Asking about intimate partner violence: advice from female survivors to health care providers
Introduction
Over the past 20 years, medical and public health communities have recognized that intimate partner violence (IPV) against women is prevalent and associated with significant morbidity, mortality and medical cost. Approximately 1.5 million women experience physical or sexual violence from a current or former intimate partner each year in the United States [1]. Lifetime IPV prevalence rates against women range between 25 and 31% [1], [2]. In addition to injuries, IPV has been associated with other medical problems including gastrointestinal disorders [3] depression, anxiety, chronic pain syndromes [4] gynecological problems, sexually transmitted diseases [2] increased substance abuse, and suicidal ideation [5]. Studies of female homicide victims reveal that between 30 and 60% of murdered women are killed by a current or former intimate partner [6], [7], [8]. IPV victims also incur 2–2.5 times the health care costs as non-victims [9], [10].
Advocacy groups and health care organizations have called for health care facilities and providers to develop and implement routine screening and intervention for IPV [11], [12], [13], [14], [15], [16], [17], [18], [19]. Some of these organizations provide specific guidelines regarding how clinicians should ask about IPV including suggestions such as routinely asking about IPV, asking when the woman is alone and using a nonjudgmental tone [11], [17], [20]. Some guidelines contain examples of screening questions and statements introducing the questions [11], [13], [20]. Limited information exists, however, from the perspectives of women who have experienced IPV on how they would advise clinicians to raise and discuss this issue.
Research indicates that both abused and non-abused women want to be asked about IPV [21], [22], [23], [24] and that the manner in which they are asked is important [25], [26]. Rodriguez et al. found an association between IPV disclosure and being asked directly about IPV [27]. Hamberger et al. found that battered women valued assessment for violence as a part of their complete medical history as long as it did not create “an atmosphere of interrogation (p. 580)” [28]. Several other studies found that many women experiencing current partner violence will deny their abuse even when asked [23], [29], [30]. Our study seeks to expand upon this literature by providing additional detail about the advice women who have experienced IPV would give regarding asking about IPV.
Our study objective was to identify what advice women who had experienced IPV would give health providers regarding how to ask about and discuss the issue of IPV. From the perspectives of women who have experienced IPV, we can learn what specific techniques of addressing IPV may help increase their comfort and willingness to disclose and/or seek help.
Section snippets
Study design
Using focus group interviews, we obtained advice regarding IPV inquiry and discussion from women who had experienced IPV. We chose a qualitative method to avoid approaching the topic with preconceived theories or hypotheses. Qualitative research is helpful in providing in-depth understanding of personal perspectives and experiences [31]. Our study used focus groups because we believed that participants would be more comfortable discussing this sensitive topic while supported by a group of women
Participants
Forty-one women participated in the focus groups. Table 1 presents participant characteristics. The mean age of the participants was 37 years (range 22–77) with most of the women in their mid- or late-thirties or early forties. The majority was employed (63%) and had completed at least a high school education (75%). Most (89%) had children. Thirty-two of the 41 women (78%) had seen a physician during the past year. Of the total participants, 71% had experienced physical violence from their
Discussion
Our study provides empirical support for the professional guidelines for asking about IPV: they wish to be asked while unaccompanied in a safe, confidential setting and in a kind, nonjudgmental manner. Additionally, they suggested that statements providing a context to explain the reason for inquiry helps alleviate worries regarding stigma and uncertain consequences as well as communicate the clinician's concern.
Expanding upon these guidelines, our participants provided additional details in
Acknowledgments
Dr. Chang was a Robert Wood Johnson Clinical Scholar at the University of North Carolina at Chapel Hill when this study was conducted. This study was supported by the University of North Carolina Program on Health Outcomes, the Robert Wood Johnson Clinical Scholars Program and the Centers for Disease Control and Prevention Injury Prevention Funding Unit (US4/CCU/417847-02).
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