Disclosure Of Intimate Partner Violence Research Articles

Factors Influencing Shared Decision-Making Between Healthcare Providers and Lesbian, Gay, Bisexual, Transgender, and Queer People of Color About Intimate Partner Violence.

Within the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community, people of color (POC) disproportionately experience intimate partner violence (IPV). While shared decision-making (SDM)-a model of patient-provider communication-about IPV could benefit LGBTQ POC, its unique challenges merit consideration. This study identifies key factors affecting SDM between LGBTQ POC and healthcare providers surrounding IPV. LGBTQ POC participants (n = 217) in Chicago and San Francisco completed surveys about demographic information, healthcare utilization, and IPV history. Individual interviews and focus groups were then conducted with a Chicago-based subset of participants (n = 46) who identified as LGBTQ IPV survivors of color. Descriptive analyses were conducted of survey responses while focus group and interview transcripts were analyzed and thematically coded. Although 71% of survey participants experienced IPV, only 35% were asked about IPV in healthcare interactions within the previous year. Focus group and interview participants endorsed encounter-, patient-, and provider-centered factors affecting SDM around IPV. When IPV was discussed, patient-provider trust was essential while concordance of identities could either encourage or discourage IPV disclosure. Patients were hesitant to disclose IPV if they had never discussed their LGBTQ identity with their provider or thought providers would ignore their preferences for addressing IPV. Deterrents to SDM included providers denying the prevalence of IPV among LGBTQ individuals or lacking resources to support LGBTQ IPV survivors of color. This study highlights the identity-driven barriers that LGBTQ POC face in discussing IPV with providers. Utilizing SDM to discuss IPV with LGBTQ POC can better address the diverse health needs of this community. However, its success requires that providers acknowledge the diversity of experiences among this population, promote LGBTQ-inclusive practices, and identify resources welcome to LGBTQ POC.

Experiences of physical and emotional intimate partner violence during the COVID-19 pandemic: a comparison of prepandemic and pandemic data in a longitudinal study of Australian mothers

ObjectiveThere is a lack of longitudinal population-based research comparing women’s experiences of intimate partner violence (IPV) prior to and during the COVID-19 pandemic. Using data from the Mothers’ and Young...

Sex Workers’ Experiences of Screening for Intimate Partner Violence

ObjectiveTo examine experiences of intimate partner violence (IPV) screening among women who sell sex. DesignA qualitative descriptive study. SettingTelephone interviews during the COVID-19 pandemic (June 2020 to October 2020). ParticipantsWomen aged 18 to 49 years who sold or traded sex for food, drugs, money, or shelter at least three times during the past 3 months before recruitment (N = 22). MethodsWe used individual, semistructured telephone interviews to collect data about participants’ experiences with IPV and IPV screening during health care encounters. We used reflexive thematic analysis to examine these data. ResultsWe identified two overarching themes related to IPV screening experiences: Preferences for IPV Screening and Barriers to Disclosure of IPV Experiences. Participants described a preference for IPV screening done face-to-face with providers who show a genuine interest in their responses. Stigma was a barrier of IPV disclosure. ConclusionHealth care providers are a trusted safety net for disclosure of IPV experiences. Providing screening in a trauma-informed, nonstigmatizing manner may facilitate disclosure of IPV by women who sell sex. Future research among marginalized populations is needed to examine ways to address IPV in clinical settings with a harm reduction empowerment lens.

Perspectives on HIV pre-exposure prophylaxis (PrEP) implementation in Mississippi among Black women and clinical staff: Recommendations for clinical trauma-informed programs

Intimate partner violence (IPV) can constraint Black women’s ability to prioritize and access Human Immunodeficiency Virus (HIV) pre-exposure prophylaxis (PrEP) services. Recent research has called for the development of trauma-informed PrEP implementation programs to improve the delivery of PrEP to Black cisgender women; however, many PrEP-prescribing settings do not reflect this recommendation. The current study sought to identify key components to develop a trauma-informed PrEP implementation program for Black cisgender women and clinical staff. We conducted focus groups with PrEP-eligible Black cisgender women (February-June 2019), and semi-structured interviews with clinical staff offering HIV prevention and treatment services (October-November 2020) in community healthcare clinics in Mississippi. Seven themes were identified as needed to facilitate integration of trauma-informed approaches into existing PrEP programs, including defining intimate partner violence (IPV), appropriate IPV screening and response, HIV prevention in abusive relationships, staff training needs, and creating supportive clinic environments. PrEP-eligible Black women and clinical staff generally agreed on how to best operationalize IPV screening and response, the importance of trauma-informed staff training, and the need for Black women-specific informational campaigns. However, Black women highlighted the need for providers to discuss HIV prevention in controlling relationships, and to respond to IPV disclosure. HIV pre-exposure prophylaxis has yet to achieve the potential impact observed in trials. Ultimately, realizing the HIV prevention potential of PrEP in the US necessitates centering the perspectives of Black cisgender women and staff to better integrate trauma-informed approaches.

Disclosure and Help-Seeking Experiences of Sexual and Gender Minority Victims of Intimate Partner Violence: A Mixed-Methods Study.

Sexual and gender minorities assigned female at birth (SGM-AFAB) experience high rates of intimate partner violence (IPV), with negative effects on health and well-being. Disclosure of and help-seeking for IPV can support the well-being of IPV survivors, yet are understudied among SGM-AFAB people. To better understand the IPV disclosure and help-seeking experiences in this population, we conducted semi-structured interviews with 41 SGM-AFAB young adults who experienced physical, sexual, or severe psychological IPV. Qualitative analyses explored to whom SGM-AFAB disclosed IPV, barriers to disclosure/help-seeking, the types of responses received, and perceived helpfulness of responses. Exploratory mixed methods analyses assessed frequency of code endorsement, demographic differences, and associations among codes. Three-quarters of participants disclosed IPV, though rates were lower for sexual and physical than psychological IPV and very few sought help from formal sources. The most common barriers to disclosure were not viewing the IPV as abuse and anticipation of negative responses, often due to stigma; other participants described inability to access formal help and concerns about SGM incompetence in those services. Most actual responses received were considered helpful, including emotional support, labeling the IPV as unhealthy, nonjudgmental listening, actions to stop the IPV, and practical support. Minimizing IPV or criticizing the victim was common unhelpful response; advice to end the relationship was considered helpful and unhelpful. Whereas 92% of friend responses were described as helpful, around half of family (56%) and therapist (62%) responses were helpful. Findings suggest that efforts to increase access to culturally affirmative services and educate SGM youth to recognize IPV in their relationships may help promote help-seeking and well-being among SGM-AFAB IPV survivors.

Evaluating a scalable ARCHES (Addressing Reproductive Coercion in Health Settings) model in government health facilities in Uasin Gishu county, Kenya: study protocol for a cluster-randomized controlled trial

BackgroundSince 2013, the World Health Organization has recommended that reproductive coercion (RC) and intimate partner violence (IPV) be addressed within reproductive health services and, in 2018, the Lancet Commission on Sexual and Reproductive Health and Rights found that RC and IPV were significant contributors to unmet need for family planning (FP) and unintended pregnancy. In Kenya, the Ministry of Health (MOH) has made reduction of unintended pregnancy and gender-based violence a primary objective. Despite this need and guidance, no clinic-based intervention models outside of the U.S. (apart from the one described here) have demonstrated efficacy to improve FP use and reduce IPV or RC thereby reducing unintended pregnancy. ARCHES (Addressing Reproductive Coercion in Health Settings) is a brief, clinic-based intervention delivered by existing FP providers aiming to: (1) Increase women’s ability to use FP without interference, (2) Provide a safe and supportive environment for IPV disclosure and referral to support services, and (3) Improve quality of FP counseling, including addressing RC and IPV. The objective of this study is to generate evidence on scaling integrated FP services (including FP, RC, and IPV) in public sector health facilities in Uasin Gishu county, Kenya via adaptation and implementation of ARCHES in partnership with the Kenya MOH.MethodsA cluster-randomized controlled trial paired with concurrent implementation science assessments will test effectiveness of the ARCHES model, adapted for scale by the Kenya MOH, in reducing unintended pregnancy. Female FP clients aged 15–49 years at selected sites will complete baseline surveys (immediately prior to receiving care), immediately post-visit exit surveys, and 6-month follow-up surveys. Provider surveys will assess changes in gender-equitable attitudes and self-efficacy to address violence reported by their clients. Costs associated with scaling ARCHES will be tracked and utilized in combination with results of the effectiveness trial to assess costs and cost-effectiveness relative to the standard of care.DiscussionThis study will provide evidence of the effectiveness of a facility-based intervention to address RC and IPV within public sector FP services at scale, as adapted and implemented in Uasin Gishu county, Kenya.Trial registration Trial registered on 28 September 2023 with clinicaltrials.gov NCT06059196.

Screening for Intimate Partner Violence Experience and Use in the Veterans Health Administration

The practice of screening women for intimate partner violence (IPV) in health care settings has been a critical part of responding to this major public health problem. Yet, IPV prevention would be enhanced with detection efforts that extend beyond screening for IPV experiences to identifying those who use violence in relationships as well. To determine rates of IPV experiences and use (ie, among perpetrators of IPV) and factors associated with disclosures among adult patients seeking mental health services at the Veterans Health Administration. This cross-sectional study used electronic medical record data drawn from a quality improvement initiative at 5 Veterans Health Administration medical centers conducted between November 2021 and February 2022 to examine IPV disclosures following concurrent screening for IPV experience and use. Participants included patients engaged in mental health services. Data were analyzed in April and May 2023. Mental health clinicians were trained to screen for IPV experience and use concurrently and instructed to screen all patients encountered through routine mental health care visits during a 3-month period. Outcomes of interest were past-year prevalence of IPV use and experience, sociodemographic characteristics, and clinical diagnoses among screened patients. A total of 200 patients were offered IPV screening. Of 155 participants (mean [SD] age, 52.45 [15.65] years; 124 [80.0%] men) with completed screenings, 74 (47.7%) denied past-year IPV experience and use, 76 (49.0%) endorsed past-year IPV experience, and 72 (46.4%) endorsed past-year IPV use, including 67 participants (43.2%) who reported IPV experience and use concurrently; only 9 participants (5.8%) endorsed unidirectional IPV experiences and 5 participants (3.2%) endorsed unidirectional IPV use. Patients who reported past-year IPV experience and use were younger than those who denied IPV (experience: mean difference, -7.34 [95% CI, 2.51-12.17] years; use: mean difference, -7.20 [95% CI, 2.40-12.00] years). Patients with a posttraumatic stress disorder diagnosis were more likely to report IPV use (43 patients [59.7%]) than those without a posttraumatic stress disorder diagnosis (29 patients [40.3%]; odds ratio, 2.14; [95% CI, 1.12-4.06]). No other demographic characteristics or clinical diagnoses were associated with IPV use or experience. In this cross-sectional study of IPV rates and associated factors, screening for IPV found high rates of both IPV experience and use among patients receiving mental health care. These findings highlight the benefit of screening for IPV experience and use concurrently across gender and age. Additionally, the associations found between PTSD and IPV use underscore the importance of strengthening and developing additional targeted treatment for IPV.

Disclosure of intimate partner violence while studying positive mental health in wheelchair users: ethical dilemmas.

This case study discusses the ethical dilemmas faced by the researchers when a woman with disability voluntarily disclosed her experience of intimate partner violence during an in-depth interview on positive mental health and resilience in wheelchair users. The interviewer's role as a researcher and public health professional raised dilemmas relating to the tenets of privacy, confidentiality and nonmaleficence. Professionals working with women with disability and similar vulnerable participants should anticipate such ethical challenges around violence and discrimination that such individuals face, and strive to resolve challenges based on basic ethical tenets within a context-informed approach.

Barriers to Disclosure of Intimate Partner Violence Among Undocumented Spanish-Speaking Immigrants in the United States.

Undocumented monolingual Spanish-speaking immigrants are one of the most vulnerable and marginalized groups to experience intimate partner violence (IPV) in the United States. This paper explores the barriers that prevent IPV disclosure in healthcare settings. Qualitative interviews (n = 14) were conducted with previously undocumented Spanish-speaking legal clients of a community domestic violence agency. The major barriers expressed by the interviewees regarding IPV screening and disclosure include limited opportunities for IPV screening, misinformation about legal rights from abusers, fear of deportation and separation from children, and lack of knowledge about resources.

The influences of sociocultural norms on women's decision to disclose intimate partner violence: Integrative review.

Sociocultural norms against women can contribute to promoting intimate partner violence(IPV) and shape women's decision to disclose IPV.A cross-cultural analysis of the existing literature is needed to present an overview of the influences of sociocultural norms on women's decisions regarding the disclosure of IPV across different cultural contexts. The purpose of the review was to synthesize published quantitative, qualitative, and mixed methods (MMs) studies to identify known sociocultural norms across different cultures that may influence women's decision to disclose IPV. The Whittemore and Knafl framework, Rayyan software, and PRISMA flow diagram were used. Databases included APA PsycInfo, CINAHL, PubMed, SocINDEX, and Women's Studies International. The quality of studies was assessed by the MMs appraisal tool. A total of 15 research articles written in English and published in peer-reviewed journals were included. Main categories emerged: (1) stigma surrounding IPV disclosure, victimization, and divorce; (2) gender roles; (3) preserving family honor; and (4) Children's well-being and future. A one-size-fits-all approach is not adequate for women who are considering disclosing IPV. Findings underscore that regardless of residing in individualistic countries, those sociocultural norms related to traditional gender roles and gender inequality are still important barriers to the disclosure of IPV among women with collectivist roots.

How the Current Management of Intimate Partner Violence Can Endanger Victimized Mothers and Their Children

PurposeChildren’s exposure to intimate partner violence (IPV) is a form of child abuse and can have serious detrimental consequences on their health and well-being. Research has shown that a strong relationship with a caring adult, often the mother, is a protective factor against those consequences. For this reason, this study attempts to understand the overall experiences of victimized mothers with perpetrators, professionals, and institutions in the years following IPV disclosure.MethodsWe conducted 20 semi-structured individual interviews in Switzerland in 2020 with former patients who had been provided with a clinical forensic consultation between 2011 and 2014. The participants had reported IPV between 2011 and 2014 and had at least one minor child at the time.ResultsVictimized mothers continued to experience harmful behaviors from perpetrators/fathers after IPV disclosure. They reported feeling in danger and that the perpetrators/fathers benefited from a certain level of impunity. In parallel, the mothers were held accountable for the safety and well-being of their children in this context. These overall and multi-year experiences had short-term and long-term negative impacts on the mothers’ and children’s health, financial and administrative situation, relationship, and on school life. In this sample, the years following IPV disclosure were characterized by an enduring sense of ordeal.ConclusionsThe professional and institutional handling of IPV situations, in relation to both victims and perpetrators, can endanger victimized mothers and their children and put them at risk of adverse consequences after IPV disclosure. Avenues for change to better protect mother and child and to provide relief to the mothers as an important protective factor for their children are discussed.

Examining Cases of Child Physical Abuse Evaluations to Identify Opportunities to Improve Intimate Partner Violence Screening in Pediatric Emergency Departments.

The association between child maltreatment and intimate partner violence (IPV) is well supported. Universal IPV screening has been recommended by the American Academy of Pediatrics and the United States Preventative Task Force, and many children's hospitals have established screening protocols. However, the yield and best screening method in families undergoing a child physical abuse (PA) evaluation have not been fully explored. To determine if there is a discrepancy in IPV disclosures between universal IPV screening completed during pediatric emergency department (PED) triage ("triage screening") and IPV screening by a social worker ("social work screening") in families of children who were evaluated for PA. Caregivers of children who presented to an urban tertiary PED and underwent an evaluation for PA via a child abuse pediatrics consult. A retrospective chart review was completed. Data collection included: caregiver responses to both triage screening and social work screening, interview setting details and participants, the child's injuries, and details of the family's reported IPV experiences. Our study (N = 329) revealed that social work screening produced significantly more positive IPV disclosures than triage screening (14.0% vs. 4.3%, p < .001). Additionally, non-IPV violence concerns were identified in 35.7% (n = 5) of the positive triage screens, whereas social work screens had none. These results highlight the benefits of IPV screening by social work in high-risk scenarios, such as child PA evaluations, regardless of universal IPV screening results. Exploring differences between the two screening methods can inform decisions about screening protocols to improve IPV identification in high-risk populations.

Patient-Centered Intimate Partner Violence Screening, Brief Intervention, and Referral to Treatment

ObjectiveTo increase rates of screening for intimate partner violence (IPV), education, and follow-up of women being seen at a private obstetrics and gynecology clinic to 52% in 90 days. DesignQuality improvement project. Setting/Local ProblemIPV screening was not the standard of care at a private suburban obstetric and gynecologic practice. MethodsThis project used an evidence-backed model for improvement that incorporated plan–do–study–act cycles to implement four core interventions. InterventionsThe Hurt, Insult, Threaten, Scream (HITS) screening tool, the investigator-developed Duluth model tool, a case management log, and a team engagement plan were implemented. ResultsImplementation of the HITS screening tool was associated with an increase in IPV screening to 94.7% from a baseline of 2.5%. In addition, the IPV disclosure rate increased 7.5% over the course of the initiative. The majority of staff (64%) participated in IPV educational offerings, and an increase in IPV knowledge was noted in team surveys, on which scores increased from 68% to 76.9%. ConclusionThe combined use of the HITS screening tool and the Duluth model tool were associated with increased rates of IPV screening. Women who screened positive for IPV were referred to appropriate resources. These findings can be used as a guide for clinics to implement IPV screening into practice.

Intimate partner violence disclosure in the workplace: examining frequency, workplace occurrences, and pay level

Intimate partner violence (IPV) disclosure at work is important, given that disclosure may reduce safety-related risks and allow for better management of workplace disruptions. In line with prior literature, we suggest that when there is more workplace occurrence of IPV and higher frequency of IPV, employees are more likely to disclose to their coworkers. We also theorize that the disclosure decision will depend on employees’ pay. While we expect employees with lower pay levels to be more likely to disclose in either case of increasing IPV workplace occurrences or IPV frequency, we hypothesize that highly paid employees will be especially reluctant to disclose due to the pressures associated with the ideal worker prototype and anticipatory stigma. We test our predictions using survey data from 350 workers across four organizations reporting IPV experiences. We predict and find support that highly paid workers are more likely to disclose when IPV is both high in frequency and occurring at work. Our research points to the importance of organizational hierarchies and individual pay in understanding workplace IPV disclosure decisions.

Safe Discharge Needs Following Emergency Care for Intimate Partner Violence, Sexual Assault, and Sex Trafficking.

For survivors of gender-based violence (GBV) seeking care in hospital emergency departments (ED) the need for medical care and safe discharge is acute. In this study we evaluated safe discharge needs of GBV survivors following hospital-based care at a public hospital in Atlanta, GA, in 2019 and between April 1, 2020-September 30, 2021, using both retrospective chart review and evaluation of a novel clinical observation protocol for safe discharge planning. Of 245 unique encounters, only 60% of patients experiencing intimate partner violence (IPV) were discharged with a safe plan and only 6% were discharged to shelters. This hospital instituted an ED observation unit (EDOU) to support GBV survivors with safe disposition. Then, through the EDOU protocol, 70.7% were able to achieve safe disposition, with 33% discharged to a family/friend and 31% discharged to a shelter. Safe disposition following experience or disclosure of IPV and GBV in the ED is difficult, and social work staff have limited bandwidth to assist with navigation of accessing community-based resources. Through an average 24.3 hours of an extended ED observation protocol, 70% of patients were able to achieve a safe disposition. The EDOU supportive protocol substantially increased the proportion of the GBV survivors who experienced a safe discharge.

Psychosocial barriers to, and enablers of, intimate partner violence disclosure among Asian-American immigrant women

Although Asian women immigrants to the USA rarely disclose intimate partner violence, local research indicates that among them domestic abuse is prevalent. This study aimed to determine the main psychosocial barriers and enablers to disclosure among Asian-American women in California, and whether barriers outweighed benefits. We used a novel qualitative methodology of indirect and direct questioning with sixty married women from four ethnicities (Korean, Chinese, Thai and Vietnamese). Overall, barriers to disclosure were more compelling and tangible than enablers, particularly among Mandarin Chinese and Korean speakers. Five main barriers were found: victim-blaming, beliefs in female inferiority and male dominance, familial shame, individual shame and fear of undesirable consequences. Only extreme violence and the need to protect children from harm were seen as warranting disclosure. As a result, health and other providers’ encouragement of disclosure is unlikely to be sufficient to achieve behavioural change. Abused Asian immigrant women need anonymous ways of obtaining professional counselling, information and resources. In addition, community-level awareness programmes in Asian languages are needed to reduce victim-blaming and misinformation.

Challenges in recognizing and facilitating disclosures of intimate partner violence in customer service calls about maintenance support

Separated parents in Sweden need to sort out child maintenance themselves unless there are ‘special reasons’, such as experiences of intimate partner violence (IPV), in which case the Swedish Social Insurance Agency (SSIA) may function as an intermediary. In such cases, the parent must disclose their experiences for institutional assessment. This study uses conversation analysis (CA) to examine 132 phone calls between parents and SSIA officers, examining how parental conflict and possible violence is brought up and responded to. The analysis shows how parents describe cooperative problems in non-specific terms, incrementally adding information that makes possible violence inferentially available, rendering it difficult for case officers to distinguish IPV from post-separation conflicts. Case officers typically respond minimally and do not encourage further tellings, which means that IPV may go unnoticed. The study highlights the need for training in how to recognize possible IPV and how to facilitate such disclosures.

‘It is a hard decision’: a qualitative study of perinatal intimate partner violence disclosure

BackgroundPerinatal intimate partner violence is a hidden under reported and difficult to identify problem which has negative effects on mother and child. The present study aimed to explore barriers and facilitators of perinatal intimate partner violence disclosure.MethodsThis qualitative study was carried out from October 2019 to January 2021 in Mashhad, Iran. Participants included 23 abused women (11 pregnant and 12 after birth) which were selected via purposive sampling. Semi-structured in-depth interviews and focus group discussion were conducted until the data saturation was achieved. The data analysis was performed based on conventional content analysis adopted by Graneheim & Lundman.ResultsThe main themes “barriers to disclosure” and “facilitators of disclosure” were emerged as the result of data analysis. Barriers to disclosure included negative disclosure consequences and protection of family privacy. Facilitators of disclosure included maternal self-efficacy, threats to security, and formal and informal supportive networks.ConclusionsMost abused women did not disclose violence despite routine screening for perinatal intimate partner violence in antenatal care. Recognizing the barriers to and facilitators of violence disclosure play an important role in eliminating barriers, strengthening facilitators, providing effective supportive services for abused women, and reducing perinatal violence. Focus on the barriers to and the facilitators of disclosure will be useful to policymakers, health program planners, and health care providers to identify and manage intimate partner violence, appropriately.

Disclosure of intimate partner violence by men and women in Dar es Salaam, Tanzania.

Intimate Partner Violence (IPV) has severe health consequences, though may be underreported due to stigma. In Tanzania, estimates of IPV prevalence range from 12 to >60%. List experiments, a technique of indirectly asking survey questions, may allow for more accurate prevalence estimates of sensitive topics. We examined list experiment and direct questions about experiences of physical and sexual IPV from a 2017 cross-sectional survey among 2,299 adults aged 40+ years in Dar es Salaam. List experiment prevalence estimates were determined through quantitative analysis and compared qualitatively to direct question prevalence estimates. The list experiment estimated a higher prevalence of IPV in all cases except for physical violence experienced by women. This study contributes to the estimation of IPV prevalence. If the list experiment estimates yield an unbiased estimate, findings suggest women openly report experiencing physical IPV, and IPV experienced by men is underreported and understudied.

Conceptualizing Physicians' Roles in Addressing Intimate Partner Violence: A Critical Discourse Analysis of Resources for Canadian Physicians.

Resources addressing intimate partner violence (IPV) play a role in shaping how physicians conceptualize and perform their roles in caring for affected patients. This study combines environmental scanning with critical discourse analysis (CDA) to parse how roles of physicians were represented in 28 education materials and policy documents about IPV, taking the Canadian training milieu as an example. We developed a cyclical model of three core physician roles in addressing IPV-learning about IPV, identifying patients experiencing IPV, and responding to patients' disclosures of IPV. The construction of these physician roles is suggestive of an ongoing process of medicalization of IPV.