity with WAST in Spanish speaking patients.

Iverson, K. M., King, M. W., Resick, P. A., Gerber, M. R., Kimerling, R., & Vogt, D. (2013). Clinical utility of an intimate partner violence screening tool for female VHA patients. Journal of general internal medicine, 28(10), 1288-1293.

Sample:

Participants — 160 women who reported being in an intimate relationship in the past year

Race/Ethnicity — 80% White

Summary:

This study evaluated the accuracy of a brief IPV victimization screening tool for use with female Veterans Health Administration (VHA) patients. Participants completed a paper-and-pencil mail survey that included the four-item Hurt/Insult/Threaten/Scream (HITS) and the 39-item Revised Conflict Tactics Scales (CTS-2). Operating characteristics, including sensitivity and specificity, were calculated using the CTS-2 as the reference standard for past-year IPV. Primary measures included the HITS (index test) and the CTS-2 (reference standard). The percentage of women who reported past-year IPV, as measured by any physical assault, sexual coercion, and/or severe psychological aggression on the CTS-2,was 28.8%. The receiver-operator characteristic curve demonstrated that the HITS cutoff score of 6 maximizes the true positives while minimizing the false positives in this sample. The sensitivity of the optimal HITS cutoff score of 6 was 78% (95% CI=64% to 88%), specificity 80 % (95% CI 71% to 87%), positive likelihood ratio3.9 (95% CI=2.61 to 5.76), negative likelihood ratio 0.27 (95% CI=0.16 to 0.47), positive predictive value 0.61(95% CI 0.47, 0.73), and negative predictive value 0.90 (95% CI 0.82, 0.95).  For a low-burden screen, the HITS demonstrated good accuracy in detecting past-year IPV relative to the CTS-2 in a sample of female VHA patients with an optimal cutpoint of 6.

Shakil, A., Bardwell, J., Sherin, K., Sinacore, J. M., Zitter, R., & Kindratt, T. B. (2014). Development of verbal HITS for intimate partner violence screening in family medicine. Family medicine, 46(3), 180-185.

Sample:

Participants — 103 adult female patients

Race/Ethnicity — 66% Caucasian

Summary:

A secondary analysis of data from prior HITS research was conducted. From this, the screening questions were modified for oral presentation so that patients could respond with a yes or no answer. To test the comparability of the two screening formats, 103 adult female patients completed both forms of the HITS during routine office visits. Phase one of this study used Optimal Data Analysis (ODA) on 210 cases from prior HITS research to create a cut score that differentiates clinic patients from self-identified victims of abuse. From this, written HITS questions were modified for verbal administration. Phase two of this study used t test, ANOVA, and classification of two screening formats to compare the written and verbal HITS administered to 103 adult female family medicine patients. Responses to both types of screening were related. The mean score on the written HITS was statistically higher for respondents who reported “yes” to a Verbal HITS question. This was consistent across all four questions. Also, the mean written HITS score increased linearly as a function of the number of yes answers on the Verbal HITS. The screening classification (positive, negative) from both forms of the HITS was the same for 83% of the respondents. 

Date Reviewed: July 2020 (Originally reviewed in July 2020)