How Health Care Providers Help Battered Women: The Survivor's Perspective

Abstract

This qualitative study aimed to describe, from the perspective of domestic violence survivors, what helped victims in health care encounters improve their situation and thus their health, and how disclosure to and identification by health care providers were related to these helpful experiences. Semi-structured, open-ended interviews were conducted with a purposeful sample of survivors in the San Francisco Bay Area. Data were analyzed using constant comparative techniques and interpretative processes. Twenty-five women were interviewed, the majority being white and middle-class, with some college education. Two overlapping phenomena related to helpful experiences emerged: (1) the complicated dance of disclosure by victims and identification by health care providers, and (2) the power of receiving validation (acknowledgment of abuse and confirmation of patient worth) from a health care provider. The women described a range of disclosure and identification behaviors from direct to indirect or tacit. They also described how-with or without direct identification or disclosure-validation provided "relief," "comfort," "planted a seed," and "started the wheels turning" toward changing the way they perceived their situations, and moving them toward safety. Our data suggest that if health care providers suspect domestic violence, they should not depend on direct disclosure, but rather assume that the patient is being battered, acknowledge that battering is wrong, and confirm the patient's worth. Participants described how successful validation may take on tacit forms that do not jeopardize patient safety. After validating the patient's situation and worth, we suggest health care providers document the abuse and plan with the patient for safety, while offering ongoing validation, support, and referrals.

“Between me and the computer”: Increased detection of intimate partner violence using a computer questionnaire

“…14 Qualitative reports from women who have escaped abuse indicate that even brief discussions with physicians are therapeutic when conversations are conducted in a concerned, nonjudgmental way. 15 Effective communication with a health care provider has been linked to improved health outcomes in a number of areas. 16,17 For domestic violence, physician-nurse communication skills might also be a key predictor of patient outcome.…”

Mothers' Comfort with Screening Questions about Sensitive Issues, Including Domestic Violence

“…Other work suggests that creating an environment with posters and brochures about DV helps to normalize the issue as well as reassuring patients that the inquiry is part of the routine for everyone. 26,27,46,47 Participants reported both positive and negative responses to the 5 DV questions. This suggests that there may not be a perfect question for face-to-face screening.…”

Taking a Fresh Look at Routine Screening for Intimate Partner Violence: What Can We Do About What We Know?

“…The act also establishes an independent nongovernmental group that is seeking stakeholder input for refining a mission devoted to patient-centered outcomes research. 39 Given the broad-based support for screening and addressing IPV and among patients, 18,22 it is highly likely that any stakeholder-informed agenda seeking to improve population-based health will support health care interventions for violence and co-occurring psychosocial risk factors. However, at this point it is not yet clear how the movement toward population-based care and patient-centered outcomes will be operationalized and how the incentives can be ultimately aligned to help hospitals and health systems determine how to deliver better health care in ways that reduce costs and improve the health of communities.…”

“…14 Substantial barriers were identified that span the spectrum of physicians' knowledge, attitudes, beliefs, and behaviors. [15][16][17][18][19][20] Even system-level interventions with extensive physician education demonstrated marked improvements in screening without an increase in IPV identification. 21 During this time, the movement for the use of evidence to guide clinical practice was also developing.…”