Women's opinions about domestic violence screening and mandatory reporting

BACKGROUND: The purpose of this paper is to describe women's opinions and policy preferences concerning domestic violence screening and mandatory reporting. METHODS: This case-control study included 202 abused women and 240 randomly selected non-abused women recruited from a large metropolitan health maintenance organization who were interviewed by telephone. Of these women, 46.6% had a college degree, 53.4% were white, and 60% had a household income of $50,000 or more. RESULTS: Forty-eight percent of the sample agreed that health care providers should routinely screen all women, with abused women 1.5 times more likely than non-abused women to support this policy. For mandatory reporting, 48% preferred that it be the woman's decision to report abuse to the police. Women thought it would be easier for abused women to get help with routine screening (86%) and mandatory reporting (73%), although concerns were raised about increased risk of abuse with both screening (43%) and reporting (52%) policies. Two thirds of the sample thought women would be less likely to tell their health care providers about abuse under a mandatory reporting policy. Interventions offered in managed care settings that would be well received, according to the women in this study, include counseling services, shelters, and confidential hotlines. CONCLUSIONS: Women expressed fears and concerns about negative consequences of routine screening and, even more so, for mandatory reporting. Domestic violence policies and protocols need to address the safety, autonomy, and confidentiality issues that concern women.     

Adverse consequences of intimate partner abuse among women in non-urban domestic violence shelters

OBJECTIVE: This study examined the health consequences of having experienced both sexual and physical abuse relative to women experiencing physical abuse but not sexual abuse. METHODS: A cross-sectional study was conducted among 203 women seeking refuge in battered women's shelters. Controlling for sociodemographics, logistic regression analyses were conducted to assess the consequences of experiencing both sexual and physical abuse. RESULTS: Compared to women experiencing physical abuse, women experiencing both sexual and physical abuse were more likely to have a history of multiple sexually transmitted diseases (STDs) in their abusive relationships, have had an STD in the past 2 months, be worried about being infected with HIV, use marijuana and alcohol to cope, attempt suicide, feel as though they had no control in their relationships, experience more episodes of physical abuse in the past 2 months, rate their abuse as more severe, and be physically threatened by their partner when they asked that condoms be used. CONCLUSIONS: Given the prevalence of adverse health outcomes, domestic violence shelters could counsel women to avoid using alcohol/drugs as a coping strategy, educate women about alternative healthy coping strategies, counsel women about methods of STD prevention that they can control, and provide STD screening and treatment.     

Screening for intimate partner violence by health care providers. Barriers and interventions

INTRODUCTION: Routine screening for intimate partner violence (IPV) is endorsed by numerous health professional organizations. Screening rates in health care settings, however, remain low. In this article, we present a review of studies focusing on provider-specific barriers to screening for IPV and interventions designed to increase IPV screening in clinical settings. METHODS: A review of published studies containing original research with a primary focus on screening for IPV by health professionals was completed. RESULTS: Twelve studies identifying barriers to IPV screening as perceived by health care providers yielded similar lists; top provider-related barriers included lack of provider education regarding IPV, lack of time, and lack of effective interventions. Patient-related factors (e.g., patient nondisclosure, fear of offending the patient) were also frequently mentioned. Twelve additional studies evaluating interventions designed to increase IPV screening by providers revealed that interventions limited to education of providers had no significant effect on screening or identification rates. However, most interventions that incorporated strategies in addition to education (e.g., providing specific screening questions) were associated with significant increases in identification rates. CONCLUSION: Barriers to screening for IPV are documented to be similar among health care providers across diverse specialties and settings. Interventions designed to overcome these barriers and increase IPV-screening rates in health care settings are likely to be more effective if they include strategies in addition to provider education.     

Involving the health care system in domestic violence: what women want

PURPOSE Domestic violence is prevalent among women using primary health care services in Lebanon and has a negative effect on their health, yet physicians are not inquiring about it. In this study, we explored the attitudes of these women regarding involving the health care system in domestic violence management. METHODS We undertook a qualitative focus group study. Health care professionals in 6 primary health care centers routinely screened women for domestic violence using the HITS (Hurt, Insult, Threaten, Scream) instrument. At each center, 12 women who were screened (regardless of the result) were recruited to participate in a focus group discussion. RESULTS Most of the 72 women encouraged involvement of the health care system in the management of domestic violence and considered it to be a "socially accepted way to break the silence." Women expected health care professionals to have an "active conscience"; to be open minded, ready to listen, and unhurried; and to respect confidentiality. Additionally, they recommended mass media and community awareness campaigns focusing on family relationships to address domestic violence. CONCLUSIONS Addressing domestic violence through the health care system, if done properly, may be socially acceptable and nonoffensive even to women living in conservative societies such as Lebanon. The women in this study described characteristics of health professionals that would be conducive to screening and that could be extrapolated to the health care of immigrant Arab women.     

Physical and mental health effects of intimate partner violence for men and women

BACKGROUND: Few population-based studies have assessed the physical and mental health consequences of both psychological and physical intimate partner violence (IPV) among women or men victims. This study estimated IPV prevalence by type (physical, sexual, and psychological) and associated physical and mental health consequences among women and men. METHODS: The study analyzed data from the National Violence Against Women Survey (NVAWS) of women and men aged 18 to 65. This random-digit-dial telephone survey included questions about violent victimization and health status indicators. RESULTS: A total of 28.9% of 6790 women and 22.9% of 7122 men had experienced physical, sexual, or psychological IPV during their lifetime. Women were significantly more likely than men to experience physical or sexual IPV (relative risk [RR]=2.2, 95% confidence interval [CI]=2.1, 2.4) and abuse of power and control (RR=1.1, 95% CI=1.0, 1.2), but less likely than men to report verbal abuse alone (RR=0.8, 95% CI=0.7, 0.9). For both men and women, physical IPV victimization was associated with increased risk of current poor health; depressive symptoms; substance use; and developing a chronic disease, chronic mental illness, and injury. In general, abuse of power and control was more strongly associated with these health outcomes than was verbal abuse. When physical and psychological IPV scores were both included in logistic regression models, higher psychological IPV scores were more strongly associated with these health outcomes than were physical IPV scores. CONCLUSIONS: Both physical and psychological IPV are associated with significant physical and mental health consequences for both male and female victims.     

Partner violence and medical encounters: African-American women’s perspectives

Objective: To examine the relationship between intimate partner violence (IPV) victimization and patient satisfaction with medical encounters among an African-American population.Design: Cross-sectional, self-administered, anonymous survey.Setting: Community-based, primary care center.Patients: Consecutive African-American women recruited from an urban health center. A total of 102 women provided sufficient information to reveal whether they were currently experiencing IPV and to allow us to assess their experiences in their most recent primary care encounter.Measurements: Patients’ perceptions of their most recent encounter using questions adopted from the Medical Interview Satisfaction Scale and Consultation Satisfaction Questionnaire. We used the Conflicts Tactics Scale, supplemented with questions measuring sexual violence and emotional abuse, to assess IPV “in the past year.”Results: Women who reported current IPV rated several aspects of the encounter more negatively than did women who did not report current abuse. The IPV victims were less likely to report that they felt respected and accepted during the encounter, and they provided lower ratings of the quality of communication with their providers.Conclusions: It is unclear why victims of partner violence experience medical encounters as less satisfactory. Researchers need to expand studies of medical encounters as experienced by abused women to determine whether IPV status adversely affects general medical care.     

Health status and health care use of Massachusetts women reporting partner abuse

BACKGROUND: Studies indicate that women abused by their intimate partners are at increased risk for a number of health problems and have increased rates of health care utilization. However, these findings are based mainly on studies using clinic or health plan populations. In this study, we examined the association between intimate partner abuse (IPA) and health concerns and health care utilization in a population-based sample of adult women. METHODS: We analyzed data on 2043 women aged 18 to 59 who participated in the 1998 Massachusetts Behavioral Risk Factor Surveillance System (BRFSS), a population-based health survey that included questions on IPA. IPA was defined as experiencing physical violence by, fear of, or control by an intimate partner. Consequences of IPA and self-rated health status and health care utilization of women experiencing IPA were examined. RESULTS: A total of 6.3% of Massachusetts women aged 18 to 59 reported IPA during the past year. Women experiencing IPA were more likely than other women to report depression, anxiety, sleep problems, suicidal ideation, disabilities, smoking, unwanted pregnancy, HIV testing, and condom use. Women experiencing IPA were less likely to have health insurance, but received routine health care at similar rates as other women. CONCLUSIONS: These results indicate that women in the general population experiencing IPA are at increased risk for several serious emotional and physical health concerns. Most of these women are in routine contact with health care providers. These findings also suggest that the BRFSS may provide a valuable mechanism for tracking state-based IPA prevalence rates over time.     

Screening for domestic violence in a predominantly Hispanic clinical setting

BACKGROUND: Domestic violence is a public health problem that is common across ethnic groups. The utility of validated screening tools to detect abuse in diverse populations remains largely unknown. OBJECTIVE: The purpose of the study was to test the reliability and validity of a brief 4-question instrument, HITS, among predominantly Hispanic women. METHODS: We conducted a cross-sectional study in an urban clinical setting. Two hundred and two women completed HITS and two other previously validated tools, the Index of Spouse Abuse-Physical Scale (ISA-P) and the Woman Abuse Screening Tool (WAST). Instruments were prepared in English and translated to Spanish. Reliability and validity of HITS were compared with the ISA-P and WAST. Performance measures of HITS were compared with the ISA-P or WAST as a criterion standard. RESULTS: Cronbach's alphas were 0.76 and 0.61 for the English version and Spanish version of HITS, respectively. When administered first and analysed 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%. CONCLUSIONS: 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. HITS may help physicians detect abuse in predominantly Hispanic clinical settings.     

Association of intimate partner violence and health-care provider-identified obesity

ABSTRACT

The association of physical and nonphysical intimate partner violence (IPV) with obesity was examined. Women (N = 1,179) were surveyed regarding demographics, obesity, and IPV exposure using humiliate-afraid-rape-kick (HARK), an IPV screening tool. A three-level lifetime IPV exposure variable measured physical, nonphysical or no IPV. Health-care provider-identified obesity was defined if participants were told by a medical provider within the past 5 years that they were obese. Bivariate analyses examined obesity by IPV and demographics. Multivariable logistic regression assessed odds of obesity by IPV type, adjusting for age, race/ethnicity, education, and marital status. Among participants, 44% reported lifetime IPV (25% physical, 19% nonphysical), and 24% reported health-care provider-identified obesity. In unadjusted analyses, obesity was more prevalent among women exposed to physical IPV (30%) and nonphysical IPV (27%), compared to women without IPV (20%, p = .002). In multivariable models, women reporting physical IPV had 1.67 times greater odds of obesity (95% confidence interval [CI] 1.20, 2.33), and women reporting nonphysical IPV had 1.46 times greater odds of obesity (95% CI 1.01, 2.10), compared to women reporting no exposure. This study extends prior data by showing, not only an association between physical IPV and obesity, but also an association between obesity and nonphysical IPV.     

农村地区已婚妇女家庭暴力知晓情况调查

目的了解我国农村地区已婚妇女对家庭暴力态度及相关知识情况。方法2004年11月～2005年1月，在吉林、安徽省和重庆铜梁市的人口基金项目县，采用多阶段容量比例抽样方法选择了25个乡镇，对3998名18岁及以上的已婚育龄妇女进行问卷调查。结果我国农村地区已婚妇女对家庭暴力存在一定的错误认识，51．4％妇女认为夫妻打架属家庭私事，只能与家里人讲，68．6％妇女认为在某些情况下丈夫可以打妻子。85．2％妇女对家庭暴力概念不了解。文化程度影响妇女对家庭暴力的态度和听说过家庭暴力情况。但对其家庭暴力行为了解情况没有明显作用。结论我国农村地区妇女对家庭暴力的认识和了解情况较差，需要加大宣传教育力度。并将家庭暴力的知识纳入教育系统中，增强全面应对家庭暴力的能力。     

Female victims of intimate partner physical domestic violence (IPP-DV), California 1998

BACKGROUND: This study was conducted to identify factors associated with adult female victims of intimate partner physical domestic violence (IPP-DV) in California and to estimate statewide IPP-DV prevalence. METHODS: We analyzed data from the 1998 California Women's Health Survey, a random, computer-assisted telephone interview (CATI) survey of 4006 California women aged > or = 18, conducted by the California Department of Health Services. RESULTS: Data from the survey indicated that 6% of the women reported that in the previous 12 months, their intimate partners threw objects at them, or hit them with an object, or kicked, pushed, slapped, choked, beat up, or threatened them with a gun or a knife. Odds ratio (OR) analyses controlling for age and race/ethnicity suggest that a large number of factors are associated statistically with IPP-DV victims. These factors include feelings of ill physical and mental health; pregnancies at early age; smoking status; nutritional needs; low income; participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program; having children aged < 18 in the household; and limited access to health care. Among the non-U.S.-born respondents, IPP-DV victims were significantly younger when they entered the United States than their nonvictim counterparts. A multiple logistic regression model identified the following factors as main correlates with IPP-DV: feelings of being overwhelmed in the past 30 days (OR = 3.4, 95% confidence interval [CI] = 2.5-4.6); aged 18 to 44 (OR = 2.8, 95% CI = 1.9-4.1); current smoking status (OR = 2.1, 95% CI = 1.5-2.9); participation in WIC in the previous 2 years (OR = 1.8, 95% CI = 1.2-2.6); and being out of work (OR = 1.4, 95% CI = 1.1-1.9). CONCLUSIONS: The above findings suggest that a variety of venues (e.g., schools, mental and physical health care providers, WIC, immigration programs, and social services) will be needed in order to identify/gain access to IPP-DV victims, provide referral resources, and implement any future prevention efforts.     

Improving surveillance of intimate partner violence by use of multiple data sources

BACKGROUND: Intimate partner violence (IPV) is a significant public health problem in the United States. Estimates of incidence and prevalence vary widely, depending on the data source used. Combining information from different sources can enhance our understanding of IPV. METHODS: In this paper, we used 1998 data from the Rhode Island (RI) Department of Health Violence Against Women Public Health Surveillance System to describe the prevalence of IPV reported to police, the demographic characteristics and help-seeking efforts of women reporting IPV, and characteristics of IPV incidents. We used data from the 1998 RI Department of Health Behavioral Risk Factor Surveillance System survey to examine associations between health care use and health outcomes of victims and nonvictims of IPV, and to explore the correlates of IPV. We also discuss the use of both narrow and broad definitions of IPV. RESULTS: Our findings show that the definition of IPV and the source used to identify IPV victims can produce a markedly different picture of IPV victims, and that combining information from different data sources can enhance our understanding of IPV. An important finding for health care providers is that IPV victims do not appear to be significantly different from nonvictims in their access to and utilization of routine health care, and that more than 60% of victims at highest risk for injury reported seeing a health care provider because of IPV. CONCLUSIONS: Our findings underscore the importance of health care providers addressing IPV and its consequences among their patients.     

‘We’re all wounded healers’: A qualitative study to explore the well‐being and needs of helpline workers supporting survivors of domestic violence and abuse

Domestic violence and abuse (DVA) can include physical, psychological, sexual, emotional or financial abuses, and is a globally widespread problem across all age groups, cultures and socioeconomic groups. Alongside the impacts of DVA experienced by survivors, there is a growing recognition that other people, who form the support network of survivors, may also be affected by the situation. Domestic violence organisations such as helplines are important third sector services supporting survivors. However, there has been little research into the impact on those providing the support. This qualitative study of domestic violence helpline workers explored their needs and well‐being. We used qualitative methodology, conducting interviews with staff recruited from a selection of different helplines who all undertook direct client‐focused work. The interviews used a semi‐structured format and followed a topic guide covering the training received before commencing work, self‐care strategies, the impact of work on their daily life and support offered by their employer. Ten helpline staff were interviewed, all female. Following analysis of the qualitative data, a number of themes emerged. Participants disclosed numerous ways in which their work challenged their well‐being, including burnout, impact on personal relationships, and lack of training and support at work. Participants used some self‐care strategies in order to “switch off” from work, but they also wanted clinical supervision to support them with the difficulties they experienced at work. This study suggests that helpline staff should receive more education about trauma triggers, and ongoing support to reduce the impact on their home and social life, thus improving mental well‐being and job satisfaction. This work begins the debate on the well‐being needs of frontline helpline workers, and whether better meeting these needs can facilitate the provision of better support.     

'I could have just done with a little more help': an analysis of women's help-seeking from health visitors in the context of domestic violence

Domestic violence is a serious issue that adversely affects large numbers of women and children. Despite having an adverse impact upon health and welfare, women experiencing domestic violence face a number of difficulties seeking help about their situation from statutory health and welfare agencies. The present paper is based upon a study of British health visiting in relation to women experiencing domestic violence. Drawing upon interview data from 16 women who experienced domestic violence and were the mothers of small children, this paper explores their accounts of contact with the health visiting service. All of the 16 women who participated in this research described difficulties in seeking help about domestic violence. These included practical concerns such as fears for their own safety, lack of knowledge regarding appropriate sources of support and protection, and concerns about losing custody of their children. Given these concerns, some women concealed their experiences of domestic violence from their health visitors. For those who disclosed the domestic violence to their health visitors, they did not always receive appropriate support or protection. Of particular concern was the absence of information about accessing more specialist services. The research findings suggest that there is considerable scope for practice development in order to ensure that women experiencing domestic violence are able to receive safe and appropriate responses from health visitors.     

The impact of childhood abuse history, domestic violence and mental health symptoms on parenting behaviour among mothers in Japan

Background To assess the impact of childhood abuse history, domestic violence experiences and mental health symptoms on the parenting behaviour of mothers in Japan who have separated from violent husbands or partners. Methods A self‐administered questionnaire survey was conducted on a sample of mothers (n= 304) and their children (n= 498) residing in 83 mother–child homes in Japan. The survey assessed the mothers' childhood abuse history (physical, psychological and sexual abuse and neglect history), domestic violence experiences, current mental health symptoms (dissociative, depressive and traumatic symptoms) and parenting behaviours after moving into the homes to separate from a violent husband or partner. Results The mothers' childhood abuse history and experience of domestic violence were not associated with their not playing with their children. In contrast, the mothers' dissociative and depressive symptoms were significantly associated with not playing with their children. Although there was no association between the mothers' total childhood abuse history and not praising their children, their childhood physical abuse history was significantly associated with their not praising their children. The dissociative and depressive symptoms were also associated with no praise. Interestingly, the experience of domestic violence showed an inverse association with no praise. Conclusions Mental health symptoms, more specifically dissociative and depressive symptoms, are associated with a decrease in parenting quality. Mothers who were physically abused as children are less likely to praise their own children, independent of maternal mental health symptoms. In contrast, mothers who experienced domestic violence but subsequently separated from their violent husbands or partners are more likely to praise their children. The treatment of mental health symptoms, particularly dissociative and depressive symptoms, therapy for childhood abuse history and separation from violent husbands or partners might be effective ways to enhance the quality of parenting in Japan.     

Help-seeking for intimate partner violence and forced sex in South Carolina

PURPOSE: In this population-based, random-digit-dial, cross-sectional survey, we assessed the lifetime victimization of intimate partner violence (IPV) and forced or coerced sex among 556 women and men in South Carolina, and the help-seeking behaviors of victims. RESULTS: Among women, 25.3% experienced IPV (sexual, physical, or emotional violence) compared with 13.2% of men. Although women were significantly more likely to report physical or sexual IPV (17.8%) than were men (4.9%), men (8.3%) were as likely as women (7.4%) to report perceived emotional abuse without physical or sexual IPV. One half of men and women with annual incomes <$15, 000 reported IPV. Among women experiencing physical or sexual IPV, 53% sought community-based or professional services for IPV; women with higher education levels and those experiencing more severe violence were most likely to seek services. CONCLUSIONS: These data show that IPV is common and that most victims do not receive services to address this violence.     

Health professionals’ beliefs about domestic abuse and the issue of disclosure: a critical incident technique study

Domestic abuse is increasingly recognised as a serious, worldwide public health concern. There is a significant body of literature regarding domestic abuse, but little is known about health professionals’ beliefs about domestic abuse disclosure. In addition, the intersection between health professionals’ beliefs and abused women's views remains uninvestigated. We report on a two‐phase, qualitative study using Critical Incident Technique (CIT) that aimed to explore community health professionals’ beliefs about domestic abuse and the issue of disclosure. We investigated this from the perspectives of both health professionals and abused women. The study took place in Scotland during 2011. The study was informed theoretically by the Common Sense Model of Self‐Regulation of Health and Illness (CSM). This model is typically used in disease‐orientated research. In our innovative use, however, CSM was used to study the social phenomenon, domestic abuse. The study involved semi‐structured, individual CIT interviews with health professionals and focus groups with women who had experienced domestic abuse. Twenty‐nine health professionals (Midwives, Health Visitors and General Practitioners) participated in the first phase of the study. In the second phase, three focus groups were conducted with a total of 14 women. Data were analysed using a combination of an inductive classification and framework analysis. Findings highlight the points of convergence and divergence between abused women's and health professionals’ beliefs about abuse. Although there was some agreement, they do not always share the same views. For example, women want to be asked about abuse, but many health professionals do not feel confident or comfortable discussing the issue. Overall, the study shows the dynamic interaction between women's and health professionals’ beliefs about domestic abuse and readiness to discuss and respond to it. Understanding these complex dynamics assists in the employment of appropriate strategies to support women post‐disclosure.     

Identification and management of domestic violence: a randomized trial

BACKGROUND: Diagnosis of domestic violence (DV) in primary care is low compared to its prevalence. Care for patients is deficient. Over a 1-year period, we tested the effectiveness of an intensive intervention to improve asking about DV, case finding, and management in primary care. The intervention included skill training for providers, environmental orchestration (posters in clinical areas, DV questions on health questionnaires), and measurement and feedback. METHODS: We conducted a group-randomized controlled trial in five primary care clinics of a large health maintenance organization (HMO). Outcomes were assessed at baseline and follow-up by survey, medical record review, and qualitative means. RESULTS: Improved provider self-efficacy, decreased fear of offense and safety concerns, and increased perceived asking about DV were documented at 9 months, and also at 21 months (except for perceived asking) after intervention initiation. Documented asking about DV was increased by 14.3% with a 3.9-fold relative increase at 9 months in intervention clinics compared to controls. Case finding increased 1.3-fold (95%, confidence interval 0.67-2.7). CONCLUSIONS: The intervention improved documented asking about DV in practice up to 9 months later. This was mainly because of the routine use of health questionnaires containing DV questions at physical examination visits and the placement of DV posters in clinical areas. A small increase in case finding also resulted. System changes appear to be a cost-effective method to increase DV asking and identification.     

To disrupt and displace: placing domestic violence on the public health agenda

In 1996, in Geneva, the World Health Assembly declared the violence as a major and growing public health problem. Others have gone further in describing (sexual) violence against women as a weapon of terror. In the local community of Hamilton, Ontario Canada (population approximately 500,000), domestic violence represents 25% of the workload of the local police service. The literature has shown that violence in general, and domestic violence in particular, presents tremendous social and health impacts for individuals and communities. In this local community, however, an evaluation of a recently piloted cutting edge domestic violence response system highlights how difficult it is to place domestic violence on the policy and/or public health agendas. Qualitative interviews with 23 key stakeholders were undertaken to assess their views on the success of the program. While overall findings indicate that the success of this brief (11 month) pilot project was limited, important insights emerged around responding to the domestic violence issue, at the community level.