How Health Care Providers Address Intimate Partner Violence
How Health Care Providers Address Intimate Partner Violence
Data were available from 142 of the original 150 women who took part in the health care study (we excluded 8 participants because of missing demographic data). Sixty-one percent (n = 87) of the women were nonwhite. Participants had relatively low educational attainment, with 68% (n = 97) having earned a high school diploma or less, and were low income, with 88% (n = 124) reporting an annual individual income less than $20,000. Participation criteria required an age range from 18 to 65 years, with 41% (n = 59) aged 18 to 35 years, 32% (n = 45) aged 36 to 45 years, and 27% (n = 38) aged 46 to 65 years.
The demographics of the sample, divided by recruitment site, are displayed in Table 2. The demographics of our participants differed by site for race, age, education, and alcohol abuse. The family court (70.5%; n = 31) and primary care practice (66.1%; n = 41) sites had more minority women compared with the psychiatric practice (41.7%; n = 15). Family court also had a greater number of younger women (65.9%; n = 29). Twenty-four percent of respondents at the primary care practice noted an alcohol problem, in contrast with only 13.9% and 2.3% at the psychiatric practice and family court sites, respectively. Differences in reported drug use between sites were not significant. Notwithstanding these differences in race, age, and alcohol abuse, we combined the samples for our subsequent analyses because they represent predominantly low-income women with histories of relationship violence.
Of the 142 female participants, 51% (n = 72) reported that their HCPs—including medical doctors, nurses, nurse practitioners, and physician assistants—knew of the abuse in their relationships (see Table 1). Of those participants, 65% (n = 47) reported that they had been asked about IPV by a HCP, which indicates that 65% of these HCPs are following the recommended guidelines. However, in a different question, only 31% (n = 22) reported having volunteered information about IPV to an HCP. Eighty-five percent of the participants whose HCP knew of their abuse (n = 61) reported having told at least one primary care provider, including 25 who said they reported to their obstetrician/gynecologist. Of the 49% (n = 70) who reported that their HCPs did not know about the abuse, 63% (n = 44) indicated they would have disclosed the information if their HCP had asked.
Logistic regression revealed that race, employment, and self-reported drug use were not associated with an HCP asking about IPV. However, women aged 36 to 45 years were almost 4 times as likely to say they had been asked (odds ratio, 3.99; 95% confidence interval, 1.53–10.44) compared with the reference group (women aged ≤36 years).
Of the 72 women who reported that their HCP knew about the abuse, 85% (n = 61) reported their HCP was open to talking about IPV, 65% (n = 47) felt comfortable approaching their HCP about it, and 74% (n = 53) felt their HCP was knowledgeable about the topic.
Among the 72 participants whose HCPs knew of the abuse, 71% (n = 51) reported they felt their HCPs wanted them to leave the abusive relationships, and half of those (n = 27), or 37.5% of the total, stated that their HCP specifically advised them to leave their abusive partners (see Table 3). Twenty-five percent (n = 18) of the abused women reported their HCP advised them to leave the abusive partner but the women did not indicate they were given any safety advice. Few participants (31%; n = 22) reported safety assistance such as referral to community agencies. Only 6 women (8%) stated that HCPs offered safety advice and left the decision about leaving or staying in the abusive relationships to them. Considered by site among the same 72 participants who spoke with their HCP about abuse, 43% (n=9) recruited at the psychiatric practice reported receiving safety advice, compared with 31% (n=10) at the primary care practice and 16% (n=3) recruited at the family court.
The following quotes are from participants who described the HCP as helpful:
"[My doctor] was a friend and the only one I could trust…"
"[ My doctor was] compassionate, supportive. She took her time with me and spent about 2 hours when I broke down."
"I felt like it helped me because [ the doctor] was supporting my decision to get help…"
"He will kill you—get out…" [HCP statement to participant]
The following quotes are from participants who described the HCP as unhelpful:
"I felt scared that [the doctor] would report me to the police, welfare…"
"Persons in emergency brought up the situation when my husband was still there…then they asked him to leave and I was scared."
"'All those times that you kept going back, I told you not to go back, now you are on your own.' [HCP statement to participant] I changed doctors after that."
"[I felt] embarrassed and unprotected. I felt like [my doctor] defended my husband."
"I was in such denial that I didn't want to hear any of her advice and opinions; closed ears…"
"I want to get pregnant. My OB/GYN [ won't prescribe] my meds, so I won't get pregnant. If I leave him she will give them to me again. I have an illness that keeps me from getting pregnant."
Results
Data were available from 142 of the original 150 women who took part in the health care study (we excluded 8 participants because of missing demographic data). Sixty-one percent (n = 87) of the women were nonwhite. Participants had relatively low educational attainment, with 68% (n = 97) having earned a high school diploma or less, and were low income, with 88% (n = 124) reporting an annual individual income less than $20,000. Participation criteria required an age range from 18 to 65 years, with 41% (n = 59) aged 18 to 35 years, 32% (n = 45) aged 36 to 45 years, and 27% (n = 38) aged 46 to 65 years.
The demographics of the sample, divided by recruitment site, are displayed in Table 2. The demographics of our participants differed by site for race, age, education, and alcohol abuse. The family court (70.5%; n = 31) and primary care practice (66.1%; n = 41) sites had more minority women compared with the psychiatric practice (41.7%; n = 15). Family court also had a greater number of younger women (65.9%; n = 29). Twenty-four percent of respondents at the primary care practice noted an alcohol problem, in contrast with only 13.9% and 2.3% at the psychiatric practice and family court sites, respectively. Differences in reported drug use between sites were not significant. Notwithstanding these differences in race, age, and alcohol abuse, we combined the samples for our subsequent analyses because they represent predominantly low-income women with histories of relationship violence.
Of the 142 female participants, 51% (n = 72) reported that their HCPs—including medical doctors, nurses, nurse practitioners, and physician assistants—knew of the abuse in their relationships (see Table 1). Of those participants, 65% (n = 47) reported that they had been asked about IPV by a HCP, which indicates that 65% of these HCPs are following the recommended guidelines. However, in a different question, only 31% (n = 22) reported having volunteered information about IPV to an HCP. Eighty-five percent of the participants whose HCP knew of their abuse (n = 61) reported having told at least one primary care provider, including 25 who said they reported to their obstetrician/gynecologist. Of the 49% (n = 70) who reported that their HCPs did not know about the abuse, 63% (n = 44) indicated they would have disclosed the information if their HCP had asked.
Logistic regression revealed that race, employment, and self-reported drug use were not associated with an HCP asking about IPV. However, women aged 36 to 45 years were almost 4 times as likely to say they had been asked (odds ratio, 3.99; 95% confidence interval, 1.53–10.44) compared with the reference group (women aged ≤36 years).
Of the 72 women who reported that their HCP knew about the abuse, 85% (n = 61) reported their HCP was open to talking about IPV, 65% (n = 47) felt comfortable approaching their HCP about it, and 74% (n = 53) felt their HCP was knowledgeable about the topic.
Among the 72 participants whose HCPs knew of the abuse, 71% (n = 51) reported they felt their HCPs wanted them to leave the abusive relationships, and half of those (n = 27), or 37.5% of the total, stated that their HCP specifically advised them to leave their abusive partners (see Table 3). Twenty-five percent (n = 18) of the abused women reported their HCP advised them to leave the abusive partner but the women did not indicate they were given any safety advice. Few participants (31%; n = 22) reported safety assistance such as referral to community agencies. Only 6 women (8%) stated that HCPs offered safety advice and left the decision about leaving or staying in the abusive relationships to them. Considered by site among the same 72 participants who spoke with their HCP about abuse, 43% (n=9) recruited at the psychiatric practice reported receiving safety advice, compared with 31% (n=10) at the primary care practice and 16% (n=3) recruited at the family court.
The following quotes are from participants who described the HCP as helpful:
"[My doctor] was a friend and the only one I could trust…"
"[ My doctor was] compassionate, supportive. She took her time with me and spent about 2 hours when I broke down."
"I felt like it helped me because [ the doctor] was supporting my decision to get help…"
"He will kill you—get out…" [HCP statement to participant]
The following quotes are from participants who described the HCP as unhelpful:
"I felt scared that [the doctor] would report me to the police, welfare…"
"Persons in emergency brought up the situation when my husband was still there…then they asked him to leave and I was scared."
"'All those times that you kept going back, I told you not to go back, now you are on your own.' [HCP statement to participant] I changed doctors after that."
"[I felt] embarrassed and unprotected. I felt like [my doctor] defended my husband."
"I was in such denial that I didn't want to hear any of her advice and opinions; closed ears…"
"I want to get pregnant. My OB/GYN [ won't prescribe] my meds, so I won't get pregnant. If I leave him she will give them to me again. I have an illness that keeps me from getting pregnant."