Disclosing intimate partner violence to health care clinicians—what a difference the setting makes: a qualitative study. BMC Publ Health 8:229

Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave, Boston, MA 02118, USA .
BMC Public Health (Impact Factor: 2.26). 02/2008; 8(1):229. DOI: 10.1186/1471-2458-8-229
Source: PubMed


Despite endorsement by national organizations, the impact of screening for intimate partner violence (IPV) is understudied, particularly as it occurs in different clinical settings. We analyzed interviews of IPV survivors to understand the risks and benefits of disclosing IPV to clinicians across specialties.
Participants were English-speaking female IPV survivors recruited through IPV programs in Massachusetts. In-depth interviews describing medical encounters related to abuse were analyzed for common themes using Grounded Theory qualitative research methods. Encounters with health care clinicians were categorized by outcome (IPV disclosure by patient, discovery evidenced by discussion of IPV by clinician without patient disclosure, or non-disclosure), attribute (beneficial, unhelpful, harmful), and specialty (emergency department (ED), primary care (PC), obstetrics/gynecology (OB/GYN)).
Of 27 participants aged 18-56, 5 were white, 10 Latina, and 12 black. Of 59 relevant health care encounters, 23 were in ED, 17 in OB/GYN, and 19 in PC. Seven of 9 ED disclosures were characterized as unhelpful; the majority of disclosures in PC and OB/GYN were characterized as beneficial. There were no harmful disclosures in any setting. Unhelpful disclosures resulted in emotional distress and alienation from health care. Regardless of whether disclosure occurred, beneficial encounters were characterized by familiarity with the clinician, acknowledgement of the abuse, respect and relevant referrals.
While no harms resulted from IPV disclosure, survivor satisfaction with disclosure is shaped by the setting of the encounter. Clinicians should aim to build a therapeutic relationship with IPV survivors that empowers and educates patients and does not demand disclosure.

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    • "When patients do disclose IPV to health care providers, there is wide variation in clinicians' responses (Dichter et al., 2013; Gerber, Leiter, Hermann, & Bor, 2005; Liebschutz et al., 2008; Rhodes et al., 2007). Responses range from those that patients may find unhelpful, alienating, and/or distressing (Liebschutz et al., 2008), such as not acknowledging a disclosure or telling patients that they must report the violence and/or leave the relationship, to those that meet the standards of best practices (Family Violence Prevention Fund, 2004), including validation, further assessment, safety planning, and link to needed health care and social services (Liebschutz et al., 2008; Rhodes et al., 2007). As an integrated health care system providing both primary and specialty care for medical and mental health needs, as well as a range of social services and VA-related benefits, there may be unique characteristics of the VHA system that influence IPV detection and response. "
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    ABSTRACT: Women veterans experience high rates of intimate partner violence (IPV), with associated negative health impacts. The Veterans Health Administration (VHA) has recently developed plans to implement routine IPV screening and provide IPV-related follow-up services for VHA patients. Previous research has examined barriers and facilitators to health care provider screening for IPV. The next step is to examine patients' disclosure of IPV experiences to health care providers and effective response to such disclosures. We sought to identify VHA patients' and providers' perspectives on how to facilitate effective IPV detection and care in VHA. We conducted semistructured, qualitative interviews with 25 female veteran patients and 15 VHA health care providers. We used an inductive approach to analyzing interview transcripts and identifying themes that constituted study findings. Themes fell in to two broad categories: 1) barriers to disclosure and 2) barriers to an adequate response to disclosure and providing follow-up care. Barriers to disclosure of IPV to health care providers included lack of provider inquiry, lack of comfort, and concerns about the consequences of disclosure and lack of privacy. Patients and providers both indicated a need for expanded resources to respond to IPV in VHA. Findings support current plans for IPV program implementation in VHA and point to recommendations for practice and implications for further research. Published by Elsevier Inc.
    Women s Health Issues 07/2015; 25(5). DOI:10.1016/j.whi.2015.06.006 · 1.61 Impact Factor
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    • "This lack of health care provider action led to future avoidance of health care. [7] Nurses are an important professional group concerned with women's health and have close interpersonal contact with women in community health settings. Screening for IPV is a crtical nursing function that can be done at first contact with women in community health settings. "
    05/2015; 5(9). DOI:10.5430/jnep.v5n9p11
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    • "These positive sides of screening were also identified by women in a review by Feder et al. (2009) but, despite their recognition of the benefits of using a screening test, Lanzenbatt et al. discovered that only 50% of their midwives were in favour of routine screening for all pregnant women (Lazenbatt et al., 2009). The midwives considered their relationship with the women as a key factor in the effectiveness of screening, and this is supported by the conclusions of other qualitative studies of midwives' perceptions of screening (Hindin, 2006; Jack et al., 2008; Liebschutz et al., 2008; Feder et al., 2009; Sprague et al., 2012). Studies of battered women's views of domestic violence screening have also found that, when a health professional can sensitively and non-judgementally ask about violence in a confidential environment, women feel supported, cared for and understood, and relieved that someone is finally talking to them about it (Feder et al., 2009). "
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    ABSTRACT: the aim of this qualitative study was to explore midwives׳ knowledge and clinical experience of domestic violence among pregnant women, with particular emphasis on their perceptions of their professional role. the data collected for this phenomenological-hermeneutical qualitative study were collected using semi-structured interviews, and analysed according to Denzin and Lincoln (2011). fifteen hospital and community midwives working in the local health district of Monza and Brianza in northern Italy were recruited between July and October 2012. three main themes emerged: 'it is difficult to recognise domestic violence' because of a limited knowledge of the most common signs and symptoms of violence, a lack of training, cultural taboos, and the women׳s unwillingness to disclose abuse; 'we have a certain number of means of identifying violence', such as relationships with the woman, specific professional training and screening tools, which have advantages and disadvantages; 'the professionals involved' in identifying and managing family violence highlight the importance of a interdisciplinary approach. midwives acknowledge their crucial role in identifying and managing domestic violence but are still unprepared to do so and indicate various barriers that need to be overcome. There is a need to implement basic university education on the subject and provide specific professional training. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Midwifery 02/2015; 31(5). DOI:10.1016/j.midw.2015.02.002 · 1.57 Impact Factor
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