Middle-aged Women’s Experiences of Intimate Partner Violence Screening and Disclosure: “It’s a private matter. It’s an embarrassing situation”

Abstract

BACKGROUND: National guidelines indicate that healthcare providers should routinely screen women of reproductive age for experience of intimate partner violence. We know little about intimate partner violence (IPV) screening and disclosure experience among women older than reproductive age. OBJECTIVE: To examine the perspectives of middle-aged women who had experienced past-year IPV regarding IPV screening and disclosure in the healthcare setting. DESIGN: Individual semi-structured qualitative interviews were conducted in-person as part of a larger study examining IPV screening and response services through the Veterans Health Administration. PARTICIPANTS: Twenty-seven women aged 45-64 (mean age 53) who experienced past-year IPV and received care at one of two Veterans Affairs Medical Centers. APPROACH: Interviews were digitally recorded and transcribed. Data were sorted and analyzed using templated notes and line-by-line coding, based on codes developed by the study team through an initial review of the data. Themes were derived from further analysis of the data coded for "screening" and "disclosure" for respondents aged 45 and older. KEY RESULTS: Barriers to disclosure of IPV to a healthcare provider included as follows: (a) feelings of shame, stigma, and/or embarrassment about experiencing IPV; (b) screening context not feeling comfortable or supportive, including lack of comfort with or trust in the provider and/or a perception that screening was conducted in a way that felt impersonal and uncaring; and (c) concerns about privacy and safety related to disclosure. Provider demonstrations of care, empathy, and support facilitated disclosure and feelings of empowerment following disclosure. CONCLUSIONS: Middle-aged women may benefit from routine IPV screening and response in the healthcare setting. Such interventions should be sensitive to concerns regarding stigma and privacy that may be prevalent among this population.

Women’s experiences and expectations of intimate partner abuse identification in healthcare settings: a qualitative evidence synthesis

“…So I think it’s the person, I think it’s the way the questions are set up, and I think it’s the presentation. Because everybody is in their own bubble and if you make things where people feel like they’re more interrogated, then we’re less likely to say anything 43 (p2659).…”

“…Thirty-one of the included studies supported the idea that HCPs need to create a safe and supportive environment to facilitate women’s disclosure 5 32 34–52 54–60 62–67. For many participants, deciding to share their experiences of IPA was a difficult process entangled in a range of fears 5 34 35 37 39 41–43 45–50 52 54–59 62–64 66 67.…”

“…The 34 included studies represented 17 countries: 13 were conducted in the USA, [32][33][34][35][36][37][38][39][40][41][42][43][44][45] 4 in Australia, [46][47][48][49][50][51] 3 in the UK 5 52 53 and 1 each in Ecuador, 54 India, 55 Israel, 56 Japan, 57 Kyrgyzstan, 58 Mexico, 59 New Zealand, 60 Nigeria, 61 Norway, 62 Palestine, 63 South Africa, 64 Spain, 65 Sweden 66 and Taiwan. 67 The 37 papers resulting from these studies were published in 2016 (n=7), 2017 (n=10), 2018 (n=4), 2019 (n=9), 2020 (n=6) and 2021 (n=1), and included a total of 1016 participants.…”

Intimate Partner Violence (IPV) in Military and Veteran Populations: A Systematic Review of Population-Based Surveys and Population Screening Studies

“…In part, this may result from screening for general violence among veterans [ 84 , 85 ], which could support identification of individuals who use violence in their relationships. In contrast, the trend towards lower rates of victimisation in health services could reflect low rates of inquiry by service providers, sub-optimal quality of inquiry (e.g., impersonal, rushed, lack of eye-contact, and sensitivity), or other obstacles such as concerns about having IPV documented in medical records [ 86 , 87 ]. There is broader literature suggesting that such issues can affect identification of IPV in health services [ 88 , 89 ], and has informed interventions that aim to increase IPV disclosure and appropriate responses in such contexts [ 90 , 91 ].…”

Practical Implications of Research on Intimate Partner Violence Experiences for the Mental Health Clinician

“…Following informed consent regarding reporting requirements, clinicians should be mindful to frame and ask questions about IPV experiences with empathy and nonjudgement. Clients experiencing IPV may not disclose these experiences early in the intake/assessment process for various reasons, including shame, privacy and safety-related concerns (e.g., fear the partner will find out/retaliation violence, legal or immigration concerns), fear of family disruptions or social service involvement, not recognizing their experiences as abusive or sufficiently serious enough to report, and a desire to trust the clinician before sharing relationship details [6,99,100]. Therefore, clinicians should continue to provide opportunities for disclosure throughout assessment and treatment, as therapeutic rapport and trust is established.…”