Disclosure of Intimate Partner Violence in Urban Emergency Department Settings: A Mixed Methods Study

Abstract

<p> This mixed methods study seeks to explain women's decision making regarding intimate partner violence disclosure in urban emergency departments. It contributed to an overall program of research led by Dr. H.L. MacMillan examining the effectiveness of screening in health care settings to reduce violence and improve the quality of women's lives.</p> <p> The study included a randomized, controlled trial with a quantitative sub-analysis and a grounded theory approach. The trial goal was to evaluate whether routine screening for IPV in health care settings, as compared to usual care, does more good than harm. The quantitative sub-analysis included 1,182 participants from three trial emergency departments. In the sample, 1.9% were exposed to intimate partner violence disclosed to the health care provider. Of those who disclosed, 62.9% were positive on both the screening tool and criterion standard. The grounded theory phase involved 19 participants and sought to examine the problems that trial participants associated with intimate partner violence disclosure and the processes they used to resolve them.</p> <p> "Being found out" was the basic social psychological problem that influenced women's decisions against disclosure. This led to a three-phase process where participants attempted to "minimize their risks." The basic social psychological process included: (a) deciding to seek health care, (b) evaluating trust in the clinician, and (c) establishing internal readiness for disclosure. Participants stated that the emergency department was not an ideal place to disclose violence due to overcrowding, chaos, long wait times, and a lack of privacy. Results indicated that abused women wanted clinicians to offer empathy and support, and to minimize the intrusion caused by assessment. Clinician education is required to improve communication, client engagement and comfort discussing intimate partner violence. Future research could explore the barriers and facilitators to care quality and patient satisfaction among abused women seeking emergency care.</p>